WPC yB; UGcv( k%(**u$CSy.όJ~4z~`uH=s݅2 ӵYWX~ugI 2"gpW_Y}vϵnc:~  +QHE Oܲwxr؈81e'<[%%Vnc $ϨG-DEŎA:ChS]#"%yuLsFjɶj_S]6qKĶY$m#U/dk  v #\6IV.kw5d'/5 l ̘tPk|m '/b# %  0UU N+^  zUXN] mXwN4E NN& 0(NLb D1" BSSSSSSSSSSSSSSSSSSSSSSSSS 0pppp B [[ 0x D3 D-O 0K|| AS 0 0D A Asssssssssssssssssssssssssssssssssssssssssssssssssss 0HP LaserJet 8000 Series PS0 C:\PROGRA~1\COREL\WORDPE~1\TEMPLATE\CUSTOM~1\CUSTOM~1\OPINION3.WPT(`$.8dd8    ("  Z6Times New Roman RegularC:\Program Files\Corel\WordPerfect Office 2000\Template\Custom WP Templates\Custom WP Templates\opinion3.wpt`)  C:\PROGRA~1\COREL\WORDPE~1\TEMPLATE\CUSTOM~1\REVISE~1.WPTC:\Program Files\Corel\WordPerfect Office 2000\Template\Custom WP Templates\revised standard opinion.wpt(hH  Z 6Times New Roman RegularULevel 1Level 2Level 3Level 4Level 5Level 1Level 2Level 3Level 4Level 5Level 1Level 2Level 3Level 4Level 5Level 1Level 2Level 3Level 4Level 5"q~)lT3|x   (|3$ !.8@d d 8     C:\OFFICE\WPWIN\TEMPLATE\STANDARD.WPT- -99)! dxdxP Pd(|G2s$ !.8@d d 8         0  X%X d(|3$ !.8@d d 8     VVVV'dxd)!dxdx( $ Figure  1  ^_X`YE<<CLevel 1Level 2Level 3Level 4Level 5(|3$ !.8@d d 8     ($$   1  X[Z&OLE 2.0 Box <=8C HKKKKXy  <<= 8C(3-@$ !.8@d d 8      d !.8Ztd d8     _  8=TXXdd 8    P@@7 7 INTHESUPREMECOURTOFTENNESSEE  SPECIALWORKERSCOMPENSATIONAPPEALSPANEL  @@ATJACKSON $ (April2000Session) 6  XBX  # X XB#STATEAUTOMOBILEMUTUALINSURANCECOMPANYv.  4 NATALIEHURLEY XBX    H @@ DirectAppealfromtheCircuitCourtofShelbyCounty  H @@No.96329T.D.JohnR._McCarroll_,Jr.,Judge  4  @@*AV) ` dE<` A   No.W199901765SCWCMCVM\ailedAugust31,2000;FiledDecember7,2000# X XB# XBX    AV) ` dE<z` A {      ThisworkerscompensationappealhasbeenreferredtotheSpecialWorkersCompensation v AppealsPaneloftheSupremeCourtinaccordancewithTenn.CodeAnn.50-6-225(e)(3)for b hearingandreportingtotheSupremeCourtoffindingsoffactandconclusionsoflaw# X XBl# XBX .Theplaintiff, N StateAutomobileMutualInsuranceCompany(StateAuto),appealsthejudgmentoftheCircuit : CourtofShelbyCountywhichorderedStateAutotopaytothedefendant,NatalieHurley(Hurley), &v $28,873.91beingthetotalofhermedicalbills.Forthereasonsstatedintheopinion,wefindthe b trialcourterredandreversethejudgmentofthetrialcourt. N      Tenn.CodeAnn.50-6-225(e)(1999)AppealasofRight; & JudgmentoftheCircuitCourtReversed   # X XBv# XBX W.Michael_Maloan_,Sp.J.,deliveredtheopinionofthecourt,inwhichJaniceM.Holder,J.,  andHenryD.Bell,Sp.J.,joined.  JamesE._Conley_,Jr.,Memphis,Tennessee,fortheappellant,StateAutomobileMutualInsurance ^!  Company. J"! R._Sadler_ԀBailey,Memphis,Tennessee,fortheappellee,NatalieA.Hurley. "$r#     MEMORANDUMOPINION # X XB[ # XBX  %J!