Davis v. Director, Office of Workers' Compensation Programs

124 F. App'x 1
CourtDistrict Court, District of Columbia
DecidedMarch 1, 2005
DocketNo. 04-1025
StatusPublished
Cited by4 cases

This text of 124 F. App'x 1 (Davis v. Director, Office of Workers' Compensation Programs) is published on Counsel Stack Legal Research, covering District Court, District of Columbia primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Davis v. Director, Office of Workers' Compensation Programs, 124 F. App'x 1 (D.D.C. 2005).

Opinion

JUDGMENT

PER CURIAM.

This petition for review of an order of the Benefits Review Board (“Board”) was considered on the briefs and appendices filed by the parties. See Fed. R.App. P. 34(a)(2); D.C.Cir. Rule 34®. It is

ORDERED AND ADJUDGED that the petition for review be denied for the reasons stated in the accompanying memorandum.

Pursuant to D.C. Circuit Rule 36, this disposition will not be published. The Clerk is directed to withhold issuance of the mandate herein until seven days after resolution of any timely petition for rehearing or petition for rehearing en banc. See Fed. R.App. P. 41(b); D.C.Cir. Rule 41.

MEMORANDUM

Petitioner is asking this court to determine that the district court has exclusive jurisdiction to review the Benefits Review Board’s (“Board”) decision on his entitlement to certain medical benefits under the Longshore and Harbor Workers’ Compensation Act (“LHWCA”), as extended by the previously-codified District of Columbia Workmen’s Compensation Act of 1928 (“DCWCA”), D.C.Code §§ 36-501 et seq.1 Under the applicable statutory scheme, however, the Board adjudicates the entitlement to a specific medical benefit award and judicial review is in the Court of Appeals. 33 U.S.C. § 921(b) (1972).2 The district court has jurisdiction only to process and enforce such an award. 33 U.S.C. § 921(d). This court has no authority to alter this review structure.

I.

The DCWCA covered most employment in D.C. between 1928 and 1982. Although the DCWCA was repealed in July 1982, it remains in effect for pre-1982 injuries such as petitioner’s and incorporates the version of the LHWCA that was in effect when the DCWCA was repealed. See LHWCA Amendments of 1972, Pub. L. 92-576, § 14, 86 Stat. 1251, 1261; Keener v. WMATA, 800 F.2d 1173, 1179 (D.C.Cir. 1986). The LHWCA establishes a comprehensive and exclusive administrative scheme for resolving work-related injury disputes. 33 U.S.C. §§ 921(b), (c), (d), (e) (discussing the functions of the Board and administrative law judges, and explaining the different functions of the district court and court of appeals in handling LHWCA claims); see Railco Multi-Construction Co. v. Gardner, 902 F.2d 71, 73-75 (D.C.Cir.1990).

Under the LHWCA’s 1972 amendments, an administrative law judge (“ALJ”) holds a hearing to resolve disputed facts concerning a claim for medical benefits, 33 U.S.C. § 919(d), the ALJ issues a “compensation order,” id. § 919(e), and the Board reviews the ALJ’s decision. Id. § 921(b)(3). The ALJ’s findings of fact “shall be conclusive if supported by substantial evidence in the record considered as a whole.” Id. If judicial review is [3]*3sought, review is in the U.S. Court of Appeals for the circuit in which the injury occurred. Id. § 921(c).

Under this scheme, there are no proceedings in district court. If, however, after a final compensation order is issued by the administrative agency, an employer fails to comply with the Board’s benefits award, enforcement proceedings may be brought in the appropriate United States district court. Id. § 921(d).

II.

In 1982, petitioner’s entitlement to certain medical benefits was determined by the Board. Later that year, petitioner filed an enforcement action in district court. In 1982, that court established procedures for petitioner to obtain payment from the employer’s carrier, Liberty Mutual Insurance Co (“Liberty Mutual”). In 2001, the district court modified those procedures and directed, among other things, that the parties try to resolve any medical billing disputes with the help of a designated “settlement judge.”

The ALJ was subsequently notified of the parties’ inability to resolve their disputes and thereafter resumed the proceedings at the agency level (on the matters of Dr. Snow’s bills; the Sibley Hospital bill; petitioner’s claim for reimbursement of medications, mileage, parking, and exercise equipment; and petitioner’s request to buy a powered wheel chair and van lift). The Board affirmed the ALJ’s refusal to hold the employer liable for the various medical charges submitted by petitioner for reimbursement or authorization.

Petitioner now challenges that entitlement determination. Consideration of this petition for judicial review requires the court to ensure that the Board did not exceed its scope of review. To make that assessment, the court needs to determine “(1) whether the Board adhered to the applicable scope of review, (2) whether the Board committed any errors of law, and (3) whether the ALJ’s findings are supported by substantial evidence on the record considered as a whole.” Crum v. General Adjustment Bureau, 738 F.2d 474, 477 (D.C.Cir.1984). Substantial evidence is what a reasonable person would accept as adequate to support a conclusion. See Richardson v. Perales, 402 U.S. 389, 401, 91 S.Ct. 1420, 28 L.Ed.2d 842 (1971).

The Board’s decision is affirmed; not only did the Board adhere to the appropriate scope of review and commit no errors of law, but the ALJ’s conclusions are supported by substantial evidence in the record. Based on an examination of bank statements showing Liberty Mutual had fully reimbursed petitioner for the amount he claimed for prescription drugs, over-the-counter medication, mileage, and parking fees, the ALJ properly rejected that claim. Joint appendix (“JA”) at 26-27.

Based on petitioner’s failure to seek prior authorization for exercise equipment he purchased which was fancier and more expensive than the equipment which had been approved in advance by Liberty Mutual, and his failure to demonstrate an emergency which justified purchasing the equipment without prior approval, the ALJ properly rejected the claim for the difference between the authorized amount and the amount ultimately paid. See 33 U.S.C. § 907(d) (claimant may not obtain reimbursement for medical treatment or services unless he requests authorization pri- or to obtaining the treatment or services, except in cases of emergency or refusal or neglect of the request by the employer or the insurer); JA at 27.

Moreover, petitioner’s claim for authorization to purchase a powered wheelchair and van lift was properly denied [4]*4because he failed to demonstrate that either apparatus was medically necessary or reasonably related to his work-related injury.

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Davis v. United States Department of Labor
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Bluebook (online)
124 F. App'x 1, Counsel Stack Legal Research, https://law.counselstack.com/opinion/davis-v-director-office-of-workers-compensation-programs-dcd-2005.