THOMAS C. MILLARD, Claimant-Appellant,
ABCO CONSTRUCTION, INC., Employer; and WORKERS COMPENSATION FUND OF UTAH, Surety, Defendants-Respondents.
Opinion No. 122
from the Industrial Commission.
Commission ruling, affirmed.
& Beck Law, Pocatello, for appellant. James D. Ruchti
& Bailey, Boise, for respondents. R. Daniel Bowen argued.
C. Millard appeals the Idaho Industrial Commission's
(Commission) ruling that certain medical payments made by the
Workers Compensation Fund of Utah on behalf of Millard were
payable at the statutorily scheduled fee amounts rather than
the full invoiced amounts. Millard argues that the Commission
incorrectly applied this Court's holding in Neel v.
Western Construction, Inc., 147 Idaho 146, 206 P.3d 852
(2009), by ruling that a surety may deny a claim then still
be allowed to pay the medical fee schedule rate so long as
the surety makes payment before the Commission issues a
decision on compensability. We affirm.
FACTUAL AND PROCEDURAL BACKGROUND
a resident of Preston, Idaho, was involved in an industrial
accident in October 2006 while working for ABCO Construction,
a Utah construction firm. The accident rendered Millard
totally and permanently disabled. Millard continues to suffer
from back and left lower extremity pain, neck and shoulder
pain, and a traumatic brain injury. The Workers Compensation
Fund of Utah originally handled Millard's industrial
claim as a Utah case, however, once the case entered
litigation, the case was transferred to Pinnacle Risk
Management Services, a third-party administrator in Boise
(ABCO, Workers Compensation Fund of Utah, and Pinnacle
collectively "Surety"). Millard settled his
original litigation with a lump sum agreement that left open
medical care and related charges.
Millard's ongoing medical care included epidural steroid
injections and physical therapy. Millard received epidural
injections from Vikas Garg, M.D., between October 2012 and
October 2014. He received physical therapy treatments from
late August 2011 through December 2011. From October 2012
until October 2013, Millard's visits with Dr. Garg were
unauthorized by Surety and Surety refused to pay for those
visits. Surety authorized treatment by Dr. Garg beginning in
November 2013 and visits from that time up to November 2014
were paid for by Surety.
Commission hearing, Millard argued that he was entitled to
payment for the October 2012 to November 2013 treatment with
Dr. Garg. Millard also argued that he should be reimbursed
for his medical expenses related to the epidural injections
and physical therapy sessions at the full invoiced rate
rather than the scheduled fee rate. Adopting the
Referee's proposed findings of fact and conclusions of
law as its own, the Commission ruled that pursuant to Idaho
Code section 72-432(1) Surety had failed to provide
reasonable medical care from October 2012 to November 2013.
Accordingly, Surety was required to pay for Millard's
treatment with Dr. Garg for the period of October 2012
through November 2013. Furthermore, the Commission ruled that
under Neel, Millard was entitled to reimbursement at
the full invoiced rate for the epidural injections completed
between October 2012 and November 2013. The Commission found
that the remaining epidural treatments and physical therapy
sessions were not subject to Neel and payment at the
fee schedule rates was appropriate. Millard timely appeals
the Commission's ruling that Millard was not entitled to
the full invoiced amounts for the epidural injections from
November 2013 through October 2014 and the late August 2011
through December 2011 physical therapy sessions.
II. STANDARD OF REVIEW
Court exercises free review over the Commission's legal
conclusions but does not disturb factual findings that are
supported by substantial and competent evidence."
Neel, 147 Idaho at 147, 206 P.3d at 853.