Thursday, January 15, 2009

Attorney Fees Awarded to Medical Provider

In a case of first impression the Court of Civil Appeals addressed the right of a medical provider to attorney fees for prevailing in a Form 19 contest. In Pinnacle Rehabilitation Hospital v. Rivera-Villareal claimant was hospitalized for a lengthy time after collapsing at work from heat exhaustion. Pinnacle was paid according to the Medical Fee Schedule after prevailing on its Form 19. The last sentence of 85 O.S. §14F(5) states: "When a medical care provider has brought a claim in the Workers' Compensation Court to obtain payment for services, a party who prevails in full on the claim shall be entitled to a reasonable attorney fee."

What does "prevails in full" mean? Pinnacle argued that the phrase cannot require that a medical provider receive the entire amount billed in order to prevail "in full," because that would mean attorney fees could never be awarded since all provider requests are automatically reduced under the Fee Schedule.

COCA, Division IV, agreed. The trial judge is prohibited from exceeding the Fee Schedule, and therefore a "medical provider has prevailed in full under §14(F)(5) so as to be entitled to an attorney fee if it receives the maximum amount reimbursable under the Fee Schedule."

Pinnacle also addresses awarding attorney fees and costs under 85 O.S. §30 due to the unreasonable denial of payment of the claims of Pinnacle and claimant's physician, Dr. Washburn.

This case and others are cited at my website under the title, Penalty, Interest, Attorney Fees, Contempt.

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