Idaho Law Blog
In October of 2006 the Claimant, Thomas C. Millard, fell 25’ on to a cement pad and injured his back, left leg, neck and shoulder. As a result of the accident the Claimant also suffered a serious brain injury.
As a part of his treatment the Claimant in 2012 and 2013 had injections completed by his doctor Vikas Garg, M.D. Claimant also received physical therapy treatments in 2011.
The Idaho Workers Compensation Company (“Surety”) would not pay these bills in a timely fashion, so the Claimant filed a complaint with the Idaho Industrial Commission. The Claimant asked that the Commission require the Surety pay 100% of the invoice price under the Neel v. Construction Inc., 147 Idaho 146, 206 P. 3d 852 (2009).
The Idaho Industrial Commission held that since the Surety had paid some of these medical bills prior to the Commission’s decision being issued that the Surety could purge themselves from all fault and they just had to pay the reasonable and customary amount under the Surety’s medical fee schedule and not the 100% invoiced price. The Idaho Supreme Court said the Idaho Industrial Commission got to the right result but applied the test wrong and stated:
Thus, under its plain language, Neel holds that a surety is liable for the full invoiced amounts of a worker’s medical bills when (1) the surety denies a claim and (2) that claim is subsequently deemed compensable by the Commission. The question remains, however, what the term “claim” encompasses. Surety argues that “claim” should only refer to the initial or threshold claim of compensability. Millard argues that “claim” encompasses demands made on the employer to pay for medical services, including those made after the initial determination of compensability has been approved. Millard is correct
The Idaho Supreme Court stated that the Idaho Industrial Commission got it wrong when it tried to add a third prong to the Neel test by stating the claim has to paid unpaid from the time of the initial denial up to the time the Commission issued a determination of compensability. Neel does not mention anything about bills remaining unpaid up to a determination of compensability.
This is a great victory for Idaho Worker’s Compensation Claimants. Idaho Worker’s Compensation Company who unreasonably deny claims have to face the music, they have to pay the full invoice price for unreadably denied medical bills under Neel.
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