ELIZABETH DOWNING, Employee-Respondent v. McDONALD'S SIRLOIN STOCKADE, Employer-Appellant.

418 S.W.3d 526, 2014 WL 185585, 2014 Mo. App. LEXIS 41
CourtMissouri Court of Appeals
DecidedJanuary 17, 2014
DocketSD32683
StatusPublished
Cited by1 cases

This text of 418 S.W.3d 526 (ELIZABETH DOWNING, Employee-Respondent v. McDONALD'S SIRLOIN STOCKADE, Employer-Appellant.) is published on Counsel Stack Legal Research, covering Missouri Court of Appeals primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
ELIZABETH DOWNING, Employee-Respondent v. McDONALD'S SIRLOIN STOCKADE, Employer-Appellant., 418 S.W.3d 526, 2014 WL 185585, 2014 Mo. App. LEXIS 41 (Mo. Ct. App. 2014).

Opinion

MARY W. SHEFFIELD, J.

This appeal involves a workers’ compensation claim filed by Elizabeth Downing (“Employee”) against McDonald’s Sirloin Stockade, Inc. (“Employer”). The Labor and Industrial Relations Commission (“the Commission”) awarded compensation, and Employer appeals. Specifically, Employer claims the Commission erred in making an award for past medical expenses because Employer did not authorize the medical expenses. This argument is without merit, and we affirm the Commission’s award.

Standard of Review

“In reviewing a workers’ compensation final award, ‘we review the findings and award of the Commission rather than those of the ALJ.’ ” Pruett v. Federal Mogul Corp., 365 S.W.3d 296, 303 (Mo.App. S.D.2012) (quoting Birdsong v. Waste Mgmt., 147 S.W.3d 132, 137 (Mo.App. S.D.2004)). Under Section 287.495, RSMo (2000), appellate review of the Commission’s award is limited to consideration of the following questions: (1) whether “the [C]ommission acted without or in excess of its powers;” (2) whether “the award was procured by fraud;” (3) whether “the facts found by the [C]ommission do not support the award;” and (4) whether “there was not sufficient competent evidence in the record to warrant the making of the award.” § 287.495.1, RSMo (2000). “Whether the award is supported by competent and substantial evidence is judged by examining the evidence in the context of the whole record.” Pruett, 365 S.W.3d at 303-04 (quoting Hampton v. Big Boy Steel Erection, 121 S.W.3d 220, 223 (Mo. banc 2003)). Furthermore, “we defer to the Commission on issues involving the credibility of witnesses and the weight to be given to their testimony.” Id. at 304 (quoting Pavia v. Smitty’s Supermarket, 118 S.W.3d 228, 234 (Mo.App. S.D.2003)). Contrariwise, “[w]e independently review questions of law.” Martin v. Town and Country Supermarkets, 220 S.W.3d 836, 844 (Mo.App. S.D.2007).

Factual and Procedural Background

Employee worked as a waitress for Employer from October 1985 until October 2007. She first began to have back pain in 2005. In March 2006, Employee sought treatment on her own from a chiropractor, Dr. Wayne Webb (“Dr. Webb”). Employee reported a constant, sharp pain in her hip and leg. Employee also stated she thought the pain might be related to her work and that her work duties aggravated her pain. As treatment progressed, Dr. Webb determined an MRI was needed. Dr. Webb spoke with Employee about the need for an MRI on at least two occasions in late April.

In April or May 2006, Employee spoke with Employer’s owner, Terry McDonald (“Owner”). Owner suggested Employee seek treatment through Employer’s workers’ compensation insurance. LuAnn Henderson (“Claims Representative”), a senior claims representative for Employ *528 er’s workers’ compensation insurance carrier, was notified of the claim around that time.

Employer referred Employee to Dr. Dennis Estep (“Dr. Estep”). Dr. Estep examined Employee on May 12, 2006. Dr. Estep recommended Employee be examined by a surgeon.

On May 18, 2006, Claims Representative spoke with Employer’s assistant manager, Jim Vaughn (“Assistant Manager”). She told him she did not believe Employee’s condition was compensable because (1) Employee waited so long to report it and (2) Employee did not recount a specific injury. Claims Representative told Assistant Manager she “would be contacting [Employee] to get information then would be sending out a denial.”

Employer subsequently referred Employee to Dr. Brian Ipsen (“Dr. Ipsen”) who examined Employee on June 18, 2006. During that visit, Employee reported severe and intolerable right leg pain. Conservative treatment, including pain medication, chiropractic care, and cortisone injections, had not provided relief. Dr. Ipsen believed proceeding to surgery was reasonable and ordered an MRI to assess the situation.

Claims Representative authorized payment for the MRI. The MRI was performed on June 17, 2006. The MRI revealed disc degeneration at L5-S1 as well as a large extrusion “causing impingement on the right SI nerve root.” Dr. Ipsen scheduled surgery for June 23, 2006.

There were three phone calls between Employee and Claims Representative in which Employee requested permission to undergo the scheduled surgery. Claims Representative finally told Employee the surgery was not authorized because the company needed more information.

Employee took out a loan and proceeded to undergo surgery by Dr. Ipsen on June 23, 2006, when Employee underwent a right L5-S1 microdiskectomy. She experienced complications from the surgery, and on June 25, 2006, Dr. Ipsen conducted a complete diskectomy. The total cost for these surgeries and related medical treatment was $43,399.23. On August 11, 2006, Employee filed a claim for compensation with the Division of Workers’ Compensation (“the Division”).

On June 11, 2007, Employee underwent an independent medical evaluation by Dr. Brent Koprivica (“Dr. Koprivica”). Dr. Koprivica reviewed Employee’s medical records and performed a physical examination. Dr. Koprivica concluded (1) Employee’s work for Employer was the prevailing factor in causing Employee’s herniated disc and (2) the surgeries were reasonable and necessary to treat the herniated disc.

The Division held a hearing regarding Employee’s claim for compensation. Employee presented her own testimony, her medical records, and the opinion of Dr. Koprivica. Employer presented no expert testimony. The Administrative Law Judge (“ALJ”) determined the condition arose out of and in the course of employment and entered an award for (1) unpaid medical expenses for two emergency room visits, (2) temporary total disability, and (3) permanent partial disability. The ALJ did not make an award for the cost of the two surgeries.

Employee sought review by the Commission. The Commission adopted the ALJ’s award and findings except with respect to the issue of past medical expenses. The Commission modified the award to include coverage of past medical expenses for the two surgeries and related medical treatment. Employer appeals.

Discussion

In its sole point on appeal, Employer argues the facts found by the Commis *529 sion do not support the award of past medical benefits for the surgeries because the medical expenses were not authorized and the treatment was not needed on an emergency basis. This argument is without merit.

The portions of Section 287.140 1 which are relevant to the present case provide that:

1 ....

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418 S.W.3d 526, 2014 WL 185585, 2014 Mo. App. LEXIS 41, Counsel Stack Legal Research, https://law.counselstack.com/opinion/elizabeth-downing-employee-respondent-v-mcdonalds-sirloin-stockade-moctapp-2014.