CASE NO. 1039 CRD-2-90-6Workers’ Compensation Commission
JUNE 29, 1990
The appeal in the above matter concerned issues between Lawrence Memorial Hospital and the Respondents. Therefore, no appearance on behalf of the claimant was necessary.
Day Kimball Hospital was represented by Thomas J. Riley, Esq., Dupont, Tobin, Levin, Carberry O’Malley, P.C.
The respondent was represented by Jason M. Dodge, Esq., Pomeranz, Drayton Stabnick.
This Petition for Review from the June 11, 1990 Finding and Award of the Commissioner for the Second District was heard June 29, 1990 before a Compensation Review Division panel consisting of the Commission Chairman, John Arcudi, and Commissioners A. Thomas White, Jr., and James Metro.
OPINION
JOHN ARCUDI, CHAIRMAN.
This matter concerns the appropriateness of hospital charges. Claimant suffered a compensable injury April 19, 1986. As a result he was furnished medical services by Day Kimball Hospital. The Hospital calculated its charges based on Connecticut’s All Payor System, the so called Diagnostic Related Group [DRG] as provided by Sec. 19a-165 et seq, first effective in the 1986 fiscal year. The DRG charges were $9,953.00. The itemized charges rate was $2,958.57.
Respondents paid the itemized charges, i.e. $2,958.57. The Hospital sought the DRG amount. The Second District agreed with the Hospital.
Tanner v. Walgren Tree Experts, 748 CRD-8-88-7 (decided January 17, 1990) appeal docketed, No. A.C. 8865 (Conn.App. Feb. 2, 1990) transferred to Supreme Court, No. 13996 is directly on point. In Tanner, we held the appropriate amount was the DRG charge pursuant to Sec. 19a-165f. Consequently Tanner is dispositive of the legal issue raised. However, for the reasons set out below we remand to the Second District Commissioner for further proceedings.
Respondents’ appeal also contends that the DRG rate was improper as the date of injury preceded the effective date of the DRG legislation. This argument relies on the concept that substantive rights to which a claimant is entitled vest as of the date of injury. See, Chieppo v. Robert E. McMichael, Inc. 169 Conn. 646 (1975). Respondents then argue that sec. 19a-165f took effect after the date of this injury and therefore the charges were not subject to the DRG rate. However, if the hospital services were rendered after the beginning of the hospital’s 1986 fiscal year, the employer is still obligated to pay the rate which prevails at the time services are rendered. Otherwise it might be argued if a claimant injures his back in 1984 but does not require surgery until 1988, then the charges by the hospital and the surgeon must be limited to those prevailing in 1984. However, in the instant case it is impossible for us to determine from the facts found the actual date on which the hospital provided services. If that date was before the effective date of the DRG enactment, then respondents’ argument has validity. We therefore remand to the trial Commissioner for such a determination.
Commissioners A. Thomas White, Jr. and James Metro concur.