A Missouri appellate court has ruled that health care providers who treat injured employees in workers compensation claims are also subject to comp exclusive remedy in fee disputes concerning partial payment by employers’ comp insurers.
The Court of Appeals of Missouri, Eastern District, in a Tuesday decision, found that health care providers seeking additional payment in comp claims may not pursue litigation to be paid for remaining treatment charges, but rather must plead their case in the comp system.
The case, Orthopedic Ambulatory Surgery Center of Chesterfield LLC v. Sharpe Holdings Inc., concerned health care providers who sued numerous employers and comp insurers for payment of additional medical charges arising from injured worker treatment.
The plaintiffs sued for breach of contract, unjust enrichment, negligent misrepresentation and other claims.
The defendants argued that the matter belonged in the comp system, because the state Division of Workers’ Compensation has exclusive authority over fee disputes relating to charges incurred for medical care.
The appeals court agreed with the defendants, writing that the comp law provides health care providers the “exclusive procedures and remedies” for claims for unpaid medical bills in injured worker cases.
The court wrote that “we cannot ignore the legislature’s unequivocally mandatory language” requiring medical fee disputes to be handled in the comp system and not the tort system.
With their ruling, the appeals judges affirmed a similar conclusion reached at the trial court level.