Opinion ID: 2544668
Heading Depth: 1
Heading Rank: 4

Heading: La. R.S. 23:1203(B)

Text: La. R.S. 23:1203(B) reads: The obligation of the employer to furnish such care, services, treatment, drugs, and supplies, whether in state or out of state, is limited to the reimbursement determined to be the mean of the usual and customary charges for such care, services, treatment, drugs, and supplies, as determined under the reimbursement schedule annually published pursuant to R.S. 23:1034.2 or the actual charge made for the service, whichever is less. (Emphasis added). Agilus and the lower courts read La. R.S. 23:1203(B) as specifically requiring payment in the amount of the reimbursement schedule or the actual charge, while reading actual charge as the standard charge for the service listed on the bill, as discussed in the next section below. We disagree. La. R.S. 23:1203(B) only limits the obligation of the employer. It does not impose an affirmative duty on the employer to pay one amount or the other. It simply caps the employer's monetary obligation to the health care provider. The employer's obligation to pay for the medical care of the injured employee comes from La. R.S. 23:1203(A), which states, ... the employer shall furnish all necessary drugs, supplies, hospital care and services, medical and surgical treatment.... (Emphasis added). La. R.S. 23:1203(B) only operates to limit the amount of the obligation established in La. R.S. 23:1203(A). Further, when read in pari materia with the rest of the LWCA, specifically La. R.S. 23:1034.2(E), which states, Nothing in this Section shall prevent a health care provider from charging... less than the [reimbursement schedule], it is clear that nothing in the LWCA operates to invalidate an agreed upon discounted charge that is less than the reimbursement schedule. The meaning of a law is determined by considering the law in its entirety along with all other laws concerning the same subject matter and construing the provision in a manner that is consistent with the express terms of the statute and with the obvious intent of the legislature in enacting it. SWAT 24 Shreveport Bossier, Inc. v. Bond, 2000-1695, (La.6/29/01); 808 So.2d 294, 302. The statute must therefore be applied and interpreted in a manner that is logical and consistent with the presumed purpose and intention the legislature had in enacting it. Id. Courts should give effect to all parts of a statutory scheme, if possible, and should not adopt a statutory construction that makes any part superfluous or meaningless. Id. La. R.S. 23:1034.2(C)(1) states, The reimbursement schedule shall include charges limited to the mean of the usual and customary charges for such care, service, treatment, drugs, and supplies. (emphasis added). Further, La. R.S. 23:1034.2(D) states, Fees in excess of the reimbursement schedule shall not be recoverable against the employee, employer, or worker's compensation insurer. Finally, La. R.S. 23:1034.2(E) states, Nothing in this section shall prevent a health care provider from charging a fee for such care, services, treatment drugs, or supplies that is less than the reimbursement established by the reimbursement schedule. Read together, these statutes indicate the clear intent of the legislature to cap the employers liability for reimbursement and encourage health care providers to charge less than the amounts provided in the reimbursement schedule. The object of the court in construing a statute is to ascertain the legislative intent and, where a literal interpretation would produce absurd consequences, the letter must give way to the spirit of the law and the statute construed so as to produce a reasonable result. First Nat'l Bank of Boston v. Beckwith Mach. Co., 94-2065, p. 8 (La.2/20/95), 650 So.2d 1148, 1153 (quoting Smith v. Flournoy, 238 La. 432, 115 So.2d 809, 814 (1959)). It is clear from the statutes that the LWCA reimbursement schedule is comprised of the maximum allowable fees the provider is allowed to charge, and any amount above that is not recoverable. Because the statutes provide the maximum allowable charge for care to a workers' compensation patient and provides that nothing in this section shall prevent a lesser charge, it is unreasonable to conclude that the statutes operate to prohibit a provider from contracting to accept less than the reimbursement schedule, especially when the provider was fully able to charge less than the schedule without the contract.