Orthopedic Ambulatory Surgery Ctr. of Chesterfield, LLC v. Sharpe Holdings, Inc.

675 S.W.3d 574

ORTHOPEDIC AMBULATORY SURGERY CENTER OF CHESTERFIELD, LLC, and Chesterfield Spine Center, LLC, Appellants,

v.SHARPE HOLDINGS, INC., Employers Insurance Co., of Wausau, Pilot Travel Centers, LLC, Liberty Mutual Insurance Co., Noranda Aluminum, Inc., New Hampshire Insurance Co., Cascades Holdings US Inc., Zurich American Insurance Co., CIC Group, Inc., Arch Insurance Co., City of Webster Groves, St. Louis Area Insurance Trust, N & R of Fulton, Inc., Missouri Nursing Home Insurance Trust, City of Ferguson, Missouri, St. Louis Area Insurance Trust, Unilever Manufacturing (US) Inc., the Insurance Co. of the State of Pennsylvania, Fiserv Solutions, Inc., New Hampshire Insurance Co., Sedgwick Claims Management Services, Inc., Trumbull Insurance Co., Liberty Utilities Service Corp., Zurich American Insurance Co., ERB Equipment Co., Inc., Old Republic Insurance Co., Employbridge Midwest3, Inc., XL Specialty Insurance Co., City of University City, Missouri, St. Louis Area Insurance Trust, the Dufresne Spencer Group, LLC, and American Zurich Insurance Co., Respondents.

No. ED 110859

Missouri Court of Appeals, Eastern District, DIVISION FOUR.

Filed: July 25, 2023

Motion for Rehearing and/or Transfer to Supreme Court Denied August 28, 2023

Application for Transfer to Supreme Court Denied October 24, 2023

FOR APPELLANTS: Jack B. Spooner, 34 N. Brentwood Blvd, Suite 210, St. Louis, Missouri 63105.

FOR RESPONDENTS SHARPE HOLDINGS, EMPLOYERS INSURANCE CO. OF WAUSAU, PILOT TRAVEL CENTERS, LLC, LIBERTY MUTUAL INSURANCE CO., NEW HAMPSHIRE INSURANCE CO., CASCADES HOLDINGS US, INC., ZURICH AMERICAN INSURANCE CO., CIC GROUP, INC., ARCH INSURANCE CO., CITY OF WEBSTER GROVES, ST. LOUIS AREA INSURANCE TRUST, N& R OF FULTON, INC., MISSOURI NURSING HOME INSURANCE TRUST, CITY OF FERGUSON, MISSOURI, ST. LOUIS INSURANCE TRUST, UNILEVER MANUFACTURING (US) INC., THE INSURANCE COMPANY OF THE STATE OF PENNSYLVANIA, FISERV SOLUTIONS, INC., NEW HAMPSHIRE INSURANCE CO., SEDGWICK CLAIMS MANAGEMENT SERVICES, INC., TRUMBULL INSURANCE CO., LIBERTY UTILITIES SERVICE CORP., ERB EQUIPMENT CO., INC., OLD REPUBLIC INSURANCE CO., EMPLYBRIDGE MIDWEST3, INC., CITY OF UNIVERSITY CITY MISSOURI, ST. LOUIS AREA INSURANCE TRUST, THE DUFRESNE SPENCER GROUP, LLC, AMERICAN ZURICH INSURANCE COMPANY, NORANDA ALUMINUM, INC., XL SPECIALTY INSURANCE COMPANY: Joshua K. Friel, 225 S. Meramec Ave., Suite 325, St. Louis, Missouri 63105.

FOR RESPONDENT CAT'S MEOW EMBROIDERY & GIFTS, LLC AND THE HARTFORD INSURANCE COMPANY OF THE MIDWEST: Doug S. Laudel, 1010 Market Street, Suite 1510, St. Louis, Missouri 63101.

FOR RESPONDENT UNITED PARCEL SERVICE, INC., AND LM INSURANCE CORPORATION: Spencer Low, 10 E. Cambridge Circle Dr., Suite 300, Kansas City, Kansas 66103.

FOR RESPONDENTS FAULTLESS LANDRY COMPANY, LLC AND OLD REPUBLIC INSURANCE CO.: Brian K. McBrearty, 222 S. Central Ave., Suite 200, St. Louis, Missouri 63105.

FOR RESPONDENTS JACK COOPER TRANSPORT COMPANY, INC., AND CONTINENTAL INDEMNITY COMPANY: Martin J. Buckley, 800 Market Street, Suite 2900, St. Louis, Missouri 63101.

FOR RESPONDENTS HUBBELL INCORPORATED DELAWARE, WYNDHAM WORLDWIDE OPERATIONS, INC., MISSISSIPPI LIME COMPANY, ACE AMERICAN INSURANCE COMPANY, SCHOLASTIC, INC. AND INDEMNITY INSURANCE CO., OF NORTH AMERICA: Gregory T. Cook, 505 N. 7^th Street, Suite 2100, St. Louis, Missouri 63101.

Kelly C. Broniec, C.J., Philip M. Hess, J., and James M. Dowd, J.

James M. Dowd, Judge

Introduction

This case concerns health care providers (HCPs) that rendered medical care pursuant to the Missouri Workers’ Compensation Act, section 287.010 et seq., to injured workers at the request of employers and the employers’ workers’ compensation insurance companies. The issue before us is whether those HCPs, after receiving partial payment for that medical care from the employers, may pursue through common law claims in the circuit court those employers and insurance companies for the remaining balance of those charges or whether their recourse is exclusively limited to the procedures and remedies available under the Act.

