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IN RE: Veterans Memorial Medical Center

CASE NO. 3063 CRB-8-95-5

COMPENSATION REVIEW BOARD

WORKERS’ COMPENSATION COMMISSION

MAY 20, 1996

IN RE: VETERANS MEMORIAL MEDICAL CENTER

MEDICAL PROVIDER

APPELLANT

APPEARANCES:

The appellant medical provider was represented by Bart Peters, Esq., Brown & Welsh, P. C., Meriden Executive Park, 538 Preston Ave., P. O. Box 183, Meriden, CT 06540-0183.

The various claimants and respondents were represented in certain cases only. Those parties and individuals are too numerous to mention here, but notice was provided to all interested parties.

This Petition for Review from the May 12, 1995 decision of the Commission Chairman was heard April 1-3, 1996 before a Compensation Review Board panel consisting of Commissioners George A. Waldron, Donald H. Doyle, Jr., and Robin L. Wilson.

OPINION

GEORGE A. WALDRON, COMMISSIONER. This action began when the appellant Veterans Memorial Medical Center (VMMC), through its attorney, sent 696 informal hearing requests to the Eighth District office in Middletown, although many of the requests involved claims allegedly arising in districts other than the Eighth. The VMMC in each case allegedly provided medical care to a person who, at the time service was rendered, indicated in some way that her injury was connected to her employment. In all of those cases, the only information that VMMC provided to the district office was a hearing request form that listed the name and address of the medical provider (VMMC), the person who received the medical attention, the alleged employer, and the workers’ compensation insurer, if known. The form stated that the issue to be discussed at said hearing was “Ascertainment of Liability for payment of Veterans Memorial Medical Center hospital services provided to claimant, pursuant to C.G.S. Section 31-294d(d).”

On May 12, 1995, the chairman of the Workers’ Compensation Commission sent a letter to VMMC’s attorney stating that the Commission would not process VMMC’s hearing requests, citing this board’s decisions in Greiner v. Pratt Associates, 13 Conn. Workers’ Comp. Rev. Op. 222, 2000 CRB-8-94-3 (April 12, 1995), Baigert v. Fosdick Corp., 13 Conn. Workers’ Comp. Rev. Op. 78, 1784 CRB-8-93-7 (Jan. 20, 1995), and Cookson v. G.R. Cummings Co., 13 Conn. Workers’ Comp. Rev. Op. 76, 1796 CRB-8-93-7 (Jan. 20, 1995), all of which involved VMMC. The chairman explained that those decisions place the burden on the medical provider of relating its services to an accepted workers’ compensation case, and that this Commission lacks subject matter jurisdiction “until there is established a claim of connection to a compensable injury.” VMMC then filed a petition for review from the chairman’s denial of its hearing requests.

The central question in this appeal is whether VMMC is entitled to a hearing on the compensability of its medical services in cases where no workers’ compensation claim has been filed by an injured employee.1 The recent decision of our supreme court in Figueroa v. C&S Ball Bearing, 237 Conn. 1 (1996), is dispositive of this issue. That decision also involved VMMC’s appeal from a ruling on claims similar to those here.

“Jurisdiction of the subject-matter is the power to hear and determine cases of the general class to which the proceedings in question belong. . . . A court has subject matter jurisdiction if it has the authority to adjudicate a particular type of legal controversy. . . . It is a familiar principle that a court which exercises a limited and statutory jurisdiction is without jurisdiction to act unless it does so under the precise circumstances and in the manner particularly prescribed by the enabling legislation.” Id., 4, quoting Castro v. Viera, 207 Conn. 420, 427-28 (1988). An administrative agency such as the Workers’ Compensation Commission is such a tribunal. Its subject matter jurisdiction cannot be created through consent or waiver, but must be conferred by statute. Castro, supra, 428.

In Figueroa, the court noted that this Commission does not have jurisdiction under the Workers’ Compensation Act until a written notice of claim has been filed, or unless one of the alternatives under § 31-294c(a) C.G.S. has been satisfied. The court did not accept the plaintiff’s argument that the medical provider may furnish the requisite notice of claim on behalf of an employee. “Although the statute does not explicitly state that an ‘employee’ shall provide the notice of claim, it is clear from a reading of the act that employees, not medical providers or other third parties, have standing to initiate a claim. . . . [T]he statutory scheme reflects [the intent to benefit injured employees] and requires that the injured employee invoke the commission’s jurisdiction by furnishing the required notice if he wishes to take advantage of the act.” Id., 6-7 (emphasis in original).

The court also rejected the medical provider’s argument that it has independent standing to initiate a claim under the Workers’ Compensation Act. Although decisions such as Gonzalez v. Electric Transport (Penske), 13 Conn. Workers’ Comp. Rev. Op. 6, 8, 1729 CRB-1-93-5 (Oct. 13, 1994), and Derman v. City of Norwalk, 8 Conn. Workers’ Comp. Rev. Op. 100, 101-02, 860 CRD-7-89-5 (May 24, 1990), have established that a medical provider has standing before the Commission to request a hearing regarding its medical bills, they are restricted to situations where the jurisdiction of the Commission has already been invoked by the employee or employer. Figueroa, supra, 8; see also Baigert, supra, 80 (without an underlying assertion by claimant to workers’ compensation benefits, commissioner would have no basis on which to inquire about medical services). The court distinguished the one case where the employee filed a workers’ compensation claim (this board’s Cookson decision) from the cases in which no proof was provided that claims were filed by the injured employees. Id., 10.

