By Jane Salem, staff attorney, Nashville

The medical fee schedule applies to all medical treatment in workers’ compensation claims, whether it’s authorized or unauthorized. The Appeals Board reached this conclusion on Friday in Hands v. Fresenius Medical Care Holdings, Inc.

The case presented many issues at trial. Hands alleged knee and back injuries from work, and Fresenius denied the back claim. But after a compensation hearing, the trial court found the back injury work-related and ordered Fresenius to pay the unauthorized medical bills under the fee schedule. The Court also rejected Hands’ permanent total disability claim and instead awarded permanent partial disability.

Hands appealed the order involving payment under the fee schedule only.

He contended the trial court didn’t have the authority to impose the fee schedule in cases involving treatment the employer denied but was later found liable for. Instead, the employer should be legally obligated to pay the full cost of that treatment, he said, relying principally on two cases involving subject-matter jurisdiction.

In Acevedo v. Crown Paving, LLC, the Appeals Board held that a medical provider can’t intervene in a workers’ compensation action to protect its interest in the payment of medical bills, because as a court of limited jurisdiction, the workers’ comp court can’t exercise jurisdiction over a medical provider.

Hands also cited Knox Stove Works v. Hodge, a 1926 case from the Tennessee Supreme Court where an employer argued that a justice of the peace didn’t have the authority to resolve a billing dispute between it and a physician for treatment of an employee. The justices disagreed, concluding that the justice of the peace had jurisdiction because the issue was essentially a contract dispute unrelated to the underlying workers’ compensation case.

The Board wrote that Hands’ reliance on Acevedo and Knox Stove Works was misplaced. Acevedo involved a medical provider’s ability to intervene in a case, which wasn’t the issue here. As for Knox Stove Works, that was decided “well before” lawmakers created both the fee schedule and the medical payment committee in the Reform Act of 2013.

“[W]e conclude the Court of Workers’ Compensation Claims is statutorily obligated to order an employer and its insurer to abide by the medical fee schedule as set out in Tennessee Code Annotated section 50-6-204(a)(3)(A)(iii) for all reasonable and necessary medical bills arising from a compensable work injury,” the Board held.

“Beyond that, disputes between a medical provider and the employer/insurer must be addressed in accordance with statutory provisions governing the medical payment committee in Tennessee Code Annotated section 50-6-125.”

The Board acknowledged that it previously held that an employer who denies medical treatment “runs the risk” of being held responsible for unauthorized medical treatment if the claim is later determined compensable. But paying for treatment at higher rates than the fee schedule isn’t one of those risks.

“[W]e have found no statute or regulation that suggests payment of medical bills differs depending on whether the treatment was authorized or unauthorized,” they reasoned. “If such a change is to be made, it is for the legislature, not the courts, to address.”

At oral argument, Hands argued that the unauthorized medical providers could attempt to collect outstanding balances from him if Fresenius only paid under the fee schedule. But his counsel admitted that that hadn’t happened yet, so this issue wasn’t ripe for appeal, the Board held.

“[W]e conclude that neither the statute nor the rules require an employee to pay for reasonable and necessary medical care a court has ordered the employer to provide. In short, we find Employee’s arguments that he will be held responsible for balances above what any particular medical provider receives from Employer pursuant to the fee schedule to be, at this point, speculative, not supported by applicable statutes and regulations, and not ripe for consideration.”

The Board affirmed. In a footnote, the judges pointed out that, had they ruled differently, Hands’ attorney’s fees could potentially negate his disability award in its entirety.