Opinion
No. 23368
Handdown Date: July 14, 2000
APPEAL FROM: THE MISSOURI LABOR AND INDUSTRIAL RELATIONS COMMISSION
APPEAL DISMISSED.
Kenneth H. Reid and Jeffrey T. Davis, counsel for appellant.
Jason N. Shaffer and Steve Marsh, counsel for respondent.
Crow, P.J., recuses; Parrish and Montgomery, JJ., concur.
This is a workers' compensation case in which the Labor and Industrial Relations Commission (Commission) ordered Employer and Insurer to make a $105,968.35 direct payment to Hospital. This payment was for treatment Hospital gave Robert L. Curry (Employee) for injuries he sustained while on the job. Commission's direct payment order came after Employee had settled his claim with Employer and Insurer for $33,597.20. Commission relied on section 287.140.13(6) as its authority for ordering the additional payment directly to Hospital. Appellants urge reversal of Commission's award on the basis that Hospital's services were not "authorized in advance" within the meaning of section 287.140.13(6). We never reach Appellants' complaint, however, because Commission lacked authority to enter the award; consequently, the award is void. We dismiss the appeal. FACTS AND PROCEDURAL BACKGROUND On November 11, 1997, Employee was working for Employer when he fell from a scaffold and was injured. He was immediately taken to Hospital where he was treated until his discharge on December 12, 1997. Hospital charged $112,573.22 for the care given Employee during this period.
When in this opinion we reference "The Workers' Compensation Law" (Chapter 287) we call it "the Law."
"Employer" is Ozarks Electric, Inc. "Insurer" is Continental Western Insurance Company. When referring to Employer and Insurer collectively, we call them "Appellants."
The notice of appeal refers to the medical provider as "Cox Health Systems." Other parts of the record on appeal refer to the medical provider as "Lester E. Cox Medical Center." For purposes of this opinion we call the medical provider "Hospital."
Unless otherwise indicated, all statutory references are to RSMo 1994.
In January 1998, Employee filed a claim for workers' compensation benefits with Missouri's Division of Workers' Compensation (Division). Because Hospital's bill was not paid within ninety days of its first billing, Hospital filed a "Notice of Services Provided and Request for Direct Payment" in Employee's case. By this notice, Hospital attempted to avail itself of the benefits of section 287.140.13(6), which provides:
"A hospital . . . whose services have been authorized in advance by the employer or insurer may give notice to the division of any claim for fees or other charges for services provided for [a work-related injury] that is covered by this chapter, with copies of the notice to the employee, employer and the employer's insurer. Where such notice has been filed, the administrative law judge may order direct payment from the proceeds of any settlement or award to the hospital . . . for such fees as are determined by the division. The notice shall be on a form prescribed by the division."
Employee's claim and Hospital's request were both set for hearing before an Associate Administrative Law Judge (ALJ) on January 10, 1999. Just before the hearing, Employee and Appellants "entered into [a] compromise settlement under the provisions of sections 287.390, RSMo, for payment of the lump sum of $33,597.20 to the claimant." Afterward, the ALJ held an evidentiary hearing on Hospital's request for direct payment for its services. The ALJ denied Hospital's request because "the medical care provided by [Hospital] . . . was not authorized in advance by the employer or its insurer."
At Hospital's request, Commission reviewed the ALJ decision. With one member dissenting, the Commission ruled that Appellants were liable to Hospital "for direct payment of $105,968.35 . . . because the medical services were authorized in advance."
Commission disallowed the part of Hospital's charges which were for treatment of Employee for alcohol withdrawal symptoms, i.e., $6,604.87. Disallowance of that sum is not an issue on appeal.
This appeal followed.DISCUSSION AND DECISION Appellants' single point on appeal asserts there was insufficient, competent evidence in this record to support Commission's finding that Employer gave advance authorization to Hospital to provide medical services to Employee. They contend the Commission clearly misinterpreted and misapplied section 287.140.13(6) to the facts; consequently, they urge this court to reverse Commission's decision.
