Medical Expenses Must Be Submitted Within 60 Days

A recent Supreme Court case held that if there are medical expenses or mileage claimed by the injured worker as out-of pocket medical expenses, they must be submitted to the insurance carrier within 60 days, on a Form 114.

Susan Garno v. Solectron USA; et al.

Opinion of the Court – Affirming

2010-SC-000154-WC

Date Rendered: 12/16/2010, TO BE PUBLISHED

Lower Court: From Court of Appeals

Key words: workers' compensation, 60-day period for request for reimbursement of out-of-pocket medical expenses, interlocutory order

The claimant was awarded worker's compensation benefits in a 2006 interlocutory order which ruled that a low back surgery she had undergone was a result of a work related injury, ordered temporary total disability to be paid, and placed the claim in abeyance until she reached maximum medical improvement. After she reached maximum medical improvement in 2007 the claim was reassigned to a different ALJ, who ordered that the claim be removed from abeyance and the parties to take proof on a second surgery. During that proof period, the claimant submitted medical bills from her doctors. prescriptions and mileage exceeding $20,000, some of which dated from 2002 and 2003. The claimant testified that she had submitted these medical expenses to the attorney for one of the insurers for the defendant previously, as a reason for failing to submit the medical expenses with 60 days of incurring the costs. The ALJ found that the second surgery was not reasonable or necessary, and denied reimbursement for the medical expenses, finding that she did not submit them earlier, and that she did not have a reasonable excuse for failing to submit them after the interlocutory order was entered in 2006. The claimant appealed, arguing that she would not have been able to enforce the request for reimbursement of medical expenses, via a Circuit Court action, until the ALJ rendered a final Order in the case, because an interlocutory order is not final and appealable. The Supreme Court affirmed the ALJ, and held that the interlocutory order entered in 2006 was an enforceable Order until it was appealed, and therefore the claimant had no reason to wait until the entire case was final to submit her medical expenses. Finally, the Supreme Court held that evidence did not compel a finding that the claimant did, in fact, submit the expenses during the litigation in 2006.