Church Mut. Ins. Co. v. Dardar

• Decision Date: 07 May 2014
• Docket Number: No. 2013–C–2351.,2013–C–2351.
• Citation: 145 So.3d 271
• Parties: CHURCH MUTUAL INSURANCE COMPANY and Trinity United Methodist Preschool v. Thelma DARDAR. Thelma Dardar v. Trinity Universal Methodist Preschool, et al.
• Court: Louisiana Supreme Court

145 So.3d 271

CHURCH MUTUAL INSURANCE COMPANY and Trinity United Methodist Preschool

v.Thelma DARDAR.

Thelma Dardar

v.Trinity Universal Methodist Preschool, et al.

No. 2013–C–2351.

Supreme Court of Louisiana.

May 7, 2014.

WEIMER, Justice.

We granted certiorari in this case to determine the applicability of La. R.S. 23:1203.1, which provides, among other matters, for the adoption of a medical treatment schedule for use in making medical treatment decisions in workers' compensation matters. The precise question before the court is whether La. R.S. 23:1203.1 applies to requests for medical treatment and/or disputes arising out of requests for medical treatment in cases in which the compensable accident or injury occurred prior to the effective date of the medical treatment schedule.

The Office of Workers' Compensation (OWC) ruled that the medical treatment schedule applies to all requests for medical treatment submitted after its effective date, regardless of the date of injury or accident. The court of appeal reversed, holding that La. R.S. 23:1203.1 is substantive in nature and cannot be applied retroactively to rights acquired by a claimantwhose work-related accident antedates the promulgation of the medical treatment schedule. For the reasons that follow, we disagree with the conclusion of the court of appeal and find that La. R.S. 23:1203.1 is a procedural statute and, thus, does not operate retroactively to divest a claimant of vested rights. As a result, the statute applies to all requests for medical treatment and/or all disputes emanating from requests for medical treatment after the effective date of the medical treatment schedule, regardless of the date of the work-related injury or accident.

FACTS AND PROCEDURAL HISTORY

Thelma Dardar injured her back in a work-related accident on October 21, 1999, while attempting to rise from a seated position on the floor. On January 30, 2008, the OWC approved a settlement between Ms. Dardar, her employer, Trinity United Methodist Preschool (“Trinity”), and her employer's insurer, Church Mutual Insurance Company (“Church Mutual”). In exchange for a one time lump sum payment of $100,000, Ms. Dardar agreed to release Trinity and Church Mutual from any and all claims for indemnity she might possess, specifically reserving her right to continue to receive “medical benefits due pursuant to the Louisiana Workers' Compensation Act.”

The instant litigation arose on October 18, 2012, with the filing of a LWC Form 1008, Disputed Claim for Compensation, by Ms. Dardar with the OWC. In her Disputed Claim, Ms. Dardar alleged that her employer and its insurer had failed to authorize office visits, medication refills and injections recommended by her physician, Dr. Rand Metoyer. In addition to seeking authorization for the requested treatment, Ms. Dardar requested an award of penalties and attorney's fees for the alleged arbitrary and capricious refusal to approve the requested services. Trinity and Church Mutual answered the Disputed Claim, asserting an exception of prematurity based on Ms. Dardar's failure to comply with the provisions of La. R.S. 23:1203.1 and submit a LWC Form 1009 to the medical director of the OWC prior to filing the Disputed Claim.

At a hearing, Ms. Dardar argued that the guidelines for seeking medical benefits contained in La. R.S. 23:1203.1 do not apply to her Disputed Claim because she was injured in 1999 and the settlement reserving her right to medical benefits was confected in 2008, prior to the effective date of the statute. The OWC disagreed, finding the date treatment is requested, and not the date of injury, controls the applicability of La. R.S. 23:1203.1. Because the claim for injections recommended by Dr. Metoyer was submitted after the statute's effective date, judgment was entered maintaining the exception of prematurity. Ms. Dardar was ordered, consistent with the provisions of La. R.S. 23:1203.1, to “re-submit the request for injections to the payor on Form 1010 and to the Medical Director on Form 1009 within thirty days.”

Ms. Dardar applied for supervisory review of this adverse judgment. Her writ application was consolidated with a previously lodged appeal on unrelated rulings.¹Following briefing and argument, the court of appeal reversed the decision of the OWC. Church Mutual Insurance Company v. Dardar, 12–0659, 13–0037 (La.App. 4 Cir. 6/26/13), 119 So.3d 967.