Here, VMMC offered no evidence to support the existence of a compensable injury in any of the cases when it filed its hearing requests. Instead, it sought hearings based solely on the scant information contained in the request forms. Although the question of subject matter jurisdiction, once raised, must be fully resolved, and a court has jurisdiction to determine its own subject matter jurisdiction once it has been put in issue; Id., 4, 10; Castro, supra, 429-30; not every situation warrants a hearing. Whereas courts of general jurisdiction, such as the Connecticut Superior Court, are presumed to have jurisdiction, there is no similar presumption where tribunals of limited jurisdiction, such as the Workers’ Compensation Commission, are concerned. Figueroa, supra, 10-11; State v. State Employees’ Review Board, 231 Conn. 391, 406 (1994). Thus, as a threshold matter, the party seeking to invoke the jurisdiction of this Commission must allege and prove the necessary jurisdictional facts to be recognized in this forum.

In Figueroa, just as in the cases at issue here, VMMC did no more than allege its request for payment of medical services, the date services were provided, the name of the employee, and the name of the employer and insurer, if known. The court held that “the plaintiff failed to allege any jurisdictional facts, such as whether the employee provided his employer with adequate notice of his injury, or whether the employer furnished the employee with medical services. . . . Consequently, the plaintiff’s allegations were insufficient to invoke the commission’s jurisdiction to determine whether it had subject matter jurisdiction.” Id., 11 (citation omitted). We see no basis for a different outcome here, given the limited information provided by VMMC in its hearing requests.

The next logical question becomes, what jurisdictional facts suffice to merit a hearing? Clearly, some proof that a colorable claim exists (or would have existed at the time of injury) under the Workers’ Compensation Act must be provided in order to invoke the Commission’s jurisdiction to establish the provider’s due process right to a hearing. In cases where a claim has been filed, a copy of the Form 30C would go a long way toward demonstrating some basis for the medical provider’s claim. In many instances, medical services are provided and medical bills are paid without the involvement of this Commission, thus obviating the need for the filing of a formal notice of claim, and perhaps the need for the claimant’s involvement in substantiating a work-related injury. Where no claim has been filed, proof that the employer had paid a medical bill, or that the claimant had requested a hearing, or that the parties had issued a voluntary agreement would be useful in meeting the requirement that the provider allege the indicia of subject matter jurisdiction.2

However, invoking the Commission’s jurisdiction by alleging the requisite jurisdictional facts and establishing the right to a hearing does not automatically grant VMMC that hearing. Chapter 568 sets forth certain conditions precedent that must be met prior to having a hearing. Section 31-297 mandates that the commissioner schedule a hearing once an employer, injured employee or his legal representative notifies the commissioner of a failure to reach an agreement on the issue of compensation. Administrative Reg. § 31-279-6 requires that an assignment for a hearing normally be requested only when prior consultation between the parties has failed to achieve an agreement that can be reduced to writing. The regulation also states that it shall be “considered an impropriety for a hearing to be requested by an employer or carrier with no prior discussions between the claimant and the respondent.” At oral argument, VMMC’s counsel described the efforts that the hospital generally expends to investigate its outstanding medical bills, as well as the specific attempts it made in these cases. This information was not provided in the hearing requests, however.

Although VMMC sent the Middletown district office no information besides the hearing request forms, the three-day appellate review session held by this panel on the VMMC cases uncovered a variety of scenarios. The factual predicates to some of the cases appealed by VMMC were not elaborated upon at all, as no further information had been obtained by the appellant, including the name of the insurer. In other cases, claimants and attorneys for the insurers were present, sometimes disclosing that the claims had been accepted as compensable by the insurer or employer. Far too often, it turned out that VMMC had already been paid or granted a hearing, and that it had simply neglected to withdraw the appeal. In short, not every one of the 696 claims stands on equal footing in terms of its viability. Some should not be pursued without more information, while others have already been settled.

Assuming nothing further had been provided by VMMC in accordance with the chairman’s letter, pursuant to statute VMMC could not avail itself of the Workers’ Compensation Commission as an investigative tool in its collection efforts. It should also be pointed out that, once further information concerning a claim was provided, statutory prerequisites were often satisfied and hearings were then held pursuant to VMMC requests, thus facilitating the withdrawal of many of the subject appeals.

Accordingly, the appeals are dismissed.

Commissioners Donald H. Doyle, Jr., and Robin L. Wilson concur.

1 The appellant has also argued that the chairman did not have the statutory authority to refuse its request for a hearing. Because, in accordance with Figueroa v. C&S Ball Bearing, 237 Conn. 1 (1996), we conclude that this Commission lacks subject matter jurisdiction over the claims on appeal, we need not reach the issue of whether the chairman’s ruling was an administrative act or an adjudicatory act. Id., 3 n. 4; see also Dixon v. United Illuminating Co., 232 Conn. 758, 779 (1995). BACK TO TEXT

2 We also note that an injured employee who fails to exercise his option of taking advantage of the Workers’ Compensation Act may be exposing himself to personal liability for a medical provider’s services. Figueroa, supra, 9. BACK TO TEXT

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State of Connecticut Workers' Compensation Commission, John A. Mastropietro, Chairman
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