AUTOMATION TOOL & DIE, INC. v. MEDINA HOSPITAL, et al.
C.A. No. 18CA0009-M
IN THE COURT OF APPEALS NINTH JUDICIAL DISTRICT COUNTY OF MEDINA, OHIO
May 6, 2019
2019-Ohio-1691
CARR, Judge.
APPEAL FROM JUDGMENT ENTERED IN THE COURT OF COMMON PLEAS COUNTY OF MEDINA, OHIO CASE No. 17CIV0642
CARR, Judge.
{¶1} Plaintiff-Appellant Automation Tool & Die, Inc. (“ATD“) appeals from the judgment of the Medina County Court of Common Pleas. This Court affirms.
I.
{¶2} ATD is an employer participating in the State Insurance Fund under the Ohio Workers’ Compensation System. In 2008, one of ATD‘s employees filed a First Report of Injury with the Ohio Bureau of Workers’ Compensation alleging he was injured while employed at ATD. The employee sought treatment at Medina General Hospital and was seen by a certified nurse practitioner who was collaborating with physician Defendant-Appellee Francine Terry, M.D.
{¶3} When, after conservative treatment, the employee continued to be experiencing pain, the nurse practitioner “rubber-stamped” Dr. Terry‘s signature on a form requesting that the Ohio Bureau of Workers’ Compensation approve an MRI for the employee. The MRI was
{¶4} The employee was separated from his employment in April 2009. He subsequently sought and received Temporary Total Disability Compensation. ATD later discovered that the employee was working while claiming to be disabled. The matter was investigated and the employee‘s physicians were interviewed. The Industrial Commission vacated the additional allowances.
{¶5} In July 2017, ATD refiled a complaint against Defendant-Appellant Medina Hospital and Dr. Terry. ATD asserted that the documentation submitted by Medina Hospital and Dr. Terry contained “false, fraudulent, deceptive and misleading information in that they appear to reflect opinions as to causation reached by a physician based on actual medical evidence, when in fact they were founded upon nothing more tha[n] a standard office protocol, unsupported by any medical evidence.” ATD maintained that, as a result of the additional allowances, ATD incurred costs and expenses defending the employee‘s claim that it would not have incurred had it received accurate information.
{¶6} ATD alleged two claims: one for “Breach of Statutory and Regulatory Duties” pursuant to
{¶7} Ultimately, the trial court granted Medina Hospital‘s and Dr. Terry‘s motion. The trial court found that
{¶8} ATD has appealed, raising a single assignment of error for our review.
II.
ASSIGNMENT OF ERROR
THE TRIAL COURT COMMITTED REVERSIBLE ERROR IN GRANTING APPELLEES’ MOTION FOR PARTIAL JUDGMENT ON THE PLEADINGS ON THE FIRST COUNT OF AUTOMATION‘S COMPLAINT “BREACH OF STATUTORY AND REGULATORY DUTIES” ARISING OUT OF OHIO ADMINISTRATIVE CODE 4123-6-20(A).
{¶9} ATD argues in its sole assignment of error that the trial court erred in granting the motion for partial judgment on the pleadings as
{¶10} Civ.R. 12(C) states, “[a]fter the pleadings are closed but within such time as not to delay the trial, any party may move for judgment on the pleadings.” “Under Civ.R. 12(C), dismissal is appropriate where a court (1) construes the material allegations in the complaint, with all reasonable inferences to be drawn therefrom, in favor of the nonmoving party as true, and (2) finds beyond doubt, that the plaintiff could prove no set of facts in support of his claim that would entitle him to relief.” (Internal quotations and citation omitted.) Merryweather Mgt., Inc. v. KNL Custom Homes, Inc., 9th Dist. Summit No. 25971, 2012-Ohio-2977, ¶ 8.
{¶11} “In determining whether statutes may create a private cause of action for enforcement, the Ohio Supreme Court has held that a ‘statutory policy’ may not be implemented
{¶12} Here, ATD alleged in its complaint that
{¶13} The regulation states:
A provider is responsible for the accuracy and legibility of all reports, information, and/or documentation submitted by the provider, the provider‘s employees, or the provider‘s agents to the bureau, industrial commission, claimant, employer, or their representatives, MCO, QHP, or self-insuring employer in connection with a workers’ compensation claim. The provider, the provider‘s employees, and the provider‘s agents shall not submit or cause or allow to be submitted to the bureau, industrial commission, claimant, employer, or their representatives, MCO, QHP, or self-insuring employer any report, information,
and/or documentation containing false, fraudulent, deceptive, or misleading information.
{¶14} Even assuming we were to conclude that ATD, as an employer and an entity of the type listed in the regulation, was “of the class for whose especial benefit the statute was enacted[,]” see Strack, 33 Ohio App.3d at 337, we still must examine the remaining two prongs. (Emphasis omitted.) Those prongs look to whether there is any indication of legislative intent, explicit or implicit, either to create or deny a private cause of action and whether it is consistent with the underlying purposes of the legislative scheme to infer such a remedy for the plaintiffs. See id.
