Travelers Insurance Co. v. Reliable Home Health Care, Inc.

857 So. 2d 1039, 2003 La. App. LEXIS 2607, 2003 WL 22244959
CourtLouisiana Court of Appeal
DecidedSeptember 17, 2003
DocketNo. 2002-CA-1762
StatusPublished
Cited by1 cases

This text of 857 So. 2d 1039 (Travelers Insurance Co. v. Reliable Home Health Care, Inc.) is published on Counsel Stack Legal Research, covering Louisiana Court of Appeal primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Travelers Insurance Co. v. Reliable Home Health Care, Inc., 857 So. 2d 1039, 2003 La. App. LEXIS 2607, 2003 WL 22244959 (La. Ct. App. 2003).

Opinions

1DAVID S. GORBATY, Judge.

In this appeal, Reliable Home Health Care, Inc. (“Rehable”) appeals the judgment of the workers’ compensation court finding that it overbilled Travelers Insurance Company (“Travelers”) for nursing care provided to Theresa Robinson. For the reasons set forth below, we affirm.

FACTS AND PROCEDURAL HISTORY

This lawsuit arises out of a billing dispute between Travelers and Rehable, who provided in-home nursing care to injured worker Theresa Robinson. Ms. Robin[1041]*1041son’s claim was settled and is not at issue here.

Reliable provided skilled nursing care on an hourly basis from 1996 through 1998 for the home health care of Theresa Robinson. Dr. Warren Gottsegen ordered “skilled nursing” care first for eight hours per day. This amount was later increased to sixteen hours per day.

The trial court found that no convincing evidence was presented that Ms. Robinson required only a Registered Nurse for her skilled nursing care. The trial | ..court further ruled that both Registered Nurse services and Licensed Practical Nurse services were appropriate skilled nursing care for Ms. Robinson, depending on the duties being performed each day. The trial court additionally held that the hourly amounts charged by Reliable were too high, and that the amounts due must be recalculated at a lower hourly rate. Finally, the trial court ruled that Travelers must be reimbursed, or given a credit for, $625,821.13, the amount Travelers had overpaid. Reliable subsequently filed this appeal.

DISCUSSION

Reliable asserts the following assignments of error:

1. The trial court erred in not awarding judgment in favor of Reliable for the “skilled nursing care” it provided to claimant, Theresa Robinson. Further, the trial court erred in ruling that no convincing evidence was presented showing an oral contract existed between Travelers and Reliable for hourly skilled nursing care at $100.00 per hour. Additionally, the trial court erred in not awarding Reliable $100.00 per hour for past skilled nursing care provided to Theresa Robinson pursuant to its agreement with appellee, Travelers.

Factual findings in workers’ compensation cases are subject to the manifest error or clearly wrong standard of review. Smith v. Louisiana Dept. of Corrections, 93-1305, p. 4 (La.2/28/94), 633 So.2d 129, 132. In applying the manifest error-elearly wrong standard, the appellate court must determine not whether the trier of fact was right or wrong, but whether the factfinder’s | ^conclusion was a reasonable one. Stobart v. State, 617 So.2d 880, 882 (La.1993). Where there are two permissible views of the evidence, a factfinder’s choice between them can never be manifestly erroneous or clearly wrong. Stobart, 617 So.2d at 882.

Reliable claimed to have a verbal contract with Travelers. The burden of proof in an action for breach of contract is on the party claiming rights under the contract. Vignette Publications, Inc. v. Harborview Enterprises, Inc., 2000-1711 (La.App. 4 Cir. 9/12/01), 799 So.2d 531. The existence of the contract and its terms must be proved by a preponderance of the evidence. Bond v. Allemand, 632 So.2d 326 (La.App. 1 Cir.1993).

Mr. David Butler, a supervisor at Travelers, testified that there was no contract or agreement between Travelers and Reliable. He stated that the only employees who had authority to enter into contracts with healthcare providers are Regional Managed Care Representatives. Mr. Butler had never spoken with Mr. Louis Age, the administrator for appellant, about his charges for services before they agreed to employ Reliable as Ms. Robinson’s healthcare provider. The adjuster handling the case did not enter into a contract with Rehable to pay a certain amount for the services being provided. Further, he testified that there is no instance of Travelers agreeing to pay more than what the fee schedule provides.

Ms. Suzanne Klein, a Travelers employee who handled Ms. Robinson’s file, cor[1042]*1042roborated Mr. Butler’s testimony that adjusters do not have the authority to 1¿enter into contracts. Ms. Klein stated that there was no indication anywhere in the file that Travelers had agreed to pay a certain amount to Reliable for their services.

Ms. Alberta Frishon Gardner, who was the first adjuster to deal with Reliable, did not have any conversation with anyone at Reliable regarding the charges that would be made by Reliable. She never agreed verbally, or in writing to pay $100 per hour for the services being rendered to Ms. Robinson.

At trial, Mr. Louis Age testified that Reliable was obligated to charge Travelers the same amount that Reliable charged Medicare for skilled nursing care. At his deposition, he indicated that the decision to charge Travelers $100 per hour was “not a decision that necessarily involved anybody.” Mr. Age stated that he contacted Travelers to verify coverage. When Ms. Gardner returned Mr. Age’s call, seeking to “verify rates,” he claims that he advised her that Reliable charged $110 per hour, and that Ms. Gardner countered, seeking $100 per hour for their services. It is this conversation that Mr. Age contends formed the basis of the verbal contract between Travelers and Reliable.

On cross-examination, Mr. Age modified his story somewhat. He speculated that Ms. Robinson might have been the first person to call and seek Reliable’s services, as opposed to her doctor calling to refer Ms. Robinson to them. He also stated that Ms. Gardner’s first contact with Reliable might not have been a conversation with him regarding their rates, but that she might have actually entered into the alleged agreement after speaking with Mr. Age’s daughter, Iyanna. He was also not entirely sure whether he actually had the alleged conversation | Kregarding rates with Ms. Gardner before Reliable began rendering treatment, or after Reliable received Travelers’ first payment. Upon reflection, he stated that he did speak with Ms. Gardner prior to Reliable rendering any treatment, but that it was an extremely short conversation.

In the case at bar, other than the testimony of Mr. Age, which he subsequently corrected, there is no evidence to support Reliable’s contention that Travelers agreed to pay $100 per hour. Further, Travelers did not tacitly agree to pay $100 per hour. A party must have full and actual knowledge of the obligation before it can agree to it. Everett v. Foxwood Properties, 584 So.2d 1233 (La.App. 2 Cir.1991). In this matter, Travelers was unaware of the billing error until Marianna Hixon pointed it out to them. Once Travelers was aware, it immediately took corrective action. As such, we find that there was sufficient evidence to support the ruling of the trial court. This assignment of error is without merit.

2. The trial court erred in ruling that in 1990, the reasonable and customary charge for a Licensed Practical Nurse (“LPN”) was $30.00 per hour and $40.00 for a Registered Nurse (“RN”), and that amount is what should have been billed and received by Reliable for the skilled nursing care provided to claimant.

On the second day of trial, Mr. Butler detailed the process of submitting and releasing bills for payment in Travelers’ office. He explained that had the proper code been submitted when Reliable sought payment for Ms. Robinson’s treatment, the computer would have priced the bill at $44/hour.

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Bluebook (online)
857 So. 2d 1039, 2003 La. App. LEXIS 2607, 2003 WL 22244959, Counsel Stack Legal Research, https://law.counselstack.com/opinion/travelers-insurance-co-v-reliable-home-health-care-inc-lactapp-2003.