The Benefits Review Board recently resolved a dispute discovery issue by holding that an administrative law judge possesses the authority to order a claimant to sign a medical release. However, the Board also provided rules limiting the scope of those releases.
As the Board explained in Mugerwa v. Aegis Defense Services, BRB No. 17-0407 (4/27/18), lower federal courts are split as to whether judges possess the authority to compel a plaintiff to sign medical releases. These courts generally consider the competing issues concerning the plaintiffs’ privacy and fairness to the defendant. Without much analysis, the Board held that “[w]eighing the competing interests identified in these cases, we hold that administrative law judges have the authority to compel claimants to sign narrowly-tailored medical releases when it is reasonable under the circumstances to do so.” As a predicate to this holding, the Board first determined that medical release forms are a permitted method of discovery, because of the broad range of the discovery methods and the authority of administrative law judges.
Having determined that the ALJ could order the claimant to sign a medical release, the Board nevertheless restricted the scope of those releases, providing rules that no doubt guide the use of releases in the future. The Board stated:
1. The “employer must first establish a reasonable inference of the existence of additional relevant records in light of claimant’s assertion that he has produced all relevant records.” The Board added that “in the face of a denial of the existence of or control over documents, the requesting party must produce specific evidence challenging the assertion.”
2. “If the administrative law judge finds that claimant has acted in good faith by producing his relevant medical records and employer has not shown the likely existence, relevance, and necessity of the additional requested medical information, the medical release forms are unnecessary, and the administrative law judge should deny employer’s motion to compel.”
3. “If, however, the administrative law judge finds that claimant has acted in good faith but employer has shown the relevance and necessity of medical information held by a medical provider, or if employer establishes claimant has not acted in good faith, then the medical releases may be warranted.”
4. “If they are needed, the administrative law judge must greatly narrow their scope or must order the parties to work together to generate mutually-agreeable medical release forms. If claimant refuses to sign the narrowed medical release forms, then the administrative law judge may grant employer’s motion to compel.”
This case arose under the Defense Base Act, and involved a Ugandan citizen injured in Afghanistan. The employer argued that the releases were the only manner it had to secure medical records, because the administrative law judge could not compel a subpoena in a foreign country.
An administrative law judge cannot determine rights under contracts for medical services, according to a recent decision from the Benefits Review Board.
In Watson (Wardell Orthopaedics) v. Huntington Ingalls Industries, the employer voluntarily paid all benefits arising from the claimant’s knee injury, including medical benefits. However, the employer paid one provider less than half its claimed invoice, alleging that a series of contracts the employer had with its health insurance company and that insurer’s affiliates allowed it to pay reduced fees for the medical provider’s services. Over the employer’s objection, the administrative law judge determined she had authority over the dispute. The employer filed an interlocutory appeal to the Benefits Review Board.
The Board began its analysis of the issue presented by recognizing that Section 19(a) of the Act grants an ALJ “full power and authority to hear and determine all questions in respect of such claim.” This statute has been interpreted as allowing an ALJ to hear and determine contractual issues that are necessary to the resolution of a claim. For example, an ALJ may determine rights under a workers’ compensation insurance policy. However, the U.S. Fifth Circuit Court of Appeals has held that Section 19(a) does not grant jurisdiction for an ALJ to consider contractual issues wholly unrelated to a claim for compensation.
The Board determined that the ALJ could consider the amount of fees due to the medical provider, but could not adjudicate whether the contracts with the health insurer entitled the employer to reduced fees. The Board found that the primary issue before the ALJ was the amount of fees to which the medical provider was due. The Board recognized that the medical provider could bring its own claim for these fees, and the ALJ had the authority to determine the amount of the fees at the prevailing community rates. However, the Board held that interpreting the contracts the employer had with its health insurer was not “in respects” of a claim, and could not be considered by the ALJ. According to the Board, “[i]nterpretation of these contracts goes beyond that which is necessary to resolve the claim under the Act.”
Watson (Wardell Orthopaedics) v. Huntington Ingalls Industries, BRB No. 16-0545 (6/30/17).
© 2018 Ira J. Rosenzweig