STEPHEN HUTTON
v.
ZIMMERMAN MARINE INC
PENINSULA NEUROSURGICAL ASSOCIATES, Medical Provider
COMMERCE AND INDUSTRY INS CO, Insurance Carrier
AIG CLAIMS, INC., Claim Administrator
Jurisdiction Claim No. VA00000429045
Virginia Workers Compensation
Virginia Workers’ Compensation Commission
March 22, 2021
Date
of Injury: December 16, 2010.
Claim
Administrator File No. 709924012.
Michele S. Lewane, Esquire For the Claimant.
Timothy D. Watson, Esquire For the Defendants.
Philip
J. Geib, Esquire, For Peninsula Neurosurgical Associates,
Inc.
REVIEW
on the record by Commissioner Marshall, Commissioner Newman,
and Commissioner Rapaport at Richmond, Virginia.
OPINION
RAPAPORT Commissioner.
The
medical provider requests review of the Deputy
Commissioner’s October 14, 2020 Opinion finding the
defendants were not responsible for additional payments to
the medical provider. We AFFIRM.
I.
Material Proceedings1
The
claimant sustained a compensable injury by accident on
December 16, 2010. The Commission awarded medical benefits
and disability benefits. Pursuant to an agreement by the
parties, on October 8, 2013, the Commission approved a
settlement of all issues involving workers’
compensation benefits to the claimant as a result of the
December 16, 2010 accident.
On
September 1, 2018, Peninsula Neurosurgical Associates filed a
claim seeking payment of $7,181 for services rendered to the
claimant from May 26, 2011 through May 25, 2012 for the
December 16, 2010 accident.
The
defendants defended the medical provider’s application
on the grounds that an agreement between the medical provider
and the insurer (“AIG”) controlled the amounts
paid for the services rendered, payments were properly made
pursuant to this agreement, and the payments made result in a
balance of $6,686 owed to the medical provider should the
agreement not be found controlling.
The
Deputy Commissioner held an on-the-record hearing on July 31,
2020. On October 14, 2020, he held the defendants established
that the contract governed the amounts the medical provider
should receive for the services rendered to the claimant. He
denied the medical provider’s application for
additional payment.
The
medical provider requests review of the Deputy
Commissioner’s decision. The medical provider argues
the Deputy Commissioner erred in finding the contract
controlled, and the defendants paid in accordance with the
contract. The medical provider also alleges the Deputy
Commissioner erred in allowing redacted sections of the
contract, and his finding that the redacted portions were not
pertinent or probative.
II.
Findings of...
