The Indiana Court of Appeals ruled yesterday that health care providers are not responsible for proving whether their charges are excessive in billing disputes involving patients injured on the job.
Rather, the three-judge panel said the onus falls on the employer or its insurer to establish whether medical expenses for injured employees might be considered higher than what’s allowed under the state’s workers’ compensation law.
“We conclude that placing the burden of proof on the employer is more consistent with Indiana law generally and with the Act itself,” the court wrote.
The ruling involved three cases: Washington Township Fire Department v. Beltway Surgery Center; City of Michigan City v. Memorial Hospital; and Onward Fire Department v. Clarian Health Partners.
In the Washington Township case, an injured firefighter was billed $11,563 for injuries he sustained on the job in March 2005. The township’s workers’ compensation insurer hired a billing review service as allowed by the Indiana Workers’ Compensation Act.
The service determined the surgery center had charged too much and recommended paying only $5,104. The center, in turn, took the case to the Indiana Workers’ Compensation Board to recover the remaining unpaid amount it had billed.
The three judges unanimously determined that if an employer or its insurer refuses to pay the full amount, the employer must prove before the compensation board that it is liable for less than the billed charges.
The panel of judges affirmed each of the decisions by the board to place the burden on employers, and award the full amount of billed charges.