A Medical Provider’s Right to Bring a Protective Application

Virginia Code § 65.2-605.1 governs a medical provider’s rights to prompt payment for medical expenses arising out of workers’ compensation claimant. Virginia Code § 65.2-605.1, which was recently amended in 2024, provides medical providers with a statute of limitations of one year from the date the last payment was received by the health care provider or if the employer denied or contested payment for any portion of the health care services, such claim must be filed within one year of the date the medical award covering such date of service for a specific item or treatment in question becomes final.

Prior to the rule change in July 2024, the one-year statute of limitations, as stated above, only applied to medical services rendered after July 1, 2014. Therefore, medical providers were able to timely seek recovery for unpaid and/or underpaid medical expenses for any treatment prior to July 1, 2014. In anticipation of the July 2024 change, we saw medical providers file a myriad of “protective” medical provider applications in an attempt to toll the statute of limitations for medical services provided prior to July 1, 2014. These “protective” applications were generally vague and non-specific as to the dates of treatment or amounts allegedly owed to the medical providers.

The Full Commission has recently clarified whether these “protective” applications toll the statute of limitations set forth in Virginia Code § 65.2-605.1. In Tamela Majors v. Whole Foods, the Full Commission held that a medical provider’s “protective” application did not toll the statute of limitations in Virginia Code §65.2-605.1. JCN VA00001200056 (January 14, 2025). In coming to this conclusion, the Commission held that a medical provider does not have an absolute right to file “protective” claims which attempt to preserve all potential rights or causes before the Commission. The Commission further determined that a medical provider does not “stand in the shoes” of the claimant and is not afforded the same rights as a claimant in terms of protective applications.

Based on the recent amendment to Virginia Code § 65.2-605.1 and the Commission’s ruling in Tamela Majors, it appears that Commission is narrowing the statute of limitations for medical providers to bring applications to ensure timely adjudication of these matters. When evaluating medical provider applications, we recommend that adjusters pay close attention to the dates of service, date of payment or denial and date of the medical award to determine if an application was timely filed. Due to the complexity of these cases, we recommend that adjusters reach out to defense counsel early when faced with untimely medical provider applications. As always, our highly skilled team of professional are available and happy to answer any questions you may have.

Should you have any questions about the issues discussed here or other legal issues, please do not hesitate to contact the lawyers at Ford Richardson.

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