Ford v. Wal-Mart Associates, Inc.

155 S.W.3d 824, 2005 Mo. App. LEXIS 186, 2005 WL 221284
CourtMissouri Court of Appeals
DecidedFebruary 1, 2005
DocketED 84455, ED 84468
StatusPublished
Cited by3 cases

This text of 155 S.W.3d 824 (Ford v. Wal-Mart Associates, Inc.) 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
Ford v. Wal-Mart Associates, Inc., 155 S.W.3d 824, 2005 Mo. App. LEXIS 186, 2005 WL 221284 (Mo. Ct. App. 2005).

Opinion

KATHIANNE KNAUP CRANE, Judge.

In this worker’s compensation case, employer, Wal-Mart Associates, Inc., and insurer, Insurance Company of the State of Pennsylvania, appeal 1 from the final award of the Labor Industrial Relations Commission (Commission) allowing compensation and modifying the award and decision of the Administrative Law Judge (ALJ), with one member concurring in a separate opinion. 2 The ALJ had found claimant permanently and partially disabled, but denied claimant’s request pursuant to Section 287.510 RSMo (2000) to double the temporary award previously made for noncompliance. The Commission modified the award to impose the penalty of doubling the temporary award because employer had not paid $21,445.27 of claimant’s medical bill, which caused the treating physician to refuse to provide claimant with further medical services. Employer and insurer assert that the Commission erred in doubling the temporary award because, they argue, they complied with the temporary award, and the unpaid medical bill was a legitimate fee dispute not involving claimant or causing her detriment. We affirm.

FACTUAL AND PROCEDURAL BACKGROUND

On June 10, 1998, while claimant was lifting boxes to stock shelves in employer’s automotive service department, she felt pain and heard her back “pop.” She notified her supervisors and, because the pain continued, she began treatment with her own physician, Peter Montgomery, M.D., the next day. Employer subsequently authorized her to see Frank Petkovich, M.D.

On June 24, 1998 claimant filed a claim for compensation. On July 27, 1999, the ALJ entered a Temporary or Partial Award finding claimant entitled to temporary total disability payments from June 11, 1998 and continuing for as long as the condition continues. The award ordered medical treatment in the following language:

Section 287.140 RSMO provides that the employer shall provide such medical treatment as may reasonably be required after the injury or disability to cure and relieve from the effects of the injury. The claimant need not present conclusive evidence of the need for future medical treatment; claimant need only show the need as a matter of “reasonable probability”. Tate, at p. 329. The testimony of Dr. Petkovich and Dr. Mirkin is persuasive as a matter of reasonable probability that Ms. Ford is in need of such medical care as may cure and relieve of the effects of her work injury. The employer is to provide such treatment consistent with the recommendations of Dr. Petkovich.

In compliance with the temporary award, employer and insurer authorized Dr. Pet-kovich to perform an anterior lumbar dis-cectomy at L5-S1 of the lumbar spine, and a fusion of L5 and SI with two cages and bone grafting from the iliac crest on August 30, 1999. A second fusion was performed on April 13, 2000.

*827 On June 28, 2000, Dr. Petkovich filed an Application for Payment of Additional Reimbursement of Medical Fees pursuant to 8 CSR Section 50-2.030. Dr. Petkovich’s bill for services rendered for claimant’s injury totaled $32,181.10. Employer paid $10,735.83, leaving a balance of $21,445.27.

Dr. Petkovich examined claimant several times after the April 13, 2000 fusion. On October 24, 2000, he concluded that claimant had reached maximum medical improvement (MMI).

In August, 2001, claimant experienced an increase in back pain. Dr. Theodore Rummel, an orthopedic surgeon who had performed surgery on claimant’s arms, advised her to return to Dr. Petkovich. On August 15, 2001, claimant’s attorney made a written request to employer to authorize claimant to see Dr. Petkovich. In addition, on August 24, 2001, claimant’s attorney sent her to J.H. Morrow, Jr., D.O. who also determined that claimant was at MMI. On September 11, 2001, claimant was treated by her primary physician, Dr. Montgomery, who advised her to return to Dr. Petkovich.

In December, 2001, claimant’s attorney received a verbal authorization from employer for additional treatment from Dr. Petkovich, which he relayed to claimant. Claimant scheduled a visit for January 16, 2002. However, on January 15, 2002, Dr. Petkovich’s office sent claimant’s attorney a facsimile transmission advising that Dr. Petkovich would not see claimant again until his balance was paid in full. Claimant reported to Dr. Petkovich’s office for her scheduled visit, but was also told she would not be seen because her bill had not been paid.

Prior to the hearing on the final award, claimant filed a request for a penalty under Section 287.510 RSMo (2000) for employer’s failure to pay Dr. Petkovich. Employer requested that Dr. Petkovich’s claim and the issue of the reasonableness of his fees be heard in a separate proceeding from the hearing on the final award. The ALJ found that claimant had an interest in the issue because of her request for a penalty and denied employer’s request for a separate hearing. This issue was included at the final hearing held on January 7 and March 11, 2003.

At the final hearing, Dr. Petkovich testified that at the time he saw claimant on October 24, 2000, he determined that she would not need any further orthopaedic care unless she developed additional problems, but that she would need intermittent analgesics in the future for her lower back pain. He concluded that she suffered from persistent pain that would continue. At the time of the hearing he believed that claimant’s pain would be a permanent condition. Dr. Petkovich testified that, if claimant was experiencing severe back pain on January 16, 2002, he would have recommended that she be seen by him.

Prior to the entry of the final award by the ALJ, employer paid the outstanding balance on Dr. Petkovich’s bill and Dr. Petkovich withdrew his Application for Payment. Accordingly, in his final award, the ALJ did not rule on the merits of the fee dispute. The ALJ found that claimant was permanently and totally disabled. The ALJ also found that the employer and insurer need to provide ongoing analgesics for pain as recommended by Dr. Petko-vich. However, he denied claimant’s requests for attorney’s fees, costs, and a double award under Section 287.510 RSMo (2000).

Both claimant and employer requested review by the Commission. The Commission affirmed the ALJ’s award and decision allowing compensation for the permanent total disability, but modified the ALJ’s award by doubling the award for *828 noncompliance under Section 287.510 RSMo (2000). The Commission found that a temporary or partial award must be complied with until a final award is issued. It determined that employer and insurer’s failure to pay the outstanding balance owed to Dr. Petkovich resulted in the denial of treatment to which claimant was entitled under the temporary award. As a result, the Commission ordered employer and insurer to pay $57,522.39 as a penalty.

DISCUSSION

For their sole point on appeal, employer and insurer contend that the Commission abused its discretion in doubling the temporary award. They argue that they fully complied with the temporary award and that they were not required to provide medical treatment after claimant had reached MMI. They also argue that the unpaid balance of Dr.

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155 S.W.3d 824, 2005 Mo. App. LEXIS 186, 2005 WL 221284, Counsel Stack Legal Research, https://law.counselstack.com/opinion/ford-v-wal-mart-associates-inc-moctapp-2005.