State ex rel. Almendinger v. Indus. Comm.

2013 Ohio 5103
CourtOhio Court of Appeals
DecidedNovember 19, 2013
Docket12AP-601
StatusPublished
Cited by1 cases

This text of 2013 Ohio 5103 (State ex rel. Almendinger v. Indus. Comm.) is published on Counsel Stack Legal Research, covering Ohio Court of Appeals primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
State ex rel. Almendinger v. Indus. Comm., 2013 Ohio 5103 (Ohio Ct. App. 2013).

Opinion

[Cite as State ex rel. Almendinger v. Indus. Comm., 2013-Ohio-5103.]

IN THE COURT OF APPEALS OF OHIO

TENTH APPELLATE DISTRICT

State of Ohio, ex rel. : Joel Almendinger, : Relator, : No. 12AP-601 v. : (REGULAR CALENDAR) Industrial Commission of Ohio and McGraw Construction Co., :

Respondents. :

D E C I S I O N

Rendered on November 19, 2013

Crowley, Ahlers & Roth Co., L.P.A., and Edward C. Ahlers, for relator.

Michael DeWine, Attorney General, and Cheryl J. Nester, for respondent.

IN MANDAMUS ON OBJECTION TO THE MAGISTRATE'S DECISION CONNOR, J. {¶ 1} Relator, Joel Almendinger, brings this original action seeking a writ of mandamus ordering respondent, Industrial Commission of Ohio ("commission"), to vacate its order denying relator's physician's request for medical services, and to enter an order granting the request. {¶ 2} Pursuant to Civ.R. 53 and Loc.R. 13(M) of the Tenth District Court of Appeals, this matter was referred to a magistrate, who has now rendered a decision and recommendation that includes findings of fact and conclusions of law, which is No. 12AP-601 2

appended to this decision. The magistrate concluded that the commission abused its discretion in denying the request for medical services, and recommended that this court issue the requested writ of mandamus. {¶ 3} The commission has filed the following objection to the magistrate's decision: The magistrate erred in substituting his judgment for that of the Industrial Commission in its factual interpretation of the report of Dr. Elwert.

{¶ 4} As reflected in the facts given in the magistrate's decision, relator suffered an industrial injury in 1983. His industrial claim was allowed for sprain lumbar region; herniated disc L5-S1. Relator received care over the years from several chiropractors. Relator began receiving chiropractic care from Rob Cartwright, D.C. in May 2011. Dr. Cartwright filed an Ohio Bureau of Workers' Compensation ("bureau") C-9 on February 1, 2012, requesting authorization for medical services. Specifically, the C-9 requested authorization for chiropractic manipulation and therapy, to include electrical stimulation and mechanical traction, once per month for a six-month period. The bureau requested that Jeffrey C. Elwert, D.C. conduct a medical review of relator. {¶ 5} Dr. Elwert issued his report on February 21, 2012. Dr. Elwert reviewed relator's medical history, and concluded that the medical services requested were not reasonably related to the industrial injury, were not reasonably necessary for the treatment of the industrial injury, and that the costs for the requested services were not medically reasonable. Regarding the form C-9 filed by Dr. Cartwright, Dr. Elwert noted that Dr. Cartwright "fail[ed] to identify sympomatology as specifically related to the claim allowance of a herniated disc" and "fail[ed] to support that subjective complaints and objective findings are consistent with claim allowances." (Stipulated Record, 9.) Dr. Elwert further found that relator's visits with Dr. Cartwright were "on a fairly consistent monthly increment indicating regularly scheduled appointments on a supportive care/maintenance basis." (Stipulated Record, 9.) Dr. Elwert noted that, pursuant to the Official Disability Guidelines regarding chiropractic care, "many passive and palliative interventions can provide relief in the short term but may risk treatment dependence without meaningful long-term change." (Stipulated Record, 9.) As relator No. 12AP-601 3

