Maine High Court Rules Against Employer in Medical Fee Dispute

An employer must pay more generous medical provider fees available under Maine workers’ compensation law than available under the federal Longshore and Harbor Workers’ Compensation Act, even though employees received benefits under the federal law, the Maine Supreme Court has ruled.

Maine’s high court reached that conclusion Tuesday, August 18, in the case of St. Mary’s Regional Medical Center v. Bath Iron Works.

The ruling upholds a finding by a Maine Workers’ Compensation Board hearing officer who weighed two consolidated cases—one in which an employee suffered a neck injury in 2001, and another in which a worker suffered a back injury in 2003.

Both received treatment at St. Mary’s Medical Center, which billed BIW $31,417 for treating the neck injury and $75,179 for the back injury. But BIW paid St. Mary’s according to a Longshore Act fee schedule that allows only $13,566 for the neck injury and $24,633 for the back injury.

The hearing officer concluded that federal and state jurisdiction are concurrent on this issue and found no “authority that would bar a health care provider from seeking medical payments under state law when the employees chose to proceed under the federal act.”

BIW argued on appeal to the Maine Supreme Court that the comp board lacked jurisdiction because the Maine Workers’ Compensation Act of 1992 is not applicable when employees chose to proceed under the Longshore Act. But the court affirmed the hearing officer’s finding.

Filed by Roberto Ceniceros of Business Insurance, a sister publication of Workforce Management. To comment, e-mail editors@workforce.com.

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