Cox Health Systems v. Division of Workers' Compensation of the Department of Labor & Industrial Relations

190 S.W.3d 623, 2006 Mo. App. LEXIS 629, 2006 WL 1222791
CourtMissouri Court of Appeals
DecidedMay 9, 2006
DocketWD 65530
StatusPublished
Cited by5 cases

This text of 190 S.W.3d 623 (Cox Health Systems v. Division of Workers' Compensation of the Department of Labor & Industrial Relations) is published on Counsel Stack Legal Research, covering Missouri Court of Appeals primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Cox Health Systems v. Division of Workers' Compensation of the Department of Labor & Industrial Relations, 190 S.W.3d 623, 2006 Mo. App. LEXIS 629, 2006 WL 1222791 (Mo. Ct. App. 2006).

Opinion

*625 VICTOR C. HOWARD, Judge.

The Division of Workers’ Compensation (“Division”) appeals from a writ of mandamus ordering it to consider certain medical fee dispute applications filed with the Division by Cox Health Systems (“Cox”). The Division’s sole point on appeal is that the trial court erred in issuing its writ of mandamus ordering the Division to consider Cox’s medical fee dispute applications identified in trial exhibits A, B, and C because its judgment erroneously declares and applies the law in that section 287.140 1 and 8 CSR 50-2.030 establish procedural requirements — including time limitations — for applications to be submitted, and the Division properly rejected Cox’s applications, which were untimely.

We affirm.

Factual and Procedural Background

This case is a dispute over the operation of sections 287.140 and 8 CSR 50-2.030, which govern medical fee disputes associated with treatments compensable under the workers’ compensation system. Under section 287.140, the Division is granted jurisdiction to hear all disputes over com-pensable medical charges, and health care providers are bound by the Division’s determination as to the reasonableness of those charges. The statute also requires the Division to promulgate rules governing the procedure for hearing medical fee disputes, and the Division has done so at 8 CSR 50-2.030.

The parties state in their joint stipulation of facts that health care providers that have been authorized to provide services to an injured worker can avail themselves of the Division’s medical fee dispute hearing processes under one of two circumstances: if either (1) bills for services have not been paid, or (2) the health care provider disputes the amount paid for services by an employer or its insurance carrier. The Division refers to disputes in the former category as “applications for direct payment.” Properly filed applications for direct payment are made a part of and are heard with the underlying workers’ compensation case. The Division refers to disputes in the latter category as “applications for payment of additional reimbursement of medical fees.” Properly filed applications for payment of additional reimbursement of medical fees are heard separately from the underlying workers’ compensation case, and the employee is not a party to the proceeding.

The Division rejected numerous medical fee dispute applications filed with the Division by Cox. Cox then filed a petition for a writ of mandamus, prohibition and/or declaratory judgment with the trial court, alleging that the Division had a ministerial duty to accept and adjudicate all its medical fee disputes without regard to whether the underlying workers’ compensation case was open or closed.

Cox submitted with its petition, and the trial court admitted into the trial record, three voluminous appendices consisting of copies of returned applications falling in both of the categories described above (Exhibits A, B, and C). Four examples, denominated in counts I, II, III, and IV in Cox’s petition were stipulated to be representative of those contained in the appendices: 2

1. The M.A. application, in which an application for payment of additional reim *626 bursement of medical fees, alleging that no payment had been made, was returned to Cox because the underlying workers’ compensation case had been settled/dismissed.

2. The M.B. application, in which an application for payment of additional reimbursement of medical fees, alleging that only partial payment had been made, was returned to Cox because the underlying workers’ compensation case had been closed.

3. The C.B. application, in which an application for payment of additional reimbursement of medical fees, alleging that only partial payment had been made, was returned to Cox because the underlying workers’ compensation case was closed and the statute of limitations had run; and

4. The D.M. application, in which an application for direct payment, alleging that no payment had been made, was returned to Cox because the underlying workers’ compensation case was settled/dismissed.

As indicated by the above examples, and agreed to by the parties in their joint stipulation of facts, the Division has returned Cox’s applications whenever (1) the employee reached a settlement with his or her employer and/or its insurer in the workers’ compensation claim prior to Cox’s application; (2) the employee’s workers’ compensation claim was dismissed or otherwise administratively closed prior to Cox’s application; and (3) the application exceeded the statute of limitations. 3

The trial court found for Cox on the issue of mandamus and issued its writ on May 13, 2005. It denied relief in the form of prohibition, and dismissed Count V (declaratory judgment) as moot. The court specifically found that the Division “has a ministerial duty to accept the Medical Fee Dispute Applications identified in trial Exhibits A, B and C and [that] the health care provider properly filed the Medical Fee Dispute Applications contained in Exhibits A, B and C.” It ordered the Division “to consider those Medical Fee Dispute Applications filed as of the stamped date contained on said documents.” The Division appeals.

Standard of Review

“Generally, mandamus is reviewed on appeal as any other non-jury civil matter.” Lewis v. Bellefontaine Habilitation Ctr., 122 S.W.3d 105, 107-08 (Mo.App. W.D.2003). We will sustain the judgment of the trial court “unless no substantial evidence exists to support it, it is against the weight of the evidence, or it erroneously declares or applies the law.” Id. at 108. “Questions of law are matters reserved for de novo review by the appellate court, and we therefore give no deference to the trial court’s judgment in such matters.” Commerce Bank, N.A. v. Blasdel, 141 S.W.3d 434, 442 (Mo.App. W.D.2004) (quoting H & B Masonry Co., Inc. v. Davis, 32 S.W.3d 120, 124 (Mo.App. E.D.2000)).

Discussion

The Division’s sole point on appeal is that the trial court erred in issuing its writ of mandamus ordering the Division to consider Cox’s medical fee dispute applications identified in trial exhibits A, B, and C because its judgment erroneously declares and applies the law in that section 287.140 and 8 CSR 50-2.030 establish procedural requirements — including time limita *627 tions — for applications to be submitted, and the Division properly rejected Cox’s applications, which were untimely.

“Mandamus is a discretionary writ, and there is no right to have the writ issued.” State ex rel. Mo. Growth Ass’n v. State Tax Comm’n, 998 S.W.2d 786, 788 (Mo. banc 1999).

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190 S.W.3d 623, 2006 Mo. App. LEXIS 629, 2006 WL 1222791, Counsel Stack Legal Research, https://law.counselstack.com/opinion/cox-health-systems-v-division-of-workers-compensation-of-the-department-moctapp-2006.