Virginia Lawyers Weekly VA Lawyers Weekly
An employer may raise a statute of limitations defense to a medical provider’s unpaid bill even if the employer did not follow the statutory requirements for disputing the bill.
The medical provider must submit a timely bill to make the argument that the employer did not comply with the statutory requirements.
Overview
The Virginia Workers’ Compensation Commission awarded a city of Portsmouth employee lifetime medical benefits and temporary partial disability benefits for a work-related knee injury. Atlantic Orthopaedic provided treatment between Jan. 12, 2017, to June 2, 2017. Atlantic billed Portsmouth on four different dates. Portsmouth made only partial payments.
On Nov. 7, 2019, Atlantic filed a claim with the commission for the unpaid bills. This was more than two years after Atlantic received its last payment from Portsmouth and more than two years after the March 8, 2017, award became final.
The commission held that the one-year statute of limitations in Code § 65.2-605.1(F) barred the claim. The commission rejected Atlantic’s argument that Portsmouth could not raise a statute of limitations defense. The commission stated, “‘the medical provider maintains that the defendants failed to comply with the provisions of Subsections A and B of Virginia Code § 65.2-605.1, and hence, they cannot benefit from Subsection F.
“‘The medical provider argues the defendants “contested” its charges because they did not pay the full charges as billed and the defendants failed to pay bills in the required sixty-day timely manner (services rendered on February 20, 2017). It alleges the defendants failed to provide it with the statutorily required notifications of its remedies.’ …
“[T]he full Commission stated that ‘the medical provider argues the defendants detrimentally failed to comply with Subsections A and B. However, the medical provider had the responsibility of timely filing a claim in which to make these assertions.’
“Consequently, the full Commission concluded, ‘The medical provider could disagree with an alleged underpayment in any fashion – but the Virginia Workers’ Compensation Act dictates the time limits within which it must do so.’”
We affirm.
No preconditions
“Atlantic Orthopaedic contends that subsections (A) and (B) of Code § 65.2-605.1 contain ‘preconditions’ that the employer must follow before the employer can raise a statute of limitations defense under subsection (F).
“Atlantic Orthopaedic argues that, because Portsmouth contested the bills for the health care services but failed to provide ‘the required notification’ under subsection (B) for contesting the bills, Portsmouth cannot rely on a statute of limitations defense under subsection (F) against Atlantic Orthopaedic’s November 7, 2019 claim.
“In addition, Atlantic Orthopaedic contends that Portsmouth failed to comply with subsection (A) because Portsmouth failed to make its payment for the February 20, 2017 health care service within the sixty-day window under that subsection.
“Atlantic Orthopaedic, therefore, argues that Portsmouth’s non-compliance under subsection (A) for that payment bars Portsmouth from raising a statute of limitations defense under subsection (F).
“This Court is not persuaded by Atlantic Orthopaedic’s interpretation of Code § 65.2-605.1.
“While the employer is required to follow the procedures under subsections (A) and (B) of Code § 65.2-605.1 after receiving bills for health care services, Code § 65.2-605.1 does not contain any language predicating the employer’s ability to raise a statute of limitations defense under Code § 65.2-605.1(F) on the employer’s compliance with subsections (A) and (B).
“The health care provider certainly could file a claim regarding the employer’s failure to adhere to subsections (A) and (B) of Code § 65.2-605.1. Furthermore, it could seek interest under Code § 65.2-605.1(C) on those payments that were not timely made. However, any of those claims must be filed within the statutory time frame set out in Code § 65.2-605.1(F).
“In short, regardless of the employer’s compliance with subsections (A) and (B), the General Assembly mandates that the health care provider file the claim within the one-year statute of limitations under Code § 65.2-605.1(F).
“If the General Assembly had intended to make an employer’s compliance with subsections (A) and (B) of Code § 65.2-605.1 a mandatory condition of the employer’s right to raise a statute of limitations defense under subsection (F), then it could have included language making compliance a pre-condition, as it has done in other sections of the Workers’ Compensation Act.”
Affirmed.
Atlantic Orthopaedic Specialists v. City of Portsmouth, Record No. 0977-20-1, April 27, 2021. CAV (Beales) from the Virginia Workers’ Compensation Comm’n. Philip J. Geib for appellant, Timothy D. Watson for appellee. VLW 021-7-049, 14 pp. Published.
