Workers' Compensation

Hatchet Job: Delaware IAB Orders Separation of Bills for Compensable Body Part

Today's post is offered up by attorney Chris Logullo of Chrissinger & Baumberger.  A recent Motion Day Hearing on the issue of what happens when the carrier requests that the doctor delineate his medical charges to parcel out the compensable treatment for an arguably unrelated body part and the doctor declines to do so.  Liberty Mutual's concern in this case, a well-founded one indeed, was that if it paid bills that were subsumed within them the treatment for the disputed low back, they would be vulnerable to the argument that any denial of causation would be deemed waived.  In this case there was an acknowledged claim for the neck and shoulder-- the provider was Dr. Jay Fried who testified briefly.  Dr. Fried had recorded in his records that the low back was "significant and debilitating," which was somewhat contradictory to the claimant's position that this was "incidental treatment".  A summary of Dr. Fried's testimony as follows:

"He documents all of a patient's medical problems, including pain in all body parts, in order to justify treatment.  He cannot bill two different insurance carriers for one appointment and one service.  Claimant would have the same appointments and medications even without the lumbar spine because he is already on a high dose of medication for his neck and shoulder issues."

And what did the Board do with this?  They issued an Order compelling Dr. Fried to "separate out the bills for treatment to the neck and shoulder versus the lumbar spine."  I kind of wondered what exactly that meant from a practical standpoint.  I spoke to Chris Logullo who explained that as a result of this Order, Liberty Mutual expects to be billed at two-thirds of the total charge, allowing that there are now three body parts involved and two of them are admittedly compensable under work comp.  According to Chris, the Board members asked the doctor if he had Medicare patients-- he replied that he did.  He was then admonished that if he could parse out treatment in a Medicare context, there should be no impediment to delineating his treatment in a case like this.

The case is Roland Foskey v. Johnny Janosik, IAB# 1300738 (9/15/11) (ORDER).

Thanks again to Chris Logullo and the gang at Chrissinger & Baumberger for bringing this to my attention!

Irreverently yours,
Cassandra Roberts

Delaware Detour & Frolic   Visit Delaware Detour & Frolic, a law blog by Cassandra Roberts

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