Opinion
NO. 2015 CW 0814
08-14-2015
JEANETTE ARTHUR v. SLIDELL MEMORIAL HOSPITAL AND HOSPITAL SERVICES LOUISIANA, INC.
In Re: Hospital Services Louisiana, Inc., applying for supervisory writs, Office of Workers' Compensation, District 06, No. 15-01148. BEFORE: PETTIGREW, WELCH, HIGGINBOTHAM, CRAIN, AND DRAKE, JJ.
WRIT GRANTED. That portion of the May 11, 2015 judgment by the Workers' Compensation Judge denying defendant Hospital Services Louisiana, Inc.'s exception of no cause of action is hereby reversed and judgment is entered in its favor, dismissing plaintiff Jeanette Arthur's claims against it with prejudice. Because a third-party administrator is not responsible for providing funds to a workers' compensation claimant, it is not a "payor" as defined in the Workers' Compensation Act. See La. R.S. 23:1021(12).
TMH
EGD
JTP
Welch, J., concurs in part and dissents in part. The Office of Workers' Compensation Form 1008 does not specifically allege that based on the contract between Slidell Memorial Hospital and Hospital Services Louisiana, Inc., Hospital Services Louisiana, Inc., as a third-party administrator, is liable to pay workers' compensation benefits and evaluate workers' compensation claims on behalf of Slidell Memorial Hospital, plaintiff's employer. As such, I agree with the ruling of the majority, granting the writ with regard to Hospital Services Louisiana, Inc.'s exception of no cause of action. However, I would allow the plaintiff to amend her petition to state a cause of action, if possible, pursuant to La. Code Civ. P. art. 934. With regard to Hospital Services Louisiana, Inc.'s exception of no right of action, I find that the contract, admitted into evidence, clearly shows that Hospital Services Louisiana, Inc. was obligated to pay workers' compensation claims on behalf of the plaintiff's self-insured employer. Hospital Services Louisiana, Inc. further maintained funds in an account to pay workers' compensation claims, in essence acting as an insurance company. A third-party administrator who controls the payment of workers' compensation claims pursuant to a clear contract with the employer should not be relieved of responsibility for the correct payment of those claims simply by asserting its status as an "administrator." I, therefore, find that the definition of "payor" set forth in La. R.S. 23:1021(12) clearly encompasses Hospital Services Louisiana, Inc. Crain, J., dissents and would deny the writ. The Louisiana Supreme Court set forth the criteria for the exercise of supervisory jurisdiction by an appellate court in Herlitz Const. Co. v. Hotel Investors of New Iberia, Inc., 396 So.2d 878 (La. 1981) (per curiam). Insofar as the criteria of Herlitz have not been met in this case, I would decline to exercise this Court's supervisory jurisdiction. COURT OF APPEAL, FIRST CIRCUIT /s/_________
DEPUTY CLERK OF COURT
FOR THE COURT