*1 APPEALS IN THE COURT OF EXPRESS, INC. COURIER OF APPLE v. COMMERCIAL ESTATE (2005)] unnecessary review of the remain- opinion. mandate makes this This by respondent. ing issues raised and remanded.
Reversed
Judges McGEE and ELMOREconcur. APPLE, APPLE, Behalf of WORTH ESTATE OF WORTH Deceased Employee, APPLE, APPLE, Widow of WORTH BESSIE HUTCHINS Deceased Employee, INC., EXPRESS, MICHIGAN Employer; COMPANY, MUTUAL INSURANCE Defendants Carrier No. COA03-850-2 January 2005) (Filed 18 employee’s Compensation— estate — med- Workers’ — third-party by employer ical owed employee’s a claim An estate did not past expenses owed to a due medical employer com- defendant compensability; pensation claim when: admitted provider entered into an accord and (2) the and medical satisfaction; provider made no claim for relief (3) the medical Commission; (4) plaintiff made no before the However, in fact. the failure to make results compensation claimant preclude a workers’ holding does not only compensation claim when the claim pursuing a medical has not been an intervention of disputed or contested and there provider in the lawsuit. a medical only. concurring in result
Judge Tyson Award entered 13 Appeal by plaintiff from an Heard February by the North Carolina Industrial Commission. July Opinion filed 20 2004. Appeals 30 March 2004. the Court of 2004, reconsidering the case August rehearing granted Petition for super- only. following opinion The filing of additional briefs with July replaces opinion filed 20 sedes and APPEALS IN THE COURT OF COURIER ESTATE OF APPLE COMMERCIAL *2 [168 plaintiff-appellant.
R. James Lore Roth, P.A., by Klick, & F. Jr. Carruthers Norman and J. Patrick defendant-appellees. Haywood, for HUNTER,Judge. appeals Opinion Award of the Full Commission of February
the North Carolina Industrial Commission filed 13 2003 rul- Express, (“CCE”) Michigan that Commercial Courier Inc. Company (collectively Mutual “defendants”) Insurance were not responsible payments for additional for rehabilitation care of Worth Apple (“Apple”). Because we conclude lacks to bring claim, portion this we must vacate of the Commission’s Opinion and Award. Apple This case stems from the same facts as Estate of Express, Inc., App. 530,
Commercial Courier 165N.C. Apple working as a courier for CCE when he was attacked and in the with a in August hit head hammer 1994. He persistent January vegetative remained in a state until his death in appeal solely by plaintiff 2001. This a claim involves that defendants pay $160,000.00 failed to in accrued medical to Winston- pursuant (“W-SRehab”) Salem Rehabilitation and Healthcare Center parties. to a Form 21 entered into the W-SRehab did not intervene in the action and the record accepted $50,000.00 case reveals W-SRehab a reduced as Apple in full for services rendered to and the account was issue, settled to the satisfaction of W-S Rehab. On this the concluded, Commission inter alia: compensable injury,
3. As a result of decedent’s decedent provide necessary was entitled have all to defendants compensable injury arising treatment from his to the extent it cure, give tended to effect a relief or lessen decedent’s disabil- ity. . . . Plaintiff failed establish . . . that to defendants failed agreed pro- the reimbursement for the reasonable services vided W-SRehab. estopped request compensa- further Rehab] [W-S $50,0000 payment accepting
tion after full accord and potential unpaid satisfaction of the claim or claim for services. . . .
ESTATE OF APPLE Thus, in the award Award, responsible Commission stated: “Defendants are not any additional monies to W-SRehab for the care of . . decedent.
Although the Commission ruled favor of defendants on the primarily merits of the case on ground of accord and satisfac- tion Rehab, dispositive between defendants and W-S issue be- fore us is whether even has to assert non-payment expenses by of medical decedent’s ato third-party provider.
