Bank One Corp. v. INDUS. COM'N OF ARIZONA

244 P.3d 571, 226 Ariz. 134, 596 Ariz. Adv. Rep. 22, 2010 Ariz. App. LEXIS 222
CourtCourt of Appeals of Arizona
DecidedNovember 30, 2010
Docket1 CA-IC 09-0028
StatusPublished
Cited by2 cases

This text of 244 P.3d 571 (Bank One Corp. v. INDUS. COM'N OF ARIZONA) is published on Counsel Stack Legal Research, covering Court of Appeals of Arizona primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Bank One Corp. v. INDUS. COM'N OF ARIZONA, 244 P.3d 571, 226 Ariz. 134, 596 Ariz. Adv. Rep. 22, 2010 Ariz. App. LEXIS 222 (Ark. Ct. App. 2010).

Opinion

OPINION

BROWN, Judge.

¶ 1 This is a special action review of an Industrial Commission of Arizona (“ICA”) award and decision upon review finding that *135 the respondent employee (“Claimant”) is entitled to continuing supportive care. The petitioner employer, Bank One Corporation (“Bank One”), argues the administrative law judge (“ALJ”) erred in concluding that Brown v. Industrial Commission precluded the ALJ from considering whether Claimant’s medications should be modified based on a review clause included in a settlement agreement. 199 Ariz. 521, 19 P.3d 1237 (App.2001). Based on the plain language of that agreement, which provides for annual review of Claimant’s supportive care for “need and/or use,” we set aside the award.

BACKGROUND

¶ 2 While employed by Bank One, Claimant sustained a lower back injury on October 23, 2000. She filed a workers’ compensation claim, which was accepted for benefits. Claimant initially received conservative medical treatment and then underwent lower back surgery. She eventually was released to return to work following an independent medical examination.

¶ 3 The petitioner earner, ESIS/ACE USA (“ESIS”), closed the claim with an unscheduled permanent partial impairment, and the ICA entered its findings and award for no loss of earning capacity. Claimant timely protested the ICA’s award, but before the parties litigated the claim, they entered into the settlement agreement. The agreement provided for annual supportive care for Claimant’s lumbosacral injury, including epidural injections, anti-inflammatory and antidepressant medications, muscle relaxers, narcotic pain medication, and medication for sleep enhancement. An ALJ issued a decision upon hearing and award approving the settlement agreement in August 2003.

¶ 4 Four years later, Claimant wrote to the ICA stating that ESIS was failing to adhere to the terms of her supportive care award. She then requested a hearing pursuant to Arizona Revised Statutes (“A.R.S.”) section 23-106KJ) (Supp.2009). 1 Six ICA hearings were held to permit testimony from Claimant, her treating orthopedic surgeon, psychiatrist, and pain management specialist. Two independent medical examiners, an orthopedist and a pain management specialist, also testified. Following these hearings, the ALJ entered an award finding that Claimant’s supportive care award as entered in 2003 should remain unchanged. The ALJ based the award on his determination that under Brown, 199 Ariz. at 525, ¶ 17, 19 P.3d at 1241, ESIS was required to “show something more than merely a change in medical opinion in order to avoid the preclusive effect of a prior award.” The award was summarily affirmed on administrative review and this timely special action followed. 2 This court has jurisdiction pursuant to A.R.S. §§ 12-120.21(A)(2) (2003), 23-95KA) (1995), 3 and Arizona Rules of Procedure for Special Actions 10.

DISCUSSION

¶ 5 Bank One argues the ALJ erred in finding that he was precluded from considering modification of Claimant’s supportive care award under Brown. Bank One contends that Brown is inapplicable here because the award of supportive care had never been “actually litigated.” Additionally, Bank One asserts that the settlement agreement shows the intent of the parties was to provide for regular review of the appropriateness of Claimant’s supportive care benefits. In response, Claimant argues that her supportive care award cannot be relitigated unless there has been a change in her physical condition or a change in medical procedure. She therefore contends that her medications cannot be altered based solely on differing medical opinions about the proper course of treatment.

*136 ¶ 6 In reviewing findings and awards of the ICA, we defer to the ALJ’s factual findings, but review questions of law, including the interpretation of a contract, de novo. Young v. Indus. Comm’n, 204 Ariz. 267, 270, ¶ 14, 63 P.3d 298, 301 (App.2003); Grosvenor Holdings, L.C. v. Figueroa, 222 Ariz. 588, 593, ¶ 9, 218 P.3d 1045, 1050 (App.2009).

¶ 7 The Arizona Workers’ Compensation Act does not specifically authorize supportive care awards; instead, these awards are issued voluntarily by workers’ compensation carriers “to prevent or reduce the continuing symptoms of an industrial injury after the injury has become stabilized.” Capuano v. Indus. Comm’n, 150 Ariz. 224, 226, 722 P.2d 392, 394 (App.1986). In Capuano, the carrier issued two notices of supportive care providing for medication plus office visits. Id. at 225, 722 P.2d at 393. Each notice included a ninety-day protest clause and an annual review clause. Id. Two years later, the claimant’s doctor requested authorization to alter the medications and increase the office visits, to which the carrier objected. Id. After the claimant requested a hearing under AR.S. § 23-1061(J), the ALJ granted the request for additional supportive care. Id. at 225-26, 722 P.2d at 393-94. On appeal, we rejected the earner’s argument that the claimant’s request was barred by res judicata. Id. at 226, 722 P.2d at 394. We held that an award of supportive care subject to annual review “does not determine with finality the effect of the claimant’s original, industrially related condition upon a future continuing need for supportive care benefits.” Id. We further concluded that a carrier’s “voluntary payment of supportive care benefits does not bar its request for a later determination whether a claimant’s current condition is still causally related to the industrial injury.” Id. at 227, 722 P.2d at 395.

¶ 8 Fifteen years later, in Brown, we recognized an exception to the general rule that notices of supportive care do not bar subsequent adjustment to the benefits provided. 199 Ariz. at 524, ¶ 14, 19 P.3d at 1240. In that case, the claimant’s entitlement to supportive care benefits was litigated and decided by an ALJ. Id. at 522, ¶ 2, 19 P.3d at 1238. When the carrier subsequently terminated those benefits based on a new independent medical examination, the claimant protested. Id. at 523, ¶ 7, 19 P.3d at 1239. On appeal, we held:

Respondents did not seek review of ... [the ALJ’s initial] award, [of supportive care] and it became final. And, absent some change in ... [claimant’s] physical condition!,] or in medical procedures, ... respondents insurer and employer are precluded from relitigating the supportive care issue merely by filing a notice of claim status.

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Bluebook (online)
244 P.3d 571, 226 Ariz. 134, 596 Ariz. Adv. Rep. 22, 2010 Ariz. App. LEXIS 222, Counsel Stack Legal Research, https://law.counselstack.com/opinion/bank-one-corp-v-indus-comn-of-arizona-arizctapp-2010.