Workers' Compensation--past due medical expenses owed to third-party medical provider-
-standing
Plaintiff employee has no standing to bring a claim for past due medical expenses owed
to a third-party medical provider by defendant employer in a compensable workers'
compensation claim because: (1) the medical provider has made no claim for relief before the
Commission; and (2) plaintiff has made no showing that the failure to make payment results in
injury in fact.
R. James Lore for plaintiff-appellant.
Carruthers & Roth, P.A., by Norman F. Klick, Jr. and J.
Patrick Haywood, for defendant-appellees.
HUNTER, Judge.
The Estate of Worth Apple (“plaintiff”) appeals an Opinion and
Award of the Full Commission of the North Carolina Industrial
Commission filed 13 February 2003 ruling that Commercial Courier
Express, Inc. (“CCE”) and Michigan Mutual Insurance Company
(collectively “defendants”) were not responsible for additional
payments for rehabilitation care of Worth Apple (“Apple”). Because
we conclude plaintiff lacks standing to bring this claim, we must
vacate that portion of the Commission's Opinion and Award.
This case stems from the same facts as Apple v. Commercial
Courier Express, Inc., 165 N.C. App. 514, 598 S.E.2d 625 (2004). Apple was working as a courier for CCE when he was attacked and hit
in the head with a hammer in August 1994. He remained in a
persistent vegetative state until his death in January 2001. This
appeal solely involves a claim by plaintiff that defendants failed
to pay $160,000.00 in accrued medical expenses to Winston-Salem
Rehabilitation and Healthcare Center (“W-S Rehab”) pursuant to a
Form 21 agreement entered into by the parties.
W-S Rehab did not intervene in the action and the record in
this case reveals W-S Rehab accepted a reduced payment of
$50,000.00 as payment in full for services rendered to Apple and
the account was settled to the satisfaction of W-S Rehab. On this
issue, the Commission concluded, inter alia:
3. As a result of decedent's
compensable injury, decedent was entitled to
have defendants provide all necessary medical
treatment arising from his compensable injury
to the extent it tended to effect a cure, give
relief or lessen decedent's disability. . . .
Plaintiff failed to establish . . . that
defendants have failed to pay the agreed
reimbursement for the reasonable services
provided by W-S Rehab.
4. [W-S Rehab] is estopped to request
further compensation after accepting the
$50,0000 payment as a full accord and
satisfaction of the claim or potential claim
for unpaid medical services. . . .
Thus, in the award portion of the opinion and award, the Commission
stated: “Defendants are not responsible for payment of any
additional monies to W-S Rehab for the care of decedent . . . .”
Although the Commission ruled in favor of defendants on the
merits of the case primarily on the ground of accord and
satisfaction between defendants and W-S Rehab, the dispositive
issue before us on appeal is whether plaintiff even has standing toassert the non-payment of medical expenses by his employer to a
third-party provider.
If a party does not have standing to bring a claim, a court
has no subject matter jurisdiction to hear the claim. See Neuse
River Found., Inc. v. Smithfield Foods, Inc., 155 N.C. App. 110,
113, 574 S.E.2d 48, 51 (2002). Standing consists of three main
elements:
“(1) 'injury in fact' -- an invasion of a
legally protected interest that is (a)
concrete and particularized and (b) actual or
imminent, not conjectural or hypothetical; (2)
the injury is fairly traceable to the
challenged action of the defendant; and (3) it
is likely, as opposed to merely speculative,
that the injury will be redressed by a
favorable decision.”
Id. at 114, 574 S.E.2d at 52 (citing Lujan v. Defenders of
Wildlife, 504 U.S. 555, 560-61, 119 L. Ed. 2d 351, 364 (1992)).
The issue of standing generally turns on whether a party has
suffered injury in fact. See id.
In this case, plaintiff has made no showing that injury in
fact has resulted or will result if defendants are not required to
pay W-S Rehab the full $160,000.00. First of all, there is no
outstanding debt to W-S Rehab to be collected as evidenced by W-S
Rehab's own correspondence. Further, even if there was an
outstanding debt, W-S Rehab is barred by law from attempting to
collect any such debt from plaintiff. See N.C. Gen. Stat. § 97-
88.3(c) (2003) (class 1 misdemeanor for a healthcare provider to
knowingly hold an employee responsible for medical expenses
incurred as a result of a compensable injury); see also N.C. Gen.
Stat. § 97-90(e) (2003) (a health care provider shall not pursue aprivate claim against an employee for costs of treatment unless
claim is adjudicated not compensable). In addition, the sole and
exclusive remedy for a healthcare provider seeking payment from an
employer in a compensable claim is to apply for relief from the
Commission. See Palmer v. Jackson, 157 N.C. App. 625, 634-35, 579
S.E.2d 901, 908 (2003), disc. review improvidently allowed, 358
N.C. 373, 595 S.E.2d 145 (2004). No such application was made in
this case.
As such, we conclude plaintiff has no standing to bring a
claim for past due medical expenses owed to a third-party medical
provider by an employer in a compensable workers' compensation
claim where (1) the medical provider has made no claim for relief
before the Commission, and (2) plaintiff has made no showing that
the failure to make payment results in injury in fact.
(See footnote 1)
Accordingly, the portion of the opinion and award of the Commission
addressing this issue, as contained in paragraphs 3 and 4 of the
Commission's conclusions of law and paragraph 3 of the award, must
be vacated.
(See footnote 2)
Vacated in part.
Judges WYNN and TYSON concur.
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