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Winn-Dixie La. v. Physicians Surgical Specialty Hosp.

Supreme Court of Louisiana

February 21, 2014

WINN-DIXIE LOUISIANA AND SEDGWICK CLAIMS MANAGEMENT
v.
PHYSICIANS SURGICAL SPECIALTY HOSPITAL

IN RE: Sedgwick Claims Managment; Winn-Dixie Louisiana; - Plaintiff(s); Applying For Writ of Certiorari and/or Review Office of Workers' Compensation, District 9, No. 12-04188; to the Court of Appeal, First Circuit, No. 2013 CA 0075.

Writ granted. Court of appeal reversed. Remanded to the Office of Workers' Compensation.

Jefferson D. Hughes, III, Bernette J. Johnson, Jeffrey P. Victory, Jeannette Theriot Knoll, John L. Weimer, Greg G. Guidry, Marcus R. Clark.

OPINION

[2013-2680 La. 1] PER CURIAM

At issue is whether the three-year prescriptive period set forth in La. R.S. 23:1209(C) applies to a claim by an employer to recover overpayment for medical services paid on behalf of an injured employee. For the reasons that follow, we conclude La. R.S. 23:1209(C) does not apply under these facts, and we therefore reverse the judgments below.

FACTS AND PROCEDURAL HISTORY

For purposes of this opinion, the facts are largely undisputed. In March 2007, Esther Lirette was injured in the course and scope of her employment with Winn-Dixie Louisiana (" Winn-Dixie" ). As a result, Ms. Lirette sought treatment from Physicians Surgical Specialty Hospital (" Physicians" ). Following treatment, Winn- Dixie reimbursed Physicians for Ms. Lirette's medical treatment for a reduced amount of the total bill. Thereafter, Physicians requested additional payment from Winn-Dixie, and maintained the services rendered to Ms. Lirette qualified as an

Page 1130

outlier reimbursement.[1] On November 26, 2007, Winn-Dixie paid Physicians an additional $24,770.45, for a total payment of $33,613.45.

[2013-2680 La. 2] In July 2008, Winn-Dixie advised Physicians that this case did not meet the criteria for outlier reimbursement, and as a result, it had overpaid Ms. Lirette's medical bill by $24,680.45. Physicians refused the demand for a refund.[2]

On June 8, 2012, Winn-Dixie filed a disputed claim for compensation against Physicians with the Office of Workers' Compensation (" OWC" ), seeking recovery of the overpayment in the amount of $24,680.45. In response, Physicians filed an exception of prescription pursuant to La. R.S. 23:1209(C), arguing Winn-Dixie's claim is subject to the three-year prescriptive period. Because the alleged overpayment was made in 2007, Physicians argued Winn-Dixie's 2012 claim was prescribed.

After a hearing, the OWC granted the exception and dismissed Winn-Dixie's claim. Winn-Dixie appealed. The court of appeal affirmed in a split decision. Winn-Dixie Louisiana v. Physicians Surgical Specialty Hospital, 13-0075 (La.App. 1 Cir. 10/18/13), 136 So.3d 801. One judge dissented, finding La. R.S. 23:1209(C) was inapplicable in this case.

Winn-Dixie then sought review in this court. The sole error assigned by Winn-Dixie is that the prescriptive period set forth La. R.S. 23:1209 ...


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