796 S.E.2d 469
Va. Ct. App.2017Background
- Claimant injured on October 8, 2010 while employed by Newport News Shipbuilding (now Huntington Ingalls). Claim filed Dec. 13, 2010.
- Parties executed a joint petition and proposed settlement; deputy commissioner entered settlement order Jan. 14, 2013: employer to pay medical treatment "pursuant to Section 65.2-603 incurred by the Claimant through the date of the entry of the Order approving the settlement." Claimant received a lump sum; employer reserved contesting compensability.
- Wardell Orthopaedics (provider) sought payment from employer on Oct. 20, 2014 for services rendered to claimant before the Jan. 14, 2013 cutoff; provider had received some payments under the Longshore and Harbor Workers’ Compensation Act (LHWCA) and internally wrote off remaining balances.
- Deputy commissioner awarded provider $12,438.43 for unpaid services incurred before the settlement order; full Commission unanimously affirmed; employer appealed to Court of Appeals of Virginia.
- Employer raised jurisdictional challenge, argued settlement barred provider’s claim, contended Dr. Wardell was not an authorized treating physician, argued provider needed to prove compensability, and asserted accord and satisfaction based on LHWCA payments and write-offs.
Issues
| Issue | Plaintiff's Argument (Provider/Claimant) | Defendant's Argument (Employer) | Held |
|---|---|---|---|
| Whether the Commission had jurisdiction to decide provider’s application | Provider: Commission has exclusive authority over physician fee disputes and enforcement of its orders | Employer: No injured worker’s right was at stake; Bogle bars jurisdiction for third-party reimbursement claims | Held: Commission had jurisdiction under Va. Code §§65.2-700, 65.2-714 and §65.2-201 because claimant’s right to have medicals paid was before the Commission |
| Whether the settlement order obligated employer to pay provider’s pre-order medical bills | Provider: Settlement language makes employer responsible for medical treatment incurred through entry date, so employer is liable | Employer: Order should be read to bar further claims and renders settlement meaningless if provider recovers | Held: Plain language binds employer to pay medicals incurred through Jan. 14, 2013; award consistent with settlement and does not render it meaningless |
| Whether employer’s authorization/compensability defenses bar payment to provider | Provider: Settlement makes proof of compensability or authorization unnecessary for bills through the cutoff date | Employer: Provider must prove compensable injury and authorized treating physician to recover | Held: Because employer agreed to pay medicals through the entry date despite contesting compensability, provider need not prove compensability or authorization for those pre-order treatments |
| Whether acceptance of LHWCA payments and internal write-offs create accord and satisfaction | Provider: Acceptance of LHWCA payments does not preclude recovery under Virginia Act absent evidence of intent to accept in full satisfaction | Employer: Provider’s acceptance and write-offs amounted to accord and satisfaction, barring further recovery | Held: Employer failed to prove offer and acceptance establishing accord and satisfaction; internal write-offs alone insufficient to show provider accepted LHWCA payments as full settlement |
Key Cases Cited
- Bogle Dev. Co. v. Buie, 250 Va. 431 (Va. 1995) (limits Commission jurisdiction where no right of the employee is at stake)
- Combustion Eng’g v. Lafon, 22 Va. App. 235 (Va. Ct. App. 1996) (Commission has exclusive jurisdiction over physician fee disputes)
- Ceres Marine Terminals v. Armstrong, 59 Va. App. 694 (Va. Ct. App. 2012) (acceptance of Longshore payments does not necessarily preclude recovery under state Act)
- Gelles & Sons Gen. Contr. v. Jeffrey Stack, Inc., 264 Va. 285 (Va. 2002) (accord and satisfaction requires debtor’s intent and claimant’s acceptance)
- Virginia-Carolina Elec. Works v. Cooper, 192 Va. 78 (Va. 1951) (party asserting accord and satisfaction bears the burden to prove offer and acceptance)
- Cent. State Hosp. v. Wiggers, 230 Va. 157 (Va. 1985) (claimant bears burden to prove compensable injury)