STATE OF LOUISIANA COURT OF APPEAL, THIRD CIRCUIT
07-1282
DR. FAYEZ K. SHAMIEH (RUDOLPH JACKSON)
VERSUS
LIQUID TRANSPORT CORP., ET AL.
**********
APPEAL FROM THE OFFICE OF WORKERS' COMPENSATION - # 3 PARISH OF CALCASIEU, NO. 05-04552 AARON FRANK MCGEE, WORKERS COMPENSATION JUDGE
ELIZABETH A. PICKETT JUDGE
Court composed of Glenn B. Gremillion, Elizabeth A. Pickett, and J. David Painter, Judges.
REVERSED AND REMANDED.
Thomas Allen Filo Cox, Cox, & Filo 723 Broad Street Lake Charles, LA 70601 Counsel for Secondary Plaintiff/Appellant: Dr. Fayez K. Shamieh
Henry Clay Ward III Attorney at Law 1111 Ryan St. Lake Charles, LA 70601 Counsel for Defendant/Appellant: Liquid Transport Corp. and Great West Casualty Company Perry R. Staub Jr. Mark VanHorn Larry E. Demmons Taggart, Morton, Ogden, Staub & O’Brien, L.L.C. Counsel for Intervenor: CCN Managed Care, Inc.
Judy Y. Barrasso Stephen L. Miles Edward R. Wicker Jr. Barrasso, Usdin, Kupperman 909 Poydras St., Suite #2400 New Orleans, LA 70112 Counsel for Other—Amicus for CCN : Liberty Mutual Insurance Co. Helmsman Management Services Co. Employers Insurance of Wausau PICKETT, Judge.
Both appeals before this court, 07-1159 and 07-1282, come from the same
proceedings, 05-4552, in the Office of Workers’ Compensation (OWC). In appeal
07-1159, the defendants, Liquid Transport Corporation and Great West Casualty
Company, appeal a judgment from the OWC ordering the defendants to pay the
plaintiff, Dr. Fayez Shamieh, $122.50 in under-payment on a medical bill for the
plaintiff’s treatment of Rudolph Jackson, a workers’ compensation claimant. The
OWC also awarded Dr. Shamieh $4,000.00 in penalties ($2,000.00 for under-payment
and $2,000.00 for late payment) and $3,950.00 in attorney’s fees. The plaintiff, Dr.
Shamieh, also appeals seeking additional attorney’s for the work necessitated by this
appeal. In appeal 07-1282, Community Care Network, Inc. (CCN), appeals a
judgement of the WCJ denying its petition to intervene. We reverse the judgment of
the Workers’ Compensation Judge (WCJ), on CCN’s petition to intervene, nullify the
judgment signed July 25, 2007 (in appeal 07-1159), and remand the case for
additional proceedings consistent with this opinion. We defer consideration of the
plaintiff’s request for additional attorney’s fees.
FACTS
The plaintiff, Dr. Shamieh, sought to recover the difference between what he
was paid for his services to a patient, a workers’ compensation claimant, under a
Preferred Provider Organization (PPO) agreement and what the workers’
compensation schedule of payments allowed. Dr. Shamieh is a member of the Lake
Charles Physicians Hospital Organization (PHO). The PHO entered into a PPO
contract with the intervenor/appellant CCN. In order to have claims(bills) processed
1 and paid, CCN, either directly or indirectly, entered into contracts with Reny Co.,
Medata Inc., and with one of the original defendants, Great Western Casualty Co.
The contract between CCN and PHO states in pertinent part as follows:
1. DEFINITIONS
1.01 “Beneficiary” or “Claimant” is a person as defined in the
applicable Insuring Agreement who may be entitled to
Health Care Services or Benefits.
1.02 “Insuring Agreement” is the contract, certificate, policy,
plan document, or any other legally enforceable instrument
issued or sponsored by a Payer under which a Beneficiary
or Claimant may be entitled to or receive Health Care
Services or Benefits.
1.03 “Health Care Services or Benefits” shall be any and all
covered medical services or benefits for such services
rendered or provided to a Beneficiary or Claimant under an
Insuring Agreement.
