Hale v. Vickers, Inc.

635 N.W.2d 458, 10 Neb. Ct. App. 627, 2001 Neb. App. LEXIS 244
Nebraska Court of Appeals·Decided November 13, 2001·No. A-01-326·Published·Cited by 6 cases

Opinion

Sievers, Judge.

Vickers, Inc., appeals from the Nebraska Workers’ Compensation Court’s award to Vickers’ employee Marvin Hale. At issue is whether Hale unreasonably refused to submit to an examination by Vickers’ physician, thereby creating a reasonable controversy about the compensability of Hale’s claim, and whether the trial court adhered to the fee schedule of the Workers’ Compensation Court in awarding Hale medical expenses.

FACTUAL BACKGROUND

Hale has a history of knee problems. Hale testified before the Workers’ Compensation Court trial judge that in the late 1970’s, his right knee often locked up due to loose cartilage. In 1978 or 1979, Hale became unable to work, so he underwent knee surgery. Hale testified that following this surgery, he did not seek any additional treatment to his right knee, that the surgery did not limit his activities, and that he never missed any work due to knee problems until the instant situation.

On July 11, 1999, while working for Vickers as a machine operator, Hale stepped off of the platform on which he worked, wedging his right foot between the platform and the floor. He twisted his right knee as he fell. Hale told his employer immediately that he had been hurt but continued his shift that day. When he got home, Hale made an appointment with Dr. Samar Ray, who saw him on July 16, 1999. Dr. Ray wrote the following in his progress note of that date:

Marvin says on 07/12/99 he fell at work and twisted his right knee and since then, he has had considerable discomfort in the knee. The knee is also swollen. He said he can hardly walk on this knee. In the past, he had an open meniscectomy of the right knee, might be about 20-25 years *630 ago. He said he never really had any problem with the right knee until he fell.

Dr. Ray also noted that x rays of the knee showed moderately advanced degenerative arthritis. He gave Hale a cortisone injection and a program of physical therapy. Hale continued to work, but with substantial difficulties. On July 30,1999, Hale reported to Dr. Ray that he was better than before, but still felt numbness while driving and a tightness in his knee. Dr. Ray prescribed anti-inflammatory medication and advised Hale to continue with the physical therapy.

On August 6, 1999, Hale reported to Dr. Ray that he “really [was] not making any progress,” “continue[d] to have significant pain,” could not “do many of the activities he would like to do,” and was “having problems sleeping at night.” Dr. Ray noted in his progress report that the cortisone injection had provided Hale some relief, but that Hale felt ready to proceed with total knee arthroplasty. Hale ceased work at this time, as Dr. Ray advised Hale not to work until after the surgery.

According to Hale, his condition continued to worsen from the day of the accident up to the date of surgery, which Dr. Ray had scheduled for August 25, 1999. Dr. Ray first mentions the surgery in his progress note of August 6, although the note does not specify a date for the procedure. Vickers’ labor relations manager testified that Vickers did not learn of the proposed surgery until August 18, when its industrial nurse received a copy of Dr. Ray’s progress note of August 6.

Soon after receiving notice of the scheduled surgery, Katie Eilers, a Vickers claim representative, telephoned Hale to request that he submit to an examination by a doctor of Vickers’ choice. Hale agreed, and Eilers told him that Vickers had scheduled an August 30,1999, appointment for Hale to be seen by Dr. Michael Morrison. Hale said that he could not keep that appointment because of his surgery on August 25, and Eilers told him to postpone the surgery. Hale testified that he told her “[n]o, I’m in too much pain. I can’t sleep. I’m eating ... Advil by the bottles. I’m not postponing my surgery.” Eilers sent Hale a letter on August 20, confirming the appointment as follows: “As per our telephone conversation, an appointment has been made for you with Dr. Michael Morrison on August 30, 1999 at 3:15 RM. ... As we *631 discussed, when the type of surgery that is involved is this extensive, it is important to have a second opinion.”

Hale underwent surgery as scheduled and therefore did not attend the August 30, 1999, appointment with Dr. Morrison. On October 21, Eilers wrote Hale a letter denying his workers’ compensation claim. The letter explains the denial as follows:

It is our position that your refusal to attend this examination prior to surgery substantially prejudiced our rights to investigate the extent your injury affected your preexisting degenerative knee condition.
For this reason, we assume your surgery is related solely to your preexisting degenerative knee condition, and are thus denying the expenses for surgery and your claim for benefits due to time missed from work as unrelated to your alleged work injury.

After Hale filed this action for benefits, Vickers hired Dr. Peter Cimino to examine Hale’s knee, and Hale saw Dr. Cimino as Vickers requested. Dr. Cimino’s August 17, 2000, report indicates that Hale’s accident at work “led to acute onset of severe knee pain.” Further, Dr. Cimino noted:

He went to therapy without relief. I believe he did try an injection. His unrelenting pain eventually led to a total knee replacement by Dr. Ray in August of 1999. The surgery has proved very helpful for his pain relief. He was returned back to work in December of 1999 with a 25 pound lifting restriction. I believe he has been back to work ever since.

Dr. Cimino also noted Hale’s “significant” history for knee problems and stated that “[h]e did have some, aching discomfort intermittently but never severe until the work accident.” Finally, Dr. Cimino acknowledged that “[t]he claim is complicated by the fact that there was a pre-existing condition. The work injury exasperated [sic] this condition, thus leading to the knee replacement procedure.” Dr. Cimino found that “the procedure was a success and Mr. Hale will be able to continue with very little restrictions.”

Dr. Ray rendered an opinion that a right total knee replacement was required as a result of the aggravating injury and that Hale had “sustained a permanent partial disability of thirty-seven percent (37%) of the right lower extremity.” In his letter to Vickers’ attorney, Dr. Cimino generally agreed with this *632 assessment: “It does appear that the knee replacement procedure was excelerated [sic] by the work aggravation on July 11, 1999. I am in agreement with the permanent assessment of 30 percent to the right lower extremity as a result of the knee replacement.”

PROCEDURAL BACKGROUND

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Hale v. Vickers, Inc., 635 N.W.2d 458, 10 Neb. Ct. App. 627, 2001 Neb. App. LEXIS 244 (Neb. Ct. App. 2001).

635 N.W.2d 458 (Hale v. Vickers, Inc.) — published by Counsel Stack Legal Research, free access to 12M+ legal documents.

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