Pearson v. C.P. Buckner Steel Erection Co.

486 S.E.2d 723, 126 N.C. App. 745, 1997 N.C. App. LEXIS 630
CourtCourt of Appeals of North Carolina
DecidedJuly 15, 1997
DocketNo. 96-814
StatusPublished
Cited by2 cases

This text of 486 S.E.2d 723 (Pearson v. C.P. Buckner Steel Erection Co.) is published on Counsel Stack Legal Research, covering Court of Appeals of North Carolina primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Pearson v. C.P. Buckner Steel Erection Co., 486 S.E.2d 723, 126 N.C. App. 745, 1997 N.C. App. LEXIS 630 (N.C. Ct. App. 1997).

Opinions

LEWIS, Judge.

This appeal presents a question of first impression in this state: Where an employer denies liability but is later ordered to pay reasonable and necessary medical expenses under the Workers’ Compensation Act and where Medicaid has already paid a portion of those expenses, does the employer merely have to reimburse Medicaid or must it also pay those expenses authorized by the Act but not covered by Medicaid?

By opinion and award entered 7 February 1995, the Industrial Commission (“Commission”) concluded that plaintiff sustained an injury by accident arising out of and in the course of his employment with defendant-employer, C.R Buckner Steel Erection Company (“Buckner Steel”) on 4 May 1992. The Commission ordered Buckner Steel to pay plaintiff $299.67 per week in temporary total disability payments plus “all reasonable and necessary medical expenses.”

[747]*747By letter dated 6 November 1995, plaintiff’s attorney notified the Commission of a dispute relating to the extent of Buckner Steel’s liability for plaintiff’s past medical expenses. Defendants reimbursed Medicaid, which had paid a portion of plaintiff’s medical expenses while liability was being determined by the Commission, but refused to pay the medical providers any amount in excess of the Medicaid payments. The Commission treated this letter as a motion for an order to require defendants to pay the medical expenses charged, i.e. the difference between the workers’ compensation schedule and Medicaid.

Cary Health Care Center, Inc. (“Cary Health”), which had provided medical services to plaintiff, some of which were not paid by Medicaid, moved to intervene in the matter. By order dated 28 November 1995, the Commission allowed this motion.

The full Commission, citing Marshall v. Poultry Ranch, 268 N.C. 223, 150 S.E.2d 423 (1966), found and concluded that through Medicaid, “Congress intended to provide medical treatment to indigent persons but did not intend to relieve an employer of his statutory duty to provide medical treatment for his injured employees.” Therefore, the Commission ordered defendant-carrier to pay Cary Health $49,883.81 for medical treatment provided and to pay all other medical providers the difference between the Medicaid amount and the amount allowable under the Workers’ Compensation Act. Additionally, the Commission ordered defendant-carrier to pay costs and attorneys’ fees.

Defendants moved the Commission to reconsider its order, for an evidentiary hearing and, alternatively, to amend its order. These motions were denied. Defendants appeal.'

Defendants first contend that the Commission lacked subject matter jurisdiction to enter the orders at issue because they dealt with matters outside the scope of the Commission’s statutory authority, namely the application of state and federal Medicaid statutes. We disagree.

N..C. Gen. Stat. section 97-91 provides: “All questions arising under this Article if not settled by agreements of the parties interested therein, with the approval of the Commission, shall be determined by the Commission, except as otherwise herein provided.” N.C. Gen. Stat. § 97-91 (1991). The General Assembly intended that the Commission have continuing jurisdiction of all proceedings [748]*748begun before it. Butts v. Montague Bros., 208 N.C. 186, 188, 179 S.E. 799, 801 (1935). “[I]t is clothed with such implied power as is necessary to perform the duties required of it by the law which it administers.” Hogan v. Cone Mills Corp., 315 N.C. 127, 137, 337 S.E.2d 477, 483 (1985). Furthermore, this Court has recognized that “the Commission’s continuing jurisdiction over its judgments includes the power to supervise and enforce them.” Hieb v. Howell’s Child Care Center, 123 N.C. App. 61, 68, 472 S.E.2d 208, 212, disc. review denied, 345 N.C. 179, 479 S.E.2d 204 (1996). The Workers’ Compensation Act bestows on the Commission the authority to approve medical fees. N.C. Gen. Stat. § 97-90(a) (1996 Supp.).

Defendants recognize the fact that the Commission is vested with the power to approve charges for medical treatment, but argue that this case is controlled by Eller v. J & S Truck Services, 100 N.C. App. 545, 397 S.E.2d 242 (1990), disc. review denied, 328 N.C. 271, 400 S.E.2d 451-52 (1991). We disagree.

In Eller, the Commission authorized attorneys’ fees for plaintiff’s attorneys and directed them to be divided between the attorneys involved as they deemed appropriate. Eller, 100 N.C. App. at 546, 397 S.E.2d at 243. This Court held that the Commission did not have statutory authority, and therefore lacked subject matter jurisdiction, to adjudicate a dispute which later arose between the attorneys over the division of the fees. Id. at 548, 397 S.E.2d at 244.

Despite defendants’ contentions to the contrary, we conclude that Eller does not apply in the present matter. This is not a situation-in which two medical providers are arguing over how to split a sum granted by the Commission and are requesting the Commission’s involvement. Rather, in this case, plaintiff is seeking enforcement of the Commission’s earlier order awarding him reasonable and necessary medical expenses after a dispute arose over what expenses defendants must pay. G.S. 97-90 enables the Commission to approve medical expenses. The fact that the Commission was also required to interpret state and federal statutes is irrelevant. Accordingly, because the Commission was acting within its statutory mandate, we hold that it had subject matter jurisdiction to hear and decide these issues.

Defendants next argue that the Commission erred by failing to rule that federal Medicaid statutes and regulations preclude their having to pay in excess of the Medicaid amount. They argue that Congress did not intend for health care providers to receive payment through Medicaid as well as seek reimbursement from third parties [749]*749because participation in the Medicaid program is restricted to health care providers who agree to accept Medicaid as payment in full. They further argue that if contradictory state law exists, it is pre-empted by federal law.

Plaintiff and intervenor argue that North Carolina Medicaid regulations entitle health care providers to receive third party payment in addition to Medicaid. They point to N.C. Admin. Code tit. 10, r. 26K.0006(e), which provides that a provider who accepts a patient as a Medicaid patient must agree to accept Medicaid payment plus any third party payment as “payment in full.” They contend that this regulation does not conflict with any federal statutes or regulations. They also argue that public policy requires us to demand full payment of defendants. If not, they assert, employers will have an incentive to deny liability, let Medicaid pay and thereby reduce the amount owed by them to injured employees.

“Congress established the Medicaid program as Title XIX of the Social Security Act, ‘for the purpose of providing federal financial assistance to States that choose to reimburse certain costs of medical treatment for needy persons.’ ” Elliot v. N.C. Dept. of Human Resources, 115 N.C. App.

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Related

Pearson v. C. P. Buckner Steel Erection
533 S.E.2d 532 (Court of Appeals of North Carolina, 2000)
Hansen v. Crystal Ford-Mercury, Inc.
531 S.E.2d 867 (Court of Appeals of North Carolina, 2000)

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Bluebook (online)
486 S.E.2d 723, 126 N.C. App. 745, 1997 N.C. App. LEXIS 630, Counsel Stack Legal Research, https://law.counselstack.com/opinion/pearson-v-cp-buckner-steel-erection-co-ncctapp-1997.