Court Uphold Facilities' Higher WC Rates

The Maine Supreme Court has just issued a decision upholding health care facilities’ right to file workers’ compensation claims for their full service fees, even when the injured employees have not filed WC claims and have proceeded instead under the federal Longshore Act, which limits the facilities’ reimbursement rates.

In St. Mary’s v. BIW, 2009 ME 92, the two employees were injured at work and received benefits under the Longshore Act, which limit the fees to hospitals and other health care facilities.�The Maine WC Board of Directors, however, has not yet enacted a fee schedule for those facilities as it has for individual providers. �As an "interested party" under § 206 (12), St. Mary’s filed claims directly against BIW under the Maine WC Act for its full charges.�BIW requested dismissal of the petitions, arguing that the employees chose federal benefits instead, and that St. Mary’s should be bound by those choices.�HO Goodnough declined to dismiss St. Mary’s WC claims, and BIW appealed.

The Law Court found that state and federal jurisdiction was concurrent and that St. Mary’s could proceed in its WC claims against BIW, even though the employees had chosen not to do so. �But the Court also held that a double recovery was not allowed, and that St. Mary’s could only collect from BIW what it had not already collected under the Longshore Act.

The WCB has proposed a fee schedule for facilities, and public comments are due by August 27, but it appears unlikely to save Maine employers much money, and it exempts several small rural hospitals, which will be allowed to continue to charge their "usual and customary" rates.�Thus, without further amendment, the medical fees under the Maine WC system will remain significantly higher than those available under the Longshore fee schedule, Medicare, and the negotiated rates of health insurers, leaving WC the most attractive target for future claims.

Kevin Gillis

Tom Getchell

Mike Richards

Dan Gilligan