Workers' Compensation

A Momentary Lapse? Period Of Lapsed Provider Certification In Delaware Not Sufficient To Disqualify Medical Bills

A big shout-out to both Dr. Doug Briggs who brought this case to my attention, and to Donna Forrest at the DOL who brought the case to his attention.  Today's case is a very narrow issue and it is just quirky enough to be worth knowing.  The answers to questions like this is what separates the men from the boys.

Here is the issue, and it comes to us from another one of those delightful Thursday Motion Day Hearings:

Is medical treatment subject to being disallowed for lack of provider certification under 19 Del. Code Section 2322D, where the physician is initially certified, allows his certification to lapse, and then reinstates his certification?  The State was seeking dismissal of a pending DACD for medical expenses in the form of prescriptions because Dr. Sandeep Mann was not certified on the date of the scripts.  In Cynthia Williams v. State of DE, IAB#1282260 (2/6/12), the Board commented that "the lapse in certification during the time that Dr. Mann provided further prescriptions to Claimant in 2011 appears to represent simple administrative error on his part, given his former and current compliance."  Later in the decision the lapse is referred to as "de minimus."

I suspect that if the physician had a different track record on the issue of certification, a different outcome might have ensued.  Given the spirit of the workers' comp law in terms of erring liberally to find benefit entitlement, it is not shocking that the Board ruled as it did.

Have a great weekend.  I for one, cannot wait to get home.  There are two 3-pound bars of cream cheese softening on the counter along with a dozen eggs.  A little baking is in my future....and there is nothing "de minimus" about my cheesecake.....:>)

Irreverently yours,
Cassandra Roberts

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

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