State Automobile Mutual Insurance Co. v. Hurley

31 S.W.3d 562, 2000 Tenn. LEXIS 698
CourtTennessee Supreme Court
DecidedAugust 31, 2000
StatusPublished
Cited by7 cases

This text of 31 S.W.3d 562 (State Automobile Mutual Insurance Co. v. Hurley) is published on Counsel Stack Legal Research, covering Tennessee Supreme Court primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
State Automobile Mutual Insurance Co. v. Hurley, 31 S.W.3d 562, 2000 Tenn. LEXIS 698 (Tenn. 2000).

Opinion

MEMORANDUM OPINION

W. MICHAEL MALOAN, Sp. J.,

delivered the opinion of the court, in which

JANICE M. HOLDER, J., and HENRY D. BELL, Sp. J., joined.

This workers’ compensation appeal has been referred to the Special Workers’ Compensation Appeals Panel of the Supreme Court in accordance with Tenn. Code Ann. § 50-6-225(e)(3) for hearing and reporting to the Supreme Court of findings of fact and conclusions of law. The plaintiff, State Automobile Mutual Insurance Company (State Auto), appeals the judgment of the Circuit Court of Shelby County which ordered State Auto to pay to the defendant, Natalie Hurley (Hurley), $28,873.91 being the total of her medical bills. For the reasons stated in the opinion, we find the trial court erred and reverse the judgment of the trial court.

The relevant facts are not in dispute. State Auto filed suit to determine to what, if any, workers’ compensation benefits Hurley would be entitled as a result of a July 24, 1998, automobile accident. State Auto denied Hurley’s claim and did not pay any benefits. Hurley filed a counterclaim for benefits. At trial, the parties stipulated that Hurley’s medical bills of $28,873.91 were reasonable and necessary. Hurley individually paid a portion of her medical bills. The balance of $26,141.19 was submitted by her health care providers to her health insurance carrier, which paid $8,174.88 in full settlement of the total billed. On May 10, 1999, the trial court found Hurley’s injury to be compensable and awarded permanent partial disability benefits of forty percent (40%) to the right arm. The trial court granted Hurley’s post-trial motion and ordered State Auto to pay to Hurley $28,873.91, the total of her medical bills. State Auto appeals only that part of the trial court’s order requiring it to pay Hurley the total of her medical bills and allowing Hurley to retain the difference between the amount the health care providers billed and the amount they [564]*564accepted from her health insurance carrier. Hurley filed a motion for this panel to .find this appeal to be frivolous and to award her damages.

ANALYSIS

The scope of review of issues of fact is de novo upon the record of the trial court, accompanied by a presumption of correctness of the findings, unless the preponderance of the evidence is otherwise. Tenn.Code Ann. § 50 — 6—225(e)(2), Lollar v. Wal-Mart Stores, Inc., 767 S.W.2d 143 (Tenn.1989). Questions of law are reviewed de novo with no presumption of correctness. Cunningham v. Shelton Sec. Services, Inc., 958 S.W.2d 338, 340 (Tenn.1997). The sole issue presented for review is whether the trial court erred in ordering the employer to pay medical expenses directly to the employee rather than the health care providers.

On appeal, State Auto relies on Tenn. Code Ann. § 50-6-204(a)(l) to support its argument that the trial court lacked authority to order it to pay medical expenses to Hurley. Hurley submits the following arguments to support the trial court’s order: 1) that State Auto is liable for the entire amount of Hurley’s medical bills because State Auto stipulated Hurley’s medical expenses were reasonable and necessary; ; 2) allowing State Auto to pay only the discounted medical bills would violate Tenn.Code Ann. § 50-6-114; 3) State Auto’s position is against public policy; and 4) the collateral source rule should be applied in workers’ compensation cases.

Effect of Stipulation of Medical Bills As Reasonable and Necessary

Ordinarily, in a workers’ compensation case in which compensability is accepted, the employer pays the injured employee’s medical bills directly to the approved health care provider and the employee is reimbursed for any out-of-pocket medical expenses he or she may have paid. When a claim is denied, the employee may obtain medical care at his or her own expense through a group or individual health care plan or from a government health care. If the claim is found to be compensable, the employer becomes liable for the employee’s medical expenses. In the present case, Hurley’s health insurance carrier paid $8,174.80 of a total of $26,141.19 in medical bills submitted for her care. The question is who has the legal obligation to reimburse Hurley’s health insurance carrier and to receive the corresponding benefit of the discounted medical bills?

State Auto stipulated at trial that Hurley’s medical expenses were reasonable and necessary; that State Auto is legally responsible for and will pay all medical expenses; and that State Auto will reimburse Hurley’s health insurance carrier and Hurley for any medical expenses she has paid related to her injury. Hurley insists Tenn.Code Ann. § 50-6-204(a)(l) obligates State Auto to pay all her reasonable and necessary medical expenses and, since State Auto stipulated her medical expenses of $28,873.91 were reasonable and necessary, it is liable for that amount. Hurley further states that State Auto had the opportunity to provide medical services and refused to do so, and, therefore, the total medical expenses should be paid to her to be disbursed, less her attorney’s fees.

In ordering State Auto to pay the total medical expenses to Hurley, the trial court relied on the following language in Bazner v. American States Insurance Co., 820 S.W.2d 742, 747 (Tenn.1991):

We first observe that defendant is not entitled to a set-off against its liability for medical expenses. These expenses are an obligation on its part according to the statute. Bazner, 820 S.W.2d, at 747.

The panel agrees this is a correct statement of the law. This statement, however, has no application to the present case. Bazner disallowed to the employer a set-off for money received by the employee in a companion federal tort suit. Nothing in Bazner required the employer to pay med[565]*565ical expenses directly to the employee. Thus, reliance on Bazner is misplaced.

We find this issue is controlled by the language of TenmCode Ann. § 50-6-204(a)(1) and by the Tennessee Supreme Court decision of Staggs v. National Health Corp., 924 S.W.2d 79, 81 (Tenn.1996). Tenn.Code Ann. § 50-6-204(a)(l) provides in part:

The employer or employer’s agent shall furnish free of charge to the employee such medical and surgical treatment, medicine, medical and surgical supplies, ... made reasonably necessary by accident, ... as may be reasonably required; ....

In Staggs, 924 S.W.2d at 81, the Supreme Court held as follows:

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Bluebook (online)
31 S.W.3d 562, 2000 Tenn. LEXIS 698, Counsel Stack Legal Research, https://law.counselstack.com/opinion/state-automobile-mutual-insurance-co-v-hurley-tenn-2000.