Maine's highest court has just issued an important workers' compensation decision that is very favorable to Maine's hospitals. In a consolidated appeal, Fernald v. Shaw's Supermarkets and Babine v. Bath Iron Works, 2008 ME 81, decided on May 8, the Court established an important precedent regarding hospitals' entitlement to their usual and customary charges for providing care to patients with injuries covered by the Workers' Compensation Act. Kozak & Gayer, P.A. represented Maine Hospital Association ("MHA"), an amicus curiae party in the case, before the Workers' Compensation Board, and then as a party-in-interest before the Law Court. Attorney Steve Johnson briefed the appeal and presented oral argument before the Law Court on behalf of MHA and Maine hospitals. The Law Court held that healthcare facilities' published charges are conclusive proof of their "usual and customary" charges, and a healthcare facility is therefore entitled to be paid its published rates rather than discounted amounts negotiated with other thirty-party payors. The Court's decision bars employers' and insurers' attempts to introduce evidence of what third party payors, through negotiated discounts, pay hospitals for the same services provided to workers' compensation payors.
