ACE American Insurance Company v. Clayton D. Elmer

Court of Appeals of Texas·Decided September 15, 2020·No. 05-19-00386-CV·Published

Opinion

Affirm and Opinion Filed September 15, 2020

In The

Court of Appeals

Fifth District of Texas at Dallas No. 05-19-00386-CV

ACE AMERICAN INSURANCE COMPANY, Appellant V.

CLAYTON D. ELMER, Appellee

On Appeal from the 14th Judicial District Court Dallas County, Texas

Trial Court Cause No. DC-17-06888

MEMORANDUM OPINION

Before Chief Justice Burns, Justice Molberg, and Justice Carlyle Opinion by Justice Molberg

Ace American Insurance Company (Ace) appeals the judgment for Clayton D. Elmer in its suit for judicial review of a Decision and Order (Decision) issued in favor of Elmer by the Texas Department of Insurance, Division of Workers’ Compensation Division (Division), after a contested case hearing regarding injuries sustained by Elmer while working as a truck driver for Heartland Express.1

1 Elmer was not represented by counsel at the Division proceedings. Instead, he utilized the free ombudsman assistance provided for pro se claimants in administrative disputes.

Following a bench trial, the trial court entered judgment in favor of Elmer and awarded attorney’s fees.

Ace raises four issues on appeal: (1) the trial court erred by finding Elmer’s work injury extends to and includes depression, anxiety disorder, and chronic pain syndrome; (2) the trial court erred by finding Elmer’s date of maximum improvement is June 21, 2016, with an impairment rating of forty-five percent; (3) the trial court erred by awarding attorney’s fees because Elmer should not have prevailed at trial, or, alternatively, Elmer waived his fees by presenting no supporting evidence; and (4) the trial court entered an invalid judgment because it neither conformed with the evidence at trial nor complied with Texas Labor Code section 410.258. TEX. LAB. CODE § 410.258. Elmer did not file a response brief.

We affirm the trial court’s judgment.

BACKGROUND

On June 16, 2014, Elmer injured himself at work when his foot slipped while stepping out of a tractor-trailer (the work injury). He reported the incident approximately an hour-and-a-half later when he checked in with his dispatcher regarding his route to Waco. Elmer stopped several times along his route to get ice to relieve pain in his shoulder and knee. After finishing his route and dropping off the truck, his wife took him to the emergency room. Elmer eventually required surgeries on his left knee and left shoulder.

Due to post-injury pain, Elmer was able to engage only in limited physical activity. In February 2016, the parties agreed Elmer’s defined compensable injury included a left-knee medial meniscus tear, a left-knee lateral meniscus tear, a left- shoulder rotator cuff tear (original and recurrent), and left-shoulder bicipital tenosynovitis. At that time, Elmer did not claim he suffered chronic pain, anxiety, or depression related to the work injury.

On January 30, 2017, the Division held a contested case hearing. Elmer was the only witness, but he presented multiple reports from workers’ compensation doctors and medical care providers who had examined him and determined he suffered from chronic pain syndrome, depression, and anxiety as a direct result of the effects of the compensable injury. Elmer was treated for chronic pain syndrome, depression, and anxiety by several medical providers. Experts who opined in favor of Elmer included Dr. Maggie Perish, Dr. Tommy Overman, Dr. Robert Panzarella, and Marce Hufnagel, M.Ed., LPC.

Dr. Panzarella—the Division-appointed designated doctor—opined that Elmer’s compensable injury extended to and included chronic pain syndrome, depression, and anxiety, which arose from and were directly related to the work injury. According to Dr. Panzarella, Elmer reached maximum medical improvement (MMI) on June 21, 2016, with a whole person impairment rating of forty-five percent. The insurance carrier’s expert witness, Dr. Andrew Brylowski, who had examined and talked with Elmer for approximately three hours, determined Elmer

reached MMI on June 2, 2016, with a whole person impairment rating of eleven percent.

Finding in favor of Elmer, the Division’s Decision noted Elmer “presented multiple reports from multiple care providers who have determined that [Elmer] is experiencing chronic pain syndrome, depression, and anxiety as a direct result of the effects of the compensable injury.” Dr. Brylowski, the “carrier-selected post- designated doctor,” was the “only doctor who did not believe that [Elmer] sustained the disputed conditions,” i.e., chronic pain syndrome, depression, and anxiety (emphasis added). According to the Division, Dr. Brylowski’s “analysis of the results of his testing was contradictory.” The Decision observed:

On the one hand, [Dr. Brylowski] stated that his testing showed that [Elmer] was not overreporting his symptoms and that the tests reflected a technical validity of the results. Then, in the same report, he maintained that the testing was consistent with overreporting that allegedly invalidated a mental and behavioral impairment rating. Yet Dr. Brylowski also stated that people with some of the test results he obtained tended to experience anxiety, depression, and withdrawal from every day activities.

The Decision further stated that “Dr. Brylowski’s opinion was, at best, much less persuasive than the rest of the medical record” and was “contrary to [Elmer’s] testimony and all of the other medical evidence in the record.”

The Division concluded Elmer’s chronic pain syndrome, anxiety disorder, and depression were caused or aggravated by, and did arise out of or naturally flow from, the work injury. It further concluded the MMI date was June 21, 2016, with an impairment rating of forty-five percent. Ace was ordered to pay benefits in

accordance with the Division’s Decision. After exhausting its administrative remedies, Ace appealed the adverse determination in district court.

The only evidence presented during the bench trial was Elmer’s live testimony and Dr. Brylowski’s expert report and deposition testimony. At trial, Elmer testified that prior to the work injury, he was not being treated for depression, anxiety, or chronic pain; and his chronic pain developed after the injury and “limited his ability to do physical activities.” Elmer told the trial court he received both medical and psychological treatment as a result of the work injury. Over Ace’s objection, Elmer testified he was “first diagnosed with depression or anxiety” in “[m]id 2015” by Dr. Perish, who gave him “psychological testing” and treatment; “[Dr. Perish’s] records were in evidence at the Contested Case Hearing”; other counselors also treated Elmer and “[a]s part of the Workers’ Comp process [he was] requested or ordered to go to examinations by [three] doctors other than [his] treating doctors”; and he received treatment with counselors for anxiety, depression, and chronic pain. The trial court overruled Ace’s hearsay objection on the grounds that statements made for the purpose of medical treatment are an exception to the hearsay rule. See TEX. R. EVID. 803(4). Elmer testified that for and during the course of his medical treatment:

Things we spoke about was my love to work, my love of family and how it’s diminished of where I don’t see my family hardly any more; the difficulties of just daily living and self-care; and just empty and worthless feeling; not being able to be a provider.

The trial court found in favor of Elmer and entered findings of fact and conclusions of law. In its Final Judgment, the trial court stated:

Defendant Clayton Elmer credibly testified as to his treatment of chronic pain, depression and anxiety as part of his workers’

compensation injury, and of examples of pain interfering with acts of daily living, as well as difficulties with his left shoulder and left knew. He testified he was diagnosed and treated for these conditions after his 2014 compensable injury by his workers compensation doctors, and before a subsequent injury in 2015 at physical therapy.

ANALYSIS

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