When Compensability Is Denied, the 45-Day Medical-Billing Rule Is Excused for “Reasonable Grounds,” and Workers’ Compensation Petitions for Review Count as “Briefs” for Amicus Timing

I. Introduction

Tamala Harris v. Mercy Home Health (Ky. Mar. 19, 2026) is a workers’ compensation appeal arising from injuries a certified nursing assistant, Tamala Harris, sustained while providing in-home care for Mercy Home Health. The case presented four issues of recurring practical importance: (1) whether employer mileage reimbursements must be included in the employee’s average weekly wage; (2) whether an employer’s post-appeal payment of a disputed medical bill moots the controversy; (3) whether an unpaid medical bill can be denied as untimely under the “45-day rule” when the employer/insurer has denied compensability; and (4) whether the Court of Appeals may reject a motion for leave to file an amicus brief as “unauthorized” in workers’ compensation appeals because the appellant files a “petition for review” rather than a “brief.”

The Supreme Court of Kentucky affirmed the wage ruling but reversed on mootness, the unpaid bill issue, and the amicus-filing ruling. The Opinion is notable for converting into published precedent an important operational rule for contested claims: denial of compensability can constitute “reasonable grounds” excusing strict application of the 45-day billing submission requirement under KRS 342.020(4) when read alongside 803 KAR 25:096 § 6.

II. Summary of the Opinion

  • Mileage reimbursements: Properly excluded from “wages” for average weekly wage calculation because they were mere reimbursement of work travel expenses, not economic gain.
  • Mootness: The Court of Appeals erred in dismissing as moot Harris’s challenge regarding a medical bill after Mercy paid it; the “voluntary cessation” exception applied.
  • Unpaid medical bill / 45-day rule: The ALJ erred in denying compensability based on untimeliness; when compensability is denied, that denial constitutes “reasonable grounds” under 803 KAR 25:096 § 6 excusing noncompliance with the 45-day submission rule.
  • Amicus practice: The Court of Appeals erred by rejecting the motion for leave to file an amicus brief as “unauthorized”; a workers’ compensation “petition for review” is functionally a “brief” for purposes of RAP 34 timing.

Although the Court held the bill should have been awarded, it declined to remand because Mercy had already paid the provider—illustrating the Court’s willingness to resolve the legal question even when case-specific relief has become practically unnecessary, where systemic concerns remain.

III. Analysis

A. Precedents Cited

1. Standards of review and the ALJ’s fact-finding role

The Court anchored its review framework in Lexington Fayette Urban Cnty Gov't v. Gosper, reaffirming that the claimant bears the burden of proof and the risk of nonpersuasion, and that the ALJ functions like a trial judge. It further relied on W. Baptist Hosp. v. Kelly (quoted in Gosper) to emphasize that analogy. For the ALJ’s evidentiary discretion, the Court cited Paramount Foods, Inc. v. Burkhardt (ALJ determines the “quality, character and substance” of evidence), and Bowerman v. Black Equip. Co. (quoted via Gosper) for the proposition that the ALJ may believe or disbelieve parts of testimony. These authorities framed why wage classification and statutory interpretation are reviewed de novo, while fact determinations receive deference.

2. Wage definition and reimbursements

On wage calculation, the Court treated Anderson v. Homeless & Hous. COA as controlling for the proposition that “wages” exclude payments that are “mere reimbursement of expenses.” By aligning Anderson with Larson’s treatise principle (car allowance includable only to the extent it exceeds actual expenses), the Court reinforced a clean doctrinal line: compensation counts when it is economic gain for labor, not pass-through expense restoration.

3. Mootness and the voluntary cessation exception

The Court drew the baseline definition of mootness from Morgan v. Getter, which itself quotes Benton v. Clay for the classic formulation that a moot judgment lacks practical legal effect on an existing controversy. But Morgan is also the gateway for Kentucky’s articulation of the “voluntary cessation” exception, driven by the concern that a party could stop challenged conduct to evade review and later resume it.

To explain the exception’s policy logic, the Opinion (through Morgan) referenced federal and sister-state authorities and commentary—Norma Faye Pyles Lynch Family Purpose LLC v. Putnam Cnty., W.T. Grant, Friends of the Earth, Inc. v. Laidlaw Envtl. Servs., and City of Erie v. Pap's A.M.—emphasizing the judiciary’s interest in settling legality of recurring practices and preventing manipulation of appellate jurisdiction.

