Sergio Medina v. Paymasters, Inc., et al

Sergio Medina v. Paymasters, Inc., et al. No. WC21-6390 (W.C.C.A. June 17, 2021).

The Employee sustained injuries with Employer when lifting a large mold. A claim petition was filed, seeking, in part, payment of outstanding medical bills. The compensation judge found the treatment by the providers was reasonable, necessary, and related to the work injury. The compensation judge ordered payment to the Intervenors pursuant to the Minnesota Workers’ Compensation Fee Schedule.  The Employer did not make payment within 14 days and did not appeal the judge’s findings and order.

The Employee filed another claim petition seeking payment of intervention claims and penalties for refusal to pay the intervention claims. Employer and Insurer filed a motion to dismiss the claim petition, alleging that the intervention charges were excessive because the Intervenors did not accept medical assistance or MinnesotaCare patients, and that payment to the Intervenors was prohibited. The Employee argued that this issue had not been raised at the initial hearing. The judge concluded that payment of the medical bills was not prohibited by the fee schedule. The Employer appealed this order to the WCCA, and it was previously determined that the Order was not a final decision and therefore, the WCCA lacked jurisdiction. It was then returned to the compensation judge.

The claim for payment to Intervenors and penalties was heard in August 2020. The Employer argued that the judge would need to “reconsider” and “alter” her determination that Minn. R. 5221.0500 and Minn. Stat. 256B.0644 were not part of the medical fee schedule. The Employer also argued that it had complied with the judge’s order because under the Employer’s interpretation of the rules and statutes, zero dollars were due to the Intervenors. The Employee argued that Employer was prohibited from litigating a defense that had not been presented at the underlying hearing in April 2019, which had not been appealed. In the resulting Findings and Order, the compensation judge concluded that payment to the Intervenors had been ordered and that the ruling was the law of the case. The judge, however, denied the claim for penalties, finding that the Employer’s argument was asserted in good faith and constituted a “colorable” defense, and that there was no inexcusable delay. The Employer appealed the payment of the Intervention claims. Employee cross-appealed the denial of penalties.

The WCCA found that the Employer did not offer any competent or relevant evidence on the defense regarding the payments. Further, the judge did not address the issue in the May 2019 Findings and Order because it was not submitted for a decision, and Employer did not appeal.  The judge’s order did not explicitly reserve the defense to payment to be raised at a later date. The WCCA found that the Employer’s arguments were an impermissible collateral attack on the May 2019 order.  Regarding penalties, the WCCA found penalties were payable. The WCCA concluded that the Employer unilaterally withheld payment it had been ordered to make, and did not raise the defense at the original hearing. The WCCA did not address whether or not there was a good faith defense as the defense was not timely. The WCCA concluded that the compensation judge had no basis to find a colorable or good faith defense existed. The WCCA awarded 30 percent penalties of the total amount awarded by the compensation judge in the May 2019 order regarding payment to the Intervenors.

Takeaway: Be sure that all issues and defenses are asserted at hearing, otherwise the issue/defense may be barred from being heard at a later time.