1.04 “Reimbursement Amounts” are the amounts payable to
Provider for Health Care Services or Benefits rendered or
provided to a Beneficiary or Claimant pursuant to Payer
Agreements between CCN and the respective Payors. Such
2 Reimbursement Amounts shall be established solely by
CCN and Payers as specified in Exhibit A attached hereto
and incorporated herein or as established by any state
regulatory agency, whichever is less. Providers shall not
individually or collectively with other providers determine
or establish such Reimbursement Amounts.
1.05 “Payor” is an employer, insurance carrier, claims
administrator, health care service plan, trust, nonprofit
facility service plan, any governmental unit or any other
entity which has an obligation to provide Health Care
Services or Benefits to a Beneficiary or Claimant.
1.06 “Payor Agreement” is an instrument between a Payor and
CCN or its authorized representative which provides for
CCN providers, including Provider pursuant to this
Agreement, to render Health Care Services or Benefits at
Reimbursement Amounts determined and established by
CCN and such Payor.
1.07 “Provider” is the provider group composed of members
listed in Exhibit B, attached hereto, and incorporated
herein.
3 ....
2. HEALTH CARE SERVICES OR BENEFITS
2.01 Provider hereby agrees to provide Health Care Services or
Benefits to Beneficiaries or Claimants as set forth in
Beneficiary Agreements, at the Reimbursement Amounts
determined and established by CCN through Payer
Agreements with Payers, which Payer Agreements are
incorporated herein by reference. Such Reimbursement
Amounts are set forth in Exhibit A attached hereto and
incorporated herein.
2.02 Provider agrees to accept the Reimbursement Amounts as
payment in full for Health Care Services or Benefits
rendered or provided, and not to seek additional payments
or compensation from Beneficiaries or Claimants unless
required or permitted to do so by the applicable Payer
Agreement. The foregoing restriction shall not apply to
deductibles and co-payments which may be collected by
Provider in accordance with the provisions of the
applicable Insuring Agreement, nor to services or benefits
rendered to Beneficiaries or Claimants which are not
covered by the applicable Insuring Agreement.
4 ....
4. AUTHORIZATION TO CONTRACT
4.01 Provider hereby specifically authorizes CCN to act on its
behalf to contract for the provision of Health Care Services
or Benefits at Reimbursement Amounts as set forth on
Exhibit A.
4.02 Provider further authorizes CON, if applicable under the
respective Payor Agreement, to coordinate and transmit
billings to Payors for payment, on behalf of Provider.
....
6. COVENANTS OF CCN
CCN covenants and agrees to The following:
6.01 To accept sole responsibility for filing reports, obtaining
approvals and complying with applicable laws and
regulations of state, federal and other regulatory agencies
having jurisdiction over CCN, provided however, that
Provider agrees to cooperate by providing CCN with any
5 information and assistance reasonably required in
connection therewith;
Even though CCN was a party to the contract with PHO, CCN was not
originally a party in this suit. The record, i.e., testimony and documentary, indicates
that CCN sought to intervene on more than one occasion. CCN’s last attempt to
intervene, a written motion to intervene, filed June 19, 2007, the morning of the
hearing, was denied.
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STATE OF LOUISIANA COURT OF APPEAL, THIRD CIRCUIT
07-1282
DR. FAYEZ K. SHAMIEH (RUDOLPH JACKSON)
VERSUS
LIQUID TRANSPORT CORP., ET AL.
**********
APPEAL FROM THE OFFICE OF WORKERS' COMPENSATION - # 3 PARISH OF CALCASIEU, NO. 05-04552 AARON FRANK MCGEE, WORKERS COMPENSATION JUDGE
ELIZABETH A. PICKETT JUDGE
Court composed of Glenn B. Gremillion, Elizabeth A. Pickett, and J. David Painter, Judges.
REVERSED AND REMANDED.
Thomas Allen Filo Cox, Cox, & Filo 723 Broad Street Lake Charles, LA 70601 Counsel for Secondary Plaintiff/Appellant: Dr. Fayez K. Shamieh
Henry Clay Ward III Attorney at Law 1111 Ryan St. Lake Charles, LA 70601 Counsel for Defendant/Appellant: Liquid Transport Corp. and Great West Casualty Company Perry R. Staub Jr. Mark VanHorn Larry E. Demmons Taggart, Morton, Ogden, Staub & O’Brien, L.L.C. Counsel for Intervenor: CCN Managed Care, Inc.