%     Therelevantfactsarenotindispute.StateAutofiledsuittodeterminetowhat,ifany, '"#' workerscompensationbenefitsHurleywouldbeentitledasaresultofaJuly24,1998,automobile ($( accident.StateAutodeniedHurleysclaimanddidnotpayanybenefits.Hurleyfileda )$) counterclaimforbenefits.Attrial,thepartiesstipulatedthatHurleysmedicalbillsof$28,873.91 *%* werereasonableandnecessary.Hurleyindividuallypaidaportionofhermedicalbills.Thebalance +&+ of$26,141.19wassubmittedbyherhealthcareproviderstoherhealthinsurancecarrier,whichpaid n,', $8,174.88infullsettlementofthetotalbilled.OnMay10,1999,thetrialcourtfoundHurleys Z-(- injurytobecompensableandawardedpermanentpartialdisabilitybenefitsoffortypercent(40%)  totherightarm.# X XB # XBX Ԁ# X XB # XBX ThetrialcourtgrantedHurleysposttrialmotionandorderedStateAutotopayto  Hurley$28,873.91,thetotalofhermedicalbills.# X XBd# XBX ԀStateAutoappealsonlythatpartofthetrialcourts  orderrequiringittopayHurleythetotalofhermedicalbillsandallowingHurleytoretainthe t differencebetweentheamountthehealthcareprovidersbilledandtheamounttheyacceptedfrom ` herhealthinsurancecarrier.Hurleyfiledamotionforthispaneltofindthisappealtobefrivolous L  andto# X XBC# XBX Ԁawardherdamages. 8    @& ANALYSIS   `   Thescopeofreviewofissuesoffactisdenovoupontherecordofthetrialcourt,  8  accompaniedbyapresumptionofcorrectnessofthefindings,unlessthepreponderanceofthe $  evidenceisotherwise.Tenn.CodeAnn.50-6-225(e)(2),_Lollar_ԀvWalMartStores,Inc.,767   S.W.2d43(Tenn.1989).Questionsoflawarerevieweddenovowithnopresumptionof   correctness.Cunninghamv_Shelton_ԀSec.Services,Inc.,958S.W.2d338,340(Tenn.1997).# X XBB# XBX ԀThesole   issuepresentedforreviewiswhetherthetrialcourterredinorderingtheemployertopaymedical   expensesdirectlytotheemployeeratherthanthehealthcareproviders.# X XBf# XBX  p   Onappeal,StateAutoreliesonTenn.CodeAnn.50-6-204(a)(1)tosupportitsargument H thatthetrialcourtlackedauthoritytoorderittopaymedicalexpensestoHurley.Hurleysubmits 4 thefollowingargumentstosupportthetrialcourtsorder:1)thatStateAutoisliablefortheentire  p amountofHurleysmedicalbills# X XB# XBX ԀbecauseStateAutostipulatedHurleysmedicalexpenseswere  \ reasonableandnecessary;;2)allowingStateAutotopayonlythediscountedmedicalbillswould H violateTenn.CodeAnn.50-6-114;3)StateAutospositionisagainstpublicpolicy;and4)the 4 collateralsourceruleshouldbeappliedinworkerscompensationcases.# X XBw# XBX     @ # X XBQ# XBX EffectofStipulationofMedicalBillsAsReasonableandNecessary     Ordinarily,inaworkerscompensationcaseinwhichcompensabilityisaccepted,the  employerpaystheinjuredemployeesmedicalbillsdirectlytotheapprovedhealthcareproviderand l theemployeeisreimbursedforanyoutofpocketmedicalexpensesheorshemayhavepaid.When X  aclaimisdenied,theemployeemayobtainmedicalcareathisorherownexpensethroughagroup D! orindividualhealthcareplanorfromagovernmenthealthcare.Iftheclaimisfoundtobe 0"  compensable,theemployerbecomesliablefortheemployeesmedicalexpenses.Inthepresentcase, #l! Hurleyshealthinsurancecarrierpaid$8,174.80ofatotalof$26,141.19inmedicalbillssubmitted $X" forhercare.ThequestioniswhohasthelegalobligationtoreimburseHurleyshealthinsurance $D # carrierandtoreceivethecorrespondingbenefitofthediscountedmedicalbills? %0!