Blythe v. University of Oklahoma

• Decision Date: 23 December 2003
• Docket Number: No. 98,371.,98,371.
• Citation: 2003 OK 115,82 P.3d 1021
• Parties: Vickie BLYTHE, Petitioner, v. The UNIVERSITY OF OKLAHOMA, Compsource Oklahoma, and The Workers' Compensation Court, Respondents.
• Court: Oklahoma Supreme Court

82 P.3d 1021

2003 OK 115

Vickie BLYTHE, Petitioner, v. The UNIVERSITY OF OKLAHOMA, Compsource Oklahoma, and The Workers' Compensation Court, Respondents.

No. 98,371.

Supreme Court of Oklahoma.

December 23, 2003.

Jack F. Tracy of Purcell, OK, for Petitioner/Claimant.

M. Thad Groom and Tava S. Jones of Groom & Hammond, P.C., of Oklahoma City, OK, for Respondent/Employer.

LAVENDER, J.

¶ 1 The issue in the present cause is whether the collateral source rule applies in the context of a workers' compensation claim for prescription expense reimbursement. If applicable, the collateral source rule ensures that the injured employee's recovery is not diminished by benefits, saving or insurance of the injured employee. We hold that the collateral source rule, to the extent it is codified in the Workers' Compensation Act at 85 O.S.2001 § 45(A.), applies in this case and the COCA erred in sustaining the WCC's refusal to apply that rule and/or the terms of that statute in the instant case.

I

FACTS AND PROCEDURAL HISTORY¹

¶ 2 Claimant initiated her workers' compensation action in July, 1994 alleging she suffered a work-related injury during her employment with the University of Oklahoma. Claimant alleged primarily neck injury and consequential psychological overlay injury arising from lifting, bending and straining. In June, 1999, the WCC awarded PTD benefits and further ordered Employer to provide Claimant with reasonable and necessary continuing medical maintenance "limited to medications needed to maintain the [C]laimant's physical and psychological state, to be provided under the care of Dr. Ed Ellis (including examinations to provide same)." This order was affirmed by a three-judge panel of the WCC. Employer appealed and the COCA affirmed the PTD award and order regarding continuing medical maintenance limited to medications necessary to maintain Claimant's physical injury, but reversed the trial court's determination regarding Claimant's alleged psychological injury. In accordance with its determination that competent medical evidence did not support a finding that Claimant suffered a psychological injury, the COCA modified the trial court's order by eliminating Claimant's award for continuing medical maintenance related to her psychological conditions.²

¶ 3 In January, 2000, Claimant filed her Form 19 in the Workers' Compensation Court, seeking reimbursement for the cost of prescription medications. Employer challenged Claimant's recovery of the cost of prescriptions on three bases: (1) Claimant sought reimbursement for cost of prescriptions unrelated to her work-related injury; (2) the reasonableness and necessity for the numerous quantities of prescription medications being obtained by Claimant; and (3) Claimant sought reimbursement for cost of prescriptions not personally paid out of her own pocket, but actually paid on Claimant's behalf by her health insurance carrier. Pursuant to Employer's objections, the WCC entered an Order for an Independent Medical Opinion on reasonable and necessary prescriptions. The record reflects that ultimately, the parties stipulated to a detailed itemization of related, reasonable and necessary prescription medications, which included stipulated amounts of Claimant's out-of-pocket expenses in the amount of $19,882.42 as well as the total amount of prescription medication expenses (Claimant's actual out-of-pocket cost plus the cost actually paid by Claimant's health insurance carrier) in the amount of $46,344.24.

¶ 4 The record illuminates little detail regarding Claimant's health care coverage other than the fact that the third-party payor, Blue Cross and Blue Shield health insurance carrier, was a "group health policy" provided to Claimant by Employer as a part of a disability/compensation package as an employee at the University of Oklahoma. Claimant alleges (and Employer does not dispute) that she personally paid at least a portion of premiums³ for her own health insurance with Blue Cross. Unfortunately, we are prevented from verifying specifics concerning the subject insurance coverage because neither the policy, nor the terms thereof were included in the record.

¶ 5 Claimant argued her entitlement to reimbursement for the total amount of $46,344.24 for prescription expenses pursuant to application of the collateral source rule and 85 O.S. § 45⁴, which provides in pertinent part as follows:

A. No benefits, saving or insurance of the injured employee, independent of the provisions of this act shall be considered in determining the compensation or benefit to be paid under this act.

