Aurora Consolidated Health Care & Sentry Insurance v. Labor & Industry Review Commission

2010 WI App 173, 794 N.W.2d 520, 330 Wis. 2d 804, 2010 Wisc. App. LEXIS 970
CourtCourt of Appeals of Wisconsin
DecidedNovember 30, 2010
DocketNo. 2010AP208
StatusPublished
Cited by2 cases

This text of 2010 WI App 173 (Aurora Consolidated Health Care & Sentry Insurance v. Labor & Industry Review Commission) is published on Counsel Stack Legal Research, covering Court of Appeals of Wisconsin primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Aurora Consolidated Health Care & Sentry Insurance v. Labor & Industry Review Commission, 2010 WI App 173, 794 N.W.2d 520, 330 Wis. 2d 804, 2010 Wisc. App. LEXIS 970 (Wis. Ct. App. 2010).

Opinions

BRENNAN, J.

¶ 1. Aurora Consolidated Health Care and its insurer Sentry Insurance, A Mutual Insurance Company (collectively "Aurora") appeal a circuit court order that upheld a decision of the Labor and Industry Review Commission ("LIRC"). The LIRC decision found Jeffrey Schaefer permanently and totally disabled as a result of a work injury and awarded Schaefer benefits on that basis. Aurora argues that LIRC violated the Worker's Compensation Act and denied Aurora its right to due process when it prohibited Aurora from cross-examining the independent medical examiner appointed by the Department of Workforce Development ("the Department"), and further, that LIRC's decision is not based on credible and substantial evidence. Because LIRC permitted Aurora to present evidence rebutting the independent medical examiner and reasonably relied on the independent medical examiner's reports, we affirm.

BACKGROUND

¶ 2. On February 27, 2001, Schaefer, employed as a courier by Aurora, slipped on ice and fell onto concrete while making a delivery. Schaefer experienced lower back pain and bilateral leg pain, but finished his shift.

¶ 3. On March 5, 2001, Schaefer went to Dr. James Cain, complaining of the injuries he sustained from the February 27, 2001 fall. Dr. Cain ordered an MRI, which showed that Schaefer had an L5-S1 recurrent disc herniation. As a result, Schaefer underwent surgery.

¶ 4. Because Schaefer had recurrent pain after his surgery, Dr. Cain referred Schaefer to Dr. Ali Sadeghi for pain management. Dr. Sadeghi reported that [812]*812Schaefer underwent several steroid injections for pain as well as trigger point injections. Schaefer was also given a number of oral narcotic medications and adjunct analgesics to control his lower back and bilateral leg pain.

¶ 5. Sometime in 2005, Schaefer developed right hip pain, unrelated to the work injury he suffered on February 27, 2001. On August 15, 2006, Schaefer underwent a total right hip replacement with positive results. Schaefer does not seek worker's compensation for difficulties related to his hip problem.

¶ 6. On July 10, 2006, Dr. Sadeghi completed a form entitled "Lumbosacral Spine Impairment Medical Assistant," setting forth Schaefer's work restrictions. In a post-hearing submission, Dr. Sadeghi explicitly stated that the limitations listed were those stemming from Schaefer's work-related back injury and not from his subsequent hip problem. According to the Administrative Law Judge's ("ALJ") summary of the document, Dr. Sadeghi:

imposed restrictions limiting Schaefer to continuously sitting 15 minutes and continuously standing 30 minutes after which he would need to lie down. In an eight hour workday, Schaefer could sit less than two hours and stand/walk less than two hours, that Schaefer would require more than ten unscheduled breaks during the average workday, and that he could rarely lift less [than] ten pounds and was never to twist, stoop or bend. Additionally, Schaefer would likely be absent from work more than four days per month because of his impairments or treatment and would be unable to perform routine, repetitive tasks at a consistent pace or fast paced tasks. Schaefer would frequently experience symptoms which interfere with attention and concentration needed to perform even simple work tasks during a typical workday.