$   StateAutostipulatedattrialthatHurleysmedicalexpenseswerereasonableandnecessary; '#& thatStateAutoislegallyresponsibleforandwillpayallmedicalexpenses;andthatStateAutowill (#' reimburseHurleyshealthinsurancecarrierandHurleyforanymedicalexpensesshehaspaidrelated )$( toherinjury.HurleyinsistsTenn.CodeAnn.50-6-204(a)(1)obligatesStateAutotopayallher |*%) reasonableandnecessarymedicalexpensesand,sinceStateAutostipulatedhermedicalexpenses h+&* of$28,873.91werereasonableandnecessary,itisliableforthatamount.Hurleyfurtherstatesthat  StateAutohadtheopportunitytoprovidemedicalservicesandrefusedtodoso,and,therefore,the  totalmedicalexpensesshouldbepaidtohertobedisbursed,lessherattorneysfees.# X XB# XBX     InorderingStateAutotopaythetotalmedicalexpensestoHurley,thetrialcourtreliedon ` thefollowinglanguagein_Bazner_ԀvAmericanStatesInsuranceCo.,820S.W.2d742,747(Tenn. L  1991): 8  8  Wefirstobservethatdefendantisnotentitledtoasetoffagainstitsliabilityfor  ` medicalexpenses.Theseexpensesareanobligationonitspartaccordingtothe  L  statute._Bazner_,820S.W.2d,at747. 8      Thepanelagreesthisisacorrectstatementofthelaw.Thisstatement,however,hasno   applicationtothepresentcase._Bazner_Ԁdisallowedtotheemployerasetoffformoneyreceivedby   theemployeeinacompanionfederaltortsuit.Nothingin_Bazner_requiredtheemployertopay   medicalexpensesdirectlytotheemployee.Thus,relianceon_Bazner_ismisplaced.     WefindthisissueiscontrolledbythelanguageofTenn.CodeAnn.50-6-204(a)(1)and \ bytheTennesseeSupremeCourtdecisionof_Staggs_ԀvNationalHealthCorp.,924S.W.2d79,81 H (Tenn.1996).Tenn.CodeAnn.50-6-204(a)(1)providesinpart: 4 8  Theemployeroremployersagentshallfurnishfreeofchargetotheemployeesuch  \ medicalandsurgicaltreatment,medicine,medicalandsurgicalsupplies,...made H reasonablynecessarybyaccident,...asmaybereasonablyrequired;....# X XB;$# XBX 4   In_Staggs_,924S.W.2dat81,theSupremeCourt# X XB+# XBX heldasfollows:   8  Anemployeeisnotentitledtopersonallyreceivepaymentformedicalexpenses  unlessheorshepersonallypaidthemedicalexpensesandisduereimbursement.  Instead,employersmustpaytheprovidersofmedicalcaredirectlyforincurred l medicalexpense.# X XB,# XBX X    # X XBP.# XBX   We,therefore,findTenn.CodeAnn.50-6-204(a)(1)requirestheemployertofurnishfree 0"  ofchargetotheemployeereasonableandnecessarymedicaltreatment.Thestatutedoesnotrequire #l! theemployertopaythecostofmedicaltreatmenttotheemployee,unlesstheemployeehas $X" personallyincurredmedicalexpenses.TorequireStateAutotopaythetotalmedicalexpensesto $D # HurleytoreimbursehealthcareprovidersandtoallowHurleytoretainthedifferencebetweenthe %0!$ amountbilledandthatacceptedbytheprovideriscontrarytothestatuteand_Staggs_.# X XB.