WORKERS COMP – Employer estopped from denying compensability, billings by physician not accepting WC schedule: Sullivan v. Wolf Creek Collieries (COA 9/11/2009)

Sullivan v. Wolf Creek Collieries

2009-CA-000385 9/11/09 2009 WL 2901561 Released for pub. Opinion by
Senior Judge Harris; Judges Moore and Nickell concurred. The Court
affirmed a decision of the Workers’ Compensation Board finding that an
employer was equitably estopped from contesting a worker’s treatment
for depression but that the employer was only estopped from denying
compensability to the date of the ALJ’s decision. The worker was
treated by a physician who did not accept Kentucky workers’
compensation patients and with whom the worker entered into an
arrangement whereby the worker paid for his treatment out of pocket and
was then reimbursed by the employer

The Court held that it was
undisputed that the balance billing arrangement violated KRS 342.020(1)
and KRS 342.035(2) and once the employer filed the medical fee dispute,
the worker was on notice that the fees were being challenged and he
could no longer rely upon past representations or omissions on the
employer’s part.

Please note: I reserve the right to delete comments that are inappropriate, offensive or off-topic.

Leave a Reply

Your email address will not be published.