Legal and Litigation

Air Ambulance Fee Litigation Results in Conflicting Opinions
The air ambulance litigation continues amidst conflicting state and federal court opinions. In August 2021, the U.S. Fifth Circuit Court of Appeals in Air Evac EMS, Inc v.  Sullivan, No. 18-50722 (5th Cir. 2021), ruled that air ambulance fees are not subject to Texas Workers’ Compensation Fee Guidelines. The Court held that the Airline Deregulation Act (ADA) was not preempted by Texas workers’ compensation fee laws. This decision conflicts with the 2020 Texas Supreme Court decision in Tex. Mut. Ins. Co. v PHI Air Med., LLC, 610 S.W.3d 839, (Tex. 2020) which held that the Texas fee guidelines applied, and the ADA did not preempt state law.    

In February 2022, the Texas Third Court of Appeals, on remand from the Texas Supreme Court decision, addressed whether the ADA preempts Labor Code section 413.042 (balance billing prohibition). The Third Court of Appeals concluded the evidence did not establish the ADA preempts the state’s workers compensation fee guideline laws. Because the trial court did not address fair-and-reasonable reimbursement or whether PHI was entitled the full amount of its billed charges under such an analysis, the Third Court of Appeals remanded the case back to the trial court for further proceedings. This matter is pending.  

Significant Appeals Panel Decision on Redesignating Benefits as LIBs
In APD No. 220175-s, the Appeals Panel considered the issue of whether the carrier could redesignate impairment income benefits (IIBs) and supplemental income benefits (SIBs) as lifetime income benefits (LIBs).   

At the contested case hearing, the Administrative Law Judge (ALJ) ruled that the carrier could redesignate IIBs as LIBs. However, the ALJ concluded that LIBs are paid separately for specifically listed medical conditions and the law did not specifically allow for a reduction or elimination of benefits based on previous amounts paid for SIBs.  

On appeal, the Appeals Panel agreed with the ALJ that the carrier could redesignate IIBs. However, reversing the contested case hearing decision, the Appeals Panel also found that the carrier could redesignate SIBs.