Judy Y. Barrasso Stephen L. Miles Edward R. Wicker Jr. Barrasso, Usdin, Kupperman 909 Poydras St., Suite #2400 New Orleans, LA 70112 Counsel for Other—Amicus for CCN : Liberty Mutual Insurance Co. Helmsman Management Services Co. Employers Insurance of Wausau PICKETT, Judge.
Both appeals before this court, 07-1159 and 07-1282, come from the same
proceedings, 05-4552, in the Office of Workers’ Compensation (OWC). In appeal
07-1159, the defendants, Liquid Transport Corporation and Great West Casualty
Company, appeal a judgment from the OWC ordering the defendants to pay the
plaintiff, Dr. Fayez Shamieh, $122.50 in under-payment on a medical bill for the
plaintiff’s treatment of Rudolph Jackson, a workers’ compensation claimant. The
OWC also awarded Dr. Shamieh $4,000.00 in penalties ($2,000.00 for under-payment
and $2,000.00 for late payment) and $3,950.00 in attorney’s fees. The plaintiff, Dr.
Shamieh, also appeals seeking additional attorney’s for the work necessitated by this
appeal. In appeal 07-1282, Community Care Network, Inc. (CCN), appeals a
judgement of the WCJ denying its petition to intervene. We reverse the judgment of
the Workers’ Compensation Judge (WCJ), on CCN’s petition to intervene, nullify the
judgment signed July 25, 2007 (in appeal 07-1159), and remand the case for
additional proceedings consistent with this opinion. We defer consideration of the
plaintiff’s request for additional attorney’s fees.
FACTS
The plaintiff, Dr. Shamieh, sought to recover the difference between what he
was paid for his services to a patient, a workers’ compensation claimant, under a
Preferred Provider Organization (PPO) agreement and what the workers’
compensation schedule of payments allowed. Dr. Shamieh is a member of the Lake
Charles Physicians Hospital Organization (PHO). The PHO entered into a PPO
contract with the intervenor/appellant CCN. In order to have claims(bills) processed
1 and paid, CCN, either directly or indirectly, entered into contracts with Reny Co.,
Medata Inc., and with one of the original defendants, Great Western Casualty Co.
The contract between CCN and PHO states in pertinent part as follows:
1. DEFINITIONS
1.01 “Beneficiary” or “Claimant” is a person as defined in the
applicable Insuring Agreement who may be entitled to
Health Care Services or Benefits.
1.02 “Insuring Agreement” is the contract, certificate, policy,
plan document, or any other legally enforceable instrument
issued or sponsored by a Payer under which a Beneficiary
or Claimant may be entitled to or receive Health Care
Services or Benefits.
1.03 “Health Care Services or Benefits” shall be any and all
covered medical services or benefits for such services
rendered or provided to a Beneficiary or Claimant under an
Insuring Agreement.
1.04 “Reimbursement Amounts” are the amounts payable to
Provider for Health Care Services or Benefits rendered or
provided to a Beneficiary or Claimant pursuant to Payer
Agreements between CCN and the respective Payors. Such
2 Reimbursement Amounts shall be established solely by
CCN and Payers as specified in Exhibit A attached hereto
and incorporated herein or as established by any state
regulatory agency, whichever is less. Providers shall not
individually or collectively with other providers determine
or establish such Reimbursement Amounts.
1.05 “Payor” is an employer, insurance carrier, claims
administrator, health care service plan, trust, nonprofit
facility service plan, any governmental unit or any other
entity which has an obligation to provide Health Care
Services or Benefits to a Beneficiary or Claimant.
1.06 “Payor Agreement” is an instrument between a Payor and
CCN or its authorized representative which provides for
CCN providers, including Provider pursuant to this
Agreement, to render Health Care Services or Benefits at
Reimbursement Amounts determined and established by
CCN and such Payor.
1.07 “Provider” is the provider group composed of members
listed in Exhibit B, attached hereto, and incorporated
herein.
3 ....
2. HEALTH CARE SERVICES OR BENEFITS
2.01 Provider hereby agrees to provide Health Care Services or
Benefits to Beneficiaries or Claimants as set forth in
Beneficiary Agreements, at the Reimbursement Amounts
determined and established by CCN through Payer
Agreements with Payers, which Payer Agreements are
incorporated herein by reference. Such Reimbursement
Amounts are set forth in Exhibit A attached hereto and
incorporated herein.
