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 |
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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