Wis.LIRC WC Decision: Goli-Hanson, Lisa - December 6, 2007 - ND � 5.47 - Disputes About Reasonableness of Fees - employer/insurer disputed work-related injury; ALJ found such injury, ordered medical expenses paid; on appeal to LIRC employer argued alternatively that unpaid expenses should be processed according to a certified database - held, wherer employer had opportunity earlier in the proceedings to request that any unpaid expenses be processed according to a certified database, but did not do so, LIRC will not grant request to submit expenses to certified database

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

LISA GOLI-HANLON, Applicant

HEARTLAND EMPLOYMENT SERVICES INC, Employer

HEARTLAND EMPLOYMENT SERVICES INC, Insurer

WORKER'S COMPENSATION DECISION
Claim No. 2005-044494

AMENDED COMMISSION DECISION

Pursuant to the authority granted in Wis. Stat. § 102.18(4) the commission hereby amends its order dated November 15, 2007 to reflect the correct amount of medical expenses to be paid in this matter.

ORDER
The order of the commission is affirmed except as otherwise modified to correct the amount of medical expenses to be paid in this matter. Within 30 days of the commission's order, the employer and its insurance carrier shall pay to St. Luke's Medical Center the sum of $5,060.84; to Evolution Exercise and Spine Center the sum of $2,684.60; to Midwest Neurosciences Associated, LLC, the amount of $30,445.00; to R S Medical the sum of $3,265.50; to Commonwealth Medical Group, LLC the sum of $2,939.31; Anesthesiology Associates of Wisconsin, the sum of $2,835.00; to Great Lake Pathologists, S.C. the sum of $109.00; to Advanced Therapy Center, Inc. the sum of $266.00; to ERMED, S.C., the sum of $241.47; to Innovative Pain Care, LLC, the sum of $2,590.00; to Associated Surgical & Medical the sum of $5,502.00; and to Professional Neurological Services the sum of $190.00; to Wisconsin Laborer's Health Fund the sum of $17,078.77; and to the applicant the sum of $5391.10 for out of pocket medical expenses.

Dated and mailed December 6, 2007
golihli . wpr : 175 : 8 ND � 5.47

/s/ James T. Flynn, Chairman

/s/ Robert Glaser, Commissioner

/s/ Ann L. Crump, Commissioner

NOTE:
The commission has amended its order to reflect the correct amount of medical expenses to be paid in this case. The employer indicated in a letter to the commission that it should not be required to pay amounts listed on the applicant's WC-3, including amounts that had been written off by the treating healthcare providers. In past cases, the commission has declined to require insurers to pay medical expenses that have been written off by the provider, when there is no indication that the write off was withdrawn and no explanation is given for the write off. Barrera v. Grade A Construction, Inc., WC No. 2004-043779 (LIRC, July 19, 2007) and Hoefs v. Midway Hotel and Wausau Underwriters, WC No. 1999-029046 (LIRC, October 21, 2003). The commission has held that absent special circumstances medical charges reflecting write offs represent the reasonable expense of treatment for which liability accrues under Wis. Stat. § 102.42(1). There have been no special circumstances presented in this case.
In addition, the employer requested an opportunity to process any unpaid bills according to a certified database. However, the commission can find nothing in the record that warrants submitting any of the unpaid bills according to a certified database. The applicant notes in response to the employer's request that the applicant's WKC-3 setting forth Dr. White's treatment bill, as well as the other medical expenses, represent the bills that existed at the time of the hearing, and there is nothing else in the record on this issue. The commission agrees. The employer had an opportunity to request that any unpaid balances be processed according to a certified database earlier in the proceedings, however a review of the record does not indicate that the employer made such a request. The commission has found nothing to warrant submitting any unpaid medical bills to a certified database. Therefore, the employer's request is denied and the commission's prior order is amended to reflect the correct amount of medical expenses to be paid in this matter.

cc:
Attorney Thomas J. Flanagan
Attorney Daniel L. Zitzer

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