 |
 |
to fill out a simple form to connect to Personal Injury Lawyers in your area.
|
|
|
|
|
Ralyea v. KF Environmental Tech2/28/2005
Edward Ralyea ("the claimant") appeals a decision of the Industrial Accident Board ("the Board"), which held that he was not entitled to recover from his employer, KF Environmental Tech, ("the employer") for certain medical bills and mileage reimbursement which arise from a workplace injury . A large part of the medical bills had previously been paid by private insurance which the claimant had and for which he had paid the premiums. The Board denied recovery for these medical bills on two grounds: (1) that the claimant had not first submitted the bills to his employer before submitting them to his private insurer; and (2) that the claimant lacked standing to seek compensation for medical bills paid by the private insurer. In addition to denying the claimant's petition as to the medical bills paid by the private insurer, the Board's order had the effect of denying compensation for a small amount of medical bills which had not been paid by the private employer and a request for mileage reimbursement, items which the employer conceded were due. For the reasons which follow, I conclude that: (1) the claimant's failure to submit the medical bills to his employer before submitting them to his private insurer does not relieve the employer of liability for the amount of the medical bills; and (2) that the claimant does have standing to petition for recovery of medical bills even though they have been paid by his private insurance. The Board's decision will be reversed.
FACTS
The claimant suffered a work-related back injury on November 25, 2000, while employed by KF Environmental Tech. The employer accepted the claimant's injuries as compensable and paid Workers' Compensation benefits. The claimant received treatment for his injury from Central Delaware Surgical Center and Dr. Glen Rowe. On the advice of Dr. Rowe, the claimant underwent surgery on April 25, 2001. He incurred a number of medical expenses related to the injury which included $12,138.55 for treatment at Kent General Hospital, $823.72 from Central Delaware Surgical Center, and mileage expenses of $114.70. The claimant's private health insurance carrier paid $9,934.09 to Kent General Hospital after the Hospital granted a discount of $1,076.92. After demands from the claimant, the employer paid the remaining balance of $1,127.54 to Kent General Hospital but refused to pay any more because those bills had already been paid by the claimant's private insurance. The employer has paid $534 of the expenses owed to Central Delaware Surgical Center and did not contest the remaining balance at the hearing before the Board. Neither did the employer contest the mileage reimbursement of $114.70. The only dispute appears to be whether the employer must reimburse the claimant for the remaining balance of $9,934.09 which was paid to Kent General Hospital by the claimant's private insurance benefits.
The claimant filed a Petition to Determine Additional Compensation Due on December 31, 2002 against the employer requesting an order for reimbursement from the employer for the above-mentioned medical expenses and mileage reimbursement. The claimant claims he is due $12,962 under 19 Del. C. ยง 2322 because he paid premiums for his private health insurance and the employer has not paid his medical bills as is its duty under that statute. The Board held a hearing on September 24, 2003. The Board's decision, dated October 7, 2003, held that the claimant could not recover the amounts paid by his private insurer for the medical costs he incurred. The Board found that the claimant had "failed to present evidence that he requested the employer provide medical services, and that the employer refused the request, before he used his private medical insur
Page 1 2 3 Delaware Personal Injury Attorneys
Personal Injury Lawyers
|
| |
to fill out a simple form to connect to Personal Injury Lawyers in your area.
|
|