Appeal of Wingate

813 A.2d 1176, 149 N.H. 12, 2002 N.H. LEXIS 190
CourtSupreme Court of New Hampshire
DecidedDecember 27, 2002
DocketNo. 2001-400
StatusPublished
Cited by13 cases

This text of 813 A.2d 1176 (Appeal of Wingate) is published on Counsel Stack Legal Research, covering Supreme Court of New Hampshire primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Appeal of Wingate, 813 A.2d 1176, 149 N.H. 12, 2002 N.H. LEXIS 190 (N.H. 2002).

Opinion

Broderick, J.

The claimant, Thomas Wingate, appeals a decision of the New Hampshire Compensation Appeals Board (board) denying his request for payment of a medical bill incurred more than a decade after his 1988 workplace injury. He argues that the respondent, Hansen Fox Company, Inc., should have been estopped from contesting the causal relationship between his back condition treated in 2000 and his 1988 compensable work injury. We vacate in part, reverse in part and remand.

We recite the facts found by the board, presented in the record, or undisputed by the parties. In January 1988, the claimant injured his lower back while employed as a pipe fitter for the respondent. His workers’ compensation claim was accepted and benefits were paid. The claimant was treated by Dr. James M. Shea, an orthopedic physician, who diagnosed a “central bulging or herniation of a mild to moderate degree at L5-S1.” The claimant participated in physical therapy for three months and took disability leave from work in 1988 and 1989. Dr. Shea recommended that he perform daily back exercises and use a back support in his ear. The doctor also prescribed pain medication.

The claimant was last examined by Dr. Shea in 1990. Thereafter, he experienced low back pain several times per year, for which he took a prescribed pain medication. Dr. Shea last renewed the claimant’s prescription in August 1996. After Dr. Shea retired, the claimant was treated by Dr. Michael J. O’Connell. In February 1999, Dr. O’Connell concluded that the claimant suffered from “[degenerative L5-S1 disc disease with chronic recurrent lower back pain.”

When the respondent’s insurance carrier denied payment for Dr. O’Connell’s 1999 bill, the claimant requested a hearing before the New Hampshire Department of Labor (DOL) pursuant to RSA 281-A:23 (1999). While his hearing request was pending, the claimant suffered another episode of back pain and, in early March 2000, he saw Dr. Louis Candito, who diagnosed “[degenerative disc disease lumbar spine.”

In late March, the DOL conducted a hearing to determine the respondent’s obligation to pay Dr. O’Connell’s medical bill. It found that the bill was the employer’s responsibility because Dr. O’Connell’s treatment was a consequence of “[the claimant’s] recurring lower back problem stemming from the 1988 work injury.” It ruled that the claimant had met his burden of proof by demonstrating that the bill was “causally related, reasonable, and necessary treatment for [his] lower back condition.” The respondent took no appeal from this decision.

The respondent subsequently refused to pay Dr. Candito’s bill, again contending that the claimant’s back condition, for which he sought treatment, was not caused by the 1988 work injury. The claimant requested a hearing before the DOL, which found the bill compensable, [14]*14reasoning that “the claimant has suffered no new injury since January 8, 1988, that his back condition has never stabilized, and that Dr. Candito found the claimant’s condition causally related to the original injury.” The respondent appealed to the board.

Prior to the hearing before the board, the claimant filed a motion for summary judgment asserting that the earlier unappealed decision of the hearing officer concerning Dr. O’Connell’s 1999 bill estopped the respondent from disputing the causal relationship between that same back condition treated by Dr. Candito in 2000 and the 1988 work injury. The board denied the motion and after a hearing, found Dr. Candito’s bill unrelated to the original work injury treatment. It reasoned:

In coming to this conclusion, the Panel relies on the competent medical evidence of Dr. O’Connell and Dr. Candito, two treating physicians of the claimant. In both doctors’ reports, they state that the cláimant’s current problems are degenerative in nature and they do not relate the claimant’s injury in 1988 to his current condition. Further, the Panel is troubled by the fact that the claimant had failed to treat with any physician for a period of approximately eight or nine years. ,

The claimant’s motion for reconsideration was denied, and this appeal followed.

■The claimant argues that the respondent should not have been allowed to relitigate the causal relationship between his 1988 work injury and his back treatment by Dr. Candito in March 2000 because the DOL had previously ruled compensable Dr. O’Connell’s 1999 bill for treatment involving the same degenerative condition. He contends that in the earlier proceeding involving O’Connell’s bill, the respondent fully contested the causal relationship between his back condition and the 1988 work injury, and failed to appeal the DOL’s adverse ruling. Because the respondent offered no evidence of a superseding injury involving his back since Dr. O’Connell’s 1999 treatment, the claimant argues that the board erred as a matter of law in considering the causal relationship between his back condition treated in 2000 by Dr. Candito and his 1988 work injury.

‘We will [not] overturn the board’s decision [unless we find] errors of law, or if we are satisfied by a clear preponderance of the evidence before us that the order is unjust or unreasonable.” Appeal of Jamar, 145 N.H. 152, 154 (2000). The issue of whether the respondent should have been collaterally estopped, from litigating causation is a matter of law, Farm Family Mut. Ins. Co. v. Peck, 143 N.H. 603, 605 (1999), that we review de novo, Byblos Corp. v. Salem Farm Realty Trust, 141 N.H. 726, 729 (1997).

[15]*15This case involves the respondent’s responsibility to pay Dr. Candito’s bill for treating the claimant’s back condition as it existed in March 2000. Under RSA281-A:23,1:

An employer subject to this chapter, or the employer’s insurance carrier, shall furnish or cause to be furnished to an injured employee reasonable medical, surgical, and hospital services, remedial care, nursing, medicines, and mechanical and surgical aids for such period as the nature of the injury may require.

“Thus, an employer has a continuing obligation to provide or to pay for medical, hospital, and remedial care for as long as is required by an injured employee’s condition where it bears liability for the initial injury that necessitated the subsequent health care.” Appeal of Bergeron, 144 N.H. 681, 684 (2000) (quotation omitted). The injured employee bears the burden of proving that the subsequent medical treatment is reasonable and required as a result of the injury. Appeal of Levesque, 136 N.H. 211, 214 (1992). A claimant is entitled to compensation for medical treatment only so long as the condition or disability requiring the treatment is causally related to the initial compensable injury. See Appeal of Sutton, 141 N.H. 348, 350 (1996); cf. Appeal of Hiscoe, 147 N.H. 223, 231 (2001).

The board denied coverage for Dr. Candito’s medical bill, ruling not only that the claimant’s back condition was not causally related to his 1988 work injury, but also that the bill was not reasonable or necessary. Ordinarily, the latter grounds for rejecting the bill would be sufficient. The only issue properly before the board, however, was causation. In the respondent’s denial letter regarding Candito’s bill, it solely contested the causal relationship between the treatment underlying the medical bill and the 1988 work injury. There is no evidence on the record before us that the respondent presented any other issue to the DOL.

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Cite This Page — Counsel Stack

Bluebook (online)
813 A.2d 1176, 149 N.H. 12, 2002 N.H. LEXIS 190, Counsel Stack Legal Research, https://law.counselstack.com/opinion/appeal-of-wingate-nh-2002.