CECILIA D. ALBEZA, Employee,
and
ALIVIO THERAPUTIC MASSAGE, Claimant,
v.
STATE OF ALASKA, Employer, Defendant.
AWCB No. 201716937
AWCB Decision No. 19-0003
Alaska Workers’ Compensation Board
January 11, 2019
FINAL DECISION AND ORDER
William Soule, Designated Chair.
Alivio
Therapeutic Massage’s (Alivio) February 21, 2018 claim
was heard on December 20, 2018, in Anchorage, Alaska, a date
selected on November 7, 2018. A November 7, 2018 prehearing
conference hearing request gave rise to this hearing.
Non-attorney representative Whittney Woodmansee appeared,
testified for and represented Alivio. There was no appearance
for Cecelia Albeza (Employee). Attorney Adam Franklin
appeared and represented the State of Alaska (Employer).
Witnesses included Gabriella Aldebot who also testified for
Alivio. The record remained open for one week so Alivio could
file and serve emails between the parties and certified
mailing evidence, and closed on December 27, 2018.
ISSUES
Employee
did not appear for the hearing after having been noticed.
Employee had no real interest in Alivio’s claim and
neither Alivio nor Employer objected, so the hearing
proceeded.
1)
Was the decision to proceed with the hearing in
Employee’s absence correct?
Alivio
contends Employer failed to timely pay properly documented
medical bills for services it rendered to Employee. It
further contends while Employer ultimately paid the bills and
some penalties and interest, Employer still owes additional
penalties and interest to Alivio.
Employer
concedes it made errors in processing and paying
Alivio’s bills for services rendered to Employee.
However, it further contends it eventually calculated the
bills, corrected additional errors and paid appropriate
penalties and interest to Alivio. Employer contends it does
not know what additional penalties or interest Alivio
requests, and contends Alivio bears the burden to prove
Employer owes it an additional amount.
2)
Is Alivio entitled to additional penalties and
interest?
FINDINGS
OF FACT
A
preponderance of the evidence establishes the following facts
and factual conclusions:
1) On
February 22, 2018, Alivio claimed $5,832.75 in medical costs,
a penalty and interest on unpaid medical bills for services
it provided to Employee. (Claim for Workers’
Compensation Benefits, February 21, 2018).
2) On
February 22, 2018, the division served Alivio’s claim
on Alivio, Employer, Penser its adjusters and Employee.
(Letter, February 22, 2018).
3) On
March 5, 2018, Employer filed and served Employee’s
medical records received from Alivio as follows, according to
“received” stamps or facsimile headings on the
records:
-
|
TABLE I
|
|
Date of Medical Service
|
Date Penser Received Records
|
|
1/3/18
|
1/8/18
|
|
1/5/18
|
1/19/18
|
|
1/10/18
|
1/19/18
|
|
1/12/18
|
1/19/18
|
|
1/16/18
|
1/19/18
|
|
1/19/18
|
1/29/18
|
|
1/23/18
|
1/29/18
|
|
1/31/18
|
2/6/18
|
|
2/2/18
|
2/6/18
|
|
2/7/18
|
2/7/18
|
|
2/9/18
|
2/9/18
|
|
2/14/18
|
2/14/18
|
|
2/16/18
|
2/16/18
|
|
2/21/18
|
2/21/18
|
(Employer’s Medical Summary, March 2, 2018).
4) On
March 12, 2018, Employer admitted Employee sustained an
injury arising out of and in the course of her employment
with Employer. Employer said it paid and continued to pay
medical and indemnity benefits to or on Employee’s
behalf. It stated there were no documents attached to the
claim to identify the bills in dispute and Employer deferred
to its adjuster’s review of bills and neither admitted
nor denied it owed $5,832.75. Employer asked for a stay on
the claim pending its adjuster’s review of appropriate
bills and reserved its right to amend its answer as discovery
progressed. (Employer’s Answer, March 12, 2018).
5) On
March 21, 2018, Alivio explained when it sent
Employee’s medical bills to Employer’s adjuster
and provided an itemized statement called a “Claim
List” and a “Patient Ledger” showing
service dates and CPT codes along with a description of
services provided. Woodmansee stated that on March 5, 2018,
Alivio received a summary of bills received and four bills
were not included. She called someone to inquire about these
missing payments and “John” said he did not have
the referenced bills so she printed them again and sent them
along with the chart notes. Woodmansee had previously mailed
these four bills and records as follows: December 19, 2017 on
December 22, 2017; December 22, 2017 on December 29, 2017;
December 28, 2017 on December 29, 2017; and January 26, 2018
on January 30, 2018. Alivio’s “Claim List”
shows:
-
|
TABLE II
|
|
Date of Medical Service
|
Date Alivio Mailed Bills &
Records
|
|
12/19/17
|
12/22/17
|
|
12/22/17
|
12/29/17
|
|
12/28/17
|
12/29/17
|
|
1/3/18
|
1/4/18
|
|
1/5/18
|
1/8/18
|
|
1/10/18
|
1/11/18
|
...
