Julio Emilio Posada v. Virginia Polytechnic Institute & State University/Commonwealth of Virginia

Court of Appeals of Virginia·Decided December 13, 2005·No. 0954053·Published

Opinion

COURT OF APPEALS OF VIRGINIA

Present: Chief Judge Fitzpatrick, Judges Humphreys and Felton Argued at Salem, Virginia

VIRGINIA POLYTECHNIC INSTITUTE & STATE UNIVERSITY/ COMMONWEALTH OF VIRGINIA

v. Record No. 0943-05-3

JULIO EMILIO POSADA OPINION BY JUDGE WALTER S. FELTON, JR.

JULIO EMILIO POSADA DECEMBER 13, 2005

v. Record No. 0954-05-3

VIRGINIA POLYTECHNIC INSTITUTE & STATE UNIVERSITY/ COMMONWEALTH OF VIRGINIA

FROM THE VIRGINIA WORKERS’ COMPENSATION COMMISSION

Joseph F. Giordano (G. Bryant Butler, Jr.; Semmes, Bowen & Semmes, P.C., on briefs), for Virginia Polytechnic Institute & State University/Commonwealth of Virginia.

Monica Taylor Monday (Matthew W. Broughton; Gentry Locke Rakes & Moore, on briefs), for Julio Emilio Posada.

Virginia Polytechnic Institute (“employer”)1 and Julio Posada (“claimant”), each appeal from an award of the Virginia Workers’ Compensation Commission (“commission”). Employer asserts that the commission erred in finding: (1) that it unreasonably defended its failure to pay medical benefits pursuant to an existing award; (2) that a 2003 agreement between the parties to increase Melanie Davis’ weekly 24-hour attendant care compensation rate was a valid modification of the commission’s 1997 order; and (3) that claimant’s wife’s services are

1 Employer is self-insured. It contracted management and administration of commission awards, including payment of benefits, to Gates McDonald. This dispute arises out of Gates McDonald’s failure to pay benefits under an existing award.

compensable under Code § 65.2-603 for providing 24-hour attendant care, including medical attention. Claimant contends that the commission erred in (1) reducing the amount of attorney’s fees assessed against employer from $34,114.88 to $30,000; and (2) reducing the compensation to his wife, Melanie Davis (“Davis”), for her 24-hour attendant care services from $16.44 per hour to $10 per hour. For the reasons that follow, we affirm the commission’s decision.

BACKGROUND

Claimant, while an engineering student, was employed at employer’s airport. He suffered a traumatic amputation of both arms at shoulder level while using an auger to dig fence postholes. His injuries left him without ability to perform any functions of life requiring the use of arms and hands,2 including waste elimination and cleaning, scratching, removing himself from entangled bed linens, preparing and eating food, dressing and undressing, grooming, oral hygiene, skin care, transferring from one position to another, balancing, and ambulation. Employer accepted compensibility of claimant’s injuries, and, thereafter, the commission entered its award of permanent total disability benefits,3 as well as lifetime medical benefits.

In July 1988, in its award of benefits to claimant, the commission memorialized a stipulation agreement between the parties, which provided in relevant part:

[Claimant] is totally disabled under [§ 65.2-503(C)]4 of the Code of Virginia. [T]he parties acknowledge that Mr. Posada’s treating physician has ordered twenty-four hour attendant care which is reasonable and necessary under the circumstances and that such care will be rendered by individuals selected by Julio Posada.

2 As a result of the severity of the amputation of his arms, claimant was unable to use prosthetic arm devices.

3 Claimant was awarded compensation at a rate of $176.26 per week.

4 Formerly Code § 65.1-56(18).

(Emphasis added). The rate of compensation for the 24-hour attendant caregiver was to be determined by the parties and the commission from time to time over the course of claimant’s lifetime. Employer paid claimant’s chosen 24-hour caregiver pursuant to the 1988 agreement for some 16 years.5 In 1997, claimant’s then girlfriend, Melanie Davis, left her career as a systems analyst in Gaithersburg, Maryland and obtained medical training to become a certified nursing assistant (“CNA”). Davis married claimant on March 1, 1997, and she contemporaneously assumed responsibility for claimant’s 24-hour attendant care. In May 1997, the commission entered an order directing employer to “pay the sum of $910.00 per week to Melanie Davis . . . beginning March 1, 1997, and continuing until modified by agreement of the parties or Order of the Commission.” (Emphasis added).

Employer continued to pay Davis at the rate of $910 per week through May 2003 when claimant’s counsel requested an increase in the rate of compensation to $1,512. In his request, claimant’s counsel advised that Davis might not be able to continue in her role as claimant’s 24-hour attendant caregiver without the increase in pay.6 Employer’s adjuster agreed to the increase requested, and memorialized the agreement in claimant’s file.

5 Initially, claimant’s parents, siblings, and church members provided attendant care.

Claimant testified that in 1995, he sought employer’s assistance to obtain a permanent 24-hour attendant caregiver. Employer responded by asking him to find an attendant himself. Claimant inquired if employer would pay his mother to serve as his 24-hour attendant caregiver, and employer replied in the affirmative, stating that claimant could choose anyone he wanted. Employer compensated claimant’s mother at a rate of $425 per week.

6 At oral argument, claimant’s counsel noted that Davis, as claimant’s 24-hour attendant caregiver, was without employment benefits such as health and life insurance, vacation, holidays, retirement plan, and other standard employee benefits. Absent any increase in compensation to obtain such benefits, counsel suggested that Davis considered outside employment and turning her husband’s 24-hour care over to others.

During this time period, claimant and Davis moved to Edenton, North Carolina to be closer to Davis’ parents, who provided assistance in claimant’s care when it was necessary for Davis to be out of his presence for personal appointments, grocery shopping, and other essential trips outside the home.

In December 2003, Patricia Haynes became the adjuster responsible for administering the commission’s award for employer. In May 2004, Haynes unilaterally stopped (or, in her words, “delayed”) paying Davis after discovering, during a review of claimant’s file, that she was married to claimant.7 Haynes also did not pay a $68 medical bill claimant incurred for an office visit with Dr. Perry, his then treating physician, as well as a $117 pharmacy bill for claimant’s prescription for depression related to his compensable injury. Moreover, Haynes failed to notify claimant, claimant’s counsel of record, or Davis of her intent to “delay” payment under the existing award.

As a result of employer’s failure to pay claimant’s 24-hour attendant care expenses and several medical bills for nearly three months, claimant filed a Claim for Benefits and Application for Expedited Hearing on July 30, 2004. Some six weeks later, on September 13, 2004, Haynes resumed 24-hour attendant care payments to Davis, but reduced the payments to the prior rate of $910 per week, rather than the $1,512 per week rate agreed to by claimant’s counsel and the previous adjuster. At the time of the deputy commissioner’s hearing on November, 18, 2004, Haynes testified that the doctor’s office visit and prescription bills still had not been paid, but were still being “processed,” some six months after claimant submitted them to employer for payment.

7 Haynes ceased payments to Davis for her 24-hour attendant care services altogether from May 2004 until September 13, 2004.

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Julio Emilio Posada v. Virginia Polytechnic Institute & State University/Commonwealth of Virginia, (Va. Ct. App. 2005).

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