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WASHINGTON TOWNSHIP FIRE DEPARTMENT, Appellant (Defendant below), v. BELTWAY SURGERY CENTER, Appellee (Plaintiff below)

Supreme Court of Indiana2010-02-24No. No. 93S02-1002-EX-115
921 N.E.2d 825

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Opinion

majority opinion

PER CURIAM.

The Court of Appeals held the employer, not the medical provider, has the burden of proving whether the charges for medical services provided to an employee exceed the employers liability to pay under the Workers Compensation Act (the Act). See Washington Twp. Fire Dept v. Beltway Surgery Ctr., 911 N.E.2d 590 (Ind.Ct.App.2009), rehg denied. We agree and adopt the opinion of the Court of Appeals.

Beltway Surgery Center (Beltway) provided medical services to an employee of the Washington Township Fire Department (Washington Township) and then submitted a bill to Washington Townships workers compensation insurance carrier, Indiana Public Employers Plan (IPEP). IPEP hired a billing review service, Mednet, to determine whether the charges billed fell within Washington Townships pecuniary liability under the Act. See Ind.Code § 22-8-6-1(f). Pecuniary liability is an amount equal to or less than the charges made by medical service providers at the eightieth percentile in the same community for like services or products. Id. § 22-3-6-1(j). On Mednets recommendation, IPEP paid only part of Beltways bill.

Beltway filed an application for adjustment of claim with the Workers Compensation Board (the Board). The single hearing member ordered Washington Township to pay the balance on Beltways bill.

The full Board affirmed, concluding Washington Township had the burden of proving its pecuniary liability to Beltway was less than Beltways billed charges. Because the Board found Washington Township failed to produce any such evidence, it ordered the Township to pay the full balance of Beltways bill.

The Court of Appeals affirmed and held that where the employer refuses to pay in full a medical providers billed charges, and the medical provider files a elaim with the Board and establishes its charges for services to an employee, the employer has the burden of proving the charges exceed the employers liability under the Act. Washington Twp. Fire Dept, 911 N.E.2d at 599. In addition, the Court of Appeals held the Board may require an employer that fails to meet this burden to pay the medical providers full bill. Id. at 600. We agree.

We grant transfer, adopt and incorporate by reference the opinion of the Court of Appeals pursuant to Indiana Appellate Rule 58(A)(1), and affirm the Board.

SHEPARD, C.J., and DICKSON, SULLIVAN, BOEHM, and RUCKER, JJ., concur.

. The Court of Appeals reached the same result in five unpublished decisions pending before this Court. Because we grant transfer in this case to express our agreement with the Court of Appeals, we find it unnecessary to grant transfer in the other decisions. Simultaneous with this opinion, we are denying transfer in Onward Fire Dept v. Clarian Health Partners, No. 93A02-0811-EX-1007, 2009 WL 1797000 (Ind.Ct.App. June 24, 2009); Adecco, Inc. v. Clarian Health Partners, No. 93A02-0811-EX-1008, 2009 WL 1810982 (Ind.Ct.App. June 25, 2009); Morgan County Commrs v. Clarian Health Partners, No. 93A02-0811-EX-1009, 2009 WL 1811069 (Ind. Ct.App. June 25, 2009); City of Michigan City v. Meml Hosp., No. 93A02-0811-EX-1010, 2009 WL 1789307 (Ind. Ct.App. June 24, 2009); and Wayne Twp. Fire Dept v. Beltway Surgery Ctr., No. 93A02-0811-EX-1011, 2009 WL 1810996 (Ind.Ct.App. June 25, 2009).