Quaile v. National Tire and Battery

CourtSuperior Court of Delaware
DecidedJuly 7, 2022
DocketN21A-12-003 JRJ
StatusPublished

This text of Quaile v. National Tire and Battery (Quaile v. National Tire and Battery) is published on Counsel Stack Legal Research, covering Superior Court of Delaware primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Quaile v. National Tire and Battery, (Del. Ct. App. 2022).

Opinion

IN THE SUPERIOR COURT OF THE STATE OF DELAWARE RICHARD QUAILE,

Claimant-Below/Appellant,

V. C.A. No. N21A-12-003 JRJ

NATIONAL TIRE AND BATTERY,

Employee-Below/Appellee.

Submitted: April 28, 2022 Decided: July 7, 2022

MEMORANDUM OPINION

Upon Claimant's Appeal from Decision on Remand of the Industrial Accident Board — REVERSED

Adam F. Wasserman, Esquire, of CICONTE WASSERMAN & SCERBA, LLC, 1300 North King Street, Wilmington, Delaware 19801, Attorney for Claimant- Below/Appellant.

Keri L. Morris-Johnston, Esquire, of MARSHALL DENNEHEY WARNER COLEMAN & GOGGIN, 1007 North Orange Street, Suite 600, P.O. Box 8888, Wilmington, Delaware 19899, Attorney for Employer-Below/Appellee.

Jurden, P.J. This is an appeal from a decision of the Industrial Accident Board denying Claimant’s petition for additional compensation for medical expenses incurred following a work injury. After considering the parties’ briefs, the relevant evidence in the record and the Board’s findings of fact and conclusions of law, the Court concludes the Board’s decision must be REVERSED.

L FACTUAL & PROCEDURAL BACKGROUND

On August 31, 2015, Richard Quaile (“Claimant”) sustained work-related injuries after falling from a ladder (the “2015 work accident”).! TBC Corporation, a/k/a National Tire and Battery (“Employer”) denied those injury claims on September 30, 2015 and terminated Claimant’s employment.” On October 20, 2015, Claimant filed a Petition to Determine Compensation Due (the “First Petition”), which sought acknowledgment of the injuries he sustained to his right foot and ankle, right leg and lumbar spine.2 After communicating with Claimant’s counsel, Employer agreed to acknowledge Claimant’s right foot and ankle injuries, and the

two parties entered into an open Agreement for the payment of temporary total

' Video evidence of Claimant’s fall, which occurred during work hours, is documented. Claimant- Below/Appellant’s Op. Br. on Appeal (hereinafter “Cl.’s Appeal’) at 1, n.1. Claimant fell off a ladder and, according to Claimant, suffered immediate injuries to his right foot, right knee and lumbar spine. Cl.’s Appeal. at 1.

? Id.; The Industrial Accident Board of the State of Delaware’s Decision on Remand (hereinafter “Bd.’s Dec.”) at 2. Claimant’s termination caused him to lose the private health insurance coverage he received through Employer. Bd.’s Dec. at 2.

> Cl.’s Appeal at 1.

2 disability on January 29, 2016.4 However, Employer refused to compensate Claimant pursuant to the other injury claims involving Claimant’s right knee and lumbar spine; Claimant subsequently withdrew his First Petition.°

After Claimant’s employment had been terminated, he used his spouse’s private health insurance (the “private health insurance”) to pay for the medical expenses he incurred related to the injuries Employer refused to acknowledge.® Claimant underwent multiple surgeries in June and October of 2016.’ On July 14, 2016, Employer filed a Termination Petition alleging Claimant was able to work. On August 9, 2016, Claimant filed a Petition to Determine Additional Compensation Due (the “Second Petition”), seeking acknowledgement of the injuries and surgeries related to his right knee and lumbar spine.’ The Second Petition and the Termination Petition were consolidated, and the Industrial Accident Board (the “Board”’) held a

hearing on March 23, 2017.!°

* Bd.’s Dec. at 2.

> C].’s Appeal at 2; Employer/Appellee’s Answ. Br. on Appeal (hereinafter “Empl.’s Answ.”) at 2; Bd.’s Dec. at 2.

