AM Liner East, Inc. v. Osburn

627 S.E.2d 516, 47 Va. App. 724, 2006 Va. App. LEXIS 104
Court of Appeals of Virginia·Decided March 21, 2006·No. Record No. 1639-05-2·Published

Opinions

WILLIS, Judge.

AM Liner East, Inc. and its insurer (hereinafter referred to as “the employer”) filed an application seeking to terminate David T. Osbum’s temporary total disability (TTD) benefits and suspension of those benefits pending decision on the application. The commission rejected the employer’s application, holding that it failed to provide probable cause to believe it meritorious. The employer appeals. Because we find that the commission abused its discretion in rejecting the employer’s application, we reverse the commission’s decision and remand this case for referral to its hearing docket.

Background

On September 6, 2003, Osbum was involved in a motor vehicle accident while working for the employer, which accepted the accident as compensable. The parties filed agreement forms stating that Osburn had sustained multiple injuries, that he was disabled, and that he was entitled to temporary total disability (TTD) benefits beginning September 7, 2003 and continuing. On December 31, 2003, the commission entered an award memorializing this agreement.

On January 4, 2005, at the employer’s request, Dr. Betsy Blazek-O’Neill, an occupational medical specialist, examined Osbum. Dr. Blazek-O’Neill also reviewed Osbum’s medical [726] records, x-rays, a cervical MRI dated 11/26/03, a lumbar MRI dated 7/16/04, a cervical CT-myelogram dated 4/21/04, and his functional capacity evaluation (FCE) performed on December 9, 2004. In Dr. Blazek-O’Neill’s seven-page January 4, 2005 report, she opined that the level of capability indicated in the FCE report of “light to medium level” “did not appear to be a valid result.” She noted that Osburn “demonstrated markedly exaggerated pain behavior during the history and physical examination with very dramatic and histrionic comments, tearfulness, flinching, guarding, and grimacing.” She reported that he had “a non-physiologic gait pattern and non-dermatomal sensory changes.” She noted that his gait did not change significantly when walking with or without his cane. Finally, she opined:

I am unable to propose any physiologic mechanism for any symptoms that Mr. Osburn is currently reporting. His symptoms are bizarre and non-physiologic. They are not consistent with the abnormalities present on his diagnostic studies. The disc abnormality at C5-6 on the right has actually improved over time since Mr. Osburn’s injury although he is reporting progressively worsening symptoms. The location of the patient’s symptoms have been inconsistent from one physician visit to another in a manner that cannot be explained on a physiologic basis.
It is my opinion within a reasonable degree of medical certainty that Mr. Osburn has fully recovered from his work injury of 9/6/03. The symptoms that he continues to report are actually most consistent with malingering, because of their changing and non-physiologic nature. The patient has a history of depression, currently treated with Cybalta. This is unrelated to his work incident of 9/6/03.
Mr. Osburn no longer requires treatment for problems related to the 9/6/03 work incident. He does not require any medications for problems related to the incident. There is no evidence of reflex sympathetic dystrophy, complex regional pain syndrome, radiculopathy, or fibromyalgia. The patient is capable of working at his full duty position effective immediately without restriction.

[727] Dr. Blazek-O’NeiU also approved a job description describing Osburn’s pre-injury laborer position -with the employer, and signed a “Physician’s Affidavit of Recovery” under oath, stating that Osburn had fully recovered from his work injury and was capable of resuming his pre-injury position without restrictions as of January 5,2005.

On February 24, 2005, the employer filed an application seeking to terminate Osbum’s outstanding award of TTD benefits based upon Dr. Blazek-O’Neill’s January 4, 2005 report with attachments, including the job description and Physician’s Affidavit of Recovery and seeking suspension of his benefits pending decision on the application.

In response, Osburn submitted (1) a report from Dr. Maria E. Simbra, a neurologist, dated June 16, 2004, (2) January 31, 2005 discharge instructions from Dr. Robert L. Greico, and (3) records from Dr. Michael Cozza dated January 10, 2005 and March 4,2005.

