Beutler England Clinic v. MARKET BASKET

919 So. 2d 816, 2005 WL 3579352
CourtLouisiana Court of Appeal
DecidedDecember 30, 2005
Docket05-952
StatusPublished
Cited by18 cases

This text of 919 So. 2d 816 (Beutler England Clinic v. MARKET BASKET) 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 England Clinic v. MARKET BASKET, 919 So. 2d 816, 2005 WL 3579352 (La. Ct. App. 2005).

Opinion

919 So.2d 816 (2005)

BEUTLER ENGLAND CLINIC (Cheryl Brown)
v.
MARKET BASKET NO. 27.

No. 05-952.

Court of Appeal of Louisiana, Third Circuit.

December 30, 2005.
Rehearing Denied February 15, 2006.

Thomas A. Filo, Cox, Cox, Filo, Camel & Wilson, L.L.P., Lake Charles, Counsel for Plaintiffs/Appellants: Beutler England Chiropractic Clinic, Cheryl Brown.

*817 Rusty J. Savoie, Adams and Reese, LLP, Baton Rouge, Counsel for Defendant/Appellee: Market Basket No. 27.

John S. Bradford, William B. Monk, Stockwell, Sievert, Viccellio, Clements & Shaddock, L.L.P., Lake Charles, Counsel for: Southwest Louisiana Hospital Association, Amicus Curiae.

Floyd J. Falcon, Jr., Avant & Falcon, Baton Rouge, Counsel for: Louisiana American Federation of Labor and Congress of Industrial Organizations, Amicus Curiae.

John E. Galloway, Galloway, Johnson, Tompkins, Burr & Smith, Livingston, Counsel for: F.A. Richard & Associates, Inc., Amicus Curiae.

Stephen W. Glusman, Glusman, Broyles & Glusman, LLC, Baton Rouge, Counsel for: Louisiana Association of Self Insured Employers, Amicus Curiae Louisiana Association of Business and Industry, Amicus Curiae.

Denis Paul Juge, Juge, Napolitano, Guilbeau, Ruli, Frieman & Whitely, American Plaza, Building D, Baton Rouge, Counsel for: Cambridge Integrated Services, Amicus Curiae Crawford & Company, Amicus Curiae.

Christopher R. Philipp, Lafayette, Counsel for: Louisiana Municipal Risk Management, Amicus Curiae.

Edward R. Wicker, Jr., Barrasso, Usdin, Kupperman, Freeman & Sarver, L.L.C., New Orleans, Counsel for: Helmsman Management Services Company, Amicus Curiae Employers Insurance of Wausau, Amicus Curiae Liberty Mutual Insurance Company, Amicus Curiae.

Perry R. Staub, Jr., Mark E. Van Horn, Larry E. Demmons, Taggart, Morton, Ogden, Staub, Rougelot & O'Brien, L.L.C., New Orleans, Counsel for: First Health Group Corporation, Amicus Curiae.

Cory R. Cahn, Entergy Services, Inc., New Orleans, Counsel for: Entergy Services, Inc., Amicus Curiae.

Court composed of JIMMIE C. PETERS, MARC T. AMY, and ELIZABETH A. PICKETT, Judges.

AMY, Judge.

Beutler England Chiropractic Clinic filed a disputed claim form in workers' compensation court, alleging that services billed pursuant to the workers' compensation fee schedule were not fully paid by an employer's insurer. It seeks payment of the full amount billed. The defendants contend that Beutler England contracted to receive only 85% of that permitted under the fee schedule. The workers' compensation judge granted the employer's exception of lack of subject matter jurisdiction, finding that the matter did not arise out of the workers' compensation statutes. Beutler England appeals. For the following reasons, we affirm.

Factual and Procedural Background

This case involves a determination of whether the workers' compensation court has jurisdiction to consider a claim filed by a health care provider against an employer and insurer for reductions made pursuant to a preferred provider organization agreement, or PPO.

