Opinion
CASE NO. 860 CRD-7-89-5
MAY 24, 1990
The appeal in the above matter concerned between Stamford Hospital and the respondent. Therefore, no appearance on behalf of the claimant was necessary. Further, by agreement of the parties before the Compensation Review Division, it was agreed that the matter would be decided on the basis of briefs submitted and oral argument was waived.
The Stamford Hospital was represented by Griffith H. Trow, Esq., Burdett, Trow Sank, P.C.
The respondent was represented by Herbert G. Feuerhake, Esq., Tierney, Zullo, Flaherty and Murphy, P.C.
This Petition for Review from the April 17, 1989 Finding and Award of the Commissioner for the Seventh District was decided pursuant to papers submitted for the February 23, 1990 hearing before the Compensation Review Division panel consisting of the Commission Chairman, John Arcudi, and Commissioners Robin Waller, and George Waldron.
OPINION
This matter was heard below on stipulated facts. It concerns the appropriateness of hospital charges.
Claimant in the instant matter sustained a compensable injury on October 9, 1986. This resulted in the claimant's admission to Stamford Hospital [Hospital] for treatment of lumbar radiculitis from December 3, 1986 through December 8, 1986. The Hospital calculated its charges on the basis of Connecticut's All Payor System, the so called Diagnostic Related Group (DRG). The DRG charges were $4,960.73. The Hospital's billing rate on the basis of itemized charges would have been $1,837.56.
Respondents paid the Hospital the latter amount $1,837.56. The Hospital sought to be paid the DRG amount. The Seventh District agreed with the Hospital.
Tanner v. Walgren Tree Experts, 748 CRD-8-88-7 (decided January 17, 1990) appeal docketed, No. A.C. 8865 (Conn.App. Feb. 2, 1990) is directly on point. In Tanner, we held the appropriate amount was the DRG charge pursuant to Sec. 19a-165f. Consequently Tanner is dispositive of the issue here raised.
Tanner would therefore be dispositive here. However the City of Norwalk contends that the Hospital has no standing before a workers' compensation tribunal. It argues that the statute is in derogation of the common law and it only provides for the adjudication of claims between employer and employee. To support that argument it cites Castro v. Viera, 207 Conn. 420 (1988) and the limited jurisdiction reach of the commission as there described.
In making that argument the respondent omits any reference to Sec. 31-319 C.G.S. That section subjects "all fees of attorneys, physicians, podiatrists or other persons for services under this chapter . . . to the approval of the commissioner." Is the commissioner's approval simply an academic exercise permitting the expression of an opinion which the parties can then disregard? Or even if the commissioner's opinion be a valid adjudication of the amount owed, must the provider of services then resort to a Superior Court lawsuit to collect since that provider has no standing before the commission? We think not.
Sec. 31-319 C.G.S. provided at the time of Claimant's injury, "All fees of attorneys, physicians, podiatrists or other persons for services under this chapter shall be subject to the approval of the commissioner."
Also, although respondent refers to Sec. 31-294 in another part of its brief, it fails to discuss that statute with respect to its standing argument. As it notes, Sec. 31-294 speaks to charges which "prevail in the same community or similar communities" and "the amount it actually costs the hospital to render the service." Again does that language merely permit the commissioner to render a non-binding advisory opinion? How may an adjudicatory body determine prevailing charges or actual cost of services if the provider of those services has no standing to present evidence and arguments before the adjudicator?
Finally Sec. 31-327 C.G.S. provides whenever fees or expenses are "to be paid by the employer or insurer and not by the employee, the commissioner may make an award directly favor of the person entitled thereto, which award shall be filed in court, shall be subject to appeal and shall be enforceable by execution as in other cases." Can respondent seriously maintain that an award may be made "directly in favor of the person entitled thereto" but that person has no standing to appear in the forum which can make such an award? On the contrary, we think Sections 31-294, 31-319 and 31-327 unmistakably provide commission jurisdiction and grant standing to the Hospital.
Therefore, for all the reasons set out in Tanner, we affirm the Seventh District.
Commissioners Robin Waller and George Waldron concur.