12-0056. SABRINA G. SEEGARS Employee TIESZEN CHIROPRACTIC Claimant v. BOUNCIN BEARS LLC UNINSURED EMPLOYER and ALASKA WORKERS' COMPENSATION BENEFITS GUARANTY FUND Defendants.

Court:Alaska
 
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Alaska Workers Compensation Decisions 2012. Workers' Compensation Board 12-0056. SABRINA G. SEEGARS Employee TIESZEN CHIROPRACTIC Claimant v. BOUNCIN BEARS LLC UNINSURED EMPLOYER and ALASKA WORKERS' COMPENSATION BENEFITS GUARANTY FUND Defendants ALASKA WORKERS' COMPENSATION BOARD SABRINA G. SEEGARS, Employee, TIESZEN CHIROPRACTIC, Claimant, v. BOUNCIN BEARS, LLC, UNINSURED EMPLOYER, and ALASKA WORKERS' COMPENSATION BENEFITS GUARANTY FUND, Defendants.FINAL DECISION AND ORDERAWCB Decision No. 12-0056Filed with AWCB Anchorage, Alaskaon March 19, 2012AWCB Case No. 201102796Tieszen Chiropractic's (Provider) November 10, 2011 Workers' Compensation Claim was heard on March 7, 2012, in Anchorage, Alaska. Sabrina Seegars (Employee) did not appear and was not represented at hearing. Provider appeared, represented himself, and testified. Attorney Meredith Ahearn appeared and represented Bouncin Bears (Employer), which was uninsured at the time of Employee's injury. Employer's co-owner Kristy Simpson appeared and testified on Employer's behalf. Velma Thomas and Joanne Pride appeared and represented the Alaska Workers' Compensation Benefits Guaranty Fund (Fund). The record remained open to the close of business on March 7, 2012, so Employer could submit a copy of its QuickBooks statement. Employer filed the statement and the record closed on March 7, 2012. Because Employee was served with a hearing notice but did not appear at hearing, and her attorney did not appear, it was decided as a preliminary matter to proceed in Employee's absence. This decision examines the oral order to proceed in Employee's absence, memorializes it and addresses Provider's claim for a penalty on its merits. ISSUES The panel on its own motion addressed Employee's absence from the hearing. No party expressed a strong position as to whether the hearing should proceed in Employee's absence. 1) Was the oral order to proceed with the hearing in Employee's absence correct? Provider contends Employer neither timely controverted nor timely paid his medical bills for services he rendered to Employee. Though Employer eventually paid Provider's bills in a lump sum, because the payment was late, Provider contends a 25% penalty on the value of the services is warranted and should be ordered. Employer contends it paid Provider's bills in a lump sum, but the check must have been lost in the mail. Because Employer has no control over the mail, it contends it should not be subject to a penalty on Provider's bills. The fund contended it thought there was an agreement among the parties to the settlement agreement, which included payment of Provider's bills. However, the fund was not sure if Provider was included in the settlement agreement. It did not take a strong position on Provider's claim for a penalty against Employer. 2) Shall a penalty be awarded to Provider against Employer on the value of Provider's medical bills? FINDINGS OF FACT Review of the entire record establishes the following relevant facts and factual conclusions by a preponderance of the evidence: 1) On March 5, 2011, Employee was injured while working for Employer when she fell down the stairs (Report of Occupational Injury or Illness, March 7, 2010 [sic]). 2) It is undisputed Employer was not insured for workers' compensation losses at the time Employee fell (record). 3) On March 8, 2011, Employee began treating with Provider, and it is undisputed she treated with him from March 8, 2011 through June 27, 2011 (record). 4) On March 10, 2011, Employee served Employer and the fund with Provider's March 8, 2011 narrative report (Workers' Compensation Medical Summary, March 10, 2011). 5) On March 11, 2011, Employee filed the above-referenced medical summary (id.). 6) On April 14, 2011, Employee served Employer and the fund with Provider's April 6, 2011 Physician's Report, and its April 14, 2011 statement for services rendered totaling $2,135.00 (Certificate of Service, April 14, 2011). 7) On April 18, 2011, Employee filed the above-referenced service certificate and attachments (id.). 8) On April 14, 2011, Employee served Employer and the fund with Provider's medical records from March 8, 2011 through April 6, 2011 (Worker's Compensation Medical Summary, April 14, 2011). 9) On April 18, 2011, Employee filed the above-referenced medical summary and attachments (id.). 10) On July 28, 2011, Employee served Employer and the fund with Provider's health insurance claim forms from March 8, 2011 through June 27, 2011, for services rendered totaling $2,605.00 (Certificate of Service, July 28, 2011). 11) On July 29, 2011, Employee filed the above-referenced service certificate with attachments (id.). 12) On July 28, 2011, Employee served Employer and the fund with copies of Provider's medical records from March 30, 2011 through June 27, 2011 (Workers' Compensation Medical Summary, July 28, 2011). 13) By no later than July 28, 2011, Employee had served on Employer all of Provider's medical records for Employee and related medical bills necessary for Employer to make payment (observations; record). 14) Thirty days from July 28, 2011, plus three days added to account for service by mail, is August 30, 2011 (observations). 15) On July 29, 2011, Employee filed the above referenced medical summary with attachments (id.). 16) Employee's service and filing of Provider's medical records and bills included completed Physician's Reports, form 07-6102 (observations; record). 17) On August 17, 2011, the fund controverted Employee's rights to benefits, including "duplicate chiropractic treatment on the same dates," stating Employee allegedly treated with two chiropractors at the same time. The fund's controversion alleges duplicate treatment resulted in overcharges of $1,100.00 and states the "employer is in the process of remitting the balance of the amount due Dr. Tieszen in the amount of $1,505.00" (Controversion Notice, August 15, 2011). 18) Employer never controverted Employee's rights to benefits or Provider's rights to its bill for services rendered (record). 19) On September 6, 2011, Employee, Employer, and the fund filed a Compromise and Release (CandR) agreement with the board...

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