Thomas C. Millard v. ABCO Construction
161 Idaho 194
| Idaho | 2016Background
- Thomas Millard, injured in 2006 while working for a Utah employer, remains permanently disabled; his lump-sum settlement left future medical care open.
- Millard received epidural injections (Oct 2012–Oct 2014) from Dr. Vikas Garg and physical therapy (Aug 31–Dec 23, 2011).
- The Workers Compensation Fund of Utah (Surety, later administered by Pinnacle) denied payment for Oct 2012–Nov 2013 injections; it authorized and paid for injections beginning Nov 2013 (though some billings were delayed).
- The Commission found Surety failed to provide reasonable medical care for Oct 2012–Nov 2013 and applied Neel to require payment of full invoiced amounts for those injections.
- The Commission declined full-invoice reimbursement for Nov 2013–Oct 2014 injections and the 2011 physical therapy, ruling they were payable at statutory scheduled fees.
- Millard appealed the Commission’s denial of full-invoice payment for the Nov 2013–Oct 2014 injections and the Aug–Dec 2011 physical therapy sessions.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether Neel entitles Millard to full-invoice payment for 2011 physical therapy | Millard: any denial of a claim for treatment triggers Neel, so he should get full invoiced amounts | Surety: Neel applies only to initial compensability denials; payments made before Commission decision remove Neel remedy | No — 2011 PT was paid before Commission deemed compensable; Commission never deemed those sessions compensable, so Neel inapplicable |
| Whether Neel entitles Millard to full-invoice payment for Nov 2013–Oct 2014 injections | Millard: denials of treatment claims (including post-compensability requests) trigger Neel | Surety: claim means only the threshold compensability denial; also it authorized and paid injections starting Nov 2013 | No — injections from Nov 2013–Oct 2014 were authorized and paid; there was no denial and no Commission determination of compensability for those bills; Neel does not apply |
| Proper legal interpretation of Neel’s trigger | Millard: “claim” includes requests for medical expenses for treatment of compensable injury | Surety: “claim” limited to initial compensability denial | Court: “claim” includes requests for medical expenses (agreeing with Millard); Neel requires (1) denial and (2) later Commission finding of compensability, but does not require that bills remain unpaid until that finding |
| Validity of Commission’s reasoning that Neel is inapplicable if bills were paid before Commission decision | Millard: Commission misstates Neel by adding a third prong (unpaid status) | Surety: payments before decision defeat Neel remedy | Court: Commission’s factual conclusion affirmed, but its legal rationale modified — Neel does not require unpaid status up to the Commission decision; here Neel did not apply because the required compensability determination was not made for the contested bills |
Key Cases Cited
- Neel v. Western Constr., Inc., 147 Idaho 146, 206 P.3d 852 (Idaho 2009) (holding sureties that deny claims later deemed compensable by the Commission must pay full invoiced medical bills incurred during denial period)
- Seward v. Pacific Hide & Fur Depot, 138 Idaho 509, 65 P.3d 531 (Idaho 2003) (treats requests for medical expenses for treatment of a compensable injury as "claims" under relevant statute)
- Martel v. Bulotti, 138 Idaho 451, 65 P.3d 192 (Idaho 2003) (appellate court may affirm on alternate grounds)