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WORKERS COMPENSATION: Kentucky Associated General Contractors Self-Insurance Fund v. Lowther (COA 1/29/2010)

By Michael Stevens

Kentucky Associated General Contractors Self-Insurance Fund v. Lowther
2008-CA-002090 01/29/2010 2010 WL 323199

Opinion by Senior Judge Lambert; Chief Judge Combs concurred; Judge Moore dissented by separate opinion. The Court affirmed a judgment of the circuit court upholding a penalty imposed by the executive director of the Kentucky Office of Workers? Claims on an insurer and claims administrator for their failure to pay a claim. The Court held that after a final utilization review decision revealed a dispute, the obligor was required to file a Form 112 medical dispute within 30 days, whether services had been rendered and a bill sent, or whether pre-authorization had been denied. Because the insurer did not seek reopening of the claim, it was in violation of its duty under the workers? compensation laws to promptly pay or contest the claim. Upon the proper determinations by the executive director that the insurer failed to attempt in good faith to promptly pay a claim in which liability was clear and that it failed to meet the appropriate time limits imposed by KRS Chapter 342, the Office of Workers? Claims was authorized to impose a fine for each violation.

Full post as published by Kentucky Cases on March 21, 2010 (boomark / email).