record of these proceedings today the morning counsel is we're running a little late we had some technical difficulties and then the last case took a little longer than expected you all ready to proceed today are yes your honor then go right ahead mr hayes thanks thank you good morning and may it please the court this appeal involves two provisions of the worker's compensation act sections eight  two and nineteen g the judgment below should be reversed because the circuit court misapplied both of these statutory provisions st the circuit court did not have jurisdiction under commission nor was it incorporated in the commission's approval of the settlement contract in this matter nd and getting beyond this threshold jurisdictional issue the circuit court also erred in  its interpretation of section eight dollars a five and further entered a judgment that was against the manifest weight of the evidence that was presented at trial as i mentioned just a moment ago the brief background overview about the worker's compensation act may be helpful as this court knows i'm sure the the industrial commission is the exclusive forum for resolution of claims brought by an injured worker in the state and the workers compensation act is very clear in many of its provisions that the industrial commission has exclusive jurisdiction to make all determinations legal and factual that relate to those kinds of matters for instance it makes the determination about whether the injury is causally related to work whether the injured workers medical treatments are medically necessary the amount and propriety of those medical charges and ultimately the compensation that has to be awarded to an injured worker the act is in essence and up he'll has to be brought within twenty days of the commission's decision or award which did not happen here the only other provision in the act where the circuit court has any jurisdiction in this area is the provision that brings us here today section one thousand g and that provision and it's quoted in length in the briefs but i'll talk about it just briefly here with you now is in essence and enforcement and a collection mechanism it allows the circuit court gives the circuit court special jurisdiction to to enter judgment on a an award or a decision by the commission that involves that provides for the payment of compensation and are  settlement agreement or any particular the terms of settlement provision in that agreement the judge actually that the that he'd seen me switch morse's counsel relies on primarily discuss in that matter the the this court held that the circuit court can look behind the settlement contract to find out what preceded it and in that instance what preceded extend well while the circuit court does have authority to interpret contracts it does not have any jurisdiction or authority to interpret the act itself and that's what distinguishes this matter so clearly from the aging because in this matter as the court has seen from the briefing what the circuit court was called upon and did do was to interpret what section it points to a five means and on this honor although we don't we don't question and we never taken the position that the that the circuit court couldn't look hind the settlement contract that said all medical bills have been pay but have the court it the court would have seen that there was a partial payment made on the implant charges at issue and that the dispute involved construing what section eight dollars a five means which is an interpretation of the act that the case law clearly prohibits and would also find that that partial payment was made about a year before the settlement contract was entered into and so when when my client entered into the settlement contract and noted that there were no medical bills unpaid that was it's good faith belief i know that is that was in the state and they believe that my client should bear the the bear that mistake i don't believe that's correct but yes and in answer your question judge the medical bills have been pay when bowl party signed off on on that not preclude them from coming back and saying that there was unpaid bills at that time no judge i'm not saying that that it's precludes a fine not taking the position that the defendant took in the hey jean case that there is a forfeiture of rights as a result of the checking about box on the settlement form what i am saying your honor and what i believe the law supports here is that the the the nature of the issue that the circuit court would have to address goes to the heart of whether the circuit court had jurisdiction and here that issue again was what to section eight point two a five mean on a manufacturer's a net manufacturer's invoice does mean what we say this debt with the statute clearly says and in its plain terms that you're talking about the manufacturer's invoice itself or does it mean something different as morse and its counsel argue that it means any invoice and what just what the medical provider actually happened to pay the boat so i'm just a little unclear in regard to the unpaid bill which is the amount doesn't have the ability to reel it back aspect of the carrots no judge you are actually the issue about these implant charges were it was never addressed by the commission a partial payment was made my client believed was consistent with the fee schedule and so unlike aging there was a payment made it just short paid it if you want to use that term you're as they believe these charges were excessive there was absolutely