LISA POWERS
v.
SEARS ROEBUCK AND CO LIBERTY MUTUAL FIRE INS CO, Insurance Carrier
LIBERTY MUTUAL INS CO, Claim Administrator
Jurisdiction Claim No. 2140024
Claim Administrator File No. 80D003465
Virginia Workers’ Compensation
Virginia In The Workers’ Compensation Commission
March 9, 2021
Date
of Injury April 16, 2003.
Philip
J. Geib, Esquire For the Claimant.
Marilyn N. Harvey, Esquire For the Defendants.
REVIEW
on the record by Commissioner Marshall, Commissioner Newman,
and Chief Deputy Commissioner Szablewicz at Richmond,
Virginia.
1
OPINION
NEWMAN
Commissioner.
The
defendants request review of a July 31, 2020 Opinion which
awarded additional payment to several health care providers
for treatment of the claimant’s workers’
compensation injuries. The defendants deny the claimant has
standing to pursue additional payment to Bon Secours DePaul
Medical Center and Bon Secours Maryview Medical
Center.
2 We AFFIRM.
3
I.
Material Proceedings
The
claimant sustained a compensable injury by accident to her
lumbar back on April 16, 2003. She received various periods
of disability and an award of lifetime medical benefits. In a
September 25, 2007 Opinion, the Commission awarded medical
treatment for causally related reflex sympathetic dystrophy.
The parties settled the claim through a Petition and Order
approved on November 19, 2014.
Thereafter,
the claimant filed applications seeking payment of unpaid or
underpaid medical expenses to a number of health care
providers, including Bon Secours DePaul Medical Center
(DePaul), Bon Secours Maryview Medical Center (Maryview), and
the Center for Pain Management. The defendants denied the
claimant had standing to seek additional payment to these
providers.
The
Deputy Commissioner relied on our decision in Hansen v.
TMA Trucking, Inc., JCN VA00001001203 (May 28, 2019),
where we held the employee has “a judicable (sic)
interest in securing payment” for treatment by his
medical providers. The defendants tried to distinguish
Hansen based on the claimant’s settlement of
her claim. They argued the claimant no longer received
treatment for her injuries from the health care providers for
whom she sought payment. They asserted she lacked standing to
pursue additional payment.
The
Deputy Commissioner found the claimant had standing to pursue
payment to the health care providers despite the full and
final settlement of her claim. The Deputy Commissioner
concluded, “The claimant’s right of access to
medical care as a result of the underpayment of medical bills
by the defendants has clearly been implicated. Accordingly,
we find that the claimant has standing to pursue her claims
of underpayments . . . in this matter.” (Op.11.) The
Deputy Commissioner ordered the defendants to pay the
outstanding charges.
4 (Op. 13.)
The
defendants request review of the finding the claimant has
standing to pursue full payment of medical bills to these
providers.
II.
Findings of Fact and Rulings of Law
The
parties filed a fully executed Petition for Approval of
Compromise Settlement
5 along with a proposed Order
and an Affidavit on October 30, 2014. The Petition provided
for payment of a lump sum to the claimant:
[P]lus payment of all reasonable and necessary medical
expenses by authorized treating physicians, excluding
vocational rehabilitation, related to the claimant’s
injuries resulting from the industrial accident which is the
subject of this claim, pursuant to Virginia Code §
65.2-603, from April 16, 2003, through the date of the entry
of the Order approving this settlement, in full and final
settlement of all claims of every nature arising out of the
accident which is the subject of this claim.
The
Commission issued a November 19, 2014 Order approving the
compromise settlement. It included the same payment of a lump
sum and of medical expenses through the date of entry of the
Order. The Order concluded:
It is further ORDERED that in consideration of said payment
the employer and insurer are released and forever discharged
from any and all liability,
...
