Mitee Enterprises v. Yates

865 S.W.2d 654, 1993 Ky. LEXIS 163, 1993 WL 482050
CourtKentucky Supreme Court
DecidedNovember 24, 1993
Docket93-SC-435-WC
StatusPublished
Cited by22 cases

This text of 865 S.W.2d 654 (Mitee Enterprises v. Yates) is published on Counsel Stack Legal Research, covering Kentucky Supreme Court primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Mitee Enterprises v. Yates, 865 S.W.2d 654, 1993 Ky. LEXIS 163, 1993 WL 482050 (Ky. 1993).

Opinion

OPINION OF THE COURT

Claimant injured his back at work on August 7, 1986. The ensuing settlement agreement provided for a permanent, partial disability benefit and for the employer’s payment of “reasonable medical expenses pursuant to the Act.”

The employer states that when medical bills for a period beginning on August 8, 1988, were presented for payment, it refused to pay. Subsequently, on March 22, 1989, after no action was taken by claimant to compel payment, the employer filed a motion to reopen in order to contest payment of the disputed bills. Additional bills were presented to the employer after that date, and the motion to reopen was supplemented in order to include them as well. At the prehearing conference regarding the motion, the parties stipulated that the only contested issue was the “reasonableness of medical care provided by Dr. Aaron.”

The Administrative Law Judge (ALJ) determined that the continuing and nearly daily injections of narcotic pain medication were unreasonable and unnecessary for the treatment of claimant’s condition. However, KRS 342.020(1) required an employer to pay the provider of medical services within 30 days of the receipt of a statement for those services. Because the employer had neither paid nor challenged the reasonableness of any of the medical expenses until March 22, 1989, the ALJ ordered the employer to pay for those medical expenses incurred prior to February 22, 1989, 30 days prior to the filing of the motion to reopen.

On appeal to the Workers’ Compensation Board (Board) and the Court of Appeals, the ALJ’s decision was affirmed, and we affirm.

KRS 342.020 provides that an employer shall pay for the reasonable and necessary medical expenses of an injured worker. In Westvaco v. Fondaw, Ky., 698 S.W.2d 837, 839 (1985) this Court placed squarely on the employer the burden of going forward with evidence to contest the reasonableness of medical bills it denied having an obligation to pay. The Court determined that an employer who wished to dispute a medical bill submitted by a disabled worker must, within a reasonable time, file a motion to reopen the award pursuant to KRS 342.125. Subsequently, effective October 26, 1987, the General Assembly amended KRS 342.020(1) to provide that:

The employer, or an insurer on behalf of the employer, shall make all payments for services rendered to an employe directly to the provider of such services within thirty (30) days of receipt of a statement for services.

This provision was enacted to alleviate complaints of unnecessary delays in the payment *656 of medical bills. O’Daniel, 1987 Kentucky Workers’ Compensation Law, pp. 43-44. Such delays are contrary to the fundamental purposes of the Workers’ Compensation Act, one of which is the prompt resolution of workers’ compensation claims. See Searcy v. Three Point Coal Co., Ky., 280 Ky. 683, 134 S.W.2d 228 (1939).

Phillip Morris v. Poynter, Ky.App., 786 S.W.2d 124, 125 (1990), involved a worker’s motion to compel his employer to pay medical bills. In that case, the employer had failed both to pay and to file a motion to challenge medical bills received after the effective date of the 1987 amendment for an injury incurred before the effective date of the amendment. The court rejected the employer’s argument that its failure to move to reopen should not result in a waiver of its right to object to the bills. The court stated that, in view of Westvaco, supra, the employer, and not the worker, clearly was considered to be the complaining party where there was a dispute over the reasonableness of medical bills. Furthermore, without the imposition of some penalty against an employer who failed to comply with the dictates of Westvaco, supra, that decision would be ineffectual. Therefore, the court concluded that, because the employer had failed to move to reopen the claim in order to contest the allegedly unreasonable medical bills, thereby forcing the worker to move to compel payment, it had effectively waived its right to challenge them. Because the employer had not moved to reopen the claim, the 30-day time period in KRS 342.020(1) was not an issue. Nonetheless, the court noted that, in view of the principles set forth in Westvaco, supra, not only was the employer required to go forward with its objection to medical bills, it was required to do so within 30 days of receipt of those bills.

In National Pizza Co. v. Curry, Ky., App., 802 S.W.2d 949, 951 (1991), the court again emphasized that it is the employer who must either raise issues concerning the compensa-bility of medical treatment or waive the right to object. The court also reminded the bar that in such instances the employer is the complaining party upon whom falls the burden of proving that the disputed treatment is unreasonable or unnecessary.

In 1992 the legislature again amended KRS 342.020(1) thereby requiring the providers of medical services to submit a statement within 45 days of the date treatment is initiated. No other changes were made in the statute.

We believe that, considering the frequency with which issues surrounding the reasonableness or necessity of medical treatment arise, the principle that workers’ compensation claims be resolved promptly, and the apparent purpose of the 1987 Amendment to KRS 342.020(1), it is clear that the amendment was remedial rather than retrospective in nature and applies to all medical bills received after its effective date, including those that are the subject of the instant dispute. See Peabody Coal Co. v. Gossett, Ky., 819 S.W.2d 33, 36 (1991); Purdy v. Palmore, Ky., 789 S.W.2d 12 (1990).

Westvaco, supra, and its progeny set forth the procedure to be followed by employers who wish to contest medical bills, clearly placing both the burden of going forward and the burden of persuasion on the employer. Despite numerous opportunities to do so, the General Assembly has not seen fit to change the impact of those decisions, leading this Court to the conclusion that those decisions comport with the legislative intent.

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Cite This Page — Counsel Stack

Bluebook (online)
865 S.W.2d 654, 1993 Ky. LEXIS 163, 1993 WL 482050, Counsel Stack Legal Research, https://law.counselstack.com/opinion/mitee-enterprises-v-yates-ky-1993.