Medical Provider Fee Dispute—Did the Medical Provider Write-Off the Bills? If So, There Is Likely No Claim

In Virginia, we continue to see a handful of medical providers aggressively pursue alleged underpayments.  The Full Commission’s recent decision in Hessie Wagner v. Food Lion, LLC, JCN VA00000241598 (July 29, 2026) demonstrates the need for the employer and carrier to determine whether the alleged non-payment/underpayment was written off.  If so, there is no claim that can be pursued.

In Wagner, the parties settled their workers’ compensation claim in 2014.  In 2022, the claimant filed a claim seeking alleged underpayment of bills for treatment rendered by Tidewater Orthopaedic Associates.  With her Position Statement, the claimant submitted a letter from the director of operations for the practice group that stated, “Please allow this letter to serve as proof that Tidewater Orthopaedic Associates is still owed a balance of $10,315.00 for the treatment of Ms. Wagner.  This balance has been written off internally but is still in fact owed.”  The Commission noted that the medical provider presented no billing statements regarding any outstanding payments due.  Further, the medical provider had taken no action to recover the funds claimed years later.  The Full Commission found that since the claimant failed to present sufficient evidence of any outstanding balance due and owing to Tidewater Orthopaedic Associates, he failed to carry his burden of proof of an existing debt.  The Full Commission observed that “[n]either the claimant nor the medical provider has offered any explanation as to how a ‘balance’ can be both ‘written off’ the provider’s ledger, essentially zeroed out, and yet still be ‘in fact owed.’”

This Opinion demonstrates the need for the insurance adjuster to determine in a medical provider fee dispute whether the alleged non-payment/underpayment was written off.  If so, the claim should be denied.  This defense is in addition to other commonly available defenses including requirement that bills be pursued within one (1) year from the date of last payment to the provider pursuant to Va. Code § 65.2-605.1 (E) and standing.  The Virginia adjuster should be certain that the parties seeking payment indeed have standing to pursue such claim.  The Virginia adjuster should determine whether the medical provider has entered into any contracts with others whereby they may have assigned their rights to bill and collect.

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