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Ninth District Court of Appeals Holds Employer Cannot Sue A Provider For False/Misleading Information As To A Claimant’s Disability

In Automation Tool & Die, Inc. v. Medina Hospital, et. al., 9th Dist. No. 19CA009-M, a nurse practitioner was filling out forms requesting treatment and additional conditions using Dr. Terry’s rubber-stamped signature.  The company later found claimant was working while receiving temporary total disability compensation and the additional allowances were vacated by the Commission.  The company then filed a complaint against the hospital and Dr. Terry alleging fraudulent misrepresentation and breach of statutory regulatory duties under Ohio Admin. Code 4123-6-20(A).  Pursuant to Ohio Admin. Code 4123-6-20(A) a provider is responsible for the accuracy and legibility of all its reports to the Bureau of Workers’ Compensation or Industrial Commission.  The provider must not submit any report containing false, fraudulent, deceptive or misleading information.  The company alleged the documentation submitted by the hospital and Dr. Terry contained false, fraudulent, deceptive and misleading information because it appeared to reflect Dr. Terry’s opinions on causation based on actual medical evidence, but the opinions were actually founded upon “nothing more than a standard office protocol unsupported by any medical evidence.”  The company alleged as a result of the fraudulent misrepresentation they incurred costs and expenses defending the claim they would not have incurred if the documentation was accurate.  The trial court found Ohio Admin. Code 4123-6-20(A) did not provide the company with a private right of action and granted a partial judgment on the pleadings to the hospital and Dr. Terry.

The company appealed to the 9th District Court of Appeals and the court agreed with the trial court finding no indication of any legislative intent to create a private remedy for employers.  Instead, the rule authorized the Bureau to develop standards for penalizing health care providers, such as to decertify the provider.  An employer cannot bring suit against a provider for providing false and misleading information as to a claimant’s disability status.

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