Sumitomo Electric Wiring v. Kingery, No. 2013-CA-000855-WC (Ky.App. 2014 ) (designated to be published). The claimant in a medical fee dispute bears the reciprocal burden of rebutting the employer’s evidence of non-compensability.
This appeal originated as an employer’s medical fee dispute as to work-relatedness and reasonableness/necessity of office visits and various prescriptions by plaintiff’s treating physician. The ALJ found the treatment and prescriptions compensable, relying only on plaintiff’s own testimony that her neck and back pain were, at least in part, related to the work injury. The ALJ ignored the unchallenged testimony of the employer’s medical expert. The Court concluded the testimony as to compensability did not involve a situation where causation was apparent and, thus, should have been proved by competent medical evidence. Since the question was one properly within the province of medical experts, the ALJ was not justified in disregarding the medical evidence and relying instead on the claimant’s lay testimony. While the employer bore the burden of establishing non-compensability, the Court determined that claimant bore the reciprocal burden of rebutting the employer’s evidence with substantial, contrary evidence.