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High court adopts COA opinion in billing dispute

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The Indiana Supreme Court granted transfer Wednesday in a dispute over who bears the burden to prove "pecuniary liability" under the Worker's Compensation Act, and adopted the Indiana Court of Appeals' opinion on the matter.

Pursuant to Indiana Appellate Rule 58(A)(1), the high court adopted and incorporated the Court of Appeal's opinion in Washington Township Fire Department v. Beltway Surgery Center, No. 93S02-1002-EX-115, in which the appellate court held an employer, not a medical provider, bears the burden of proving whether the charges for medical services provided to an employee exceed the employee's liability to pay under the act.

Beltway Surgery Center provided medical services to a Washington Township Fire Department employee and then submitted a bill to the township's worker's compensation insurance carrier. After a review to determine Washington Township's pecuniary liability under the act, the insurer decided to only pay part of the bill. Beltway filed an application for adjustment of claim with the Worker's Compensation Board. The board ordered the township to pay the remaining balance and concluded the township has to prove its pecuniary liability to Beltway was less than Beltway's billed charges.

The COA upheld the board's decision and held that where an employer refuses to pay in full a medical provider's billed charges, and the provider files a claim with the Worker's Compensation Board and establishes the charges for services to an employee, it's up to the employer to prove the charges exceed the employer's liability under the act. The board may also require that an employer who doesn't meet this burden must pay the medical provider's full bill.

The Court of Appeals judges concluded that placing the burden of proof on the employer is more consistent with Indiana law generally and with the act itself. They also ruled it would be up to the General Assembly to amend state statute so that medical providers would have to bear the burden of establishing that their bills fall outside certain guidelines.

This is the same issue in five other cases pending before the Supreme Court. In a footnote in the opinion, the justices noted they denied transfer to the other five cases based on its adoption and agreement with the Court of Appeals' opinion in Beltway. Those other cases are Onward Fire Department v. Clarian Health Partners, No. 93A02-0811-EX-1007; Adecco, Inc. v. Clarian Health Partners, No. 93A02-0811-EX-1008; Morgan County Commissioners v. Clarian Health Partners, No. 93A02-0811-EX-1009; City of Michigan City v. Memorial Hospital, No. 93A02-0811-EX-1010; and Wayne Township Fire Department v. Beltway Surgery Center, No. 93A02-0811-EX-1011.

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  1. Judge Roger B. Cosbey is unethical and bias toward African American who seeks justice in Title VII claims. He disrespected and used his authority to attempt to intimidate me into taking an unfair settlement and when I refused he proceeded to get my case dismissed and to deny me my Constitutional and Civil Rights. He disobeying several rules of law; specifically, by ruling on summary judgment motions against the Fed. R. Civ. P., without authority of Judge William C. Lee, without consent of the attorneys, and with conspiracy to commit “fraud on the court,” as he conspired with my former attorney. He proved to me that he is bias, unethical, unfair and unfit to be reappointed. In my opinion, he should be disbarred in 2013, for committing fraud on the court, which would make him ineligible for reinstatement in 2014. See docket 3:07 cv 629 where he rules on dispositive motions, knowing magistrates are not vested with that power (especially without consent), grants the defendant an unconscionable number of extensions, accepts my former attorney request for extension for dispositive motion knowing he was working with the opposition, and unbelievably grants the defendant another extension after he requested an extension after he missed the deadline. I know another attorney filed charges against him for bias in race discrimination case(s). I know what he did in my case before he voluntarily recused himself, I just do not know how many other innocent people have been stripped of their rights because of him. I say shame on him and no more of the same.

  2. they are pushing these cases against lawyers too far. thought-crime.

  3. vagueness cannot challenged, so let's write all laws vaguely and throw the constitution out the window.Even if the court is operating under a particular law, if they don't it they will change it to their liking. What a joke!!!

  4. Two convictions becomes one conviction with exactly the same sentence, only it is not clear wheter or not that sentence will be 18 months, 120 months or 138 months. Actually if the guns were in a home, whether or not they were his, he is protected under the 2nd amendment. Jurors need to learn the law and the constitution before judging others. The cour5ts need to do this as well.

  5. With all due respect, Rick, I think you probably would be making a mistake by going to law school. The job market for attorneys is so saturated, you may well find yourself unemployed and with a lot of debt. You mention law would be a good supplement to your skills. True. But employers unfortunately don't value that. You will find that a law degree may well pigeonhole you into an attorney slot and limit career options. If you have a good job now I would hold onto that. As an attorney, you may well end up making less with the aforementioned debt.

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