In Curry v Ozark Electric Corp., 39 S.W.3d 494 (Mo.App. 2001). Claimant suffered an injury and filed a workers' compensation claim. The hospital filed a notice of claim for direct payment under Section 287.140.13(6) for medical services which were authorized in advance. The claimant and the employer/insurer settled claimant?s workers' compensation claim with the approval of an Administrative Law Judge. The hospital was not a party to the settlement and the Labor and Industrial Relations commission, in reversing an Administrative Law Judge's ruling, held that the employer authorized medical services and ordered direct payment. The employer/insurer appealed and the Supreme Court held that the parties were free to make a partial settlement as to the employee's claim and that subsequent award of direct payment to the hospital for the claimant's hospital bill was within the Commission?s authority. The Supreme Court further determined that the claimant's hospital was "authorized" within the meaning of the workers' compensation statute allowing for direct payment of medical expenses.
In Thorsen v Sach Electric Co., 52 S.W.3d 611 (Mo.App. E.D. 2001), if employer refuses to authorize further treatment at hospital where worker gets treatment, the hospital has no right to seek direct payment and Commission can award expenses directly to worker.
In Black v Hemingway's Restaurant, 11/3/00, (ALJ Holden) Medical bills submitted through group awarded to employee on findings that employer misled employee that group would pay for care.
In Dudley v City of Des Peres, (LIRC) 9/6/00 Employer liable for unauthorized medical expenses if treating physicians relied upon findings to reach diagnosis. In this case, employer was found liable for MRI ordered by claimant?s private physician.
In Hartsell v Dan Rawe, (LIRC), 3/16/00 , no abuse of discretion to award bills directly to claimant rather than medical provider. (ALJ Dinwiddie)
In Ransburg v Great Plains Drilling, 22 S.W.3d 726 (Mo.App. W.D. 2000) Employer not liable for medical expenses in absence of any medical records.
In Schneidler v Feeder's Grain and Supply, 24 S.W.2d 739 (Mo.App. E.D. 2000), a compromise settlement agreement provided for PPD and open medical treatment for future prosthetic devices. There was no language in the settlement providing that the employer could exclusively control the authorization of medical care for the replacement devices. The Court held that the absence of specific language in the settlement agreement authorizing employer's exclusive right to direct medical care, the employee could go wherever he wanted and send the bill to the employer.
In Wilmeth v TMT, Inc., 26 S.W.3d 476 (Mo.App. S.D. 2000), Commission has discretion to order the payment of medical bills directly to the claimant, rather than directly to medical care providers, including payments made by the Second Injury Fund in their coverage of uninsured employers.
In Esquivel v Day's Inn of Branson, 959 S.W.2d 486 (Mo.App. S.D. 1998), the employer must prove medical bills were not "reasonable" and the "quantum merit" rule no longer prevails. A hospital need only submit the bills with testimony that they were related to the services rendered and were a product of the workers' injury. The burden then shifts to the employer or its insurance company to provide proof that the bills were not justified.
In Stawizynski v J.S. Alberici Construction Co., 936 S.W.3d 159 (Mo.App. E.D. 1996), bills from the employee?s selected doctor were held not the responsibility of the employer, where the employer provided medical treatment. The Court rejected the employee?s argument that the