BEUTLER ENG. CHIRO. CLIN. v. Mermentau Rice

931 So. 2d 553, 2006 WL 1472826
CourtLouisiana Court of Appeal
DecidedMay 31, 2006
Docket2005-942
StatusPublished
Cited by26 cases

This text of 931 So. 2d 553 (BEUTLER ENG. CHIRO. CLIN. v. Mermentau Rice) is published on Counsel Stack Legal Research, covering Louisiana Court of Appeal primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
BEUTLER ENG. CHIRO. CLIN. v. Mermentau Rice, 931 So. 2d 553, 2006 WL 1472826 (La. Ct. App. 2006).

Opinion

931 So.2d 553 (2006)

BEUTLER ENGLAND CHIROPRACTIC CLINIC (Marie Kershaw)
v.
MERMENTAU RICE, INC., et al.

No. 2005-942.

Court of Appeal of Louisiana, Third Circuit.

May 31, 2006.

*554 Thomas A. Filo, Cox, Cox, Filo, Camel & Wilson, L.L.P., Lake Charles, LA, for Plaintiff/Appellant, Beutler England Chiropractic Clinic.

Janice B. Unland, Rabalais, Unland & Lorio, Covington, LA, for Defendants/Appellees, Mermentau Rice, Inc. and Louisiana Commerce and Trade Association Self-Insurers' Fund.

Paul D. Gibson, Gibson-Gruenert, L.L.P., Lafayette, LA, for Defendant/Appellee, MED-COMP, USA.

Court composed of ULYSSES GENE THIBODEAUX, Chief Judge, SYLVIA R. COOKS, JOHN D. SAUNDERS, OSWALD A. DECUIR, JIMMIE C. PETERS, MARC T. AMY, MICHAEL G. SULLIVAN, GLENN B. GREMILLION, ELIZABETH A. PICKETT, BILLY H. EZELL, J. DAVID PAINTER, and JAMES T. GENOVESE, Judges.

GENOVESE, Judge.

This court has agreed to accept this case for hearing en banc for the purpose of determining whether the Office of Workers' Compensation has subject matter jurisdiction to consider a claim filed by a healthcare provider against an employer and its insurer over a fee reduction pursuant to a preferred provider organization agreement. In this case, the workers' compensation judge granted Defendants' exceptions of lack of subject matter jurisdiction, and Plaintiff appealed. For the following reasons, we reverse and remand.

FACTS

Between May 8, 2002 and July 12, 2002, Marie Kershaw (Kershaw) was treated for a work-related injury at the Beutler England Chiropractic Clinic (Beutler Clinic), Plaintiff herein, while working for Mermentau Rice, Inc. (Mermentau Rice), Defendant herein. Mermentau Rice was insured by Defendant, Louisiana Commerce and Trade Association Self-Insurers' Fund (LCTA), for the workers' compensation claims of its employees. LCTA contracted with National Loss Control Management, Inc. (NLCM) to be its agent and third-party administrator for its workers' compensation claims.

Prior to providing medical treatment to Kershaw, Beutler Clinic had entered into a preferred provider organization contract (PPO) with an entity named MED-COMP, USA (MED-COMP), which has been made a third-party defendant herein, whereby Beutler Clinic agreed to a reduction or discount in medical treatment charges for its workers' compensation patients in exchange for its inclusion in the PPO network established by MED-COMP. MED-COMP had previously contracted with NLCM whereby MED-COMP agreed to reduce or discount the medical treatment charges of its network of PPOs in exchange for a fee.

Not having been paid in full for the services it rendered, Beutler Clinic, on February 17, 2003, filed a claim against Mermentau Rice and LCTA with the Office of Workers' Compensation (OWC) to recover for underpayment of Kershaw's workers' compensation medical bills pursuant to La.R.S. 23:1203 and La.R.S. 23:1034.2, and for penalties and attorney fees pursuant to La.R.S. 23:1201(F)(4). Mermentau Rice and LCTA answered Beutler Clinic's claim, asserting that they *555 were entitled to the discount based on the contracts between the various parties.