The record establishes that Cheryl Brown was employed by Market Basket # 27 at the time she sustained a work-related injury. She sought treatment from Dr. Carol Beutler, a chiropractor and partner of the Beutler England Clinic.[1]*818 According to Dr. Beutler, Ms. Brown reported "AIG" as her insurance provider. The clinic billed for the services rendered pursuant to the Louisiana Fee Schedule. AIG Claim Services, Inc. paid eighty-five percent of the fee charged.

Beutler England filed the disputed claim form initiating this matter in May 2004. The disputed claim form named Market Basket # 27 as Ms. Brown's employer and "AIG Claim Service" as Ms. Brown's insurer. The form reflects Beutler England's complaint as "Underpayment of medical bills; penalties and attorney fees for arbitrary and capricious handling of this claim."

The defendants, Market Basket # 27 and AIG Claim Services, Inc., assert that the reduced reimbursement rate is applicable in this case since Beutler England is part of the First Health Preferred Provider Organization. The record reflects that, in 1998, the predecessor of Beutler England joined the First Health Preferred Provider Organization Network. The agreement memorializing that agreement, entitled "First Health Preferred Provider Agreement," was entered into the record. As pointed out by the defendants, a portion of the agreement relates to workers' compensation claims and references a reduced rate for workers' compensation claims.[2] The defendants also point to an agreement between First Health and AIG Claim Services, Inc. whereby First Health permitted AIG Claim Services, Inc., to access the First Health PPO network.

The defendants filed an exception of lack of subject matter jurisdiction. They argued that Beutler England's claim is not merely a fee dispute, but requires consideration of the legality of two related PPO contracts. The defendants asserted that consideration of this type of contractual claim has not been specifically delineated in a grant of authority to the Office of Workers' Compensation. Following a hearing, at which time the workers' compensation judge also heard evidence related to the merits of the suit, the workers' compensation judge granted the exception.[3]

*819 Beutler England appeals, assigning the following as error in its brief to this court:

1. The Office of Workers' Compensation Hearing Officer erred in finding that it lacked subject matter jurisdiction over the claims asserted by BEUTLER ENGLAND CHIROPRACTIC CLINIC ("BEUTLER ENGLAND") for underpayment of workers' compensation medical bills pursuant to LSA-R.S. 23:1203 and LSA-R.S. 23:1034.2 and for penalties and attorney fees pursuant to LSA-R.S. 23:1201(F)(4).
2. The Office of Workers' Compensation Hearing Officer erred in failing to enter judgment after full and complete trial on the merits in favor of claimant, BEUTLER ENGLAND, for the amounts discounted below both the actual charges and the Louisiana Fee Schedule for services rendered to workers' compensation patient, Cheryl Brown.
3. The Office of Workers' Compensation Hearing Officer erred in failing to enter judgment after full and complete trial on the merits in favor of claimant, BEUTLER ENGLAND, for statutory penalties and reasonable attorney fees under LSA-R.S. 23:1201(F)(4).

We note that, in addition to the briefs of the parties, a number of amicus curiae briefs have been filed with this court addressing the merits of the claim and advocating their respective positions.

Discussion

Subject Matter Jurisdiction

Beutler England frames the question as one of a fee dispute between it as the health care provider and the employer/insurer, asserting in its brief to this court that: "Nowhere in the 1008 claim form does claimant seek redress for anything other than underpayment of medical bills and penalties and attorney fees associated therewith." Beutler England denies that it is seeking to have contracts rescinded or that it is seeking any relief provided by the Louisiana Civil Code. Instead, it contends that its cause of action arises solely under La.R.S. 23:1203 and its pursuit of penalties and attorney's fees is controlled exclusively by La.R.S. 23:1201(F)(4). Thus, Beutler England contends, the action is within the jurisdiction of the Office of Workers' Compensation pursuant to La.R.S. 23:1034.2. We conclude that the issues are not so simple.

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Cite This Page — Counsel Stack

Bluebook (online)
919 So. 2d 816, 2005 WL 3579352, Counsel Stack Legal Research, https://law.counselstack.com/opinion/beutler-england-clinic-v-market-basket-lactapp-2005.