If a claim, does not have a court has no *3 subject jurisdiction matter to hear the claim. See Neuse River Found., Foods, Inc. v. Inc., App. 110, 113, 155 N.C. 574 Smithfield 48, (2002); S.E.2d 51 see Colony Builders, Inc., also Henke v. First App. 703, 704, 126 431, N.C. 486 (1997) (stating S.E.2d 432 in a work- ers’ case, may Court ex mero motu an dismiss “[t]his subject jurisdiction, for lack of matter even if it is not raised by parties appeal”). Standing consists of three main elements:
“(1) ‘injury in protected fact’—-an invasion of a legally interest (a) particularized that is (b) concrete and imminent, actual or conjectural hypothetical; not injury fairly or is traceable to challenged defendant; action of the likely, it is opposed merely speculative, injury that the will be redressed by a favorable decision.” Found.,
Neuse River
114,
155 N.C.
(quoting
In this injury fact has resulted will required or result if are not to W-S defendants $160,000.00. all, Rehab the full First of outstanding there is no debt to by W-S Rehab to be collected as evidenced W-S Rehab’s own corre- spondence. Further, if outstanding debt, even there was an W-S attempting any Rehab is barred law from to collect such debt plaintiff. See N.C. 97-88.3(c) (2003) (class § Gen. Stat. misde- provider knowingly employee meanor for a healthcare hold an responsible compens- for medical incurred as a result of a injury); able see 97-90(e) (2003) (a also N.C. Gen. Stat. health care § provider pursue private against employee shall not an claim for adjudicated compensable). costs of treatment unless claim is not COURIER ESTATE OF APPLE COMMERCIAL remedy provider addition, and exclusive healthcare the sole is to seeking from an Jackson, apply from the See Palmer v. relief Commission. 634-35, 901, 625, (2003), 579 S.E.2d disc. review allowed, No such improvidently 358 N.C. application in this was made case. injury in fact
Nonetheless, plaintiff
it has suffered an
asserts
relationship
provider
it
protect
because must
its
with medical
fully
unlikely
ensuring
paid.
it
highly
bills are
Plaintiff contends
is
willing
providing
would
treat-
that medical
be
continue
compromised
paid at
ment when its bills are
or not
all. To constitute
injury
fact,
protected
can not
legally
an
the invasion of a
interest
conjectural
hypothetical.
Found.,
River
be
or
See Neuse
App. at
has a
interest
of interest on
com-
However,
pensation
Stat.
Gen.
under N.C. Gen.
97-86.2.
under N.C.
97-86.2,plaintiff
Stat.
would be entitled to interest on medical com-
*4
pensation only
appeal
where there is an
in an ultimate
resulting
possibility
employee.
award to
The
of a favorable decision on
protected
a legally
is not an invasion of
interest that is either
particularized, or
imminent.
River
concrete and
actual or
See Neuse
Found.,
114,
155 N.C.
at
Next, plaintiff
pecuniary
asserts it
interest in awards of
has
attorney
granted
'§§
fees
under N.C. Gen. Stat.
97-88.1 and 97-88.
97-88.1,
attorney’s
N.C.
97-88
§§
Under
Gen. Stat.
and
award of
discretionary
Taylor
fees is a
decision made
the Commission. See
Co.,
397,
681,
392,
v. J. P.
307 N.C.
298 S.E.2d
684
Stevens
plaintiffs
interest
com
regarding
Similar
assertions
on medical
attorney’s
pensation,
possibility of an
fees award is not an inva
particularized,
legally protected
sion of a
that is concrete and
interest
Found.,
114,
or
or actual
imminent. See Neuse River
N.C.
ESTATE OF APPLE Co., 239, Erection confer plaintiff. Plaintiff cites the following language Hyler: from legislature always provided conclude that the for,
[W]e
and
provide for,
continues to
components
two distinct
of an award
Compensation
under the
payment
Workers’
Act:
for the cost
of
care,
medical
now denominated
compensation,”
“medical
which consists of
employee’s
expenses
medical
job-related
incurred as a result of a
injury;
(2) general
and
“com-
pensation” for financial loss other than medical expenses, which
compensate
includes
employee’s
for an
earning
lost
capacity
expenses.
