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Blythe v. University of Oklahoma12/23/2003
__ P.3d __
CERTIORARI TO THE COURT OF CIVIL APPEALS, DIVISION II
The issue in the present cause is whether the collateral source rule applies in the context of a workers' compensation claim for prescription expense reimbursement. If applicable, the collateral source rule ensures that the injured employee's recovery is not diminished by benefits, saving or insurance of the injured employee. We hold that the collateral source rule, to the extent it is codified in the Workers' Compensation Act at 85 O.S. 2001 ยง 45(A.), applies in this case and the COCA erred in sustaining the WCC's refusal to apply that rule and/or the terms of that statute in the instant case.
I. FACTS AND PROCEDURAL HISTORY
Claimant initiated her workers' compensation action in July, 1994 alleging she suffered a work-related injury during her employment with the University of Oklahoma. Claimant alleged primarily neck injury and consequential psychological overlay injury arising from lifting, bending and straining. In June, 1999, the WCC awarded PTD benefits and further ordered Employer to provide Claimant with reasonable and necessary continuing medical maintenance "limited to medications needed to maintain the laimant's physical and psychological state, to be provided under the care of Dr. Ed Ellis (including examinations to provide same)." This order was affirmed by a three-judge panel of the WCC. Employer appealed and the COCA affirmed the PTD award and order regarding continuing medical maintenance limited to medications necessary to maintain Claimant's physical injury, but reversed the trial court's determination regarding Claimant's alleged psychological injury. In accordance with its determination that competent medical evidence did not support a finding that Claimant suffered a psychological injury, the COCA modified the trial court's order by eliminating Claimant's award for continuing medical maintenance related to her psychological conditions.
In January, 2000, Claimant filed her Form 19 in the Workers' Compensation Court, seeking reimbursement for the cost of prescription medications. Employer challenged Claimant's recovery of the cost of prescriptions on three bases: (1) Claimant sought reimbursement for cost of prescriptions unrelated to her work-related injury; (2) the reasonableness and necessity for the numerous quantities of prescription medications being obtained by Claimant; and (3) Claimant sought reimbursement for cost of prescriptions not personally paid out of her own pocket, but actually paid on Claimant's behalf by her health insurance carrier. Pursuant to Employer's objections, the WCC entered an Order for an Independent Medical Opinion on reasonable and necessary prescriptions. The record reflects that ultimately, the parties stipulated to a detailed itemization of related, reasonable and necessary prescription medications, which included stipulated amounts of Claimant's out-of-pocket expenses in the amount of $19,882.42 as well as the total amount of prescription medication expenses (Claimant's actual out-of-pocket cost plus the cost actually paid by Claimant's health insurance carrier) in the amount of $46,344.24.
The record illuminates little detail regarding Claimant's health care coverage other than the fact that the third-party payor, Blue Cross and Blue Shield health insurance carrier, was a "group health policy" provided to Claimant by Employer as a part of a disability/compensation package as an employee at the University of Oklahoma. Claimant alleges (and Employer does not dispute) that she personally paid at least a portion of premiums for her own health insurance with Blue Cross. Unfortunately, we are prevented from verifyin
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