# XBX  &"%    @PaymentofDiscountedMedicalBillasViolationofTenn.CodeAnn.50-6-114 (#'  # X XB1# XBX  )$( P     # X XB2# XBX   HurleysubmitsthatallowingStateAutotoberesponsibleonlyforpaymentofthediscounted  medicalbillswouldallowStateAutotoavoiditslegalobligationsunderTenn.CodeAnn.  50-6-204(a)(1)andwouldviolateTenn.CodeAnn.50-6-114,whichstates,inpart:     8  506114.Supremacyofchapter_Setoffs_Ԁforpaymentsbydisabilityplan. `   8  (a)Nocontractoragreement,writtenorimplied,orrule,regulationorotherdevice, 8  shallinanymanneroperatetorelieveanyemployer,inwholeorinpart,ofany $ t obligationcreatedbythischapterexceptashereinprovided. `     HurleysinterpretationofTenn.CodeAnn.50-6-114wouldrequireStateAutotopaythe  8  totalofhermedicalexpenseswithoutthebenefitofanydiscount.StateAutocitesTenn.CodeAnn. $  50-6-122(a)(2),whichencouragesemployerstocontrolmedicalcostsbyenteringintocontracts   forreducedmedicalcostswithhealthmanagementorganizations(HMO)andpreferredprovider   organizations(_PPO_).ToacceptHurleysargumentwouldgivetheemployeeandnottheemployer   thebenefitofreducedmedicalexpenses,aresultclearlyinconflictwithTenn.CodeAnn.   50-6-122(a)(2).Aswehavealreadystated,Tenn.CodeAnn.50-6-204(a)(1)requiresStateAuto p toprovidemedicalcarefreeofcharge,nottopaytoHurleythetotalcostsofhermedicalcare.# X XBM3# XBX ԀWe \ declinetoholdthatStateAutoisattemptingtoavoiditsobligationsunderTenn.Code.Ann. H 50-6-204(a)(1)toprovidemedicaltreatmenttoHurley.# X XB:# XBX Thisargumentiswithoutmerit. 4   @$ PublicPolicy  \    HurleysubmitsthatallowingStateAutotopayonlythecostofdiscountedmedicalcare 4 providedbyherhealthinsurancecarrierwouldcreateajudiciallyauthorizedincentiveforemployers   todenyclaimsinanticipationofreceivingthebenefitofareducedchargefromahealthcare   provider.HurleypointsoutthateithersheorStateAutowillreceivethebenefitofthediscounted  medicalbillsandthatitshouldbesheratherthanStateAuto,whodeniedacompensableclaim.  WerewetoagreewithHurleysposition,theresultwouldbe,ineffect,tocreateabadfaithpenalty.# X XB;# XBX   ThispanelnotesthelegislaturehasprovidedabadfaithpenaltyinTenn.CodeAnn.50-6-128# X XB!?# XBX Ԁfor l wrongfullydenyingmedicaltreatment.Thispanelisnotatlibertytojudiciallycreateanotherbad X  faithpenalty.Thisargumentiswithoutmerit. D! # X XB?# XBX   @!! CollateralSourceRule #l!    ThetrialcourtandHurleysuggestthiscaseisanalogoustothecollateralsourceruleintort $D # cases.Thatrulepermitsaplaintifftorecoverthetotalofmedicalexpensesasanelementofdamages %0!$ againstthedefendantwithoutconsiderationofwhetherthemedicalexpenseswerepaidbyinsurance &"% ornot.SteelevFt.SandersAnesthesiaGroup,P.C.,897S.W.2d270(Tenn.Ct.App.1994).We '#& agreethetrialcourtsorderrequiringStateAutotopaymedicalexpensestoHurleyisanalogousto (#' thecollateralsourcerule,butwecannotfindanyauthorityinthisstatefortheadoptionofthe )$( collateralsourceruleinworkerscompensationcases.Todosowouldoverlooktheinherent |*%) differencesbetweenatortclaimforpersonalinjuryandaclaimforworkerscompensationbenefits. h+&* WebelievethecollateralsourcerulewouldconflictwithTenn.CodeAnn.50-6-204(a)(1)and  wouldrequirelegislativeactiontoimplement.