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Lifecare Hospitals5/18/2005
Judgment rendered May 18, 2005. Application for rehearing may be filed within the delay allowed by Art. 2166, La. C.C.P.
Before BROWN, PEATROSS, and DREW, JJ.
DREW, J., concurs.
On July 17, 2001, Peter Young was seriously injured in a vehicular accident in Beckville, Texas. Young was airlifted to the LSU Medical Center in Shreveport, Louisiana. He suffered a ruptured aorta, went into cardiac arrest, and was in a comatose state until his death 14 months later. In August 2001, Young was transferred from LSU Medical Center to Lifecare Hospital, Inc. ("Lifecare"), a long-term acute care provider located in Shreveport, Louisiana, where he was cared for until November 2001.
At the time of the accident, Young was working within the course and scope of his employment with Beck Oil Field Construction, Inc., and was covered under the Texas Workers' Compensation Act. Texas Mutual Insurance Company ("Texas Mutual") provided workers' compensation coverage to Young. Monthly bills were sent by Lifecare to Texas Mutual. Claiming the amount charged was excessive, Texas Mutual paid what it concluded was the appropriate amount. Lifecare's total charges were $225,752.55; of this amount, Texas Mutual paid $125,969.
After Young's death, Lifecare filed this action in district court in Bossier Parish against Sandra Young, the wife of Peter Young, for the unpaid balance of $99,783.55. The instant case suit was instituted against Sandra Young as the surviving spouse in the community and as guarantor of the hospital bill. Sandra Young filed a third party demand against Texas Mutual. Both Lifecare and Sandra Young filed motions for summary judgment. Texas Mutual and Young filed exceptions to the jurisdiction of the state court asserting that the Texas Workers' Compensation Commission ("TWCC") had exclusive jurisdiction to decide this dispute.
The trial court dismissed the case for lack of subject matter jurisdiction. Lifecare appealed. Sandra Young appealed the dismissal of her third party claim against Texas Mutual, in the event that this court reversed the trial court. We affirm the trial court's dismissal based on lack of subject matter jurisdiction.
Procedural Background
Texas Mutual was created by the Texas legislature to guarantee the availability of affordable workers' compensation insurance. Essentially, it became the insurance provider of last resort. It was the insurer of Peter Young's employer and without question recognized coverage for the injuries he received. Lifecare received preauthorization from Texas Mutual for services it was to render to Young. Texas Mutual paid most of Lifecare's charges but refused to pay all of the medical expenses based upon Texas Mutual's interpretation of the rules and guidelines promulgated by the TWCC. The dispute centered on whether Lifecare was providing long term or acute care. Texas Mutual claimed that Lifecare exceeded the statutorily allowed per diem rate.
Lifecare commenced a Request for Medical Dispute Resolution in the Medical Review Division of the TWCC. During the course of these proceedings, Peter and Sandra Young settled a third party personal injury claim filed in the U.S. district court in Marshall, Texas. Texas Mutual had intervened in that action. Texas Mutual sought to and did recover in subrogation those amounts of workers' compensation benefits, including medical expenses, paid to or on behalf of Peter Young. The settlement provided Texas Mutual with reimbursement for past medical expenses through July 2002 and required Texas Mutual to pay for all future medical expenses. Texas Mutual did pay all medical benefits until Peter Young's death a month later on S
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