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The insurer is not obliged to pay for care after the bills have fallen due



An insurer's medical payment liability to an injured worker ceased when more than two years passed between the bills, an appeals court held.

In Dunbar v Acme Southern Inc ., The North Carolina Appeals Court on Tuesday unanimously upheld a decision by the North Carolina Industrial Commission that destroyed even if the worker still received medical care that was inadvertently billed to Medicare during the billing deadline. the insurer had no obligation to pay for medical treatment almost four years after its final bill.

Derrick Dunbar worked for Acme Southern when he was injured in a work accident in 1998. He settled his claims for compensation with Hartford Underwriters Insurance Co. but did not reach an agreement with the insurer for his medical compensation.

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3, Dunbar's medical providers began billing Medicare rather than Hartford for compensation, although he was not aware of the change. In 2017, he was referred to a medical provider for pain relief and requested permission from Hartford for treatment, which was denied because he was no longer entitled to medical compensation because he had not submitted a request for more than two years. He requested a hearing to determine if he was entitled to additional medical compensation, but the North Carolina Industrial Commission agreed with Hartford. Dunbar appealed.

The Court of Appeal upheld the Commission's decision. Dunbar argued that his claim should not be barred by the fact that Hartford made no payments for his medical compensation for two years, but the court noted that North Carolina law gives the right to terminate medical compensation two years after the employer's last payment, unless the compensation is maintained. differently.

He also argued that state law requires the insurer to notify the employee when it has made its final payment within 16 days or paid a $ 25 fine, but the court found that there was "In no way could Hartford have known within 16 days after providing coverage in October 2013 that this payment would be the last payment the plaintiff would have requested. ”

The Court also noted that Dunbar did not present any evidence that Hartford was aware that he was continuing to incur medical expenses after October 2013 or that the insurer acted in bad faith.

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