Atlantic Orthopaedic Specialists v. City of Portsmouth

CourtCourt of Appeals of Virginia
DecidedApril 27, 2021
Docket0977201
StatusPublished

This text of Atlantic Orthopaedic Specialists v. City of Portsmouth (Atlantic Orthopaedic Specialists v. City of Portsmouth) is published on Counsel Stack Legal Research, covering Court of Appeals of Virginia primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Atlantic Orthopaedic Specialists v. City of Portsmouth, (Va. Ct. App. 2021).

Opinion

COURT OF APPEALS OF VIRGINIA

Present: Chief Judge Decker, Judges Beales and O’Brien PUBLISHED

Argued by videoconference

ATLANTIC ORTHOPAEDIC SPECIALISTS OPINION BY v. Record No. 0977-20-1 JUDGE RANDOLPH A. BEALES APRIL 27, 2021 CITY OF PORTSMOUTH

FROM THE VIRGINIA WORKERS’ COMPENSATION COMMISSION

Philip J. Geib (Philip J. Geib, P.C., on brief), for appellant.

Timothy D. Watson (Midkiff, Muncie & Ross, P.C., on brief), for appellee.

Atlantic Orthopaedic Specialists (“Atlantic Orthopaedic”) appeals a decision of the

Workers’ Compensation Commission (“the Commission”) that denied its claim for additional

payments from the City of Portsmouth (“Portsmouth”) for health care services Atlantic

Orthopaedic provided to a Portsmouth employee injured in a workplace accident. On March 8,

2017, the Commission entered an award order for temporary partial disability benefits and

lifetime medical benefits for the Portsmouth employee who injured her left knee while at work

on January 12, 2017. From January 20, 2017, to June 2, 2017, Atlantic Orthopaedic provided

health care services to the employee to address her injury. Atlantic Orthopaedic billed

Portsmouth for four dates on which it provided health care services to the employee, but

Portsmouth made only partial payments for those four bills. On November 7, 2019, more than

two years after Atlantic Orthopaedic received its last payment from Portsmouth and more than

two years after the March 8, 2017 award order became final, Atlantic Orthopaedic filed a claim

with the Commission seeking the remaining balance of the four bills. The full Commission unanimously held that Atlantic Orthopaedic’s November 7, 2019 claim was barred by the

one-year statute of limitations under Code § 65.2-605.1(F).

On appeal to this Court, Atlantic Orthopaedic argues that the Commission erred in

finding that the statute of limitations under Code § 65.2-605.1(F) barred its November 7, 2019

claim. Atlantic Orthopaedic contends that the Commission erred in concluding that Portsmouth

“was not required to prove any compliance with Virginia Code Section 65.2-605.1(A) and (B) as

preconditions in order to gain the benefits” of the Code § 65.2-605.1(F) statute of limitations.

Atlantic Orthopaedic also argues that the statute of limitations under Code § 65.2-605.1(F)(ii)

does not apply to its claim because “there was no medical Award present covering the dates of

service sought in accord with Virginia Code Section 65.2-605.1(F)(ii).”

I. BACKGROUND

On January 12, 2017, Mary Shields, an equestrian police officer working for Portsmouth,

slipped in the mud and twisted her left knee while walking her horse. She suffered a “left knee

medial meniscus tear.” In the first week of March 2017, Shields and Portsmouth entered into an

award agreement in which Portsmouth agreed to compensate Shields with workers’

compensation benefits for her workplace injury. On March 8, 2017, the Commission entered an

award order awarding Shields temporary partial disability benefits. The award order also stated,

“Lifetime Medical benefits are hereby awarded for reasonable, necessary and authorized medical

treatment for the following body parts injured during the Injured Worker’s workplace injury of

January 12, 2017: Left knee medical [sic] meniscus tear.” The award order became final thirty

days later on April 7, 2017.

On January 20, 2017, Shields began seeing a doctor at Atlantic Orthopaedic for her

injury. Shields went for another appointment on January 27, 2017. On February 20, 2017,

Atlantic Orthopaedic performed surgery on her knee. On June 2, 2017, Shields had a follow-up -2- appointment with Atlantic Orthopaedic after her knee surgery, and the doctor determined that

“[s]he has reached maximum medical improvement as of this date, 06/02/17, and she will see me

as needed. She is full duty at work without restrictions.”

Atlantic Orthopaedic billed Portsmouth for the health care services that Atlantic

Orthopaedic provided to Shields on January 20, January 27, February 20, and June 2, 2017. The

total amount billed to Portsmouth for those four dates was $3,771, but Portsmouth paid only

$3,224.85. On August 14, 2017, Atlantic Orthopaedic received its last payment from Portsmouth

for $110.50 for the June 2, 2017 health care service.

