An insurer’s medical payment responsibilities to an injured worker ended when more than two years passed between bills, an appellate court held.

In Dunbar v. Acme Southern Inc., the North Carolina Appeals Court on Tuesday unanimously affirmed a North Carolina Industrial Commission decision ruing that although the worker was still receiving medical care that was being inadvertently billed to Medicare during the billing lapse, the insurer had no obligation to pay for medical treatment nearly four years after its final bill.

Derrick Dunbar worked for Acme Southern when he was injured in a workplace accident in 1998. He settled his claims for indemnity compensation with Hartford Underwriters Insurance Co. but did not reach a settlement with the insurer for his medical compensation.

Around 2013, Mr. Dunbar’s medical providers began billing Medicare rather than Hartford for reimbursement, though he was unaware of the change. In 2017, he was referred to a medical provider for pain management and sought authorization from Hartford for the treatment, which was denied on the basis that he was no longer entitled to medical compensation because he had not submitted a request for more than two years. He requested a hearing to determine whether he was entitled to further medical compensation, but the North Carolina Industrial Commission agreed with Hartford. Mr. Dunbar appealed.

The appellate court affirmed the commission’s decision. Mr. Dunbar argued that his claim should not be barred by the fact that Hartford did not make any payments for his medical compensation for two years, but the court noted that North Carolina law provides the right to terminate medical compensation two years after the employer’s last payment, unless compensation is preserved in another manner.

He also contended that state law requires the insurer to notify the employee when it has made its final payment within 16 days or pay a $25 fine, but the court held that there was “no way Hartford could have known within 16 days of providing coverage in October 2013 that this payment would be the last payment plaintiff would have sought.”

The court also noted that Mr. Dunbar presented no evidence that Hartford was aware that he was continuing to incur medical expenses after October 2013 or that the insurer acted in bad faith.