Timberlake Surgery Center asserted it was entitled to more money when the insurance company re-priced its bill and cut about 70% of the original charges. Zerrer v Ahal Concrete Contractors, 2017 MOWCLR Lexis 54
The Center tried three times to contact the Division to identify the cause number to file a claim for a medical fee dispute involving a thumb surgery The Division reported it had no reported injury involving treatment for the thumb but only had an older case involving an elbow with a different named employer.
The Surgery Center relied upon the injury number in the earlier case and continued to prosecute the claim even when they had a chance to take a "fresh look" at their initial pleadings despite the evident difference in body parts, years of accident, and names of the employer and the prosecution changed from "reasonable" to unreasonable.
The ALJ declined to address the constitutional challenge regarding the notice procedure and addressed a portion of the legal fees.
ALJ Ottenad
Atty: Spooner, Sheehan
