CNA Insurance Co. v. Arkansas Children's Hospital

386 S.W.3d 631, 2011 Ark. App. 671, 2011 WL 5387456, 2011 Ark. App. LEXIS 720
CourtCourt of Appeals of Arkansas
DecidedNovember 9, 2011
DocketNo. CA 10-1186
StatusPublished
Cited by2 cases

This text of 386 S.W.3d 631 (CNA Insurance Co. v. Arkansas Children's Hospital) is published on Counsel Stack Legal Research, covering Court of Appeals of Arkansas primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
CNA Insurance Co. v. Arkansas Children's Hospital, 386 S.W.3d 631, 2011 Ark. App. 671, 2011 WL 5387456, 2011 Ark. App. LEXIS 720 (Ark. Ct. App. 2011).

Opinion

LARRY D. VAUGHT, Chief Judge.

1 ]At issue in this appeal is the interpretation of Arkansas Workers’ Compensation Rule 30, which establishes the schedules of maximum allowable fees for medical services rendered to injured employees. The dispute concerns a medical bill (that exceeds $4 million dollars) submitted for reimbursement by appellee Arkansas Children’s Hospital (Children’s) to appellant CNA Insurance Company (CNA). The parties disagree about when Rule 30’s 150% multiplier for reimbursement for extraordinary services applies to the Inpatient Hospital Fee Schedule. Children’s interpretation of Rule 30 results in full reimbursement of its bill, while CNA’s interpretation results in the reduction of Children’s bill in excess of $880,000. The Arkansas Workers’ Compensation Commission found in favor of Children’s, ordering CNA to reimburse Children’s the full amount of its medical bill. On appeal, CNA argues that the Commission’s interpretation of Rule 30 is contrary to the General Assembly’s stated intent of containing workers’ compensation medical costs and should be reversed. We disagree and affirm.

|2The issue before us is one of statutory and rule interpretation. We review issues of statutory and rule construction de novo, as it is for us to decide what a statute means. Stromwall v. Van Hoose, 371 Ark. 267, 272, 265 S.W.3d 93, 98 (2007); Lewis v. Auto Parts & Tire Co., 104 Ark.App. 230, 232-33, 290 S.W.3d 37, 39 (2008). Arkansas Code Annotated section 11-9-704(c)(3) (Repl.2002) requires that we construe workers’-compensation statutes strictly. Strict construction requires that nothing be taken as intended that is not clearly expressed, and its doctrine is to use the plain meaning of the language employed. Lewis, 104 Ark.App. at 233, 290 S.W.3d at 40. The basic rule of statutory construction, to which all other interpretive guides must yield, is to give effect to the intent of the legislature. Id., 290 S.W.3d at 40. When a statute is clear, however, it is given its plain meaning, and the appellate court will not search for legislative intent; rather, that intent must be gathered from the plain meaning of the language used. Id., 290 S.W.3d at 40. A statute is ambiguous only where it is open to two or more constructions, or where it is of such obscure or doubtful meaning that reasonable minds might disagree or be uncertain as to its meaning. Id., 290 S.W.3d at 40. In considering the meaning of a statute, we construe it just as it reads, giving the words their ordinary and usually accepted meaning in common language. Id., 290 S.W.3d at 40. The statute should be construed so that no word is left void, superfluous, or insignificant; and meaning and effect must be given to every word in the statute if possible. Id., 290 S.W.3d at 40.

There are few disputed facts in this case. On November 13, 2007, the claimant Michael Driggers was seriously injured when he fell into saltwater that was 200 hundred degrees Fahrenheit. He was admitted to Children’s, the only certified burn-treatment facility in Arkansas. He survived, but he suffered severe burns to sixty percent of his body and had multiple system |sfailures during his 200 hundred-day stay that began on November 13, 2007, and ended on May 31, 2008. Children’s final bill for Driggers’s care was $4,112,753.10. Driggers’s claim was accepted as compensable by CNA, but it only paid medical expenses totaling $3,226,503.34 (leaving an unpaid balance of $886,249.76), claiming that was all it was required to pay under Rule 30.

Workers’ Compensation Rule 30 is titled the “Medical Cost Containment Program.” It was promulgated pursuant to Arkansas Code Annotated section 11-9-517.1 While broad in its scope, relevant to this case Rule 30 establishes schedules of maximum fees a health facility or health-care provider can charge for reasonable and necessary medical treatment for employees who are injured arising out of and in the course of their employment, and it establishes the procedures by which a health-care provider shall be paid. Rule 30(I)(A)(l)(b), (c).

In addition to Rule 30, the Commission promulgated the applicable fee schedule in this case — the Inpatient Hospital Fee Schedule (IHFS).2 Within the IHFS, there are two steps or “methods” for calculating medical-care-provider reimbursements. The first is the per diem method (PDM) of payment, which in most workers’ compensation cases is the total amount of | reimbursement a medical-care provider or facility would receive. The parties agree that the PDM is the first calculation to be made and that the allowable charge under the PDM is $267,600.3

The second step for calculating reimbursement within the IHFS is the stop-loss method (SLM) of payment. The SLM is defined as “an independent reimbursement factor established to ensure fair and reasonable compensation to the hospital for unusually costly services rendered during treatment to an injured worker.” Inpatient Hospital Fee Schedule (II)(C).4 The parties also agree that the SLM applies to the instant case.

The controversy herein arises from a provision of Rule 30, separate from the IHFS, that governs reimbursement to medical providers “when extraordinary services resulting from severe head injuries, major burns, and severe neurologic injuries or any injury requiring an extended period of intensive care are required.” Rule 30(I)(I)(3). In such cases, “a greater fee may be allowed up to 150% of the fee schedule.” Id. The parties do not dispute that Children’s rendered extraordinary services to Driggers and that the 150% multiplier applies. The issue is whether the 150% multiplier is applied before or after the SLM calculation is made, which requires a determination of whether the SLM is part of the IHFS or independent thereof.

j aThe position of Children’s is that within the IHFS there are two required calculations (the PDM and SLM) and that the 150% multiplier is to be applied to the aggregate figure that results from adding the PDM and SLM. Under this interpretation of Rule 30, CNA would be required to pay the full amount of Children’s medical bill.5 CNA argues that Children’s interpretation ^violates the stated legislative intent of Rule 30 — to contain medical costs. CNA further argues that the SLM is a method of payment distinct from the IHFS and that the 150% multiplier should not be applied to the aggregate of the PDM and SLM, but only to the PDM. Once that calculation has been made, the SLM is calculated. According to CNA, Children’s is entitled to reimbursement of $3,226,503.84,6 which it argues greatly increases Children’s standard reimbursement but also contains medical costs per the Arkansas General Assembly’s intent.

At the administrative level, Children’s sought an opinion from the Commission’s Administrator of the Medical Cost Containment Division (MCCD), who issued an administrative review order in favor of Children’s and found that CNA was liable to Children’s for the full amount of its bill.7 CNA appealed the administrative review order to the administrative law judge (ALJ).

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Cite This Page — Counsel Stack

Bluebook (online)
386 S.W.3d 631, 2011 Ark. App. 671, 2011 WL 5387456, 2011 Ark. App. LEXIS 720, Counsel Stack Legal Research, https://law.counselstack.com/opinion/cna-insurance-co-v-arkansas-childrens-hospital-arkctapp-2011.