{¶15} “In 1993, the General Assembly amended Ohio‘s workers’ compensation scheme to create the Health Partnership Program (“HPP“), a comprehensive managed care program administered by * * * the Bureau of Workers’ Compensation (“BWC“), to provide medical services to employees for their compensable injuries or occupational diseases.” Northwestern Ohio Bldg. & Constr. Trades Council v. Conrad, 92 Ohio St.3d 282, 282 (2001). “The General Assembly has delegated broad rulemaking authority to the administrator of workers’ compensation.” Id. at 286. “When the General Assembly enacted the HPP, it vested additional rulemaking authority in the administrator of workers’ compensation tailored to the specific goals of that comprehensive program.” Id. at 287. ”
{¶16} Ohio Administrative Code Chapter 4123-6 is entitled “Health Partnership Program[.]” That chapter includes the regulation at issue. Among the regulations in the chapter is a regulation that provides for the decertification of a “non-facility provider who has failed to comply with a workers’ compensation statute or rule.”
may proceed directly to the enrollment termination and/or decertification of a provider for violation of * * * [a]cts of intentional misrepresentation, misstatement, or omission of a relevant fact or other acts involving false, fraudulent, deceptive, or misleading information on reports, information, and/or documentation submitted by the provider, the provider‘s employees, or the provider‘s agents to the bureau, industrial commission, claimant, employer, or their representatives, MCO, QHP, or self-insuring employer in connection with a workers’ compensation claim.
{¶17} Another regulation provides that “[b]y signing the provider application and agreement or recertification application and agreement, the provider agrees to, and the bureau may refuse to certify or recertify or may decertify a provider for failure to * * * [c]omply with
{¶18} While the plain language of the regulation itself does not indicate a legislative intent to either create or deny a private cause of action, when the enabling statutes and other regulations in the chapter are considered as well, we cannot say there is any indication of a legislative intent to create a private remedy under
{¶19} We note that, in its reply brief, ATD asserted other statutes supported that the legislature intended for it to have a private cause of action for violations of
{¶20} Finally, we cannot say that it is consistent with the underlying purposes of the legislative scheme to infer a private cause of action for employers like ATD for violations of
[t]he [Managed Care Organization (“MCO“)] program was created as part of an overall plan, enacted by the General Assembly in
R.C. 4121.44 and4121.441 , to more efficiently manage the medical aspects of workers’ compensation claims. A committee composed of individuals from business, labor, medical providers, and the BWC staff designed the major components of the HPP, including the MCO program. The committee included representatives from the AFL-CIO, the Ohio Civil Service Employees Association, the Communications Workers of America, and the Ohio Trial Lawyers Association.On March 28, 1995, the committee reached unanimous agreement on key aspects of the BWC‘s HPP. Following public hearings, the BWC promulgated a series of administrative rules in Ohio Adm.Code Chapter 4123-6 to implement the HPP.
Under the new program, the BWC administers the HPP and monitors the MCO program, including certifying each MCO and individual provider. The BWC also conducts regular recertification reviews. The BWC exclusively determines whether a claim is compensable and what conditions are allowed, subject only to an appeal to the Industrial Commission.
Ohio Adm.Code 4123-6-043(A) ;4123-6-045 . The BWC authorizes the release of state funds to pay the medical claims.Ohio Adm.Code 4123-6-043(A) ;4123-6-045(A) . The BWC works with the MCO, the employer, the employee, and the provider to effect a course of treatment that promotes a safe and speedy return to work.Ohio Adm.Code 4123-6-043(B) .
State ex rel. Haylett v. Ohio Bur. of Workers’ Comp., 87 Ohio St.3d 325, 328-329 (1999).
{¶21} We fail to see how authorizing a private cause of action for employers like ATD for violations of
{¶22} In sum, we cannot say that a private cause of action is authorized under
III.
{¶23} All outstanding motions are hereby denied. The judgment of the Medina County Court of Common Pleas is affirmed.
Judgment affirmed.
There were reasonable grounds for this appeal.
We order that a special mandate issue out of this Court, directing the Court of Common Pleas, County of Medina, State of Ohio, to carry this judgment into execution. A certified copy of this journal entry shall constitute the mandate, pursuant to App.R. 27.
Immediately upon the filing hereof, this document shall constitute the journal entry of judgment, and it shall be file stamped by the Clerk of the Court of Appeals at which time the period for review shall begin to run. App.R. 22(C). The Clerk of the Court of Appeals is instructed to mail a notice of entry of this judgment to the parties and to make a notation of the mailing in the docket, pursuant to App.R. 30.
Costs taxed to Appellant.
DONNA J. CARR
FOR THE COURT
SCHAFER, J.
CONCUR.
APPEARANCES:
THOMAS P. MAROTTA and MICHAEL S. LEWIS, Attorneys at Law, for Appellant.
JEFFREY J. WEDEL and DAVID P. FRANTZ, Attoreys at Law, for Appellee.