Opinion
CASE NO. 748 CRD-8-88-7
MARCH 27, 1989
The appeal in the above matter concerned issues between Day Kimball Hospital and the Respondents. Therefore, no appearance on behalf of the claimant was necessary.
Day Kimball Hospital was represented by Thomas J. Riley, Esq., Dupont, Tobin, Levin, Carberry O'Malley, P.C.
Respondents Walgren Tree Experts and Orion Group were represented by Brian E. Prindle, Esq.
This Petition for Review from the July 1, 1988 Finding and Award of the Commissioner for the Eighth District was heard September 16, 1988 before a Compensation Review Division panel consisting of the Commission Chairman, John Arcudi, and Commissioners Andrew Denuzze and Frank Verrilli.
OPINION
The Hospital, which provided services to the claimant, has filed a Motion to Submit Additional Evidence before the Compensation Review Division. The respondents seek review of the Eighth District July 1, 1988 Finding and Award which ordered respondents to pay the Diagnostic Related Group (DRG) charges for claimant's hospital care. Our present review is limited to a single evidentiary issue, i.e. whether the medical provider, Day Kimball Hospital may submit additional evidence.
Administrative Regulation Sec. 31-301-9 permits a party to submit additional evidence on appeal to this tribunal when the evidence is material and there were good reasons for failing to present that evidence in the proceedings before the trial Commissioner. See Chapo v. Town of Westport, 3 Conn. Workers' Comp. Rev. Op. 14, 170 CRD-4-82 (1985). The evidence the claimant medical provider seeks to proffer is the transcript of the testimony of Susan Stanley, Director of Operations for the Commission on Hospitals and Health Care given June 29, 1988 in hearings before the Second District Commissioner on a different matter involving other parties. As Chapo, supra, held. the "test of materiality is whether or not it [the evidence] is necessary to the determination of the issue before us," (citation omitted), Id. at 17. A "material" fact has also been defined as "a fact which will make a difference in the result of the case.", United Oil Co. v. Urban Redevelopment Commission, 158 Conn. 364, 379 (1969).
Sec. 31-301-9. Additional Evidence. If any party to an appeal shall allege that additional evidence or testimony is material and that there were good reasons for failure to present it in the proceedings before the commissioner, he shall by written motion request an opportunity to present such evidence or testimony to the compensation review division indicating in such motion the nature of such evidence or testimony, the basis of the claim of materiality, and the reasons why it was not presented in the proceedings before the commissioner. The compensation review division may act on such motion with or without a hearing, and if justice so requires may order a certified copy of the evidence for the use of the employer the employee or both, and such certified copy shall be made a part of the record on such appeal.
The ultimate issue for decision is whether the respondents are liable for the DRG charge of the hospital under Sec. 31-294, C.G.S.. The trial Commissioner in the instant matter concluded that the hospital was liable under Sec. 19a-165 C.G.S.. The testimony of Ms. Stanley is proffered to describe the Commission on Hospitals and Health Care's regulation of hospital charges and the workings of a DRG based billing system.
Her testimony provides some background on the legislative intent of Sec. 19a-165, requiring hospitals to bill pursuant to the DRG schedule for services rendered a patient. Respondents object to the Hospital's Motion alleging the testimony is not material and no good reasons were shown for failure to present it at the trial level.
We conclude the transcript of Ms. Stanley's June 29, 1988 testimony is inadmissible because of the poor quality of the transcript itself. There are many incomplete sentences reflecting the poor audible quality of the hearing tape. The testimony as now transcribed from that tape cannot reasonably be expected to make a difference in the outcome of the issue to be decided.
We, therefore, deny the Hospital's Motion to Submit Additional Evidence.
Commissioners Andrew Denuzze and Frank Verrilli concur.