Lewis v. South Dakota State Department of Transportation

2003 SD 82, 667 N.W.2d 283, 2003 S.D. LEXIS 109
CourtSouth Dakota Supreme Court
DecidedJuly 16, 2003
DocketNone
StatusPublished
Cited by3 cases

This text of 2003 SD 82 (Lewis v. South Dakota State Department of Transportation) is published on Counsel Stack Legal Research, covering South Dakota Supreme Court primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Lewis v. South Dakota State Department of Transportation, 2003 SD 82, 667 N.W.2d 283, 2003 S.D. LEXIS 109 (S.D. 2003).

Opinion

KERN, Circuit Judge.

[¶ 1.] South Dakota Department of Transportation (DOT) and South Dakota Bureau of Personnel (BOP) (collectively referred to as Employer) appeal a decision of the circuit court affirming the Department of Labor’s (DOL) award of attorney fees to Kyle Lewis as a consequence of DOT’s refusal to compensate him for medical costs incurred after <an injury.

[¶ 2.] Employer also challenges the circuit court’s award of attorney fees to Lewis for the appeal to circuit court. We affirm.

BACKGROUND

[¶ 3.] Lewis is a senior highway maintenance worker for DOT. On July 31, 1998 he was operating a road sweeping device attached to his truck. The device was operated by means of a metal remote control box which was located inside the truck’s cab and connected to the sweeper by a power cord that extended through the window. As Lewis and his co-worker drove along, something caught the cord from outside the truck and yanked the metal box out of the window, striking Lewis in the face. He suffered a two-inch laceration on his chin which partly penetrated through to his mouth and required eighteen stitches to repair. The blow also damaged veneers on his four front teeth *286 which covered dark stains that had resulted from medications he took during childhood. One of his teeth was knocked from his jaw, embedded in the back of his mouth and had to be reattached.

[¶ 4.] Lewis was referred to a dentist, Dr. Loftus, who recommended replacement of all four veneers. Dr. Loftus testified by deposition that the chips on all the veneers were immediately noticeable to him when he viewed Lewis’ face. He also opined that the chips could allow food to enter the area between the remaining veneer and the teeth and promote tooth decay and deterioration. By letter dated November 10, 1998, Dr. Loftus contacted Lynn Job, BOP administrator, to inquire about the compensability for replacement of the veneers. As administrator, it was Job’s responsibility to serve as adjuster for Lewis’ claim.

[¶ 5.] Job did not seek any additional information from Dr. Loftus initially. Instead, on December 7, 1998, she e-mailed James Marsh, Director of the Division of Labor and Management for DOL, the supervisor of DOL’s hearing examiners. The following exchange occurred:

Question from Job: I have a situation where an employee was hit in the mouth and required root canal treatment on two teeth. We paid for the root canal treatment however, prior to the accident he had veneers put on his teeth. I have been informed that veneers are used mainly for cosmetic purposes. He claims that two veneers not on the teeth requiring the root canal treatment were chipped by this accident.
Because they were cosmetic, are they considered a necessary medical expense under work comp?? Are we required to pay to replace the chipped veneers?
Answer from Marsh: Hmm. I guess it depends on whether a veneer can be considered a “medical supply,” or a “denture,” or if the absence of the veneer can be considered “disfiguring” so that it must be replaced for the employee to look to the world like he did before he got smacked.... My guess, anyway, is that he only gets the veneer replaced if you can see the chips when he smiles. Seriously.

[¶ 6.] Following this exchange, Job contacted Dr. Loftus by phone. She testified that he answered “no” when asked whether the chips on the two “outside” teeth, referred to as #7 and # 10, would be visible when Lewis smiled. At his deposition, Dr. Loftus could not recall having said that the chips would not be visible.

[¶ 7.] Job denied the claim for the veneer replacement. In her December 10, 1998 letter to Lewis communicating the denial, she indicated that the veneers were cosmetic and they were not injured. At the administrative hearing, she indicated that she based this decision on Marsh’s email and her understanding that the veneers would not be visible when Lewis smiled. Job sought no further medical opinions before issuing the denial. Additionally, she did not conduct further investigation into the visibility of the chips.

[¶ 8.] Dr. Ruth McLaughlin, who first treated Lewis’ lacerations, referred him to Dr. Richard Carver, a plastic surgeon. Her letter of referral indicated that:

his residual healing leaves him with some swelling on his face above the laceration and some thickening of particularly the distal part of his laceration. I think there is probably some lymphatic obstruction from the injury giving him some puffiness. In my opinion, it would be reasonable to have this secondarily repaired.

On February 4, 1999, Dr. Carver sent a letter to BOP regarding Lewis. That letter stated: “[T]he scar is still visible, due *287 to the underlying muscle is bulging, making the scar more visible. I would strongly recommend this scar revision and defat-ting of the scar to the underlying tissue and muscle.”

[¶ 9.] Job received and read Dr. Carver’s letter on February 8,1999. The next day she e-mailed Marsh again and the following exchange occurred:

Question from Job: What is our responsibility relating to plastic surgery? We had someone get stitches on his face which left a scar? Is plastic surgery to remove a scar considered a necessary medical expense?
Answer from Marsh: Holy cow, you’re full of questions today! Our rule has been that the surgery is necessary if there is some connection with one’s ability to earn money. Model, slam dunk. Salesman, strong argument. Dock worker, get real.

The following day she denied Lewis’ request for compensation. She made no attempt to investigate further, obtain an independent medical examination, or view photos of the scar. Her denial was solely based on the e-mail from Marsh.

[¶ 10.] On March 8, 1999 Lewis petitioned DOL for compensation for damage to his teeth and surgery to repair the facial scar and also made a claim for permanent disfigurement pursuant to SDCL 62-4-6(24). He requested attorney fees based on allegations that the denial on the part of employer’s administrator was without medical foundation, unreasonable, vexatious and without any support in law, and in “bad faith,” pursuant to SDCL 58-12-3. On June 1, 2000, after a full hearing on the merits, the Administrative Law Judge (ALJ) found the claims to be compensable. The ALJ maintained jurisdiction over the issue of whether any permanent partial disability benefits might be owed to Lewis for disfigurement following the scar revision surgery.

[¶ 11.] Lewis submitted an affidavit for attorney fees on October 6, 2000. Employer moved for summary judgment on the issue of attorney fees, contending that they were not justified by the facts, that the State was immune from suit for attorney fees, and that the request for fees was untimely. By order dated January 16, 2001, the ALJ denied summary judgment.

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Bluebook (online)
2003 SD 82, 667 N.W.2d 283, 2003 S.D. LEXIS 109, Counsel Stack Legal Research, https://law.counselstack.com/opinion/lewis-v-south-dakota-state-department-of-transportation-sd-2003.