For the operative test, the Court relied on Beshear v. Goodwood Brewing Co., LLC, which adopts the stringent standard that mootness through voluntary cessation applies only when it is “absolutely clear” the allegedly wrongful behavior cannot reasonably be expected to recur. That test was decisive because Mercy had disputed compensability throughout and paid only after amicus activity, leaving no assurance the practice would not repeat in future cases.

The Court also contrasted voluntary cessation with the appellant’s voluntary dismissal rule via Bd. of Ed. of Berea v. Muncy and Smith v. Jones, underscoring that the legal system tolerates an appellant’s dismissal only when it does not prejudice others—while it is skeptical of an appellee’s strategic payment intended to erase precedential scrutiny.

4. Medical benefits, prompt payment, and the 45-day rule

The Opinion linked the medical payment regime’s purpose to Peabody Coal Co. v. Goforth, emphasizing KRS 342.020’s goal of “prompt payment of medical bills.” Against that backdrop, it addressed the “45-day rule” through Farley v. P&P Construction, Inc., which held KRS 342.020(4)’s provider submission deadline unambiguous: untimely bills are not the responsibility of employers/carriers, and the date of treatment triggers the 45-day window.

The key move in Harris is reconciling Farley with the regulation 803 KAR 25:096 § 6, which conditions noncompensability on the provider’s failure to submit within 45 days “without reasonable grounds.” The Court noted Farley explicitly refrained from addressing that regulation’s “applicability or potential implementation.” To fill that gap, the Court adopted the reasoning of the unpublished Wolford & Wethington Lumber v. Derringer: when an employer asserts the condition is non-work-related, that denial supplies “reasonable grounds” excusing strict compliance because submitting bills during denial is functionally futile.

The Court’s willingness to rely on an unpublished decision’s reasoning was supported by Taylor v. Commonwealth, acknowledging unpublished decisions are not “official pronouncements” but that fidelity and consistency matter when the Court has already applied a principle and no published authority addresses the same regulatory question.

5. Supervisory authority and appellate administration

On the amicus issue, the Court invoked its supervisory authority over the “orderly and effective administration of justice” by citing Ex parte Farley. This set the stage for correcting a systemic filing practice in the Court of Appeals that, if left unaddressed, could bar amicus participation in an entire category of appeals.

B. Legal Reasoning

1. Mileage reimbursement is not “wages” absent economic gain

The Court read the statutory wage definitions in KRS 342.140(6) and KRS 342.0011(17) through Anderson’s reimbursement distinction. The decisive factual premise was that Harris’s mileage payments were tied to “actual mileage required” for patient visits—i.e., variable reimbursement tracking travel expenses, not a fixed stipend, bonus, or fringe benefit exceeding expense. Because the record showed no “additional economic gain,” the payments did not meet the statutory concept of wages or “similar advantages.”

2. Strategic payment does not moot a legal dispute where recurrence is plausible

Mercy’s voluntary payment occurred after KEMI tendered an amicus motion supporting Harris’s legal position. The Court treated this as classic voluntary cessation: Mercy had litigated the bill as noncompensable, prevailed below, and only paid at the appellate stage. Under Beshear v. Goodwood Brewing Co., LLC’s stringent test, that posture did not make it “absolutely clear” the challenged denial practice would not recur. The Court additionally stressed the systemic purpose of KRS 342.020—prompt payment—and reasoned that last-minute payment does not “fully resolve” the dispute over entitlement to prompt payment in contested cases.

3. The 45-day rule is qualified by a “reasonable grounds” safety valve when compensability is denied

The Opinion maintains Farley’s core holding—KRS 342.020(4)’s 45-day submission command is unambiguous—while clarifying that the regulation’s “reasonable grounds” qualifier can matter. The Court adopted Wolford’s logic that denial of compensability is itself “reasonable grounds” because the provider’s timely submission would be futile: the employer has already signaled it will not pay until compelled by an award. The Court further minimized employer prejudice by pointing to KRS 342.270(1), which forces workers to raise known claims (including unpaid pre-award medical expenses) during pendency of the application, preventing sandbagging or surprise accumulation.