Dr. Simbra’s June 16, 2004 report stated that in consultation she examined Osburn and reviewed his medical records on that date. She opined that he had “chronic pain.” Based upon his complaints of numbness and weakness on the right, she ordered an MRI of his brain. She concluded that “[i]f there are no abnormalities that need to be addressed on the MRI scan, he can return on an as needed basis.”

Dr. Greico’s January 31, 2005 discharge instructions indicated a diagnosis of “myofascial pain syndrome” with follow-up in six weeks. Dr. Cozza’s “Return to Work Evaluation” dated January 10, 2005, indicated that Osburn could perform light work with certain restrictions with respect to lifting, standing, sitting, and climbing. A prescription slip dated January 10, 2005 completed by Dr. Cozza indicated that Osburn “[m]ay return to light duty work on 1-13-05.” Dr. Cozza’s March 4, 2005 Attending Physician’s Report stated that Osbum’s disability began September 17, 2003 and that he was capable of returning to light duty work as of January 13, 2005. Dr. Cozza diagnosed Osburn as suffering from “[p]ost traumatic fibromyalgia s/p whiplash injury; cervical DDD.”

[728] Osburn did not file a copy of his December 9, 2004 FCE until after the expiration of the 15-day period allowed by Rule 1:5(C) for submitting responsive evidence to the employer’s application. Accordingly, the commission noted that the full FCE report was not in evidence. However, the commission acknowledged Dr. Blazek-O’Neill’s conclusions regarding the FCE findings because her report was before it.

Based upon this record, the Senior Claims Examiner rejected the employer’s application, holding that it did not provide probable cause to grant a hearing and suspend compensation. In so ruling, the Senior Claims Examiner found as follows:

In weighing, analyzing and balancing the medical evidence presented in support and in opposition to the Employer’s Application for Hearing, it is apparent that the injured worker has not been released to return to pre-injury work. The Commission has consistently afforded greater weight to the opinion of the treating physician, rather than that of a physician that examines the employee on only one occasion.

(Citations omitted.)

On review, the commission affirmed the Senior Claims Examiner’s determination, finding as follows:

It is well settled that where there is a conflict in the medical evidence, the Commission typically affords greater weight to the attending physician’s opinion than to the views of another physician whose involvement is upon a consultative basis only.

Free access — add to your briefcase to read the full text and ask questions with AI

AM Liner East, Inc. v. Osburn, 627 S.E.2d 516, 47 Va. App. 724, 2006 Va. App. LEXIS 104 (Va. Ct. App. 2006).

627 S.E.2d 516 (AM Liner East, Inc. v. Osburn) — published by Counsel Stack Legal Research, free access to 12M+ legal documents.

Related

Bass v. City of Richmond Police Department
515 S.E.2d 557 (Supreme Court of Virginia, 1999)
Gallahan v. FREE LANCE STAR PUBLISHING COMPANY
589 S.E.2d 12 (Court of Appeals of Virginia, 2003)
Circuit City Stores, Inc. v. Scotece
504 S.E.2d 881 (Court of Appeals of Virginia, 1998)
McPeek v. P. W. & W. Coal Co.
169 S.E.2d 443 (Supreme Court of Virginia, 1969)
Pilot Freight Carriers, Inc. v. Reeves
339 S.E.2d 570 (Court of Appeals of Virginia, 1986)
Giant of Virginia, Inc. v. Pigg
152 S.E.2d 271 (Supreme Court of Virginia, 1967)
Classic Floors, Inc. v. Guy
383 S.E.2d 761 (Court of Appeals of Virginia, 1989)
Bristol Builders Supply Co. v. McReynolds
162 S.E. 8 (Supreme Court of Virginia, 1932)
Baltimore v. Benedict Coal Corp.
29 S.E.2d 234 (Supreme Court of Virginia, 1944)