737 S.E.2d 544
Va. Ct. App.2013Background
- Messer, Muller Martini employee, sustained a compensable injury in 2007 and received medical treatment from Dr. Coleman at OSC.
- Dr. Coleman had a Specialist Physician Agreement with Aetna in 2003 which allowed Aetna to designate participation in new Plans with written notice.
- AWCA invitation letter allegedly designated Coleman as a Participating Provider in AWCA with opt-out option, sent December 2005 by AWCA administrator Dupuis; method of delivery not proven.
- Spa-required notice mandated written, overnight delivery with proof of receipt or certified mail; no evidence the AWCA invitation used these methods.
- OSC sought reimbursement for Messer’s 2007 services from Muller Martini’s insurer; Wausau reimbursed only a small portion.
- Deputy Commissioner and then the full Commission adopted the findings that notice was sent and that Coleman accepted participation; OSC challenged this, and the matter proceeded to appeal.
- Virginia courts reverse when notice provisions are not satisfied, waivers require writing signed by authorized officer, and modifications require clear, unequivocal evidence; here such evidence was lacking, so the contract was not validly modified to include AWCA.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Was the AWCA invitation letter sufficient to enroll Coleman? | Coleman argues no proper written notice per SPA. | Appellees contend notice was provided and accepted. | No; proper notice not satisfied, Coleman not enrolled. |
| Did Coleman waive his objection to inclusion in AWCA? | OSC argues waiver evidenced by acceptance of payments. | Waiver requires writing signed by authorized officer; there is no valid waiver. | Waiver not proven; not a valid modification. |
| Was there a modification of the SPA to include AWCA by parol agreement? | Record shows acceptance of payments implied modification. | Modification requires clear, unequivocal evidence; there is none. | No valid unwritten modification proven; contract not modified. |
Key Cases Cited
- Stanley’s Cafeteria, Inc. v. Abramson, 226 Va. 68 (Va. 1983) (waiver requires writing and signed by authorized officer; burden on waiverproofs must be clear)
- Reid v. Boyle, 259 Va. 356 (Va. 2000) (parol modification possible but must be supported by clear evidence)
- Utica Mutual v. National Indemnity, 210 Va. 769 (Va. 1970) (waivers require knowledge and intent to relinquish rights)
- Great Atlantic & Pacific Tea Co. v. Robertson, 218 Va. 1051 (Va. 1978) (modification of contract requires clear and convincing evidence)
- Luginbyhl v. Commonwealth, 48 Va. App. 58 (Va. App. 2006) (appellate ground; narrow grounds for decision)
- Envtl. Staffing Acquisition Corp. v. B&R Constr. Mgmt., 283 Va. 787 (Va. 2012) (contract interpretation; plain meaning governs)
- Reid v. Boyle, 259 Va. 356 (Va. 2000) (parol modification discussion cited in opinion)