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Worker’s medical claims timely even two years after treatment

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A worker severely burned in a workplace accident filed his claims for medical expenses in a timely manner, an appellate court held Friday.

In Wonderfoil Inc. v. Russell, the Kentucky Court of Appeals unanimously affirmed a Kentucky Workers Compensation Board’s holding that because the worker’s claim had not yet been accepted, the 60-day submission requirement for medical claims did not apply.

Richard Russell was operating a machine for Wonderfoil Inc. in November 2014 when his shirtsleeve became caught. He suffered severe burns, spent six days hospitalized and timely reported the injury to the company. However, no first report of injury was filed and the workers compensation insurer was not informed of the accident. On Oct. 31, 2016, Wonderfoil denied the claim.

Mr. Russell had submitted his claims to his health insurer because he was not sure his injury was covered by workers comp. Kentucky statutes require that medical bills be submitted within 60 days of treatment, but Mr. Russell did not submit his bills until 2018, while the two parties were still negotiating a settlement.

Wonderfoil argued that since the 45-day time period had “clearly passed” when he filed claims for medical services in 2014 and 2015 that they were not compensable. Mr. Russell argued that the 60-day period did not apply because his injury was not accepted as a compensable claim, and therefore his unpaid medical expenses were timely filed. An administrative law judge denied his claims for medical expenses, but the board reversed that decision, holding that the 60-day submission requirement should only apply post-award.

Since a decision had not been made as to the compensability of Mr. Russell’s claim, the board held that the medical bills were not untimely filed, and remanded the case to the ALJ to determine whether the medical bills were related to the work industry and whether Wonderfoil should be responsible for payment.

The appellate court affirmed the board’s decision, finding the board’s interpretation of the 60-day submission requirement to be reasonable. “Because medical expenses are not compensable until an award is entered,” said the court, “it is reasonable that an employee is not required to submit medical expenses until an award is entered.”

 

 

 

 

 

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