Id. (footnote omitted). Employer argued that 85 O.S. § 45 had no application in this case because there is no statutory authority for prescription reimbursement.⁵

¶ 6 The WCC entered a "Miscellaneous Order" on September 25, 2002, wherein the WCC specifically rejected Claimant's demand for application of the collateral source rule to this case and limited reimbursement to $19,882.42 for Claimant's actual out-of-pocket prescription expenses and denied recovery for the additional amount expended for prescriptions on her behalf by her health insurance carrier. Claimant appealed and the COCA sustained.

II

THE COLLATERAL SOURCE RULE, AS CODIFIED IN 85 O.S.2001 § 45(A.), APPLIES IN THIS WORKERS COMPENSATION ACTION

A. The collateral source rule and 85 O.S. 2001 § 45(A.) compared

¶ 7 The collateral source rule traditionally applies in the context of common law tort actions to determine the amount of compensatory damages "which will compensate [the injured party] for all detriment proximately caused." See 23 O.S.2001 § 61⁶; Denco Bus Lines, Inc. v. Hargis, 1951 OK 11, 229 P.2d 560, 564. The general rule applied to determine the proper amount which will compensate for the injured party's "whole loss" in a common law tort action is as follows: "total or partial compensation for an injury received by the injured party from a collateral source wholly independent of the wrongdoer will not operate to lessen the damages recoverable from the person causing the injury." Id. at 564 (quoting 15 AM. JUR. Damages § 198). Further,

[i]t is well settled that damages recoverable for a wrong are not diminished by the fact that the party injured has been wholly or partly idemnified [sic] for his loss by insurance effected by him and to the procurement of which the wrongdoer did not contribute.... The same has been held true of compensation received by an employee from a benefit fund maintained by the employer.

Id. (quoting 15 AM. JUR. Damages § 201)(emphasis added). Pursuant to these authorities, in Hargis, this Court determined that "[u]nder the [damages] statute the receipt of compensation by the injured party from a collateral source wholly independent of the wrongdoer would not operate to lessen the damages recoverable from the person causing the injury."⁷ Id.

¶ 8 85 O.S. § 45 has been the law since its enactment in 1915.⁸ The language of that statute is clear and unambiguous on its face.⁹ Case law generated since that time indicates that this statute has been construed consistently with its plain meaning¹⁰, and this Court has accordingly refused to consider "benefits, saving or insurance of the injured employee, independent of [the Workers' Compensation Act] ... in determining the compensation or benefit to be paid under this act." 85 O.S. § 45(A.). While this section of The Workers' Compensation Act has never been expressly labeled "the collateral source rule," the meaning and application of the statutory provision clearly mirrors that common law damages rule in the context of workers' compensation awards and/or benefits. Whether § 45(A.) is literally derived from the common law collateral source rule or not, the application of both the rule and the statute is the same albeit applied in different tribunals operating under distinct compensation schemes. Under both the collateral source rule and under the terms of the Workers' Compensation statutory provision, compensation is determined without any reduction for the amount of any benefits the injured party received from his or her health insurance carrier. Stated another way, under both the collateral source rule and statutory scheme, no credit or set-off is given to the liable party for the amounts previously paid by the injured party's health insurance carrier. Despite the lower courts' refusal to do so, we recognize that we are constrained to apply the terms of the statute. The collateral source rule, to the extent it is codified in 85 O.S. § 45(A.), is applicable to Claimant's claim for prescription reimbursement in this workers' compensation action.

B. Extant Oklahoma workers' compensation case law foreshadows today's pronouncement.

¶ 9 While the parties characterize this matter as a case of first impression, Oklahoma workers' compensation jurisprudence has foreshadowed the result in this case. In the workers' compensation case of Tidewater Associated Oil Co. v. Ale, 1942 OK 373, 130 P.2d 991, this Court held, pursuant to 85 O.S. § 45, employer there was not entitled to a credit for payments previously made to employee from an insurance policy procured by "joint efforts" of the employer and employee. In Tidewater, the Court noted the employee "paid a portion of the premiums." Id. at 993 (emphasis added). The precise nature and purpose of the insurance benefits at issue in Tidewater are unclear, but appear to have been either in the nature of health and/or disability benefits. Clearly, the Tidewater Court construed the meaning of the statute's prohibition against "consideration" of the injured employee's insurance, as a prohibition against crediting the Employer with that insurance benefit amount when determining the worker's compensation award or benefits to be paid pursuant to the Workers' Compensation Act.

¶ 10 More recently, this Court approved for publication the COCA opinion of Bill Hodges Truck Co. v. Humphrey, 1984 OK CIV APP 55, 704...