ACE American Insurance Company v. Clayton D. Elmer

CourtCourt of Appeals of Texas
DecidedSeptember 15, 2020
Docket05-19-00386-CV
StatusPublished

This text of ACE American Insurance Company v. Clayton D. Elmer (ACE American Insurance Company v. Clayton D. Elmer) is published on Counsel Stack Legal Research, covering Court of Appeals of Texas primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
ACE American Insurance Company v. Clayton D. Elmer, (Tex. Ct. App. 2020).

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.

–2– 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

–3– 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 –4– 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.

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ACE American Insurance Company v. Clayton D. Elmer, Counsel Stack Legal Research, https://law.counselstack.com/opinion/ace-american-insurance-company-v-clayton-d-elmer-texapp-2020.