State News : Kentucky

• $885.32 (PPD with physical ability to return to work, RTW at equal or greater wages, or RTW at equal or greater wages with subsequent cessation of work, i.e., 1x or 2x multiplier cases)

• $1,180.43 (PPD without physical ability to RTW, and no RTW at equal or greater wages, i.e., 3x multiplier cases)

KRS 342.020(4) states medical providers shall submit billings within 45-days of service. Claimant’s medical providers did not submit billings for multiple visits until several months after the visits. The medical obligor rejected the bills since they were not submitted within 45 days of the date of service.

The ALJ determined the 45-day rule did not apply until after an award of benefits. The Workers’ Compensation Board affirmed the decision, relying partly on Wonderfoil, Inc. v. Russell (holding 60 day time limit for Claimant to submit unpaid medical bills for reimbursement only applies after an award). P & P appealed arguing that the Wonderfoil decision was not applicable to the statutory duties of medical providers.

But note, the Court does reference 803 KAR 25:096 Sec. 6, which states if the provider fails to submit a statement for services as required by KRS 342.020(4) without reasonable grounds, the medical bills shall not be compensable. There was no evidence in this claim of reasonable grounds for the late submissions.

Injury Claim Existing But Not Joined at Time of Settlement of Prior Injury Claim is Barred
Rodarte v. BlueLinx Corporation, 2022-SC-0423-WC rendered 9/28/23 

Claimant sustained a work-related knee and ankle injury in 2016 and work-related shoulder injury in 2018. In 2019, Claimant filed an application for resolution of a claim (Form 101) for the knee and ankle injuries. At that time he was receiving TTD for the 2018 shoulder injury. Claimant and employer settled the 2016 knee and ankle injury. There was no language in the agreement regarding the 2018 shoulder injury. Eleven months after settling the 2016 claim, the Claimant's TTD benefits for the 2018 shoulder claim were stopped and he filed a Form 101 three months later. The Employer denied the claim, arguing it was barred under KRS 342.270 which states an employee must join all accrued causes of action against the named employer and failure to join will result in those claims being barred.

The ALJ dismissed the 2018 claim. The Board reversed, stating the 2018 claim had not yet accrued at the time of the settlement of the prior claim, because Claimant was not yet at Maximum Medical Improvement (MMI). Claimant also filed a motion to reopen the 2016 claim, arguing it was a mutual mistake that the shoulder claim was not addressed in the 2016 agreement. The Motion to Reopen was denied by the ALJ and the Board upheld the denial.

The Supreme Court of Kentucky affirmed the ALJ opinion that the 2018 claim was barred, holding Claimant was required to join his 2018 shoulder claim to his 2016 knee and ankle claim prior to finality of that settlement. The Court found that the shoulder injury claim accrued on the date of the injury and had therefore accrued at the time of the settlement of the prior claim. The Court also upheld the denial of the Motion to Reopen finding no basis for same as there was no evidence the Employer mistakenly failed to include reference to the shoulder claim when settling the 2016 claim.

Timely Notice to Subsequent Employer of Harmful Change in Pre-existing CWP Condition
Tennco Energy, Inc. v. Lane, 2023-SC-0028-WC rendered 9/28/23 

Claimant was a coal miner for more that 30 years. He had been diagnosed with CWP (black lung disease) on multiple occasions starting in 2003. In 2005 he settled a CWP workers' compensation claim against his then employer. He continued working in coal mining, joining Tennco in 2009 and remaining there until his last day of employment on 1/21/19. On 7/11/19, Claimant advised Tennco he was filing a CWP claim. The medical evidence established a worsening of his CWP. Tennco argued that Claimant's prior CWP diagnoses in 2003 and 2004 rendered his 2019 notice untimely and the ALJ agreed. 

The Supreme Court of Kentucky reversed, holding that evidence of a harmful change in one's CWP condition attributable to the new employer is a likely prerequisite to any successful subsequent CWP claim, thus the Claimant's awareness of such change is the event triggering the statutory obligation to provide notice rather than the original CWP diagnosis.