Court: Louisiana Court of Appeal; January 29, 2008; Louisiana; State Appellate Court
In appeals 07-1159 and 07-1282, the court, comprising Judges Glenn B. Gremillion, Elizabeth A. Pickett, and J. David Painter, addresses issues stemming from case 05-4552 in the Office of Workers’ Compensation (OWC). In appeal 07-1159, defendants Liquid Transport Corporation and Great West Casualty Company contest an OWC ruling requiring them to pay Dr. Fayez Shamieh $122.50 for an under-payment related to medical services provided to workers’ compensation claimant Rudolph Jackson. The OWC also imposed $4,000 in penalties ($2,000 for under-payment and $2,000 for late payment) and awarded Dr. Shamieh $3,950 in attorney’s fees. Dr. Shamieh seeks additional attorney’s fees for the appeal. In appeal 07-1282, Community Care Network, Inc. (CCN) challenges the denial of its petition to intervene in the OWC proceedings. The court reverses the Workers’ Compensation Judge’s decision on CCN's petition and nullifies the July 25, 2007 judgment in appeal 07-1159, remanding for further proceedings. The court defers the decision on Dr. Shamieh's request for additional attorney’s fees. The factual background indicates that Dr. Shamieh pursued recovery for the payment differences under a Preferred Provider Organization (PPO) agreement, part of which involves the contractual relationships between CCN and multiple entities regarding reimbursement amounts for services rendered. Definitions pertinent to the agreements are outlined, including terms for beneficiaries, insuring agreements, health care services, reimbursement amounts, payors, and provider obligations, emphasizing that reimbursement amounts are established by CCN and payors, not individual providers.
Reimbursement Amounts for Health Care Services are detailed in Exhibit A, which is part of the agreement. The Provider agrees to accept these amounts as full payment, with no further claims against Beneficiaries or Claimants unless allowed by the applicable Payer Agreement. Exceptions include the collection of deductibles and co-payments as per the Insuring Agreement, and services not covered by the Insuring Agreement.
The Provider authorizes CCN to contract for Health Care Services at the specified Reimbursement Amounts and to manage billing to Payors if permitted under the relevant Payor Agreement. Although CCN was involved in the contract with PHO, it was not initially a party to the lawsuit. CCN attempted to intervene multiple times, with a motion filed on June 19, 2007, being denied, leading to appeal 07-1282.
The appeal centers on whether CCN is an indispensable party under Louisiana Code of Civil Procedure Article 641, which requires joining a party if their absence prevents complete relief or impairs their interest. The absence of an indispensable party can invalidate adjudications. The WCJ concluded there was a connection between the defendants and the CCN contract, ruling contracts that reduce medical bills below the Louisiana Workers' Compensation Reimbursement Schedule are invalid and against public policy.
The WCJ denied CCN's intervention petition and ruled against it regarding the contracts. This decision invalidated the relevant part of CCN's contract concerning workers' compensation claims. It was determined that CCN's presence was crucial for protecting its rights, and the WCJ's denial of intervention was an error. Consequently, the judgment denying CCN’s motion is reversed, the subsequent judgment is annulled, and the case is remanded for further proceedings, with costs deferred pending the outcome.