2.02 Provider agrees to accept the Reimbursement Amounts as
payment in full for Health Care Services or Benefits
rendered or provided, and not to seek additional payments
or compensation from Beneficiaries or Claimants unless
required or permitted to do so by the applicable Payer
Agreement. The foregoing restriction shall not apply to
deductibles and co-payments which may be collected by
Provider in accordance with the provisions of the
applicable Insuring Agreement, nor to services or benefits
rendered to Beneficiaries or Claimants which are not
covered by the applicable Insuring Agreement.
4 ....
4. AUTHORIZATION TO CONTRACT
4.01 Provider hereby specifically authorizes CCN to act on its
behalf to contract for the provision of Health Care Services
or Benefits at Reimbursement Amounts as set forth on
Exhibit A.
4.02 Provider further authorizes CON, if applicable under the
respective Payor Agreement, to coordinate and transmit
billings to Payors for payment, on behalf of Provider.
....
6. COVENANTS OF CCN
CCN covenants and agrees to The following:
6.01 To accept sole responsibility for filing reports, obtaining
approvals and complying with applicable laws and
regulations of state, federal and other regulatory agencies
having jurisdiction over CCN, provided however, that
Provider agrees to cooperate by providing CCN with any
5 information and assistance reasonably required in
connection therewith;
Even though CCN was a party to the contract with PHO, CCN was not
originally a party in this suit. The record, i.e., testimony and documentary, indicates
that CCN sought to intervene on more than one occasion. CCN’s last attempt to
intervene, a written motion to intervene, filed June 19, 2007, the morning of the
hearing, was denied. That action by the WCJ led to the filing of appeal 07-1282
which makes up part of this case.
LAW AND DISCUSSION
The linchpin of this appeal is the determination of whether CCN is an
indispensable party to this litigation. Louisiana Code of Civil Procedure Article 641
provides as follows (emphasis ours):
A person shall be joined as a party in the action when either:
(1) In his absence complete relief cannot be accorded among those already parties.
(2) He claims an interest relating to the subject matter of the action and is so situated that the adjudication of the action in his absence may either:
(a) As a practical matter, impair or impede his ability to protect that interest.
(b) Leave any of the persons already parties subject to a substantial risk of incurring multiple or inconsistent obligations.
It is well settled that the lack of an indispensable party to a proceeding in the
trial court is fatal to any adjudication of the dispute. La.Code Civ.P. art. 641; Frey
v. American Quarter Horse Ass’n, 95-157 (La.App. 5 Cir. 7/25/95), 659 So.2d 849.
A party shall be deemed necessary for just adjudication when that party’s presence
6 is absolutely necessary to protect its substantial rights. Industrial Companies, Inc.
v. Durbin, 02-0665 (La. 1/28/03), 837 So.2d 1207.
The WCJ, in his reasons for judgment, stated: “In accordance with the
aforementioned agreements and stipulation, the Court concludes that there is
connexity between the defendants in this case and the CCN contract, and Dr.
Shamieh.” He then went on to rule that “[a]ny contract which purports to reduce
medical bills below the Louisiana Workers’ Compensation Reimbursement Schedule
are invalid and unenforceable, and the same are a violation of Louisiana Workers’
Compensation Act, and the reimbursement schedule, and against public policy.” The
WCJ also stated: “The CCN contract, in and of itself, is not notice sufficient to
constitute compliance with Revised Statute 40:2201 or 2203.”
Before issuing his ruling, the WCJ denied CCN’s petition for intervention. He
then went on to rule CCN to be a party to the contracts at issue in this suit and finally
ruled adversely to CCN on the contracts. The effect of the judgment issued was to
invalidate that portion of CCN’s contract that pertained to workers’ compensation
claims. Considering the foregoing, we find that the presence of CCN was absolutely
necessary to protect its substantial rights, that the WCJ’s denial of its petition to
intervene was clear error, and that the judgment entered was, thus, a nullity.
Accordingly, for the reasons stated, the judgment of the Office of Workers’
Compensation judge rendered on June 6, 2007, denying CCN’s motion to intervene
is reversed; the judgment rendered on July 25, 2007 is annulled and set aside. The
case is remanded for further proceedings consistent with this opinion. Costs of this
appeal are deferred, pending the outcome of the case.