Preliminarily, however, we address sua sponte our concern that Commission's award to Hospital was void. When it appears from the face of the record that Commission made an award it had no authority to make, then the award is void and may be impeached in any proceeding, even on appeal. Woodruff v. Tourville Quarry, Inc., 381 S.W.2d 14, 19 (Mo.App. 1964), overruled on other grounds by Keener v. Black River Electric Co-operative, 443 S.W.2d 216 (Mo.App 1969). When that situation attends, it "is as if the award never existed." Woodruff, 381 S.W.2d at 19. This court does not have jurisdiction to review an appeal of a void judgment. Pritz v. Balverde, 955 S.W.2d 795, 798 (Mo.App. 1997). As in any case, we must probe our jurisdiction in workers' compensation cases sua sponte. Cable v. Schneider Transp., Inc., 957 S.W.2d 802, 803(Mo.App. 1997); Metcalf v. Castle Studios, 946 S.W.2d 282, 284 (Mo.App. 1997).
The parties were given an opportunity before oral argument to address the court's concerns about this award via supplemental briefs. The parties were also invited to address the "void award" issue at oral arguments. Both parties availed themselves of these opportunities.
Here, the award appealed from is captioned "Final Award Allowing Direct Reimbursement." The award includes the Commission finding that "[t]he employee and the employer/insurer settled the employee's claim for compensation resulting from injuries employee Robert Curry sustained in a fall at work on November 11, 1997." It is this finding and the ALJ's recital that Employee and Appellants settled Employee's claim pursuant to section 287.390 which triggers an inquiry into whether Commission had authority to make a subsequent award to Hospital. This follows because ordinarily a compromise lump sum settlement approved via section 287.390 is deemed final and conclusive and the system, including the appeal process established therein, loses jurisdiction. Morgan v. Duncan, 236 S.W.2d 281, 284 (Mo.banc 1951); 29 Mo.Prac., Worker's Compensation Law and Practice, section 7.63, p. 360 (1997). The rationale for this rule is found in Mosier v. St. Joseph Lead Co., 205 S.W.2d 227 (Mo.App. 1947):
Inexplicably, the record on appeal filed by Commission does not include a copy of the Employee/Appellants' stipulation for compromise settlement or the ALJ's approval thereof. Even so, we know from the ALJ's findings that the compromise lump sum settlement between Employee and Appellants was under section 287.390.
"[I]n approving a compromise agreement, the Commission is not called upon to render an award, but merely to enter an order approving the settlement. Where a compromise settlement is proposed under Section [ 287.390], the only power of the Commission is to either approve or reject it, . . . depending upon whether it was found to be in accordance with the rights of the parties under the act.". . . .
Section [ 287.390] contemplates the settlement of the entire claim and the discharge of the employers's entire liability, and not the splitting up of the claim into component parts, some of which are settled and released, and the others left to be adjudicated by the Commission. . . . [W]ith a settlement effected under Section [ 287.390], the whole of the parties' respective rights and liabilities were disposed of once and for all, and the Commission could thereafter acquire no jurisdiction to act under the provision of Section [ 287.400]."
Id. at 232-33 (citations omitted). See also Haase v. New Hampshire Ins. Co., 795 S.W.2d 543, 545 (Mo.App. 1990) (holding "the policy of the law is to encourage settlement of Workers' Compensation benefits and to make conclusive and irrevocable such settlements once they are approved.").
As with any administrative agency, the Commission is a creature of the legislature and has only that jurisdiction or authority which the legislature conferred upon it. Mikel v. Pott Industries, 896 S.W.2d 624, 626 (Mo.banc 1995) (citing Soars v. Soars-Lovelace, Inc., 346 MO. 710, 142 S.W.2d 866, 871 (1940). Apparently, the Commission views section 287.140.13(6) as authorizing it to award additional medical benefits via a direct payment order although it previously approved a compromise lump sum settlement pursuant to section 287.390. Whether the legislature intended such a result when it enacted section 287.140.13(6) is an issue we must now resolve.