# X XB@# XBX Ԁ# X XBE# XBX Ԁ Intheeventthedefendantbelievesaninequityexists  inthecurrentstatutoryscheme,itisamatterforthelegislaturetoconsiderandnotthispanel.# X XB=F# XBX Ԁ_Advo_,  Inc.vPhillips,989S.W.2d693,696(Tenn.1998).# X XB6G# XBX  t   @FF% CONCLUSION  L    Tennesseesworkerscompensationlawprovidestoinjuredworkersmedical,disability,and $ t deathbenefits,eachofwhichisdefinedbystatute.Ifthetrialcourtwereauthorizedtoorderthe  ` employertopaymedicalexpensesdirectlytotheemployeeandtoallowtheemployeetoretainthe  L  differencebetweentheamountbilledandtheamountacceptedbythehealthcareprovider,theresult  8  wouldprovideanadditionalbenefittotheemployeenotauthorizedbystatute. $    ThispanelismindfulthatTenn.CodeAnn.50-6-116directsthelaw begivenanequitable   constructionbythecourtsandofthenumerousdecisionsthatdirectthecourtstoconstruethe   workerscompensationlawliberallyandtoresolveanydoubtinfavoroftheemployee._Ingram_Ԁv   StateIndustries,Inc.,943S.W.2d381(Tenn.1995).However,wefindtoaffirmthetrialcourts p orderwouldbetoignoreTenn.CodeAnn.50-6-204(a)(1)and_Staggs_Ԁv.NationalHealthCorp., \ 924S.W.2d79(Tenn.1996)# X XBG# XBX .# X XBM# XBX Ԁ# X XBM# XBX  H   Thejudgmentofthetrialcourtwhichorderedtheplaintiff,StateAuto,topaymedical  p expensesdirectlytothedefendant,NatalieHurley,isreversed.Thepaneloverrulesdefendants  \ motionforfrivolousappeal._The_Ԁdefendant,NatalieHurley,istaxedwiththecostsofthis_appeal.# X XB&N# XBX _ H    `     h     _____________________________________     `     h     # X XBP# XBX W.MICHAEL_MALOAN_,SpecialJudge    l # X XBOQ#@7 7 INTHESUPREMECOURTOFTENNESSEE  @''%ATJACKSON   XBX  # X XBwR#  STATEAUTOMOBILEMUTUALINSURANCECOMPANYv.NATALIE  HURLEY XBX   $ R@yy CircuitCourtforShelbyCounty  $ @$No.96329T.D.   @*AV) ` dE<` A߈   @E E No.W199901765SCWCMCVFiledDecember7,2000   AV) ` dE<V` A W   # X XBS# XBX @( ORDER # X XB%U# XBX Ԉ R  # X XBU# XBX # X XBU# XBX   ThiscaseisbeforetheCourtuponmotionforreviewpursuanttoTenn.CodeAnn.506 f 225(e)(5)(B),theentirerecord,includingtheorderofreferraltotheSpecialWorkers'Compensation R AppealsPanel,andthePanel'sMemorandumOpinionsettingforthitsfindingsoffactand > conclusionsoflaw,whichareincorporatedhereinbyreference; *   Whereupon,itappearstotheCourtthatthemotionforreviewisnotwelltakenandshould  bedenied;and    Itis,therefore,orderedthatthePanel'sfindingsoffactandconclusionsoflawareadopted v andaffirmed,andthedecisionofthePanelismadethejudgmentoftheCourt. b   ItistheCourtsrecommendationthattheopinionoftheSpecialWorkersCompensation : AppealsPanelbepublished. & v   CostswillbepaidbyNatalie_Hurlie_,forwhichexecutionmayissueifnecessary. !N!   ITISSOORDERED. #&# # X XB&V#   `     h     PERCURIAM  )Z$( Holder,J.NotParticipating .+~&*    TRY,3'LetterheadX3' Letter 3' Letter3'T  h