Curry v. Ozarks Electric Corp.
Decision Date | 20 March 2001 |
Parties | (Mo.banc 2001) Robert L. Curry, Claimant, v. Ozarks Electric Corporation and Continental Western Insurance Company, Appellants, and Cox Health Systems, Respondent. SC82969 0 |
Court | Missouri Supreme Court |
Appeal From: Labor and Industrial Relations Commission
Counsel for Appellant: Jeffrey T. Davis and Kenneth H. Reid
Counsel for Respondent: Jason N. Shaffer and Steven E. Marsh
Opinion Summary: Robert Curry was injured while working for Ozarks and filed a workers' compensation claim. The hospital filed notice of claim for direct payment, which is permitted by section 287.140.13(6) when services are authorized in advance. Curry, Ozarks and its insurer settled Curry's claim, and the administrative law judge approved it. The hospital was not a party to the settlement. The Labor and Industrial Relations ruled Ozarks authorized medical services and awarded direct payment. Ozarks and its insurer appealed.
Court en banc holds: 1) Nothing in the statute precluded the Commission from bifurcating the settlement proceedings and hearing the direct payment claim separately from Curry's claim. The parties and the administrative judge who approved the settlement left the hospital's claim open for adjudication and intended the award to Curry as only a partial settlement. The Commission did not act outside its statutory power in awarding direct payment to the hospital.
2) The facts show Ozarks endorsed or permitted the hospital's services; the statute that requires advance authorization does not require an express promise to pay. Based on the record and plain meaning of the statutory language, the Commission's conclusion that Ozarks authorized the services in advance must be upheld.
Stith, J., not participating.
This is a workers' compensation case in which employer, Ozarks Electric Corp. (Ozarks), and its insurer, Continental Western Insurance Company, appeal a decision of the Labor and Industrial Relations Commission (Commission) awarding a direct payment of $105,968.35 to Cox Health Systems (Cox) for medical services rendered to Ozarks' employee, Robert Curry. After opinion by the Court of Appeals, Southern District, this Court granted transfer, Mo. Const. art. V, sec. 10, to determine: (1) whether the Commission had authority to award Cox direct payment under section 287.140.13(6), RSMo 1994, after Ozarks and Curry entered into a section 287.390, RSMo 1994, compromise settlement; and (2) whether Cox presented sufficient competent evidence that Ozarks authorized Cox's services in advance, as required for a direct payment claim under section 287.140.13(6). The decision of the Commission is affirmed.
Curry was injured while working for Ozarks, an employer subject to Missouri workers' compensation law, chapter 287, RSMo 1994. Ozarks' employees called an ambulance to take Curry to Cox Medical Center, operated by Cox, where he remained under treatment for one month. The total bill was $112,573.22. Curry later filed a workers' compensation claim. Because the hospital bill was not paid within 90 days of Curry's discharge, Cox filed notice of a claim for direct payment, as provided by section 287.140.13(6).
Curry, Ozarks and Continental entered into a compromise settlement of Curry's workers' compensation claim, in accordance with section 287.390, for a lump sum payment of $33,597.20. An Administrative Law Judge (ALJ) approved the settlement agreement, which provided that Cox's direct payment claim would remain open for adjudication. Cox was not a party to the settlement agreement. After a hearing on Cox's direct payment claim, the ALJ found that Cox's medical services were not "authorized in advance" by Ozarks or Continental, as required by section 287.140.13(6) and, therefore, denied direct payment. The Commission reversed the ALJ's decision and ruled that Ozarks did authorize Cox's medical services to treat Curry's work-related injury. The Commission disallowed $6,604.87 in charges directly related to alcohol withdrawal treatment and ordered Ozarks to pay Cox $105,968.35 of Curry's $112,573.22 bill.
The standard of review is that "[t]he Court will modify, reverse, remand or set aside an award only if the Commission acted without or in excess of its powers, the award was procured by fraud, the facts found by the Commission do not support the award, or there was not sufficient competent evidence in the record to warrant the making of the award." Akers v. Warson Gardens Apartments, 961 S.W.2d 50, 52 (Mo. banc 1998); sec. 287.495.
Appellants Ozarks and Continental first allege that the Commission lacked jurisdiction or authority to award Cox direct payment of Curry's medical fees under section 287.140.13(6) after the ALJ approved the compromise settlement of Curry's workers' compensation claim. To determine the extent of the Commission's authority and the effect of a compromise settlement, this Court looks to the relevant statutes, which are unambiguous on these points. Section 287.390, which governs employer-employee workers' compensation settlements, provides in pertinent part:
1. Nothing in this chapter shall be construed as preventing the parties to claims hereunder from entering into voluntary agreements in settlement thereof . . . nor shall any...
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