On November 3, 2003, Kershaw agreed to a full and final lump sum settlement of her workers' compensation claim and released Mermentau Rice, LCTA, and NLCM. After various unrelated legal proceedings, Mermentau Rice and LCTA filed separate exceptions of lack of subject matter jurisdiction with the OWC, which were granted by the workers' compensation judge (WCJ) on May 25, 2005. Beutler Clinic then filed the present appeal.

ISSUES

The following issues are presented by Beutler Clinic for review:

1. Whether the Office of Workers' Compensation possesses subject matter jurisdiction over the claim asserted by Beutler Clinic for underpaid workers' compensation benefits.
2. Whether the Office of Workers' Compensation possesses subject matter jurisdiction over the claim asserted by Beutler Clinic for penalties and attorney fees under the Louisiana Workers' Compensation Act.
3. Whether Marie Kershaw's prior settlement divested the Office of Workers' Compensation of subject matter jurisdiction over this claim brought by Beutler Clinic.

LAW AND ARGUMENT

This case is one of many filed by various healthcare providers with the OWC, seeking to recover alleged underpayment of medical bills incurred as a result of treatment for work-related injuries. The initial issue to be decided is subject matter jurisdiction, i.e., which judge (WCJ or district judge) has the legal authority to hear this type of case. The ultimate issue to be decided is the validity of the PPO contract in light of the mandates of the Louisiana Workers' Compensation Act. We conclude that the OWC does have subject matter jurisdiction over this contractual litigation.

Louisiana Constitution Article 5, § 16 provides, in pertinent part, as follows:

Section 16. (A) Original Jurisdiction. (1) Except as otherwise authorized by this constitution or except as heretofore or hereafter provided by law for administrative agency determinations in worker[s'] compensation matters, a district court shall have original jurisdiction of all civil and criminal matters. (2) It shall have exclusive original jurisdiction of felony cases and of cases involving title to immovable property, except as provided in (3) below; the right to office or other public position; civil or political right; probate and succession matters; except for administrative agency determination provided for in (1) above, the state, a political corporation, or political subdivisions, or a succession, as a defendant; and the appointment of receivers or liquidators for corporations or partnerships. (3) The legislature may provide by law that a family court has jurisdiction of cases involving title to movable and immovable property when those cases relate to the partition of community property and the settlement of claims arising from matrimonial regimes when such action arises as a result of divorce or annulment of marriage.

The above-cited constitutional provision grants original jurisdiction to district courts over all civil and criminal matters, except as otherwise provided in the constitution, and except as "provided by law for administrative agency determinations in worker[s'] compensation matters," which is set forth in Louisiana Revised Statutes Title 23 (emphasis added). Therefore, *556 Louisiana Revised Statutes Title 23 is a statutory exception to the general rule set forth in the Louisiana Constitution granting district courts original jurisdiction.

The OWC is a tribunal of limited jurisdiction. Louisiana Revised Statutes 23:1310.3(E), prior to its amendment effective August 15, 2005, set forth the jurisdictional limits as follows:

E. Except as otherwise provided by R.S. 23:1101(D) and 1378(E), the workers' compensation judge shall be vested with original, exclusive jurisdiction over all claims or disputes arising out of this Chapter, including but not limited to workers' compensation insurance coverage disputes, employer demands for recovery for overpayment of benefits, the determination and recognition of employer credits as provided for in this Chapter, and cross-claims between employers or workers' compensation insurers for indemnification or contribution.

Our supreme court in Sampson v. Wendy's Management, Inc., 593 So.2d 336, 339 (La.1992), has examined the question of subject matter jurisdiction of the OWC, stating:

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Bluebook (online)
931 So. 2d 553, 2006 WL 1472826, Counsel Stack Legal Research, https://law.counselstack.com/opinion/beutler-eng-chiro-clin-v-mermentau-rice-lactapp-2006.