BI’s Article search uses Boolean search capabilities. If you are not familiar with these principles, here are some quick tips.
To search specifically for more than one word, put the search term in quotation marks. For example, “workers compensation”. This will limit your search to that combination of words.
To search for a combination of terms, use quotations and the & symbol. For example, “hurricane” & “loss”.
An employee’s claims for medical expense reimbursement were properly denied because she failed to receive preauthorization, a Kansas appeals court held on Friday.
In Christensen v. The Home Depot, a three-panel judge of the Kansas Court of Appeals unanimously affirmed a commission’s decision holding that a Home Depot employee was not entitled to be reimbursed for physician visits that were not authorized by her employer or the administrative law judge.
In September 2007, Cindy Christensen slipped while working at Home Depot and suffered injuries to her neck, lower back and right arm. Between 2007 and 2013, Christensen filed nine applications for preliminary hearings and participated in four preliminary hearings.
In February 2013, Christensen agreed to a settlement based on 28% permanent impairment of the body as a whole on a running award, and retained the right to seek future medical treatment, but only with proper application to the director of workers compensation.
In 2014, she began seeing a podiatrist, neurologist and a doctor who recommended a muscle biopsy, but none had been authorized as a treatment provider. In September 2016, Ms. Christensen requested a post award medical hearing for reimbursement of her medical mileage. At the hearing, she acknowledged that Home Depot had not authorized her to see the doctors and admitted that she had recently been hit by a car while riding her bike and been competing in several triathlons and running races.
The administrative law judge held that Ms. Christensen failed to prove her treatment was authorized and further found that the treatment was related to her athletic activities, denying her request for reimbursement totaling more than $14,000.
She petitioned the Kansas Workers Compensation Appeals Board for review, which adopted the ALJ’s decision. She then appealed to the Kansas Court of Appeals, which affirmed the commission’s decision.
Although Ms. Christensen argued that the medical care and expenses were necessary to cure and relieve her from the effects of her 2007 injury, the court noted that the state’s Workers Compensation Act “clearly provides that when an employee does not obtain the appropriate authorization to use a particular health care provider, the maximum liability of the employer is $500.”
The court found that Ms. Christensen failed to prove Home Depot or its insurer authorized her medical treatment, and that Home Depot was not liable for those expenses. Although Ms. Christensen argued that her medical care was necessary to deal with her injury, the court found that Home Depot had “provided reasonable and necessary medical care in this case both before and after” the settlement award.
The court held that since it determined that her treatment was not authorized, it was unnecessary to address whether her treatments were related to her compensable injury.
Neither of the attorneys nor Home Depot immediately responded to calls for comment.
Wage-and-hour exclusions within employment practices liability insurance policies may not apply to expense reimbursement.