GERALD SPRINGER, Applicant

UNITED PROPERTIES, Employer

STATE FARM FIRE & CASUALTY CO, Insurer

United Properties and State Farm Casualty Company (respondents) submitted a petition for commission review alleging error in the administrative law judge's Findings and Interlocutory Order issued in this matter on January 12, 2004. The applicant submitted an answer to the petition and briefs were submitted by the parties. In his Order the administrative law judge awarded additional temporary disability, permanent partial disability, medical expense, and mileage expense. The only issue in dispute before the commission is whether the administrative law judge erred when he ordered respondents to pay four of the medical providers for certain expenses that were written off by those providers.

The commission has carefully reviewed the entire record in this matter and hereby affirms in part and reverses in part the administrative law judge's Findings and Interlocutory Order. The commission makes the following:

The administrative law judge's Interlocutory Order directs payment of medical expenses to Aurora Healthcare/St. Luke's Medical Center, Anesthesiology Associates of Wisconsin, Advanced Healthcare, and Dr. Cully R. White in paragraphs numbered 3 through 6, respectively. Those paragraphs are deleted and the following four paragraphs substituted therefor:

"3. To Aurora Healthcare/St. Luke's Medical Center the sum of One thousand eight dollars and eighty-seven cents ($1,008.87).

"4. To Anesthesiology Associates of Wisconsin the sum of One thousand three hundred fifty-two dollars and twenty cents ($1,352.20).

"5. To Advanced Healthcare the sum of Two hundred sixty dollars and ninety-one cents ($260.91).

"6. To Dr. Cully R. White, Neurosurgery & Spine, S.C., the sum of Three hundred fifty dollars ($350.00)."

The rest and remainder of the administrative law judge's Findings and Interlocutory Order are affirmed and reiterated as if set forth herein.

NOW, THEREFORE, this

The administrative law judge's Findings and Interlocutory Order are affirmed in part and reversed in part, as noted above. Jurisdiction is reserved for such further findings and orders as may be warranted.

Dated and mailed January 14, 2005
springe . wrr : 185 : 2   ND § 5.46

/s/ James T. Flynn, Chairman

/s/ David B. Falstad, Commissioner

/s/ Robert Glaser, Commissioner

In two relatively recent decisions, the commission explained why it would not order payment of a medical expense that has 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. (See Darlene R. Hoefs v. Midway Hotel and Wausau Underwriters, WC Claim No. 1999-029146 (LIRC October 21, 2003); and Richard Pospichal v. Ashley Furniture and Employers Insurance of Wausau, WC Claim No. 2002-022704 (LIRC November 30, 2004) (Copies of these decisions are available on the commission's website). In these decisions the commission explained 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). The commission therefore partially reversed the administrative law judge's Interlocutory Order to reflect this interpretation of the statute.

cc:
Attorney Thomas J. Flanagan
Attorney Michael C. Frohman

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