Wis.LIRC WC Decision: Duenkel, Thomas - June 22, 2006 - ND � 10.9 - Rights of Nonindustrial Insurers - Non-WC health insurance carrier paid certain medical expenses - ALJ erroneously found WC carrier and health carrier were same entity - in fact, employer was self-insured for non-WC health coverage - WC insurer should reimburse employer for applicant's medical expenses which it paid

STATE OF WISCONSIN
LABOR AND INDUSTRY REVIEW COMMISSION
P O BOX 8126, MADISON, WI 53708-8126 (608/266-9850)

THOMAS E DUENKEL, Applicant

CITY OF MANITOWOC PUBLIC WORKS, Employer

WAUSAU BUSINESS INS CO, Insurer

WORKER'S COMPENSATION DECISION
Claim No. 2004-008212

Pursuant to authority granted in Wis. Stat. 102.18(4)(c), the commission hereby modifies its decision and interlocutory order issued in this matter on June 30, 2005. The commission decision is modified to include a modification of the administrative law judge's decision, such that the following sentence (found on page 7 of the administrative law judge's decision) is deleted:

"The treatment expenses paid by the carrier will not be ordered reimbursed, as it appears the health carrier and the worker's compensation carrier are the same entity."

This finding appears to have been made in error, as it appears that the employer paid certain medical expenses attributable to the work injury of December 18, 2002, but that Wausau Business Insurance Company (Wausau) was the liable worker's compensation carrier, and should have reimbursed the employer for these expenses. The parties did not argue this issue before the department or the commission, and therefore the evidence of record does not enable the commission to make actual findings regarding it.

Accordingly, the interlocutory nature of the commission's order is hereby noted to expressly include the issue of reimbursement of these medical expenses from Wausau to the employer. If Wausau was the worker's compensation carrier liable for the work injury of December 18, 2002, it should immediately reimburse the employer, through the employer's third party administrator, for the work-related medical expenses the employer paid. If Wausau asserts a defense to such reimbursement, the applicant may file a new application to test that defense.

Dated and mailed June 22, 2006
duenkth . wmd : 185 : 6 ND � 10.9

/s/ James T. Flynn, Chairman

/s/ David B. Falstad, Commissioner

/s/ Robert Glaser, Commissioner

cc:
Attorney Jerome Fox
Attorney Kurt VanBuskirk

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