had received treatment at the "same/similar frequency" for quite some time, Dr. Elwert determined that the "continuation of care as requested would not be deemed appropriate." (Stipulated Record, 9.) {¶ 6} Following an April 18, 2012 hearing, a district hearing officer ("DHO") issued an order denying the C-9 request. The DHO determined that relator failed to carry his burden of proof, and determined that realtor had "not presented sufficient persuasive medical evidence from the [his] treating physician, Dr. Cartwright, establishing that the requested treatment" was reasonably related and medically necessary and appropriate for treatment of the allowed conditions. (Stipulated Record, 1.) {¶ 7} Relator filed an affidavit on April 25, 2012 indicating that, though he had conversations with physicians over the years about the possibility of back surgery, he did not want to have surgery. Relator indicated that, in "an effort to avoid surgery" he "relied upon chiropractic care which [he] found to be very helpful." (Stipulated Record, 17.) Relator noted that he did not schedule regular chiropractic visits, as he would simply call his chiropractor on a day when he felt he needed to go in for a visit. {¶ 8} On May 25, 2012, Dr. Cartwright wrote a letter to the bureau, "appealing the medically necessary care" to relator. (Stipulated Record, 13.) Dr. Cartwright identified the relator's allowed conditions, and asserted that the requested care was "directly related" to the conditions allowed in relator's industrial claim. Dr. Cartwright noted that relator's chiropractic visits allowed relator to function and to avoid surgery. Dr. Cartwright stated that relator was "doing better by 75% in pain and function, and 50% better in increased strength." (Stipulated Record, 13.) {¶ 9} Following a June 11, 2012 hearing, a staff hearing officer ("SHO") issued an order affirming the denial of the C-9. The SHO determined that the "requested chiropractic treatment [was] not appropriate or necessary for the treatment of the allowed conditions based upon the report of Dr. Elwert." (Stipulated Record, 3.) {¶ 10} The magistrate determined that the SHO abused its discretion by relying on Dr. Elwert's report to deny the C-9 request. The magistrate concluded that "[w]ith the issuance of Dr. Cartwright's May 25, 2012 report, Dr. Elwert's report is no longer some evidence that can support a finding that the C-9 is deficient because of a failure to No. 12AP-601 4

relate symptomology to the allowed conditions of the claim." (Magistrate's Decision, 8.) The magistrate further noted that, as the SHO's order did not mention Dr. Cartwright's May 25, 2012 report, the SHO's order indicated that the SHO had not considered the May 25, 2012 report. {¶ 11} Pursuant to Civ.R. 53(D)(4)(d), we undertake an independent review of the objected matters "to ascertain that the magistrate has properly determined the factual issues and appropriately applied the law." A relator seeking a writ of mandamus must establish: " '(1) a clear legal right to the relief prayed for, (2) a clear legal duty upon respondent to perform the act requested, and (3) that relator has no plain and adequate remedy in the ordinary course of the law.' " Kinsey v. Bd. of Trustees of the Police and Firemen's Disability and Pension Fund of Ohio, 49 Ohio St.3d 224, 225 (1990), quoting State ex rel. Consolidated Rail Corp. v. Gorman, 70 Ohio St.2d 274, 275 (1982). "A clear legal right exists where the [commission] abuses its discretion by entering an order which is not supported by 'some evidence.' " Id. {¶ 12} The commission is exclusively responsible for evaluating the weight and credibility of the evidence. State ex rel. Burley v. Coil Packaging, Inc., 31 Ohio St.3d 18, 20-21 (1987). Thus, the reviewing court's role is to determine whether there is some evidence in the record to support the commission's decision; a court may not substitute its judgment for that of the commission or second-guess the commission's evaluation of the evidence. State ex rel. Guthrie v. Indus. Comm., 133 Ohio St.3d 244, 2012-Ohio- 4637, ¶ 11. {¶ 13} The commission need only enumerate the evidence it relied upon to reach its decision. State ex rel. Scouler v. Indus.

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2013 Ohio 5103, Counsel Stack Legal Research, https://law.counselstack.com/opinion/state-ex-rel-almendinger-v-indus-comm-ohioctapp-2013.