Twin Resources, LLC v. Workman

394 S.W.3d 417, 2013 WL 646284, 2013 Ky. App. LEXIS 42
CourtCourt of Appeals of Kentucky
DecidedFebruary 22, 2013
DocketNo. 2012-CA-001504-WC
StatusPublished
Cited by1 cases

This text of 394 S.W.3d 417 (Twin Resources, LLC v. Workman) is published on Counsel Stack Legal Research, covering Court of Appeals of Kentucky primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Twin Resources, LLC v. Workman, 394 S.W.3d 417, 2013 WL 646284, 2013 Ky. App. LEXIS 42 (Ky. Ct. App. 2013).

Opinion

OPINION

MOORE, Judge:

The issue presented in this case is whether, under the circumstances, a Chief Administrative Law Judge (CALJ) was authorized to enter an order resolving a post-award medical fee dispute that appellant Twin Resources, LLC, filed against appel-lee Bobby Workman. Finding that the CALJ acted in excess of his statutory and regulatory authority in doing so, the Workers’ Compensation Board vacated the CALJ’s order and remanded. Finding no error, we affirm.

The pertinent facts are largely reflected on the faces of two orders that the CALJ entered in this matter. The first order, dated September 28, 2011, provides:

This matter comes before the undersigned Chief Administrative Law Judge (CALJ) upon the Frankfort Motion Docket for consideration of a motion to reopen and Form 112, medical fee dispute. Therein, the Defendant Employer [Twin] is seeking to reopen Plaintiffs [Workman’s] claim to resolve a dispute regarding the compensability of [Workman’s] medical treatment, specifically treatment rendered or to be rendered by David Weinsweig, M.D. Therefore, being otherwise duly and sufficiently advised, IT IS HEREBY ORDERED as follows:
1.David Weinsweig, M.D. is JOINED as a party to this medical fee dispute in order to have the opportunity to present proof regarding the compensability of the contested medical expenses or proposed procedure.
2. [Twin] has made a prima facie showing for reopening and the motion to reopen is SUSTAINED and the claim is assigned to the CALJ.
3. Proof taking for all parties shall commence as of the date of this notice and shall extend for fifteen (15) days, followed by thirty (30) days for [Workman] and Dr. Weinsweig only, and fifteen (15) days thereafter for rebuttal by [Twin]....
4. If no evidence is filed by Plaintiff or Dr. Weinsweig this matter may be submitted on the record to the CALJ and may result in this dispute being resolved based upon the pleadings and evidence in record.
FAILURE OF THE CLAIMANT OR JOINED PROVIDER TO FILE EVIDENCE IN RESPONSE TO THE PROOF SUBMITTED IN SUPPORT OF THE MEDICAL FEE DISPUTE BY THE END OF THE PROOF DEADLINES MAY RESULT IN A FINDING THAT THE CHALLENGED TREATMENT IS NOT COMPENSABLE.

On December 12, 2011, after no evidence or response was submitted by Workman or Dr. Weinsweig, the CALJ entered his second order. In relevant part, it provides:

This matter comes before the Chief Administrative Law Judge (CALJ) upon the Frankfort Motion Docket for consideration of a motion by [Twin] to contest certain medical expenses pursuant to K.R.S. 342.020. The motion was supported by the report of Richard Mor-tara, M.D., who opined that the contested medical treatment is not reasonable and necessary for the cure and relief from the effects of [Workman’s] work-related injury. An order rendered on [419]*419September 28, 2011 granted [Workman] and the joined medical provider forty-five (45) days to submit evidence and noted that failure to do so may result in a summary resolution of the medical fee dispute. No evidence or any other type of response was filed by [Workman] or the joined medical provider. The CALJ having reviewed the pleadings and being fully and sufficiently advised thereby, IT IS THEREFORE ORDERED as follows:
1. [Twin] has established a prima facie showing to establish the basis for reopening and the motion to reopen is GRANTED.
2. The contested medical expenses are, based on the evidence and pleadings in the record, unreasonable and/or unnecessary for treatment of [Workman’s] work-related condition pursuant to K.R.S. 842.020. Further, said expenses were timely challenged pursuant to Phillip Morris, Inc. v. Poynter, — Ky. -, 786 S.W.2d 124 (1990).
Therefore, IT IS HEREBY ORDERED that the medical fee dispute is RESOLVED in favor of [Twin], [Twin] is relieved from the responsibility of payment of the contested medical expenses and further is relieved from the responsibility of payment of any similar medical expenses for treatment of the same condition by the same medical provider.

Workman filed no petition for reconsideration. He timely appealed to the Workers’ Compensation Board, arguing only that substantial evidence did not support the CALJ’s decision to resolve the medical fee dispute in favor of Twin. Thereafter, the Board raised sua sponte the issue of whether the CALJ had acted in excess of his statutory and regulatory authority in resolving the medical fee dispute. The Board determined that Crawford & Co. v. Wright, 284 S.W.3d 186 (Ky.2009), along with 803 Kentucky Administrative Regulation (KAR) 25:012 § 1(6), prohibited the CALJ from assigning the matter of Twin’s medical fee dispute to his own docket, as he did in this matter, and further prohibited the CALJ from “set[ting] up his own makeshift proof schedule which required Workman and Dr. Weinsweig to submit proof in contravention of that introduced by Twin Resources in its motion to reopen.” As such, the Board held:

[O]nee the CALJ determines the party filing the motion to reopen and the Form 112 has made a prima facie showing in support of its motion to reopen, the CALJ is only authorized to sustain the motion and then assign the matter to an ALJ for further proof time and an adjudication of the merits. Crawford & Co. v. Wright, supra, at 141. The CALJ is to do no more.

Consequently, the Board vacated numerical paragraphs three and four of the CALJ’s September 28, 2011 order and remanded to the CALJ for “entry of an order on Twin Resources’ motion to reopen and Form 112 consistent with the view expressed in [the Board’s] opinion.”

On appeal, Twin offers essentially three arguments. First, Twin contends that because the issue of the CALJ’s statutory and regulatory authority was never raised by Workman, the Board exceeded the scope of its review and therefore erred when it vacated the CALJ’s order on that basis. Second, Twin argues that the CALJ had the authority to summarily resolve the medical fee dispute in its favor. Third, Twin argues that it submitted substantial evidence in support of its medical fee dispute and, because Workman failed to introduce any evidence to the contrary within the time limits set by the CALJ, there was nothing improper about the CALJ’s decision.

[420]*420Twin’s first argument is without merit. Although the Board may not substitute its judgment for that of the ALJ as to questions of fact or weight of the evidence, Kentucky Revised Statute (KRS) 342.285 provides that the Board may determine whether the ALJ “acted without or in excess of his powers”1 and whether “[t]he order, decision, or award is not in conformity to the provisions of [KRS Chapter 342 et seq.]”2 Our Supreme Court has instructed that it is the Board’s province on appeal to ensure that orders and awards of an ALJ are in conformity with Chapter 342, and thus, that determinations of whether an ALJ’s award or order is in conformity with Chapter 342 is a question of law. Whittaker v. Reeder, 30 S.W.3d 138, 145 (Ky.2000).

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Cite This Page — Counsel Stack

Bluebook (online)
394 S.W.3d 417, 2013 WL 646284, 2013 Ky. App. LEXIS 42, Counsel Stack Legal Research, https://law.counselstack.com/opinion/twin-resources-llc-v-workman-kyctapp-2013.