° Those injuries include Claimant’s right knee and lower back. Cl.’s Appeal at 2. Employer, again, acknowledged Claimant’s injured right foot. Jd.

7 Bd.’s Dec. at 2.

8’ Empl.’s Answ. at 3.

? Cl.’s Appeal. at 3.

10 Empl.’s Answ. at 3. Prior to the hearing, the Termination Petition was resolved and Employer issued an open Agreement for temporary partial disability benefits (“TPD”) at $679.63 per week, effective March 21, 2017, which Employer alleges Claimant continues to receive. /d.

3 The Board granted Claimant’s Second Petition on August 15, 2017.'' The Board found that Claimant’s work accident caused “meniscal tears in Claimant’s right knee, and aggravated Claimant’s preexisting lumbar spine condition to include an L3-4 herniated disc and extruded fragment.”!* Employer was ordered to pay the medical expenses related to Claimant’s right knee and his low back injuries. !?

Claimant’s medical complications continued.’ After a lumbar surgery in 2016, Claimant underwent emergency surgery for a rectal prolapse.'> Additionally, Claimant developed a torn meniscus in the left knee resulting from his altered gait, which required surgery as well.’° Employer denied the compensability of these additional “injuries and conditions” relating to Claimant’s 2015 work accident.'’

In August of 2018, the parties attempted mediation to no success.!® On April 4, 2019, Claimant filed another Petition to Determine Additional Compensation Due

(the “Third Petition”) and a Petition for Disfigurement.'? Claimant presented those

two Petitions to the Board on September 27, 2019.”°

'l C].?s Appeal at 3; See Quaile v. TBC Corp., 1.A.B. No. 1432280 (Aug. 15, 2017).

12 Id.

'3 Td. (citing Qualie, 1.A.B. No. 1432280, at *32 (Aug. 15, 2017)).

14 Tq Claimant contends those complications involved catheterization, anesthesia and constipation in connection with Claimant’s 2016 lumbar surgery. Jd.

15 Td.

16 Td.

"7 Cl.’s Appeal at 3.

'8 Td. at 4.

'9 Id Bd.’s Dec. at 4. The Third Petition alleged permanent impairment regarding several body parts and acknowledgement of the left knee injury, erectile dysfunction, rectal injury and all related medical treatment. /d.

20 C].’s Appeal at 4. The Board issued its decision concerning the Third Petition and Petition for Disfigurement on February 7, 2020 (the “February 2020 Decision”).?! The Board found Claimant’s rectal injury and surgery, as well as the left knee injury and surgery were “causally related” to the 2015 work accident.”” The Board ordered Employer to pay Claimant’s compensable medical expenses “according to the fee schedule” set forth in 19 Del. C. §2322B.3

Claimant still was unsatisfied with the Board’s decision and filed a Motion for Reargument on March 2, 2020.** That same day, Claimant sent Employer a

Huffman demand* for payment of all outstanding medical expenses with

*I Cl.’s Appeal at 4. See Quaile v. TBC Corp., 1.A.B. No. 1432280 (Feb. 7, 2020).

22 Bd.’s Dec. at 4.

3 Cl.’s Appeal at 4; Quaile v. TBC Corp., 1.A.B. No. 1432280, at *27, n.13 (Feb. 7, 2020). Claimant filed a motion for reargument, which the Board denied. See Quaile v. TBC Corp., I.A.B. No. 142280 (Apr. 24, 2020). The Workers’ Compensation Oversight Panel established a fee schedule (the “fee schedule”) for all Delaware workers’ compensation funded procedures, treatments and services based on expertise in the field. See 19 Del. C. §2322B(3)(a). A brief history recitation of Delaware’s current health care payment system (“HCPS”) is relevant for Claimant’s appeal. In 2008, the Delaware General Assembly enacted the HCPS to streamline medical payments through a transparent process, “eliminating cost-shifting among health care service categories and avoiding institutionalization of upward rate creep.” 19 Del. C. §2322B(1). The HCPS is codified at 19 Del. C.

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Quaile v. National Tire and Battery, Counsel Stack Legal Research, https://law.counselstack.com/opinion/quaile-v-national-tire-and-battery-delsuperct-2022.