Plaintiff alleges Defendant’s failure to reimburse medical expenses under workers’ compensation

In a recent legal development, a medical service provider has faced a setback in its attempt to claim reimbursement for services rendered. The case was filed by Integrative Pain Specialists at the Virginia Workers’ Compensation Commission against Whole Foods on January 14, 2025. The dispute centers around the denial of reimbursement claims for medical services provided to an injured employee.

The crux of the case lies in the interpretation and application of Code § 65.2-605.1(F), which governs the filing of claims for reimbursement within a specified period. Integrative Pain Specialists had provided medical care to Tamela Majors, an employee injured while working at Whole Foods on May 7, 2016. Despite being awarded lifetime medical benefits, the provider’s claims for reimbursement were denied by the Commission on grounds that they were invalid under the cited code.

Integrative Pain Specialists initially filed a claim on March 17, 2020, without requesting an immediate hearing. A subsequent claim was filed on December 1, 2022. However, it wasn’t until March 2023 that they requested an evidentiary hearing. The delay in seeking a hearing became pivotal as it raised questions about the timeliness and validity of their claims.

During the evidentiary hearing held in May 2024, it emerged that Integrative Pain Specialists had assigned its rights to bill and collect workers’ compensation claims to third-party companies through management service agreements. These assignments complicated their standing in filing for reimbursements directly from Whole Foods. Specifically, Ancillary Medical Solutions and later StreamCare LLC were involved in these assignments until November 2021.

The deputy commissioner ruled against Integrative Pain Specialists’ March 2020 claim due to lack of standing—citing that they had no right to receive payment when they filed because their rights had been assigned elsewhere. Furthermore, procedural stipulations established that their December 2022 claim was untimely since it exceeded one year from the last payment received on April 23, 2021.

Despite appealing this decision to the full Commission in January 2025, Integrative Pain Specialists faced another hurdle when their claim was deemed “non-specific” and unenforceable under Code § 65.2-605.1(F). The Commission did not support the deputy commissioner’s stance on standing but maintained that procedural errors rendered their claims invalid.

Seeking relief from these rulings, Integrative Pain Specialists argued that merely filing within statutory limits should suffice as a valid assertion of rights without necessitating immediate hearings—a point contested by Whole Foods who saw this as an attempt to indefinitely extend limitations periods.

Ultimately, while acknowledging potential misinterpretations by lower authorities regarding what constitutes a “claim,” higher courts upheld decisions against Integrative Pain Specialists based on established facts rather than procedural technicalities alone—applying what is known legally as “right result wrong reason doctrine.”

Representing parties involved include Philip J Geib for Integrative Pain Specialists with Rachel Hussein and Robert McAdam representing Whole Foods through Kalbaugh Pfund & Messersmith PC law firm before Chief Judge Decker alongside Judges AtLee & Humphreys under Case ID Record No:0167-25-1 presided over by Judge Richard Y Atlee Jr., issued February17th ,2026 affirming prior judgments made therein.