[813]*813¶ 7. Aurora conceded liability for the February 27, 2001 fall and paid Schaefer temporary total disability benefits, temporary partial disability benefits, and some associated medical expenses.

¶ 8. On March 6, 2006, Schaefer filed a worker's compensation claim with the Department for the February 27, 2001 fall, seeking additional compensation.

¶ 9. Relying on Dr. Cain's and Dr. Sadeghi's medical opinions, the ALJ concluded that Schaefer was permanently and totally disabled. The ALJ further concluded that Schaefer had sustained a permanent total loss of earning capacity based on the vocational expert reports.

¶ 10. Aurora petitioned LIRC for review of the ALJ's findings and order. On review, Aurora argued that the ALJ should have disregarded Dr. Sadeghi's opinion because his opinion was "untruthful" and contained restrictions, not only for Schaefer's February 27, 2001 fall, but also for Schaefer's unrelated hip problem. LIRC remanded the case to the Department with directions to the ALJ to appoint an independent medical examiner to assess only Schaefer's disabilities related to the February 27, 2001 fall.

¶ 11. The ALJ appointed Dr. Jerome Ebert to perform the independent medical assessment of Schaefer's work-related disabilities. On November 6, 2008, Dr. Ebert conducted the independent medical examination and later submitted his assessment of Schaefer's work-related injuries to the ALJ. Dr. Ebert found that "100% of [Schaefer's] disability ... is due to his back. In other words, if he had no hip problem whatsoever, his restrictions would be the same." Dr. Ebert went on to conclude that "Schaefer is disabled, and the following limitations are due entirely to his back problem: Sit for 1/2-hour, stand for 1/2-hour, [814]*814drive for 1/2-hour, walk 1/2-mile maximum. Sedentary duty lifting 10 pounds frequently, 20 pounds maximal with change in position every 1/2-hour."

¶ 12. After receiving Dr. Ebert's written assessment, the ALJ gave notice to both parties that each party could "submit medical records in response to the opinions of Dr. Ebert" within ninety days. The ALJ's notice also provided that once the additional medical records were received, the ALJ would send the case back to LIRC to render a decision.

¶ 13. LIRC reviewed Dr. Ebert's written assessment and then remanded the case to the Department a second time. On the second remand, LIRC instructed the ALJ to request clarification from Dr. Ebert by asking Dr. Ebert three specific questions:

(1) [H]ow many hours of work in an average workday would [Schaefer] be able to tolerate, given his physical restrictions;
(2) [W]ould [Schaefer]'s physical restrictions require him to take unscheduled breaks during an average workday, and if so, what is the estimate of how many such breaks would be required; and
(3) [W]ould Dr. Ebert expect the effects of [Schaefer]'s low back disability to cause him to miss work time on a recurring basis, and if so, what is the estimate of how often this missed work time might occur?

(Formatting added.) Dr. Ebert promptly replied, answering as follows: (1) "I would estimate [Schaefer] would be able to work 8 hours per day given [his] restrictions"; (2) "I'd estimate approximately two brief 10 minute breaks per day would be required"; and (3) "Chronic back pain of this nature does tend to flare at [815]*815times. Sometimes the flares are so severe that work would not be possible. I would estimate that this would occur approximately 2 times per month."

¶ 14. Following Dr. Ebert's response to the ALJ's three questions, both parties submitted a third set of vocational reports from their respective vocational experts. The vocational experts found one of Dr. Ebert's answers to the ALJ's three questions particularly relevant to their analysis of Schaefer's loss of earning capacity. This prompted Aurora to send a letter to LIRC requesting that LIRC remand the case to the Department for a third time to allow Aurora to cross-examine Dr. Ebert about his answers to the ALJ's three questions.

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

Related

Cite This Page — Counsel Stack

Bluebook (online)
2010 WI App 173, 794 N.W.2d 520, 330 Wis. 2d 804, 2010 Wisc. App. LEXIS 970, Counsel Stack Legal Research, https://law.counselstack.com/opinion/aurora-consolidated-health-care-sentry-insurance-v-labor-industry-wisctapp-2010.