When considering the Law, our primary responsibility is to discover the intent of the legislature, Mayfield v. Brown Shoe Co., 941 S.W.2d 31, 36 (Mo.App. 1997), give effect to that intent if possible, and consider the words used in their plain and ordinary meaning. Id.; Frazier v. Treasurer of Missouri, 869 S.W.2d 152, 156 (Mo.App. 1993). Words used in the Law must be considered in their context and sections of the statutes in pari materia in arriving at the true meaning of the words. Marie v. Standard Steel Works, 319 S.W.2d 871, 876 (Mo.banc 1959).
The Law is specifically designed to benefit injured employees, De May v. Liberty Foundry Co., 37 S.W.2d 640, 645 (Mo. 1930), and from its inception it made "medical and hospital services [part of the] compensation" that an employer must provide an injured employee. Stookey v. Midland Flour Milling Co., 171 S.W.2d 750, 751 (Mo.App. 1943). The medical benefit is specifically provided in section 287.140.1 as follows: "In addition to all other compensation, the employee shall receive and the employer shall provide such medical . . . and hospital treatment . . . as may reasonably be required . . . to cure and relieve from the effects of the injury." (Emphasis supplied.) The unambiguous language of section 287.140.1 (and also that of its predecessors) reveals a legislative intent that the medical benefit shall belong to "the employee," and no one else. Moreover, when the legislature in 1994 enacted section 287.140.13(6) and thereby gave ALJs discretionary authority to make direct payments to medical care providers from the "proceeds of any settlement or award[,]" it did not amend section 287.140.1 or other parts of the Law to expressly give medical care providers standing to assert a separate claim in the compensation system independent of an employee's claim.
Although never previously addressed in Missouri, other jurisdictions having workers' compensation acts with similar language have held that a health care provider may not independently assert a claim in the compensation system for services provided an employee. For example, Eastern Elevator Co. v. Hedman, 290 So.2d 56 (Fla.Sup. 1974), held that a "physician could not initiate compensation proceedings as an independent 'claimant' in workmen's compensation for his services[.]" Id. at 57. The Hedman court reasoned as follows:
"[T]he statute specifically makes the employer liable to his employee for payment of the recoverable medical expenses and any payment must be on the employee's behalf. In the face of this express legislative directive, we may not change the law to make the employer liable separately to the physician. The statute does not provide the physician with a right of action against the employer directly. The employer is liable only to the employee, the more so where, as here, compensability of the employee's condition is as yet undetermined."
Id. at 58.
In Roper Hosp. v. Clemons, 484 S.E.2d 598 (S.C.App. 1997), an employee reached a commission approved lump sum settlement with his employer. Id. at 599. Afterward, the employee's medical supplier tried to reopen the case before the commission and assert a claim for services rendered the employee. On appeal, the Clemons court concluded that no provisions in the act expressly or impliedly authorized an independent action by a medical provider, that the compensation law was enacted to decide an employee's right to compensation for a work related injury and not to decide a provider's rights to benefits, and consequently Roper Hospital was without standing before the commission. Id. at 599-601.
Other cases that reach a similar result include Figueroa v. C and S Ball Bearing, 675 A.2d 845, 849 (Conn. 1996); Medical College of Pennsylvania v. Workmen's Compensation Appeal Board, 591 A.2d 338, 340 (Pa.Cmwlth 1991); and Sloat Chiropractic Clinic v. Datsun, 706 S.W.2d 181, 182-84 (Ark.App. 1986). Also see 5 Larson's Workers' Compensation Law (1999) section 94.02[11], where the author writes: "The physician has no independent standing to make claims within the compensation system, unless this right has been expressly created by statute."
We find Hedman, Clemons, and the authorities cited in note 8 persuasive. Applying the analysis of those authorities because of the similarity in statutes and evaluating the plain language in section 287.140.13(6) which states that an ALJ "may order direct payment from the proceeds of any settlement or award[,]" we find the legislature did not intend section 287.140.13(6) as authorization for splitting an employee's workers' compensation claim into component parts. We recognize the ALJ and Commission believed differently, but the plain language of section 287.140.13(6) shows they erred in that regard. Section 287.140.13(6) allows a medical provider to participate in the compensation system but only for the limited purpose of persuading the ALJ "to order direct payment from the proceeds of any settlement or award" to the employee. In practical terms, section 287.140.13(6) does nothing more than give the compensation system discretionary authority to impress, via direct payment, what is in effect a lien on the proceeds of a workers' compensation award or settlement.