charge no challenge to that payment decision and so the commission almost a year later when they signed off on the settlement contract that issue had not been raised there and so it hadn't been litigated and so the circuit court was the very st tribunals up to which that issue was quiet and under the clear case life here about the circuit court not being able to interpret the that's the initial threshold reason why this judgment should be reversed because the court never had jurisdiction from the get go in this matter but it makes you n know the words both parties it seems didn't realize there was a short a at the time the contract was entered into right might my client was aware that that a partial payment had been made it was not aware that it  partial payment was disputed your honor writes of the it's not and there was this agreement where the commission both parties believed in good faith that neiman had been made for mr rich  it appears yes so if the court has circuit court has the ability to interpret the settlement agreement how is it to be guided it's not through the statutory provisions  sir well well your honor i believe that if that interpret the so the contract as we all know doesn't bear on this issue at all there is no discussion about implants unpaid bills anything like that shortfall right i don't know that i agree that it guarantees that it says that there are no unpaid bills so i i i follow where you're going with that i'm not ready to in other words nobody want to well at least mr rich didn't want his client exposed to some small claims case where they're going to have to as a result of the short main purpose of the sat will those matters so how is how is the circuit to interpret the language of the contract itself and but your honor is question to me asks can't interpret ing the contract the court the circuit court go further and interpret the provisions of the act that are in dispute i don't believe it can and that's why you're stiction if i misspoke i apologize i'm not asking whether the court can interpret it be act mentioned are you saying that this case is very different in that the court went further and went beyond looking to the contract  section yes judge i see my time's up saw answer your question and then and then stop with with your permission yes the court went further the court necessarily made a determination in entering judgment that section eight point two a five allows for reimbursement of wholesaler invoices not manufacture invoices that's the that's in paragraph five of the court's judgment order so  the the the circuit court did more than just refer to the acts in and what the plain language in the act is it resolved the disputed issue about whether a against the injured worker however that provision does not allow a medical provider to seek recovery of expenses or in this case charges for f implant products that are that that were within the purview of what they sought reimbursement for in the worker's compensation case so a medical provider can seek reimbursement from someone like ms morris here for certain kinds of charges but if they were charges that were in excess of what they were allowed to recover under the feast schedule that gets us back to what the fee schedule here means as implant charges they clearly are not allowed to choose my words carefully there they're not allowed to charge an excessive amount that's not recover e under the fee schedule get that not down and get paid for what is appropriate under the fee schedule and then bill them for the amount that was that was determined or is not  believe that ms morris faces no the legal peril if the judgment here is reversed and that frontenac would not have a valid claim against of defense which then would get us back to an interpretation of what is the net versus the wholesale price right pay yes judge unfortunately in our legal system we can't we can't preclude companies from filing in appropriate lawsuits and it would be unfortunate that ms morris would be put to having to defend that issue the way this should have been resolved however back to exclusive jurisdiction of the commission is this issue should have been raised in the commission decided there and then we would have clarity as to everyone's positions the circuit court's ruling on an issue beyond its jurisdiction and doesn't unfortunately doesn't resolve that issue and this issue may if you if you reverse as i'm requesting today this issue may end up going back and having her workers compensation case reopened effect still possible to have this dispute decide it but that's where respectfully it should it's been a long time and please the court mr hayes the only workers compensation act is a remedial statute it is put forth for the protection of injured workers mr hayes is used the phrase my client in this case his client does not case his client is a company called foresight which was founded in two thousand and thirteen and purchased in paradigm by paradigm in two thousand and seventeen and has a website that says it lowers costs for implants by seventy three percent by compiling its own database selling it to rd party administrators and insurance companies and then using it to pay less than what is the manufacturer's net cost and what is reasonable and customary this little dispute over what five thousand dollars goes at the very heart of mr hayes his client's business model that's why you don't see neil good for defending casey's and we've got mr hayes now judge case as an excellent question concerning what