ATTORNEYS FOR APPELLANT ATTORNEYS FOR APPELLEE
Doris L. Sweetin Anthony W. Overholt
Jeb A. Crandall Maggie L. Smith
Brandon G. Milster Indianapolis, Indiana
Indianapolis, Indiana
Apryle A. Fryer
Bryan H. Babb Indianapolis, Indiana
Kellie M. Barr
Indianapolis, Indiana ATTORNEY FOR AMICI CURIAE
Mark D. Gerth
Indianapolis, Indiana
______________________________________________________________________________
In the
FILED
Feb 24 2010, 1:49 pm
Indiana Supreme Court CLERK
of the supreme court,
_________________________________ court of appeals and
tax court
No. 93S02-1002-EX-115
WASHINGTON TOWNSHIP FIRE DEPARTMENT,
Appellant (Defendant below),
v.
BELTWAY SURGERY CENTER,
Appellee (Plaintiff below).
_________________________________
Appeal from the Indiana Worker's Compensation Board, No. P-175616
_________________________________
On Transfer from the Indiana Court of Appeals, No. 93A02-0811-EX-1006
_________________________________
February 24, 2010
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 employer's
liability to pay under the Worker's Compensation Act (the "Act"). See Washington Twp. Fire
Dep't v. Beltway Surgery Ctr., 911 N.E.2d 590 (Ind. Ct. App. 2009), reh'g denied. We agree and
adopt the opinion of the Court of Appeals.1
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 Township's worker's compensation insurance carrier, Indiana Public Employers Plan
("IPEP"). IPEP hired a "billing review service," Mednet, to determine whether the charges billed
fell within Washington Township's "pecuniary liability" under the Act. See Ind. Code § 22-3-6-
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 Mednet's recommendation, IPEP paid only part of Beltway's bill.
Beltway filed an application for adjustment of claim with the Worker's Compensation
Board (the "Board"). The single hearing member ordered Washington Township to pay the
balance on Beltway's bill.
The full Board affirmed, concluding Washington Township had the burden of proving its
pecuniary liability to Beltway was less than Beltway's billed charges. Because the Board found
Washington Township failed to produce any such evidence, it ordered the Township to pay the
full balance of Beltway's bill.
The Court of Appeals affirmed and held that where the employer refuses to pay in full a
medical provider's billed charges, and the medical provider files a claim with the Board and
establishes its charges for services to an employee, the employer has the burden of proving the
1
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 Dep't v.
Clarian Health Partners, No. 93A02-0811-EX-1007 (Ind. Ct. App. June 24, 2009); Adecco, Inc. v. Clarian Health
Partners, No. 93A02-0811-EX-1008 (Ind. Ct. App. June 25, 2009); Morgan County Comm'rs v. Clarian Health
Partners, No. 93A02-0811-EX-1009 (Ind. Ct. App. June 25, 2009); City of Michigan City v. Mem'l Hosp., No.
93A02-0811-EX-1010 (Ind. Ct. App. June 24, 2009); and Wayne Twp. Fire Dep't v. Beltway Surgery Ctr., No.
93A02-0811-EX-1011 (Ind. Ct. App. June 25, 2009).
charges exceed the employer's liability under the Act. Washington Twp. Fire Dep't, 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 provider's 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.