of funeral
Hyler, 333
N.C. at
Similarly, Buckner, Pearson v. C.P. does not confer stand- upon plaintiff. Pearson, Supreme our Court considered the issue of
whether an liability who denies but is ordered to pay medical Compensation under the Workers’ Act may (Act) fulfill obligation by merely reimbursing Medi- caid where paid providers Medicaid has the cost of treatment or whether the must also providers the difference between the amount covered by Medicaid and the full amount authorized the Act under the Industrial Commission (Commission) fee schedule for med- expenses. ical
Pearson,
348 N.C. at
Thus,
498 S.E.2d at
Pearson,
our
Supreme Court had to consider whether the federal Medicaid statutes
regulations preempted
North
Compensation
Carolina’s Workers’
*5
243-47,
Act. Id. at
ESTATE to such, plaintiff standing bring we does not have As conclude past due owed to a medical claim medical provider by compensation employer in a workers’ compensability, the where the has admitted claim provider an accord and employer and medical entered into satisfac- provider has made no for relief before the tion, (3) the medical claim Commission, (4) plaintiff and that the failure to Furthermore, holding in fact.1 our make results in today preclude compensation pur- from does not a workers’ claimant only compensation disputed is suing a medical when the claim and not been an intervention of a medical or contested there has Opinion provider Accordingly, the of the and in the lawsuit.2 addressing issue, para- contained Award of the Commission law and graphs paragraph 3 and of the Commission’s conclusions of award, must of the be vacated.3 Finally, plaintiff have to as we have concluded does not compromise settlement between defend- contest the and plaintiff impliedly appeal extent that asserts in this that defendants’ 1. To the provided by of care to make full led to a reduction the standard failure by Apple, plaintiffs defendants, recourse was not to force but W-SRehab to 97-25, provides which that § instead under N.C. Gen. Stat. Commission “[t]he was may any upon employee change request the of an order a of treatment and des- time by injured subject approval employee ignate suggested to the other treatment by expense Commission, borne and in a case the thereof shall be of the such employer....” (2003). Furthermore, if believed the care N.C. Gen. Stat. 97-25 remedy given Apple legally substandard, proper have to W-SRehab was would pursue potential against W-S of the tort action Rehab outside workers’ com- been to pensation regime. rehearing argued petition 2. that our decision could result in the its compensation 100,000 cases. Plaintiff also of more than current dismissal explained seventy-five years practice had of the that for it been the Industrial party plaintiff having injured view the as a at interest stand- Commission to real only” Indeed, Report in the of the “medical claims. last Biennial North to covering 1989-90, reported Commission, 1988-89and the number Carolina Industrial only” $1,000.00 143,040 involving or less cases medical “medical 120,407 acknowledge we that a substantial number for 1989-90.While for 1988-89 only” claims, involve we “medical reiterate compen- of cases before Industrial Commission today stated, holding impact these cases. we a workers’ does not As that our only” pursue to a “medical claim. sation claimant However, contested case the medical and the insurance carrier or in those instances where claim, plaintiff agreed compromise lacks settlement instances, pre- pursue claim. In those seeking against the claimant. redress cluded regarding remaining with indem- We note the issues dealt the Commission thus, nity compensation us on this decision does are not before remaining portion and Award. of the Commission’s address the *6 t-H r-H ESTATE OF APPLE v. COMMERCIAL COURIER (2005)1 provider, ants and the medical we do not the issue reach of whether approve Commission had to the settlement under the facts of this case. part.
Vacated in
Judge WYNNconcurs.
Judge only separate opinion. TYSONconcurs the result in a TYSON,Judge concurring only. in the result agree I with this reasoning opinion, Court’s in our first Estate of Apple Worth Express, Inc., Commercial Courier (2004) ("Apple I"). Apple As majority’s stated in I and restated above in the opinion, the issue plaintiff before this Court is whether to assert non-payment expenses by Apple’s employer of medical to a third- party provider. Apple I, we held: past has no a claim for due medical owed to a where[:] has made no claim relief before the and (2) that the fail-
Commission^] ure to make results in in fact.
Id.