the ability of the circuit court can cannot do the circuit courts if they've got the power to interpret a contract there's only one place to go for guidance to interpret that place and that is the very workers compensation act itself i try cases in workers comp land for a living this case was tried you think well wait a minute this case was settled no it wasn't this case was tried your honour's on january th inherent illinois where i sat behind a plastic picnic table on a metal folding chair and tried the case on a nineteen b petition in front of the honorable christina hemingway justices you've tried workers compensation cases and you've heard them they're not glamorous but they're very important because it helps people get back to work and get well in this case the reason there was a trial was respondent casey said disputed causal connection and so arbitrator hemenway entered an award and if i may quote d respond it is ordered to pay seventeen thousand six hundred and twenty one dollars eleven cents per the bill supports and just newsgroup exhibit one subject to the medical piece schedule as provided in section eight a and eight two and prospective medical care orders by dr rascasse pursuant to the same piece schedule on the settlement contract in question in this case the court i know judge gross i know you justices have looked at the bottom of the st page where it says has any action been taken on this case before and mr different wrote and it was him that drafted the contract and he candidly admitted that after i subpoenaed him it says see attached decision that original decision is not just the law in the state of illinois it's the in line for iran and this is that these implant costs aren't being paid because foresight and the database says you can pay for implants cheaper somewhere else and we're going to sell them to rd party administrators and we're going to use that to get doctors to take less and we're betting that doctors as judge kate so notice they're not going to go after their patients they're not going to i have one hundred of these other cases ready to file and it's becoming a nightmare in terms of this is the price in mount vernon this is the price and car my people in mount vernon get more than car my people in st louis get less but when foresight enters the picture they have their own database and it doesn't matter where you're from if you're good samaritan hospital you're taking a haircut the same way as front neck surgery d center does and they're betting that people like me won't stick up for camilla morris because i tell you what unless i get penalties i have to file a brief in the circuit court i have to file in one thousand and i have to likely appear three or four times and for what nothing nevermind the fact that lori came in from fund neck surgery center had to come down and testify and waste her day and i'd like you to direct you please forsyte why because it's their database that they're using page twelve there are many there witness amanda whately flew up from houston and said well you know we don't direct insurance companies not pay but we our codes and in this case on page twelve c c m s i which is the rd party administrator not even the insurance company they followed foresights instructions they didn't pay and respond in the st time this case was tried stipulated that the charges incurred to date seventeen thousand six hundred and twenty two dollars and zero dollars eleven cents were reasonable and customary and my client was treating with the same physician she was at the time she had her surgery we only get to a dispute when there is an implant and that's john boy you live in southern illinois but you know what we want you to go across the river to get your art out because their gas test is less even though the the dealer that you deal with also repairs your car it's convenient for you it's five minutes away but your honor we want you to drive to cape girardeau because it costs less that's their argument on page thirty two dollars for site is substituting its own  database and this would this is just boggles my mind i know probably more about the illinois a fee schedule than some of the people that that helped write it because my eyes are stored from thinking about it you know how many line items there are in the on the schedule twelve million those poor people that wrote the that part of the act took months to put that together and foresight has taken one part of it the implant part of it and said well we're going to substitute our database for all d your months and years of hard work that medical fee schedule was implemented in two thousand and seven as a result of a bill put into effect by the legislature of the state of illinois not a company from tampa florida who was bought by a company from walnut park ala fornia these are what  elected representatives have told us is to be paid to positions in their geos to parea and if the bill is not reasonable and or not customary then it's paid pursuant to the  schedule i can charge x for this i'm sorry the fee schedule governs it i can charge y for this i'm sorry the fee schedule governs it if the net manufacturer's invoice price and your honors i see that i have five minutes thirty six seconds i'm going to finish with five minutes to go the decision of arbitrator hemenway was correct the settlement document drafted by mr give horn working for respondent if it contains an ambiguity it got to be construed against mr hayes judge gross heard three days of arguments and testimony we came there