MEDICAL PROVIDER CLAIMS

MEDICAL PROVIDER CLAIMS FOR UNDERPAYMENT – MEDICAL PROVIDER’S BURDEN OF PROOF

Jacobs v. Norfolk State University, VWC File No. 222-87-91 (March 15, 2011)

Jordan Young Institute – Medical Provider

The Employer requested review of the Deputy Commissioner’s award of $10,460.00 to the medical provider for the Claimant’s January 26, 2010 surgery. The Claimant was awarded lifetime medical benefits for the injuries he suffered to his neck, right and left shoulders, left wrist, forearm, and elbow, as well as his right knee. On June 16, 2010, Jordan Young Institute, a medical provider, filed a claim for payment for an outstanding medical bill in the amount of $10,460.00. An on-the-record hearing was held and the Deputy Commissioner stated that “The defendant’s evidence consists of no more than mere conclusory statements, which we find to be unpersuasive and insufficient to meet their burden of proof.” Additionally, the Deputy Commissioner ruled that there was no evidence that the charges exceeded the prevailing community rate and there was no evidence of a reduction pursuant to a valid contract.

On Review, the Employer argued that the medical provider was required to prove that the medical treatment was causally related to the work accident and that the services are reasonable and medically necessary, which the medical provider did not prove, nor did the Deputy Commissioner consider these issues. The Commission held that in medical provider claims, the burden of proof rests with the medical provider, and it must be determined that there is a causal connection between the treatment and the work accident.

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