Hospital argues our reading of section 287.140.13(6) inserts the term "employee" immediately preceding the word "settlement," and thus, we are inappropriately adding words by implication to a statute that is unambiguous. Further, Hospital maintains the word "any" precludes this interpretation because the statute contemplates awards directly to medical care providers regardless of an employee's award or settlement. However, Hospital does not explain why an ALJ needs authority to order direct payment from an award or settlement if, as Hospital contends, a medical care provider has its own separate claim which, if proven, entitles it to a separate award. To legislatively authorize direct payment "from proceeds of any settlement or award" would be a meaningless act if, as Hospital contends, an ALJ can make a direct but separate award to a medical care provider. Missouri courts do not presume the legislature enacts meaningless workers' compensation provisions. Parrott v. HQ, Inc., 907 S.W.2d 236, 240[5,6](Mo.App. 1995).
Hospital offers several reasons to support its claim that the legislature, by its 1994 amendments to the Workers' Compensation Law, including section 287.140.13(6), intended to create an independent, non-derivative cause of action for medical providers by which they could get a separate and direct award for services rendered an injured employee. Its arguments are answered, not only by our comments elsewhere, but also by noting it is discretionary with the ALJ whether he or she will order direct payment to a medical provider "from the proceeds of any settlement or award." Had the legislature intended to carve out a special and separate award for medical providers, granting only discretionary authority to the ALJ to make the separate award would be illogical.
See, e.g., notes 9 and 11.
In its arguments, Hospital also relies heavily on Esquivel v. Days Inn, 959 S.W.2d 486 (Mo.App. 1998), which they broadly proclaim "recognized that a health care provider may obtain its own direct award pursuant to section 287.140." First, section 287.140.6(13) was neither implicated nor mentioned in Esquivel. Esquivel was a section 287.140.4 case to resolve a dispute between an employer and a medical care provider over the reasonableness of the provider's fees. Second, we agree the section 287.140.4 procedure in Esquivel, as well as the section 287.140.13(6) provision, contemplates a direct pay award to a medical provider in certain circumstances. These subsections do not, however, evidence a clear legislative intent to split an employee's claim into component parts or authorize separate, independent awards for medical benefits. Third, in Esquivel the employee "received authorized medical treatment, temporary disability benefits, and permanent disability, all of which was provided for pursuant to a written settlement agreement executed on December 27, 1995." Id. at 487. (Emphasis supplied.) Thus, the settlement in Esquivel dealt with all medical treatment, which is not this case.
Here, Appellants and Employee appeared before the ALJ and requested approval of a voluntary final settlement. We are entitled to presume the ALJ fulfilled his duty regarding the settlement by finding the settlement was "in accordance with the rights of the parties as given in" the Law, "including necessarily the finding that the claim was compensable under the Law and the Commission consequently empowered by the Law to approve or disapprove the settlement." Morgan, 236 S.W.2d at 285. We find, therefore, that the settlement approved by the ALJ on January 19, 1999, was a settlement of Employer's entire liability, including any liability for hospital care given Employee. See Shockley v. Laclede, 825 S.W.2d 44, 49 (Mo.App. 1992). The settlement thus approved fully exhausted the authority of the workers' compensation system in this case. Mosier, 205 S.W.2d at 232. Since Commission lacked authority to order Appellants to pay Hospital anything other than money out of Employee's settlement proceeds, the Commission's "Final Award Allowing Direct Reimbursement" was void. The fact that the purported direct reimbursement award was void affirmatively appears from the face of the record. See Woodruff, 381 S.W.2d at 18. Since the award is void, it is unenforceable in this or any other proceeding. Id. Accordingly, we dismiss the appeal with directions to Commission to enter an order expunging the void "Award Allowing Direct Reimbursement."