Court Opinion

ID: 9890519
Source: CourtListenerOpinion
Date Created: 2023-10-13 14:07:22.197239+00
Date Added: 2024-06-11T13:26:22.376820
License: Public Domain

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                 NOT TO BE PUBLISHED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

                                        -3-
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.

                                            -4-
BRIEF FOR APPELLANT:    NO BRIEF FOR APPELLEE.

W. Barry Lewis
Hazard, Kentucky

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