| FINAL AWARD |
| (Affirming Award on Medical Fee Dispute with Supplemental Opinion) |
| Injury No.: 12-034177 |
| Medical Fee Dispute No.: 12-01412 |
| Employee: | James Holland |
| Employer: | Meramec Mechanical Inc. |
| Insurer: | Secura Insurance |
| Health Care Provider: | St. Louis Spine & Orthopedic Surgery Center |
| Pursuant to the provisions of § 287.140, RSMo and 8 CSR 50-2.030, the above-captioned award is submitted to the Labor and Industrial Relations Commission (Commission) for review under § 287.480, RSMo. We have reviewed the evidence and considered the whole record. Pursuant to § 286.090, RSMo, we affirm the award and decision of the administrative law judge. We adopt the findings, conclusions, decision, and award of the administrative law judge with this supplemental opinion. |
| Discussion |
| A Medical Fee Dispute Award was issued by an administrative law judge on November 24, 2020. The administrative law judge ruled that an Application for Payment of Additional Reimbursement of Medical Fees by the health care provider in this dispute was not timely filed as required by § 287.140.4, RSMo. |
| The Health Care Provider (HCP) filed a timely application for review to the Commission on December 9, 2020. In its application for review, the HCP alleges that the Division erred in applying the version of § 287.140.4, RSMo, as effective on January 1, 2014, instead of the version that was effective as of the date of injury for the related workers’ compensation claim, or May 8, 2012. |
| The HCP argues that the applicable statutory version for the medical fee dispute should be the same as what applies to the workers’ compensation claim. Citing 8 CSR 50-2.030(E), the HCP points out that there would be no jurisdiction for a medical fee dispute without a filed workers’ compensation claim. Accordingly, the medical fee dispute is part of the claim and the same statutory version should apply. |
| Furthermore, the HCP argues that by applying the 2014 version of the statute, which contains a time limitation to file a medical fee dispute, the administrative law judge erroneously and retroactively applied a substantive law. |
| We point out that the services at issue in this dispute were provided to employee on January 21, 2014, after the statute of limitations became effective. The HCP received a check from employer/insurer, and an explanation of what the employer/insurer disputed, by the time the HCP deposited the check on March 17, 2014. The HCP sent a letter to employer/insurer on |
Injury No.: 12-034177
Medical Fee Dispute No.: 12-01412
Employee: James Holland
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April 7, 2014, acknowledging the payment. The HCP did not file its medical fee dispute until October 26, 2015.¹
Which Statute Applies
"Generally, the date of injury for a workers' compensation claim is used to calculate the statute of limitations and determine which version of the workers' compensation law applies. The statute of limitations for filing a claim for workers' compensation benefits is controlled by the date of injury." *Hayden v. Cut-Zaven, Ltd.*, 614 S.W.3d 44, 61-62 (Mo. App. 2020).
However, a medical fee dispute claim is not a claim for workers' compensation, does not directly involve the employee, and is not controlled by the date of employee's injury. On the contrary, Section 287.140.4, RSMo, as effective on January 1, 2014, provides:
> The division shall, by regulation, establish methods to resolve disputes concerning the reasonableness of medical charges, services, or aids. This regulation shall govern resolution of disputes between employers and medical providers over fees charged, whether or not paid, and shall be in lieu of any other administrative procedure under this chapter. The employee shall not be a party to a dispute over medical charges, nor shall the employee's recovery in any way be jeopardized because of such dispute. Any application for payment of additional reimbursement, as such term is used in 8 CSR 50-2.030, as amended, shall be filed not later than:
>
> (1) Two years from the date the first notice of dispute of the medical charge was received by the health care provider if such services were rendered before July 1, 2013; and
>
> (2) One year from the date the first notice of dispute of the medical charge was received by the health care provider if such services were rendered after July 1, 2013.
The pertinent dates in this statute of limitations are the dates of service and the date of "the first notice of dispute of the medical charge [as] received by the health care provider[.]" In this matter, the date of service and the date of notice both occurred after January 1, 2014, when this version of the statute became effective. There is nothing in the statute instructing the Division or the Commission to apply the prior version of the Section 287.140.4, RSMo, to matters where the date of injury precedes January 1, 2014.
This interpretation appears to be upheld by the Missouri Court of Appeals in *Chesterfield Spine Ctr., LLC v. Best Buy Co., Inc.*, No. WD83757 (Jan. 12, 2021). The *Chesterfield Spine Ctr.*
¹ On page 3 of the award, the administrative law judge listed September 26, 2015, as the filing date of the medical fee dispute. However, this was a typographical error. The actual filing date was October 26, 2015. See *Transcript*, p. 25.
Injury No.: 12-034177
Medical Fee Dispute No.: 12-01412
Employee: James Holland
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LLC, matter also involved a medical fee dispute where the date of injury preceded January 1, 2014, but the dates of service and the date of first notice occurred after January 1, 2014. The administrative law judge applied the new law and held that the health care provider was time barred from its medical fee dispute. The health care provider appealed up to the court of appeals.
The court recited the health care provider's argument that
in Missouri, workers' compensation claims are governed by the law in effect when the injured employee's claim was filed. Because the one-year limitations period in § 287.140.4 was not in effect when the employee's underlying claim was filed (2013), the limitations period does not apply to the Application, and the Commission's finding to the contrary violates the constitutional prohibition on retrospective application of laws.
Id., at 19.
However, the court appeared to reject this argument by holding that the application of the new law was not retrospective because the dates of service came after January 1, 2014. The court stated,
Here, the only parties affected by the one-year statute of limitations are [the health care provider] and the Employer/Insurer, the transaction at issue was the provision of approved medical services in December 2015, and the one-year limitations period went into effect on January 1, 2014. This case does not involve the retrospective application of a statute.
Id. at 21-22.
Based on the above, we conclude that the administrative law judge's application of the version of § 287.140.4, RSMo, as effective on January 1, 2014, was proper.
**Conclusion**
We affirm the award of the administrative law judge as supplemented herein.
Employer/insurer is not liable to health care provider for additional reimbursement of medical fees.
The award and decision of Administrative Law Judge Lee B. Schaefer is attached and incorporated herein.