• Compensation Review Board
  • Compensation Review Board
  • 5740 CRB-2-12-3
  • Mar 06 2013 (Date Decided)
  • Mastropietro with Gregg and Dilzer

Even properly admitted evidence may fail to prove what the moving party seeks to establish as a fact and medical bills showing a zero balance admitted into evidence without testimony or documentary evidence explaining how they were paid were too ambiguous and confusing to support orders of reimbursement. Brian Bombria, injured working on a construction site, filed a claim for workers' compensation benefits. The trial commissioner found that Bombria was an employee of the respondent, Anthony Bonafine, despite Bonafine's contest of the issue. The commissioner awarded benefits under C.G.S. §31-307 and §31-294d and and ordered Ace American Insurance through Travelers Insurance to pay various medical bills found incurred. Ace appealed asserting that the latter order was invalid as lacking foundation in any evidence establishing that there was an outstanding balance due to certain medical providers. Ace also argued that the orders were erroneous as it had no duty to reimburse a medical provider for costs already paid or otherwise not owed. The Compensation Review Board remanded the matter back to the trial commissioner, finding no statutory authority or factual predicate for the order of reimbursement. The claimant submitted a packet of medical bills introduced into evidence without objection by the respondents. No witness testified before the commissioner or at a deposition to explain the circumstances as to the bills. While the cover sheet prepared by counsel asserted that $10,812.30 was owed to the medical providers, the actual invoices attached did not document those charges. Invoices from a hospital, surgery center and therapy center showed a zero balance due. Although the claimant's mother appeared as an insured party on those invoices, any conclusion as to how the bills were paid would be purely speculation or surmise. Precedent suggests that a commissioner cannot rely on such inconclusive evidence. There was no evidence that any of the claimant's medical providers or group health insurer protected their interest to effectuate a reimbursement by perfecting a lien against an award as provided in C.G.S. §31-299a. The evidence was too confusing and ambiguous to support the orders.