4. A workers’ compensation petition for review is a “brief” for RAP 34 timing

The Court rejected the Court of Appeals clerk’s rationale that amicus motions are “unauthorized” because no “appellant’s brief” exists in a workers’ compensation petition-for-review framework. It held that, although a petition for review under RAP 49 differs in format and organization from briefs under RAP 30-32, it is functionally a “brief” because it is the operative written presentation of legal and factual contentions. Therefore, RAP 34(B)(2)’s 15-day clock is triggered by the filing (or due date) of the petition for review as the appellant’s merits document. The Court limited its holding to the filing rejection error and expressly declined to opine whether leave should ultimately have been granted on the merits.

C. Impact

1. Clarifying billing deadlines in contested claims

The most consequential doctrinal development is the published adoption of a contested-claim exception: when an employer/insurer denies compensability, that denial can constitute “reasonable grounds” under 803 KAR 25:096 § 6 to excuse late submission under KRS 342.020(4). Practically, this reduces the risk that providers (or workers who pay out-of-pocket) will be penalized for not pursuing a billing process that the carrier has already made clear will be rejected. It also signals that Farley is not a one-size-fits-all forfeiture rule when the regulation’s qualifier is triggered.

2. Mootness doctrine as a check on litigation gamesmanship

By applying voluntary cessation, the Court discourages appellees from “buying off” appellate review in order to preserve favorable but potentially incorrect legal rulings below—especially where the issue is capable of repetition and affects system-wide administration of benefits.

3. Opening the door to amicus participation in workers’ compensation appeals

The RAP 34 holding removes an administrative barrier that could have effectively eliminated amicus filings in workers’ compensation cases. That matters because many compensation issues have broad effects across employers, carriers, providers, and workers; amicus participation can improve rule clarity and consistency.

4. Continued wage-calculation stability

The mileage ruling reinforces a stable line: reimbursements that track expenses are excluded from wages. This provides predictability for home-health, hospice, and other travel-intensive employment settings.

IV. Complex Concepts Simplified

  • Average weekly wage: The weekly earnings figure used to calculate income benefits. Not every payment from the employer counts—only “wages” as defined by statute.
  • Mere reimbursement of expenses: Money paid back to the worker to cover costs the worker incurred for the employer (e.g., mileage tied to actual miles). Because it does not increase the worker’s net gain from labor, it is not treated as wages.
  • The “45-day rule” (KRS 342.020(4)): Providers must generally submit medical bills within 45 days of initiating treatment (and every 45 days thereafter if appropriate). Late billing can lead to nonpayment.
  • “Reasonable grounds” (803 KAR 25:096 § 6): A regulatory safety valve: if a provider fails to submit within 45 days without reasonable grounds, bills “shall not be compensable.” The Court holds that a denial of compensability can be “reasonable grounds” in contested cases.
  • Mootness: Courts avoid deciding cases where a decision would no longer affect the parties. But if a party stops its challenged conduct only to evade review, courts may still decide the issue.
  • Voluntary cessation: The idea that a defendant’s last-minute change (like paying a bill) does not necessarily moot a case unless it is clear the conduct won’t recur.
  • Amicus curiae brief: A “friend of the court” filing by a nonparty offering legal arguments or industry perspective. Here, the Court clarified that the procedural vehicle in workers’ compensation appeals still qualifies as a “brief” for amicus timing under RAP 34.

V. Conclusion

Tamala Harris v. Mercy Home Health delivers three system-shaping clarifications: (1) mileage reimbursements tied to actual travel expenses remain excluded from average weekly wage; (2) an employer cannot necessarily moot appellate review of a contested medical-billing practice through eleventh-hour payment, due to the voluntary cessation doctrine; and (3) most significantly, when an employer denies compensability, that denial can supply “reasonable grounds” under 803 KAR 25:096 § 6 to excuse strict forfeiture under KRS 342.020(4)’s 45-day submission rule. In addition, the Court corrected an administrative misinterpretation of RAP 34, confirming that workers’ compensation petitions for review function as “briefs” for amicus participation. Collectively, the Opinion strengthens prompt-payment policy, limits procedural gamesmanship, and clarifies how statutory deadlines operate in contested claims.