Fee Schedule Applies to Previously Unauthorized Care: court

payment money

The Tennessee Workers’ Compensation Appeals Board ruled in a published opinion that an employer ordered to pay for previously denied, unauthorized medical treatment is not required to pay more than the amounts allowed under the state’s workers’ compensation medical fee schedule.
In affirming a trial court’s order in Hands v. Fresenius Medical Care Holdings Inc., the board said it found no statute or regulation under which payment differs depending on whether treatment was authorized or unauthorized, and that any change “is for the legislature, not the courts, to address.”
The trial court found that the employee had suffered a permanent worsening of a pre-existing back condition. It awarded permanent partial disability benefits and future medical benefits, and it ordered the employer to pay past unauthorized medical bills related to treatment of the back condition pursuant to the fee schedule.
The worker had sought payment of unauthorized back-treatment bills he said totaled $562,783, though the employer calculated about $147,979, and the judge limited payment to the fee schedule.

Betty Boateng, 50, of Columbus, Ohio, was ordered to pay $53,278.40 in restitution to the Ohio Bureau of Workers’ Compensation (BWC) after pleading guilty to workers’ compensation fraud, a fifth-degree felony. A Franklin County Common Pleas judge accepted her plea and sentenced her Sept. 23.
BWC’s Special Investigations Department found she knowingly and with fraudulent intent returned to work for two employers, providing non-medical in-home care services, while collecting disability benefits she was not entitled to receive.
The sentence includes a 12-month suspended sentence, 60 months of community control and mandatory reporting requirements. The court waived fines but imposed court costs.
BWC Administrator Stephanie McCloud said fraud against the system hurts honest Ohio workers and employers and that the bureau is committed to holding offenders accountable.

AM Best Co. cautioned in a new report that the segment could be nearing an inflection point as higher costs are starting to cut into profits. Combined ratios are creeping up, reserve redundancy is shrinking and premium levels are trending downward. The redundancy is now at its lowest level since 2021, and price cuts appear to be accelerating amid competitive market conditions.
Results through the second quarter of 2026 suggest profits are thinning. The mid-year direct incurred loss ratio was the highest of the past five years.
The Hartford Group replaced Travelers Group as the top writer of workers’ compensation in 2025 after Travelers cut its book by 3.7%. California remains the largest market, with more than 20% of all workers’ compensation premiums, more than any other three states combined.