On November 7, 2019, more than two years after Atlantic Orthopaedic received its last

payment from Portsmouth (and more than two years after the March 8, 2017 award order became

final), Atlantic Orthopaedic filed a claim with the Commission seeking full payment for the

health care services provided to Shields. Atlantic Orthopaedic claimed that Portsmouth failed to

make full payments for health care treatment provided on January 20, January 27, February 20,

and June 2, 2017. Atlantic Orthopaedic requested that the Commission make Portsmouth pay the

remaining balance of $546.15 for those four bills.

On March 23, 2020, the deputy commissioner ruled that Atlantic Orthopaedic’s failure to

file its claim within the one-year statute of limitations under Code § 65.2-605.1(F) barred its

claim. The deputy commissioner stated that Atlantic Orthopaedic’s claim was time barred

because it was filed “more than one year from the last date of payment” and “more than one year

from the date the medical award became final.” On March 24, 2020, Atlantic Orthopaedic filed

a request for review by the full Commission.

On August 10, 2020, the full Commission unanimously affirmed the deputy

commissioner’s ruling that Code § 65.2-605.1(F) barred Atlantic Orthopaedic’s claim. The

Commission explained: -3- On appeal, the medical provider maintains that the defendants failed to comply with the provisions of Subsections A and B of Virginia Code § 65.2-605.1, and hence, they cannot benefit from Subsection F. The medical provider argues the defendants “contested” its charges because they did not pay the full charges as billed and the defendants failed to pay bills in the required sixty-day timely manner (services rendered on February 20, 2017). It alleges the defendants failed to provide it with the statutorily required notifications of its remedies. Lastly, the medical provider asserts the March 9, 20171 award “provided only for Lifetime Medical benefits” without making any “mention of, or referenced, treatment provided by Atlantic Orthopedics,” hence the dates of service never triggered the running of the statute of limitations. [(Citation omitted).] We are not convinced and find no error in the lower determination. Furthermore, the full Commission stated that “the medical provider argues the defendants

detrimentally failed to comply with Subsections A and B. However, the medical provider had

the responsibility of timely filing a claim in which to make these assertions.” Consequently, the

full Commission concluded, “The medical provider could disagree with an alleged underpayment

in any fashion - but the Virginia Workers’ Compensation Act dictates the time limits within

which it must do so.”

Atlantic Orthopaedic now timely appeals the opinion of the full Commission to this

Court.

II. ANALYSIS

On appeal, Atlantic Orthopaedic raises four assignments of error. In Assignment of Error

I, Atlantic Orthopaedic argues that “[t]he Full Commission erred as a matter of law in its

interpretation of Virginia Code Section 65.2-605.1 in finding that the Medical Provider’s

Free access — add to your briefcase to read the full text and ask questions with AI

Related

Elias P. Doulgerakis v. Commonwealth of Virginia
737 S.E.2d 40 (Court of Appeals of Virginia, 2013)
Chapman v. Commonwealth
697 S.E.2d 20 (Court of Appeals of Virginia, 2010)
United Parcel Service, Inc. v. Ilg
679 S.E.2d 545 (Court of Appeals of Virginia, 2009)
Alston v. Commonwealth
637 S.E.2d 344 (Court of Appeals of Virginia, 2006)
Hulcher v. Commonwealth
575 S.E.2d 579 (Court of Appeals of Virginia, 2003)
Allen P. Stanfield v. City of Hampton Fire & Rescue
522 S.E.2d 404 (Court of Appeals of Virginia, 1999)
Dionne v. Southeast Foam Converting & Packaging, Inc.
397 S.E.2d 110 (Supreme Court of Virginia, 1990)
Barr v. Town & Country Properties, Inc.
396 S.E.2d 672 (Supreme Court of Virginia, 1990)
Tina Marie Bryant v. Commonwealth of Virginia
798 S.E.2d 459 (Court of Appeals of Virginia, 2017)
Bryant v. Commonwealth
811 S.E.2d 250 (Supreme Court of Virginia, 2018)
Roanoke Ambulatory Surgery Center v. Bimbo Bakeries USA, Inc.
822 S.E.2d 675 (Court of Appeals of Virginia, 2019)
Joshua Saquan Maurice Eley v. Commonwealth of Virginia
826 S.E.2d 321 (Court of Appeals of Virginia, 2019)

Cite This Page — Counsel Stack

Bluebook (online)
Atlantic Orthopaedic Specialists v. City of Portsmouth, Counsel Stack Legal Research, https://law.counselstack.com/opinion/atlantic-orthopaedic-specialists-v-city-of-portsmouth-vactapp-2021.