Legal battle rages over whether ankles exist

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For every foot, there's an ankle. Or not.

In Texas, that all depends on a legal battle between medical doctors and podiatrists, who both claim the ankle as their turf. The debate has raged to the point that the two sides disagree in court on whether the ankle actually exists.

A state appeals court recently sided with medical doctors when it determined that the state board that licenses podiatrists exceeded its authority in defining the ankle as part of the foot.

"You don't have an ankle," said Mark Hanna, a lawyer for the Texas Podiatric Medical Association. "The foot actually includes the ankle. If you took the foot off the leg, there is nothing lying there that's the ankle."

Not so, said Dr. David Teuscher, an orthopedic surgeon in Beaumont who said treating the ankle is complicated enough to require medical school training.

"If they say the ankle doesn't exist, why do they want to operate on it?" asked Teuscher, immediate past president of the Texas Orthopaedic Association. "Everyone knows what an ankle is."

The Texas State Board of Podiatric Medical Examiners bypassed the Legislature to create its ankle-is-part-of-the-foot definition in 2001. Podiatrists say they've been treating ankles for decades and accuse medical doctors of trying to limit competition. The Texas Medical Association argues podiatrists should stick to corns, calluses and diabetic foot care.

The physicians group interprets last Friday's ruling as saying the ankle and foot are separate. The podiatrists group says the ruling doesn't go that far and plans to appeal. About 900 podiatrists await the outcome.

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Workers’ Compensation Subrogation of Administrative Fees and Costs

When a worker covered by workers’ compensation makes a claim against a third party, the workers’ compensation insurance retains the right to subrogate against any recovery from that third party for all benefits paid to or on behalf of a claimant injured at work. When subrogating for more than basic medical and indemnity benefits, the Texas workers’ compensation subrogation statute provides that “the net amount recovered by a claimant in a third‑party action shall be used to reimburse the carrier for benefits, including medical benefits that have been paid for the compensable injury.” TX Labor Code § 417.002.

In fact, all 50 states provide for similar subrogation. However, none of them precisely outlines which payments or costs paid by a compensation carrier constitute “compensation” and can be recovered. The result is industry-wide confusion and an ongoing debate and argument with claimants’ attorneys over what can and can’t be included in a carrier’s lien for recovery purposes.

In addition to medical expenses, death benefits, funeral costs and/or indemnity benefits for lost wages and loss of earning capacity resulting from a compensable injury, workers’ compensation insurance carriers also expend considerable dollars for case management costs, medical bill audit fees, rehabilitation benefits, nurse case worker fees, and other similar fees. They also incur other expenses in conjunction with the handling and adjusting of workers’ compensation claims. Workers’ compensation carriers typically assert, of course, that, they are entitled to reimbursement for such expenditures when it recovers its workers’ compensation lien. Injured workers and their attorneys disagree.

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