Albeza, 011119 AKWC, 19-0003

Docket Nº:AWCB Decision 19-0003
Case Date:January 11, 2019
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:
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:
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

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