Jab Contracting,llc v. William Caudill ( 2023 )

RENDERED: OCTOBER 6, 2023; 10:00 A.M.
NOT TO BE PUBLISHED
Commonwealth of Kentucky
Court of Appeals
NO. 2022-CA-0712-WC
JAB CONTRACTING, LLC APPELLANT
PETITION FOR REVIEW OF A DECISION
v. OF THE WORKERS’ COMPENSATION BOARD
ACTION NO. WC-19-99610
WILLIAM CAUDILL;
CUMBERLAND RIVER
BEHAVIORAL CENTER; HARLAN
ARH HOMECARE STORE;
MOUNTAIN MEDICAL
ENTERPRISES; HONORABLE PETER
GREG NAAKE, ADMINISTRATIVE
LAW JUDGE; PIKEVILLE MEDICAL
CENTER; THE RADIOLOGY GROUP,
LLC; HARLAN APPALACHIAN
REGIONAL HOSPITAL; AND
WORKERS’ COMPENSATION
BOARD APPELLEES
OPINION
REVERSING AND
REMANDING
** ** ** ** **
BEFORE: COMBS, EASTON, AND MCNEILL, JUDGES.
COMBS, JUDGE: This workers’ compensation appeal arises out of a medical fee
dispute. The sole issue involves KRS1 342.020(4), which requires medical
providers to submit their bills within 45 days of the date of service. The issue
before us is whether that statutory provision applies pre-award. The statute sets
forth as follows:
The provider of medical services shall submit the
statement for services within forty-five (45) days of the
day treatment is initiated and every forty-five (45) days
thereafter, if appropriate, as long as medical services are
rendered.
By Opinion and Order rendered on September 29, 2020, the
Administrative Law Judge (ALJ) determined that the 45-day time limit in KRS
342.020(4) does not apply prior to an award. The ALJ also found that the
following bills are compensable, that they are not barred by KRS 342.020(4), and
that they are, therefore, the responsibility of the Defendant-Employer:
a. January 3 2019 radiologic exam -- Harlan ARH by
billing provider The Radiology Group
b. January 14 2019 surgical treatment of ankle fracture --
Pikeville Medical Center
c. March 5, 2019 physical therapy -- Harlan ARH
d. March 7, 2019 physical therapy -- Harlan ARH
1
Kentucky Revised Statutes.
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e. March 12, 2019 physical therapy -- Harlan ARH
f. June 16, 2019 durable medical equipment -- Harlan
ARH Homecare Store
g. June 24, 2019 psychotherapy -- Cumberland River
Behavior
h. July 9, 2019 office outpatient and x ray --Pikeville
Medical Center.
The Appellant, JAB, the employer, appealed to the Workers’
Compensation Board. JAB argued that the bills were not timely submitted because
KRS 342.020(4) mandates their submission within 45 days of the initiation of
treatment and every 45 days thereafter and that the statute applies pre-award. By
Opinion rendered on May 20, 2022, the Board affirmed the ALJ and held that the
“the 45-day requirement set forth in KRS 342.020(4) is applicable only after a
determination of compensability of a claim by an ALJ.”
On June 23, 2022, JAB filed a petition for review on appeal in this
Court and argued that the plain language of KRS 342.020(4) applies both pre- and
post-award. No response to the petition was filed. By Order entered on September
13, 2022, we held this appeal in abeyance pending a decision in Daniel Farley v.
P&P Construction, Inc., in which the same issue was pending before our Supreme
Court. Farley has now been decided.
By Opinion rendered on August 24, 2023, the Supreme Court agreed
with JAB that “pursuant to the unambiguous language of KRS 342.020(4), medical
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providers are required to submit their billings within 45-days of service, regardless
of whether a determination of liability has been made . . . .” Farley v. P&P
Construction, Inc., ___ S.W.3d ___, 2023 WL 5444615, at *1 (Ky. 2023) (italics
original). The Court concluded that the 45-day requirement “applies both pre- and
post-award.” Id. at *7. It continued as follows:
[T]his interpretation of KRS 342.020(4) will not harm
Farley as “[t]he medical provider shall not bill a patient
for services which have been denied by the payment
obligor for failure to submit bills following treatment
within forty-five (45) days as required by KRS 342.020
and Section 6 of this administrative regulation.” 803
KAR[2] 25:096 § 10(3).
Id.
Accordingly, by virtue of SCR3 1.030(8)(a), we are compelled to
reverse the Opinion of the Workers’ Compensation Board and to remand this case
to the ALJ with direction to enter a new Opinion and Order consistent with the
Supreme Court’s holding in Farley.
ALL CONCUR.
2
Kentucky Administrative Regulation.
3
Supreme Court Rule.
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BRIEF FOR APPELLANT: NO BRIEF FOR APPELLEE.
W. Barry Lewis
Hazard, Kentucky
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