CASE NO. 1100 CRD-2-90-8Workers’ Compensation Commission
FEBRUARY 7, 1991
The appeal in the above matter concerned issues between Day Kimball Hospital and the Respondents. Therefore, no appearance on behalf of the claimant was necessary.
Day Kimball Hospital was represented by Thomas 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 August 8, 1990 Finding and Award of the Commissioner for the Second District was heard January 25, 1991 before a Compensation Review Division panel consisting of the Commission Chairman, John Arcudi, and Commissioners Andrew P. Denuzze, and Michael S. Sherman.
OPINION
JOHN ARCUDI, CHAIRMAN.
This matter concerns the appropriateness of hospital 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 fiscal year commencing in 1986.
The matter was originally heard by the Compensation Review Division on June 29, 1990. Thereafter, it was remanded to the trial commissioner for a determination of when hospital services were rendered. A supplemental finding was issued August 8, 1990. Medical services were delivered to the claimant November 19-23, 1986. The supplemental finding also incorporates the trial commissioner’s previous finding of June 11, 1990. The trial commissioner’s concluded that the respondents are liable for the full DRG charge of $9,953.00, with credits for the itemized charges of $2,958.57 already paid.
The claimant suffered a compensable injury on or about April 19, 1986. Respondents argue that since the DRG legislation took effect after the date of injury, they should not be required to pay the DRG rate. Respondents contend that substantive right to which a claimant is entitled vest as of the date of injury. However, while Sec. 31-294 C.S.G. limits the pecuniary liability of an employer, that liability is limited to the prevailing community charges. Simply put, Sec. 31-294 has been construed as obligating an employer to pay the rate which prevails in the community at the time medical services are rendered. That was our holding in our earlier consideration of this matter. Theroux v. National Patent, 1039 CRD-2-90-6 (1990). See also, Gervais v. Atlantic Builders, 8 Conn. Workers’ Comp. Rev. Op. 120, 1046 CRD-2-90-6 (1990).
The ultimate issue on appeal is whether the trial commissioner erred in ordering the respondents to pay the DRG rate. Respondents argue that Sec. 31-294 only authorizes payment of the itemized billing amount and not the DRG rate.
We think Tanner v. Walgren Tree Experts, 8 Conn. Workers’ Comp. Rev. Op. 16, 748 CRD-8-88-7 (1990) is directly on point and controlling authority. In Tanner, we held the appropriate amount to be paid for hospital services, was the DRG charge pursuant to Sec. 19a-165f. Consequently, Tanner is dispositive of the issue here raised. Therefore, for all the reasons there set out, we affirm the Second District and dismiss the appeal.
Commissioners Andrew P. Denuzze and Michael S. Sherman concur.