Rebel Distributors Corp. v. LUBA Workers' Comp.
137 So. 3d 91
| La. Ct. App. | 2014Background
- Rebel Distributors/Physician Partner (Rebel) obtained an assignment from Dr. Heard/Clinic (June 29, 2007) to pursue payment for prescription medications dispensed to workers’ compensation claimants; parties later executed a November 16, 2010 agreement purporting to convert the assignment into a retroactive agency relationship.
- WCJ initially declared the June 29, 2007 assignment void under La. R.S. 23:1205(A) and later found the November 16, 2010 agreement created an agency allowing Rebel to sue as agent for Dr. Heard.
- This court originally held the assignment violated the anti-assignment statute and that the novation/retroactive agency was ineffective; the Louisiana Supreme Court reversed, holding assignment/novation/agency were effective and that an agent can be a health care provider under La. R.S. 23:1021(6).
- On remand this court considered remaining issues (choice of pharmacy, applicability of $750 cap under La. R.S. 23:1142, and entitlement to penalties/attorney fees) and motions to strike portions of LUBA’s assignments of error.
- The panel struck several of LUBA’s assignments as not pleaded in its answer or resolved by the Supreme Court, affirmed the WCJ on the remaining issues, and split on the $750 statutory interpretation (dissenting judge would exclude medication from the cap).
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether Rebel (as assignee/agent) could obtain injured workers’ choice of pharmacy | Rebel argued the WCJ should have awarded claimants their choice of pharmacy | LUBA argued only the actual injured employee (and possibly employer/insurer) can assert pharmacy-choice rights and the insurer can select the dispensing pharmacy | Rejected Rebel’s argument: Rebel lacks a right to pursue the employee’s pharmacy-choice claim; no relief for Rebel on this issue |
| Whether the WCJ erred by limiting outstanding pharmacy bills to $750 under La. R.S. 23:1142 | Rebel argued §1142 was inapplicable and §1203 (benefits statute) required reimbursement of lesser of actual cost or schedule (no $750 cap on medication) | LUBA argued §1142 applies to health-care-provider claims and supports the $750 cap on nonemergency services billed by a provider/payor relationship | Affirmed WCJ: §1142 applies to claims by health-care providers/agents against payors; $750 cap properly applied to these claims (dissent disagreed, arguing medication not covered by §1142) |
| Whether Rebel was entitled to penalties and attorney fees for LUBA’s nonpayment | Rebel asserted LUBA paid nothing and should be penalized and ordered to pay fees | LUBA argued denial was reasonable given novel legal questions and notice it would not pay for these providers’ dispensing | Affirmed denial of penalties/fees: WCJ reasonably found LUBA’s denial was reasonably controverted given novel legal issues; no arbitrary or capricious conduct |
Key Cases Cited
- Rebel Distributors Corp., Inc. v. LUBA Workers’ Compensation, 129 So.3d 80 (La. App. 3 Cir. 2013) (prior appellate decision addressing assignment/agency and procedural history)
- Carradine v. Regis Corp., 52 So.3d 181 (La. App. 3 Cir. 2010) (interpretation of La. Code Civ. P. art. 2133(A) on appellee answers to appeals)
- Brown v. Texas-LA Cartage, Inc., 721 So.2d 885 (La. 1998) (definition of "reasonably controverted" for penalties under workers’ compensation law)
- Brown v. Lafayette Ass’n of Retarded Citizens, Inc., 94 So.3d 950 (La. App. 3 Cir. 2012) (standard of review for penalties/attorney-fees determinations)