Drawing upon the “general principle” that “the law in effect at the time of the injury generally governs an action for workers' compensation benefits,” the court of appeal determined that a proper analysis should focus not on the date medical treatment is requested, but on the date of Ms. Dardar's injury and whether the new medical guidelines should be applied retroactively to that injury. Id., 12–0659 at 10, 119 So.3d at 975, quoting Frith v. Riverwood, Inc., 04–1086, pp. 7–8 (La.1/19/05), 892 So.2d 7, 12–13. For this inquiry, the court of appeal employed the “two-fold” analysis outlined in Cole v. Celotex Corp., 599 So.2d 1058, 1063 (La.1992). The appellate court first determined that the “legislature did not expressly provide that the guidelines contained in La. R.S. 23:1203.1 would be applied retroactively.” Church Mutual Insurance Company, 12–0659 at 11, 119 So.3d at 975. It then found that “La. R.S. 23:1203.1, which contains guidelines that did not exist when Ms. Dardar was injured, creates and places rules, rights, and duties upon a claimant seeking reimbursement for recommended medical treatment” and, thus, is “substantive in nature.” Id. Because it is a substantive law, the court of appeal reasoned that La. R.S. 23:1203.1 cannot be applied retroactively to rights acquired by Ms. Dardar when she sustained her work-related injury in 1999. Id. Accordingly, the court granted Ms. Dardar's application for supervisory review, reversed the ruling of the OWC, and remanded the matter for the consideration of attorney's fees and penalties. Id.

On Trinity and Church Mutual's application, we granted certiorari to review the correctness of the court of appeal's decision. Church Mutual Insurance Company v. Dardar, 13–2351 (La.1/17/14), 130 So.3d 332.

LAW AND ANALYSIS

Enacted by the legislature in 2009,²La. R.S. 23:1203.1 is the product of a combined endeavor by employers, insurers, labor, and medical providers to establish meaningful guidelines for the treatment of injured workers. 1 Denis Paul Juge, Louisiana Workers' Compensation, § 13:6 (2d ed.2013). Dissatisfied with a process for obtaining needed medical treatment that was cumbersome, uncertain and often fraught with expense,³ employers and their insurers perceived a need for guidelinesthat would assure them that the treatment recommended by a medical provider was generally recognized by the medical community as proper and necessary. Id. In a similar vein, labor and their medical providers were concerned about the unreasonable delays regularly encountered in obtaining approval for treatment when disputes arose as to the necessity for the treatment and with having a procedure for obtaining approval for treatment that might vary from established guidelines. Id. Thus, La. R.S. 23:1203.1 was enacted with the express intent “that, with the establishment and enforcement of the medical treatment schedule, medical and surgical treatment, hospital care, and other health care provider services shall be delivered in an efficient and timely manner to injured employees.” La. R.S. 23:1203.1(L).⁴

In its current form, La. R.S. 23:1203.1 instructs the Director of the OWC to “promulgate rules in accordance with the Administrative Procedure Act, R.S. 49:950 et seq., to establish a medical treatment schedule.” La. R.S. 23:1203.1(B). To this end, the Director is tasked with appointing a medical advisory council, to be comprised of at least one representative from eight enumerated areas of medical practice and a medical director. La. R.S. 23:1203.1(F). The council, with the assistance of the medical director, is directed to develop guidelines to be established and promulgated as the medical treatment schedule. La. R.S. 23:1203.1(E) and (G). These guidelines must meet specific criteria outlined in the statute.⁵Id. Once the medical treatment schedule is promulgated, the Director of the OWC and the medicaladvisory council are charged with reviewing and updating the schedule no less often than once every two years. La. R.S. 23:1203.1(H).

Louisiana R.S. 23:1203.1 further instructs, in relevant part:

I. After the promulgation of the medical treatment schedule, throughout this Chapter, and notwithstanding any provision of law to the contrary, medical care, services, and treatment due, pursuant to R.S. 23:1203, et seq., by the employer to the employee shall mean care, services, and treatment in accordance with the medical treatment schedule. Medical care, services, and treatment that varies from the promulgated medical treatment schedule shall also be due by the employer when it is demonstrated to the medical director of the office by a preponderance of the scientific medical evidence, that a variance from the medical treatment schedule is reasonably required to cure or relieve the injured worker from the effects of the injury or occupational disease given the circumstances.

J. (1) After a medical provider has submitted to the payor the request for authorization and the information required by the Louisiana Administrative Code, Title 40, Chapter 27, the payor shall notify the medical provider of their action on the request within five business days of receipt of the request. If any dispute arises after January 1, 2011,⁶ as to whether the recommended care, services, or treatment is in accordance with the medical treatment schedule, or whether a variance from the medical treatment schedule is reasonably required as contemplated in Subsection I of this Section, any aggrieved party shall file, within fifteen calendar days, an appeal with the...