Appellants Orthopedic Ambulatory Surgery Center of Chesterfield, LLC, and Chesterfield Spine Center, LLC, filed suit in the Circuit Court of St. Louis County against numerous employers and their workers’ compensation insurers (Respondents¹ ) for the payment of medical charges arising from the treatment Appellants provided pursuant to the Act to Respondents’ injured workers. Appellants’ underlying civil causes of action sound in breach of contract, action on account, unjust enrichment, quantum meruit, promissory estoppel, and negligent misrepresentation.

Respondents sought summary judgment² on their affirmative defenses (1) that under section 287.120, the Division of Workers’ Compensation (or the Labor and Industrial Relations Commission) has the exclusive authority over disputes relating to charges incurred for medical care or other services provided pursuant to the Act; (2) that section 287.140 and its associated state regulation establish the exclusive remedy available to Appellants in connection with such disputes; and (3) that Appellants’ claims are barred by the doctrines of collateral estoppel or res judicata. The trial court granted Respondents’ motions for summary judgment on the "affirmative defense that the procedures established by the Act and its associated regulations provide an exclusive remedy before the Division for resolving disputes involving medical fees and charges in Workers’ Compensation cases ..."

Now on appeal, Appellants claim the trial court erred (1) because section 287.120.1's exclusivity provision does not apply to claims brought by health care providers against employers regarding unpaid bills, but is limited to employers’ liability to employees for all claims arising from an "accident,"³ and (2) the legislature did not clearly express or intend that section 287.140 and its related regulation were to be the exclusive remedy available to HCPs in medical fee disputes or to preempt HCPs’ common law claims for the payment of medical fees.

Our holding with respect to Point II — that Appellants’ claims are barred under section 287.120.1, section 287.140.3, section 287.140.4, and 8 C.S.R. 50-2.030 — is dispositive. Therefore, we need not address Point I.

Standard of Review

Our review of the grant of summary judgment is de novo. Lisle v. Meyer Elec. Co. , 667 S.W.3d 100, 103 (Mo. banc 2023). "Summary judgment will be affirmed when the moving party has established a right to judgment as a matter of law on the basis of facts as to which there is no genuine dispute." Holmes v. Steelman , 624 S.W.3d 144, 148 (Mo. banc 2021) (internal quotation omitted). A defending party may establish a right to judgment as a matter of law by showing:

(1) [F]acts that negate any one of the claimant's elements facts, (2) that the non-movant, after an adequate period of discovery, has not been able to produce, and will not be able to produce, evidence sufficient to allow the trier of fact to find the existence of any one of the claimant's elements, or (3) that there is no genuine dispute as to the existence of each of the facts necessary to support the movant's properly-pleaded affirmative defense.

ITT Com. Fin. Corp. v. Mid-Am. Marine Supply Corp. , 854 S.W.2d 371, 381 (Mo. banc 1993) (emphasis omitted). In determining whether a party has established a right to judgment, issues of "statutory interpretation are questions of law reviewed de novo. " Holmes , 624 S.W.3d at 149.

Discussion

Point II

This point presents us with the legal exercise of statutory interpretation as to whether section 287.120.1, section 287.140.3, section 287.140.4, and 8 C.S.R. 50-2.030 of the Workers’ Compensation Act provide Appellants the exclusive procedures and remedies for their claims for unpaid medical bills relating to treatment provided pursuant to the Act. We find that they do and therefore affirm the summary judgments entered by the trial court.

The facts here are undisputed. After providing medical treatment pursuant to the Act to Respondents’ injured employees, Appellants sought reimbursement from Respondents for the unpaid portions of those medical charges. In all but two of the cases consolidated before us, Appellants filed with the Division "applications for payment of additional reimbursement of medical fees."⁴ Such applications are prescribed by state regulation 8 C.S.R. 50-2.030(1)(B) as the regulatory pleading available to HCPs to pursue claims for unpaid medical bills. The Division ruled Appellants’ applications untimely and either dismissed them with prejudice or simply denied them. Instead of appealing those decisions to the Labor and Industrial Relations Commission, as contemplated by 8 C.S.R. 50-2.030(L), Appellants filed suit in the circuit court.

The primary rule of statutory construction is to ascertain the intent of the legislature from the language used and to give effect to that intent if possible. Lisle, 667 S.W.3d at 104. The language of a statute is given its plain and ordinary meaning. Id. (citing Spradlin v. City of Fulton , 982 S.W.2d 255, 258 (Mo. banc 1998) ). Language is clear and unambiguous if plain and clear to one of ordinary intelligence. Id. (citing Wolff Shoe Co. v. Dir. of Revenue , 762 S.W.2d 29, 31 (Mo. banc 1988) ).

"As a creature of statute, an administrative agency's authority is limited to that given it by the legislature." Farrow v. Saint Francis Med. Ctr. , 407 S.W.3d 579, 588 (Mo. banc 2013) (quoting State ex rel. Missouri Public Defender Com'n v. Waters , 370 S.W.3d 592, 598 (Mo. banc 2012) ). "The rules of a state administrative agency duly promulgated pursuant to properly delegated authority have the force and effect of law and are binding upon the agency adopting them." State ex rel. Martin-Erb v. Missouri Com'n on Human Rights , 77 S.W.3d 600, 607 (Mo. banc 2002).

Our review of the language of these applicable statutory sections and the related state regulation, giving them their plain and...