Special Fund Division v. Industrial Commission

302 P.3d 635, 232 Ariz. 110, 658 Ariz. Adv. Rep. 14, 2013 WL 1701762, 2013 Ariz. App. LEXIS 77
CourtCourt of Appeals of Arizona
DecidedApril 18, 2013
DocketNo. 1 CA-IC 12-0018
StatusPublished
Cited by8 cases

This text of 302 P.3d 635 (Special Fund Division v. Industrial Commission) is published on Counsel Stack Legal Research, covering Court of Appeals of Arizona primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Special Fund Division v. Industrial Commission, 302 P.3d 635, 232 Ariz. 110, 658 Ariz. Adv. Rep. 14, 2013 WL 1701762, 2013 Ariz. App. LEXIS 77 (Ark. Ct. App. 2013).

Opinion

OPINION

GEMMILL, Judge.

¶ 1 This is a special action review of an Industrial Commission of Arizona (“ICA”) award and decision upon review granting reimbursement — often called “apportionment” — under Arizona Revised Statutes (“A.R.S.”) section 23-1065(C)(3)(e) (Supp. 2012), in favor of the Employer and Carrier against Petitioner Special Fund Division. The injured worker, Karen Lane, has a pre-exist-ing congenital condition of her hands known as syndactyly.1 The administrative law judge (“ALJ”) granted apportionment based on Lane’s syndactyly, concluding that the syndactyly qualified under § 23 — 1065(C)(3)(e) as an “[ajmputated ... hand.” Because we conclude as a matter of law that Lane’s syndactyly is not included within A.R.S. § 23 — 1065(C)(3), we set aside the award of apportionment.

FACTS AND PROCEDURAL HISTORY

¶ 2 Karen Lane worked for the Respondent Employer, HealthSouth, as a licensed practical nurse. In December 2006, she injured her lower back while transferring a patient from a bed to a wheelchair. Lane filed a workers’ compensation claim that was accepted for benefits. After conservative medical treatment failed to improve Lane’s condition, she underwent lumbar surgery. It was determined that Lane had an unscheduled permanent impairment. The ICA subsequently entered its findings and award for a 6% permanent impairment, resulting in an 18.19% loss of earning capacity, and disability benefits of $240.15 per month. Believing she had sustained a greater loss of earning capacity, Lane requested a hearing.

¶ 3 Before the ALJ, both parties filed labor market expert reports and presented expert testimony. The ALJ entered an award increasing Lane’s monthly benefit to $618.40. The issue of apportionment was deferred to a [112]*112future hearing. The Employer and Carrier then moved to join the Petitioner, Special Fund, in order to seek reimbursement from the Special Fund under AR.S. § 23-1065(C).

¶ 4 At the apportionment hearing, the ALJ received medical testimony from Marjorie Eskay-Auerbach, M.D., J.D., and Peter Campbell, M.D. Dr. Eskay-Auerbach, a board certified orthopedic surgeon, testified that she performed a medical examination of Lane in December 2010. The doctor described Lane’s condition as having a “hand with the middle finger and thumb missing, and the index finger is sort of moved over closer to where the thumb” is normally located. She recognized Lane’s condition as preexisting syndactyly and explained that she used the American Medical Association Guides to the Evaluation of Permanent Impairment (“AMA Guides”) to rate this preexisting impairment, relying on Table 15-28, “Impairment for Upper Limb Amputation at Various Levels.” See AMA Guides 457 (6th ed. 2009).

¶ 5 Dr. Eskay-Auerbach based her impairment rating on two fingers missing from each hand, including the absence of two metacarpal bones per hand. The doctor opined that Lane has a 23% whole person impairment based on four missing fingers and the associated metacarpal bones. She testified that the AMA Guides typically do not differentiate between a congenital condition and a traumatic injury, but instead, measure objective anatomic findings. She also recognized that the AMA Guides provide an impairment rating for the amputation of an entire hand, but in her opinion, that provision was not applicable to Lane.

¶ 6 Dr. Campbell, a board certified orthopedic surgeon qualified in hand and upper extremity reconstruction, testified that he also examined Lane in order to evaluate her potential permanent impairment rating due to her syndactyly. Dr. Campbell opined that being born with a congenital cleft hand or foot did not constitute an amputation. Further, he disagreed with Dr. Eskay-Auer-bach’s rating determination because she utilized the section of the AMA Guides applicable to the traumatic amputation of digits. He explained that the ratings under that section of the AMA Guides include all of the additional ramifications of a traumatic amputation, i.e., “loss of function in adjacent digits, loss of activity available before injury, loss of strength, etc.”

¶ 7 At the conclusion of the hearing, the ALJ entered an award granting apportionment. The ALJ resolved the conflicts in the medical evidence in favor of the testimony of Dr. Eskay-Auerbach, who had likened Lane’s syndactyly “to an amputation of two digits on each hand.”

¶8 The Special Fund requested review, and the ALJ supplemented and affirmed the award on administrative review. The Special Fund timely appeals to this court, and we have jurisdiction under A.R.S. §§ 12-120.21(A)(2) (2003), 23-951(A) (2012), and Arizona Rule of Procedure for Special Actions 10.

ANALYSIS

¶9 The issue raised on appeal is whether the ALJ erred by awarding apportionment. No question is presented regarding the amount and duration of compensation benefits payable to Lane. Rather, the issue is whether the Employer and Carrier must pay the entire claim or whether Special Fund must reimburse part of the cost of the claim, in accordance with A.R.S. § 23-1065(C).

¶ 10 We deferentially review reasonably supported factual findings, but independently review legal conclusions. Young v. Indus. Comm’n, 204 Ariz. 267, 270, ¶ 14, 63 P.3d 298, 301 (App.2003). On questions regarding statutory interpretation, our review is de novo. Universal Roofers v. Indus. Comm’n, 187 Ariz. 620, 622, 931 P.2d 1130, 1132 (App.1996). In this case, whether the Employer and Carrier are “entitled to reimbursement under AR.S. 23-1065(C) is an issue of statutory interpretation that we review de novo.” Special Fund Div. v. Indus. Comm’n (Sordia), 224 Ariz. 29, 31, ¶ 7, 226 P.3d 398, 400 (App.2010).

¶ 11 In order to obtain apportionment, the employer or carrier is required to meet certain conditions specified in A.R.S. § 23-1065, including the establishment of a qualified preexisting impairment. An award of appor[113]*113tionment in this case requires that Lane’s preexisting syndactyly qualify under A.R.S. § 23-1065(C)(3)(e):

C. In claims involving an employee who has a preexisting physical impairment which is not industrially-related and, whether congenital or due to injury or disease, is of such seriousness as to constitute a hindrance or obstacle to employment or to obtaining reemployment if the employee becomes unemployed, and the impairment equals or exceeds a ten per cent permanent impairment evaluated in accordance with the American medical association guides to the evaluation of permanent impairment, and the employee thereafter suffers an additional permanent impairment not of the type specified in § 23-1044, subsection B,

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302 P.3d 635, 232 Ariz. 110, 658 Ariz. Adv. Rep. 14, 2013 WL 1701762, 2013 Ariz. App. LEXIS 77, Counsel Stack Legal Research, https://law.counselstack.com/opinion/special-fund-division-v-industrial-commission-arizctapp-2013.