three times and what foresight wants you to do is go over and above the plain meaning of the statute what the legislature intended and the meaning of the net manufacturers invoice price and i'm behalf of camilla morris and front neck surgery cent and every other medical provider in southern illinois that has to go through the stuff thank you time mr rich i appreciate the fact that you're willing to leave or minutes and forty seconds on the table but i would like you did just i don't think so i i think that mr philbrick who did a fine job for respondent in front of judge gross never made that argument in fact he did so hopefully that answers your question just justice barbera thank you good to see again thank you jeff any other questions just escapes well i'm a bit concerned because even though this is being raised for the i mean are you of the pinion that the circuit court merely used section eight whenever the end numbers are to interpret the contract or are you arguing that the circuit court interpreted this section has mr hayes is saying no your honor it's the st one and the quote right the court and had me versus derek cohen construction is i would characterize it more of an impassioned plea to avoid the legal issues here then and really addressing what those issues are i didn't hear any response about how section eight point two a five allows for reimbursement of wholesaler invoices when the when the statute plainly says manufacturers in argument you heard has any bearing here again i think it's important to put the chronology in perspective the the arbitrators award was entered before ms morris had the surgery an issue in which the implants were used and while that surgery was clearly authorized by the arbitrators award the issue about how much it would cost and how much implants could be charged at weren't addressed in any way of course they couldn't be the surgery hadn't happened yet so the the the the part of the story here involving the litigation before the arbitrator has no bearing at all  as i see it anyway on these issues and doesn't looking at that doesn't clarify or interpret anything in the ultimate settlement contract the argument about  we we should interpret this contract against my client because the my client's counsel in the workers compensation case was the initial drafter of it  need to point out that in the contract itself and this is in the appendix of a fourteen in the terms of settlement at the bottom of the st paragraph of that page here's what it says it says quote the parties to this agreement have mutually contributed to its drafting and consequently no provision of the scream it shall be construed against any party on the ground that such party drafted the provision so we have a embrace the gas mera case where that was a critical aspect of the court's interpretation of what that settlement contract they're there meant but i just wanted to make the point clearly that to the extent this court involves a determination on that issue such a construction cannot be afforded here because of what the parties agreed to in the settlement contract  again i heard no argument that about why under this under section eight point two a five a wholesaler invoice is compensable and that and they're  essentially asking this court to disregard the word manufacturers in that statute and find any invoice can be reimbursed at twenty five percent above that invoice amount and that's not what the  and the arguments about you shouldn't have to go over state lines to buy product and all of that i would just note and it set forth that section page thirteen of my opening brief the up charges here were significant this isn't you could buy gas for a one dollar fifteen cents on this side of the illinois border but you get it for a one dollar five cents on the missouri side we have up charges of four and a half times  each one of the implant charges and here were based on the evidence that was presented to the trial about what they cost elsewhere this wasn't some minor slight difference between here or there you know what one dollar of these products was charged at four hundred and fifty percent what it had been sold for by a manufacturer in that same ninety five dollars is the front neck price become promote price offered by the defendant was six hundred and sixty dollars now where do you buy that six one hundred and sixty dollars s well there was the actual  voice and testimony about it is in the is in the trial record your honor but as as as was is indicated here the the implant and it is it true what mr ridge said that you'd have to go to another state to buy that i don't know if that as to this play is true or not i know some of these comparisons were to illinois and one of them and it may have been the cervical plate was i believe in the record will be clear on this and i apologise if i'm wrong but one of them was you know we're talking about downstate illinois on this one of them was a charge in st louis in the st louis area so it wasn't you had to go to california to buy it and you missed it or not or nebraska and as we all know medical providers don't actually travel to another state to buy them they order them on the phone or over the internet so it's a little a little bit of hype i probably i think about the burden of purchasing an implant product the point here is that the evidence that rebutted but not accepted clearly by the trial court is that these are these aren't minor differences these aren't you could get it someplace slightly cheaper these were whopping