All opinions are subject to modification and technical correction prior to official publication in the North Carolina Reports and North Carolina Court of Appeals Reports. In the event of discrepancies between the electronic version of an opinion and the print version appearing in the North Carolina Reports and North Carolina Court of Appeals Reports, the latest print version is to be considered authoritative.
NO. COA03-850
NORTH CAROLINA COURT OF APPEALS
Filed: 20 July 2004
ESTATE OF WORTH APPLE,
on Behalf of WORTH APPLE,
Deceased Employee, and
BESSIE HUTCHINS APPLE,
Widow of WORTH APPLE,
Deceased Employee,
Plaintiff
v. North Carolina Industrial Commission
I.C. File No. 467935
COMMERCIAL COURIER EXPRESS, INC.,
Employer,
MICHIGAN MUTUAL INSURANCE
COMPANY,
Carrier,
Defendants
Appeal by plaintiff from an opinion and award entered 13 February 2003 by the North Carolina Industrial Commission. Heard in the Court of Appeals 30 March 2004.
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.,
___ N.C. App. ___, ___ S.E.2d ___ (No. COA03-829 filed 20 July 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 to
assert 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 a private 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, ___ N.C. ___, 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.[Note 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.[Note 2]
Vacated
in part.
Judges
WYNN and TYSON concur.
NOTES
1. To the extent that plaintiff impliedly asserts in this appeal that defendants’ failure to make full payment led to a reduction in the standard of care provided by W-S Rehab to Apple, plaintiff’s recourse was not to force payment by defendants, but was instead under N.C. Gen. Stat. §97-25, which provides that the “Commission may at any time upon the request of an employee order a change of treatment and designate other treatment suggested by the injured employee subject to the approval of the Commission, and in such a case the expense thereof shall be borne by the employer . . . .” N.C. Gen. Stat. §97-25 (2003). Furthermore, if plaintiff believed the care given to Apple by W-S Rehab was legally substandard, the proper remedy would have been to pursue a potential tort action against W-S Rehab outside of the workers’ compensation regime.
2. We note the remaining issues dealt with by the Commission regarding indemnity compensation to plaintiff are not before us on appeal and thus, this decision does not address the remaining portion of the Commission’s opinion and award.