Wednesday, January 21, 2009

Failure to Make Timely Payment of Medical Charges

If the employer or its insurance carrier fails to pay a medical bill according to the Medical and Hospital Fee Schedule within 60 days of receipt of the bills, the court may rule that the Fee Schedule is waived and order payment up to the full amount of the billing.

Rule 50(C) requires payment of the submitted charges in 30 days, but the full-payment penalty arises after 60 days of non-payment.

Application of this penalty was discussed in City of Duncan v. Tulsa Spine Hospital, 2008 OK CIV APP 70, __ P.3d __. Sixteen months after receiving Hospital's charges of almost $80,000 City paid $20,000 pursuant to the Medical and Hospital Fee Schedule. A hearing was conducted to determine whether the delay was reasonable. The trial judge held it was "unreasonable" and awarded an additional $50,000. COCA sustained the order holding that it was not necessary for the Hospital to show actual damages or injury caused by the delay; and "prejudice to providers may be presumed where payment is made beyond the sixty day Rule 50(C) standard."

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