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Cuascut/VMMC v. Waldbaum’s Foodmart

CASE NO. 3111 CRB-8-95-6

COMPENSATION REVIEW BOARD

WORKERS’ COMPENSATION COMMISSION

OCTOBER 1, 1996

CLARISSA CUASCUT

CLAIMANT-APPELLEE

VETERANS MEMORIAL MEDICAL CENTER

MEDICAL PROVIDER

APPELLANT

v.

WALDBAUM’S FOODMART

EMPLOYER

and

CRAWFORD & COMPANY

INSURER

RESPONDENTS-APPELLEES

APPEARANCES:

The claimant was not represented at oral argument. Notice sent to Lisa Barry, Esq., Cadden, Ivers, Ivers & Barry, P. O. Box 1739, 107 East Main St., Meriden, CT 06450.

The medical provider was represented by Houston Putnam Lowry, Esq., Brown & Welsh, P.C., Meriden Executive Park, 538 Preston Ave., P. O. Box 183, Meriden, CT 06450.

The respondents were represented by David Davis, Esq., McGann, Bartlett & Brown, 281 Hartford Tpke., Vernon, CT 06606.

This Petition for Review from the Stipulation for Agreement and Award approved June 15, 1995 by the Commissioner acting for the Eighth District was heard April 19, 1996 before a Compensation Review Board panel consisting of Commissioners George A. Waldron, Robin L. Wilson and Nancy A. Brouillet.

OPINION

GEORGE A. WALDRON, COMMISSIONER. The medical provider VMMC has petitioned for review from the June 15, 1995 approval of a stipulation by the Commissioner acting for the Eighth District. The hospital argues on appeal that it did not receive notice of the hearing to approve the stipulation, and that it should have been afforded a hearing to determine whether its medical bills are compensable. In an unusual twist, it appears that VMMC has actually filed two separate but interrelated appeals in this matter. The other appeal was one of the many hundreds of petitions for review from a May 12, 1995 ruling of the Chairman of the Workers’ Compensation Commission, which were discussed together in In re: Veterans Memorial Medical Center, 3063 CRB-8-95-5 (decided May 20, 1996). Before we move on, we must review that decision to determine which, if any, of the appellant’s concerns have already been settled.

In the prior VMMC decision, the hospital had appealed from the Chairman’s ruling that this Commission would not process 696 hearing requests by VMMC without further information. Specifically, VMMC had not alleged in any of its hearing requests that the claimant had filed a workers’ compensation claim, or that there was in fact a compensable injury. Consistent with the recent decision in Figueroa v. C&S Ball Bearing, 237 Conn. 1 (1996), this board held that VMMC did not have standing to initiate a claim itself; rather, the employee must file the claim. Once the requisite jurisdictional facts are shown by the medical provider, however, a hearing may be held at the provider’s request regarding its medical bills. See Gonzalez v. Electric Transport (Penske), 13 Conn. Workers’ Comp. Rev. Op. 6, 8, 1729 CRB-1-93-5 (Oct. 13, 1994).

There is no doubt that the claimant made allegations of compensable injuries here. The stipulation clearly sets forth the claimed injuries, the respondents’ denial of their compensability, and the parties’ agreement to settle the matter for $15,000, including compensation, disfigurement awards, and past and future medical bills. Thus, the central issue in the prior VMMC decision, i.e., the provider’s rights in the absence of a colorable claim, is not germane to this appeal. Accordingly, this panel is not prevented by the doctrine of the law of the case from addressing the hospital’s appellate arguments. Compare Chase v. State of Connecticut/Department of Motor Vehicles, 2185 CRB-2-94-9 (decided June 20, 1996) (issue raised in prior appeal may not be readdressed).

In Gonzalez, supra, the claimant and respondents settled the instant claim. Subsequently, a medical provider filed an informal hearing request concerning payment of past medical bills. The claimant’s attorney then requested that the stipulation be opened on grounds of mutual mistake, as the medical provider had never billed her client. The respondents objected. The commissioner refused the medical provider’s request to present testimony, stating that jurisdiction would not exist unless and until the motion to open was granted. Because that motion was denied, the medical provider appealed.

This board reversed the commissioner, stating that the medical provider stands in the shoes of the claimant under § 31-327(a) C.G.S., and that it has the same right to a hearing and award as the claimant. Although a stipulation cannot be set aside without the consent of all parties absent fraud, misrepresentation, accident or mistake, the medical provider was entitled to introduce evidence to support the claimant’s request to open the stipulation. Id., 8; see also Housing Authority v. Lamothe, 225 Conn. 757, 767 (1993). There was also an allegation in that case that the respondents had ignored the provider’s bill for services without notifying the claimant of its existence, which further supported the motion to open the stipulation. Thus, the matter was remanded.

The biggest difference between this case and Gonzalez is that the claimant here never requested that the stipulation be opened. However, Gonzalez states that once a claimant initiates workers’ compensation proceedings, a medical provider stands in his shoes and is entitled to a hearing regarding its service charges. Yet, VMMC did not file a motion to open the stipulation here; instead, it notified the parties that it was placing a $3674.09 lien on the proceeds of the workers’ compensation award,1 and filed this appeal. The hospital had filed a request for a hearing on May 10, 1995, just over one month before the stipulation was approved. That hearing was not held.

Despite the absence of a motion to open, it is clear from Gonzalez that the provider has the right to intervene in these proceedings if its charges are compensable. We believe that the most appropriate solution is to remand this case to the trial commissioner for a determination as to whether the stipulation should be opened or not, with VMMC having the opportunity to argue that the commissioner should exercise her discretion under § 31-315 C.G.S. to do so. Id., 8.

Commissioners Robin L. Wilson and Nancy A. Brouillet concur.

1 We note that the petition for review was filed twelve days after the approval of the stipulation. The appellant claims that it was not notified of that agreement until June 27, 1995, however, and we have no reason to dispute that contention. It appears from the record that VMMC, not being listed as a party, would not have been sent meaningful notice of the decision. See Conaci v. Hartford Hospital, 36 Conn. App. 298 (1994). Thus, we do not believe that the petition for review was untimely under § 31-301(a) C.G.S. BACK TO TEXT

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