State ex rel. Eberhardt v. Flxible Corp.
Decision Date | 09 November 1994 |
Docket Number | No. 93-705,93-705 |
Citation | 640 N.E.2d 815,70 Ohio St.3d 649 |
Parties | The STATE ex rel. EBERHARDT, Appellee, v. FLXIBLE CORPORATION et al., Appellants. |
Court | Ohio Supreme Court |
SYLLABUS BY THE COURT
1. Where an attending physician certifies a claimant as temporarily and totally disabled but indicates that there is little hope for improvement in claimant's condition unless treated through rehabilitation, and there is no other medical evidence indicating that claimant has reached the maximum medical improvement, it is an abuse of discretion for the Industrial Commission to deny temporary total disability benefits on the basis that claimant has reached the maximum medical improvement.
2. Where a physician renders an ambiguous opinion regarding a claimant's medical condition but thereafter clarifies the ambiguity, the Industrial Commission may not revive the ambiguity as a basis for rejecting the physician's opinion.
Appellee-claimant, Carl R. Eberhardt, was injured on January 23, 1989 while in the course of and arising out of his employment with appellant, Flxible Corporation ("Flxible"), a self-insured employer. Appellant Industrial Commission of Ohio ("commission") allowed the claim for "aggravation of pre- existing low back sprain," and ordered Flxible to pay temporary total disability ("TTD") compensation. Claimant received TTD compensation for intermittent periods until he returned to his former job on August 20, 1989.
On November 2, 1990, claimant filed an application to reactivate his claim (form "C-85-A") and requested TTD benefits from October 16, 1990. On the second part of the form, claimant's attending physician, Stephen A. Yoder, certified claimant as temporarily and totally disabled from October 16, 1990 through November 18, 1990. In a physician's supplemental report (form "C-84") completed with the C-85-A, Dr. Yoder stated that "I suggested pain management program and W.C. [workers' compensation] rehab[ilitation] * * *." In subsequent C-84s, Dr. Yoder certified claimant as temporarily and totally disabled to an estimated date of May 1, 1991. Each C-84 contained statements on the need for a rehabilitation program.
Claimant requested, but was denied, the services of the Ohio Bureau of Workers' Compensation Rehabilitation Division, which, by letter dated December 13, 1990, informed claimant that his file was closed on the basis that he did "not meet the eligibility requirements for Rehabilitation Division services as you are not currently receiving temporary total disability."
On February 7, 1991, claimant's C-85-A application was heard by a District Hearing Officer ("DHO") who granted TTD compensation "from 10-16-90 through 4-30-91 and to continue upon submission of medical evidence." Flxible appealed and the matter was set for a hearing on August 6, 1991 before the Toledo Regional Board of Review ("TRB").
Dr. Yoder continued to file C-84s certifying claimant's TTD through September 16, 1991, and stating his recommendation for "a rehab program, but [I] understand this is being contested thru W.C." Also filed prior to the TRB hearing were Dr. Yoder's office notes containing entries from February 22, 1989 to May 10, 1991, and a report dated June 6, 1991, addressed to Flxible's representative. The report stated, in pertinent part, that:
The TRB modified the DHO's order of February 7, 1991, finding that
Claimant appealed the TRB order and the matter was set for hearing before the Staff Hearing Officers ("SHOs") on February 26, 1992. Prior to the hearing, claimant's file with the Rehabilitation Division had been reopened. Also, a report dated August 27, 1991 from Dr. Yoder addressed to claimant's lawyer was filed at the hearing. The report read:
(Emphasis added.)
The SHO order, however, denied the claimant's appeal and affirmed the finding and order of the TRB. The order stated that
On April 14, 1992, claimant filed a complaint in mandamus in the Court of Appeals for Franklin County alleging an abuse of discretion by the commission in denying compensation. While that action was pending, claimant was informed by letter dated June 4, 1992, from the Rehabilitation Division, that he had "successfully completed rehabilitation services and a thirty (30) day monitor period and continue[s] to work at [his] original job with [his] original employer."
The court of appeals, in a split decision, issued a writ granting TTD compensation subsequent to August 6, 1991, finding as follows:
The dissenting judge referred to Dr. Yoder's office note dated June 28, 1989, which stated that claimant "has reached maximum potential that I can get him to and have recommended rehab program." The judge concluded:
The cause is now before this court upon appeals as of right.
Colasurd & Colasurd and Michael D. Colasurd, Columbus, for appellee.
Vorys, Sater, Seymour & Pease, Bradley K. Sinnott and William C. Heer III, Columbus, for appellant Flxible Corp.
Lee I. Fisher, Atty. Gen., and William J. McDonald, Asst. Atty. Gen., for appellant Indus. Com'n.
Stewart Jaffy & Associates Co., L.P.A., Stewart R. Jaffy and Marc J. Jaffy, Columbus, urging affirmance for amici curiae, Ohio AFL-CIO, United Auto Workers and Ohio Academy of Trial Lawyers.
This court employs the "some evidence" rule in determining the propriety of mandamus actions which challenge the commission's factual findings. Where the record contains some evidence to support the commission's factual conclusions, its decision will stand. Conversely, where the record contains no evidence to support the commission's order, an abuse of discretion will be found. See State ex rel. Hughes v. Goodyear Tire & Rubber Co. (1986), 26 Ohio St.3d 71, 73, 26 OBR 61, 63, 498 N.E.2d 459, 461; State ex rel. Kokocinski v. Indus. Comm. (1984), 11 Ohio St.3d 186, 188, 11 OBR 499, 500-501, 464 N.E.2d 564, 566.
The final SHO order in the case sub judice found that Dr. Yoder's "[office] notes plus his reports, taken in totality, show the claimant has reached maximum medical improvement." Indeed, the only evidence cited by the commission was generated by Dr. Yoder. The broad issue, therefore, is whether Dr. Yoder's office notes and reports, taken in totality, constitute "some evidence" that claimant has reached the maximum medical improvement.
In light of the parties' arguments, and in light of the opinions rendered in the court of appeals, it is necessary to bifurcate the issue. We must first determine whether Dr. Yoder's August 27, 1991 report is susceptible of differing interpretations regarding the permanence of claimant's medical condition. If it is, the matter ends there, and the commission acted within its discretion. If it is not, we must then determine whether Dr. Yoder's June 6, 1991 report plus his office notes afford the commission some basis upon which to reject the doctor's August 27 report.
R.C. 4123.56(A) provides that TTD payments "shall not be made for the period * * * when the employee has reached the maximum medical improvement." Maximum medical improvement is equatable with the concept of permanence. State ex rel. Youghiogheny & Ohio Coal Co. v. Kohler (1990), 55 Ohio St.3d 109, 110, 564 N.E.2d 76, 78. It ...
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