Bill Hodges Truck Co. v. Gillum
| Decision Date | 31 May 1989 |
| Docket Number | No. 66830,66830 |
| Citation | 1989 OK 86,774 P.2d 1063 |
| Parties | BILL HODGES TRUCK COMPANY, Own Risk, Petitioner, v. Wilton Ray GILLUM and The Workers' Compensation Court of the State of Oklahoma, Respondents. |
| Court | Oklahoma Supreme Court |
Chris Sturm, Oklahoma City, for petitioner.
William O. West, Messrs. West and Synar, Edmond, for respondents.
The issues presented for review are: 1) May proof of a changed condition be effectively dispensed with by an employer's in-court stipulation never sought to be withdrawn with leave of the trial tribunal? and 2) Did the worker meet his burden to establish that the heart transplant he seeks should be approved as a "reasonable and necessary" expense incident to recovery from a compensable accidental injury? We answer the first question in the affirmative and the second in the negative.
On August 20, 1982 and May 22, 1983 Wilton Ray Gillum [worker] sustained job-related accidental injuries to his heart from myocardial infarctions, for which he claimed compensation. An agreed award of October 20, 1983 (amended nunc pro tunc on November 23, 1983) allowed him both temporary total and permanent total disability. The order included the standard clause requiring the employer to pay "all reasonable and necessary medical expenses incurred by claimant as a result of said injury". This award became final when neither party challenged it by a plea for corrective relief.
The worker's Form 9, filed in February 1986 and followed by two amendments in March 1986, seeks additional temporary disability and approval of a heart transplant with incidental medical care. The latter request was heard on April 8, 1986. 1 During the hearing the parties stipulated the only issue to be submitted for the court's decision was whether a heart transplant constitutes a "reasonable and necessary" expense of an accidental injury to be borne by the employer. 2 The trial judge's May 1, 1986 order provides that a heart transplant procedure falls within the category of reasonable and necessary medical expenses previously ordered on October 20, 1983. 3 It is this order, later affirmed by a three-judge appellate panel, that is now on review.
Below the employer resisted the quest for organ substitution by contending that a heart transplant is not a reasonable and necessary medical expense within the purview of health services mandated by 85 O.S.1981 § 14. 4 On review the employer appears to retreat from, if not abandon, this defensive theory. It asserts instead that (1) the compensation court "lacked jurisdiction" to enter the award because the worker had failed to press a § 28 5 reopening claim by proper motion and to prove a change in his physical condition arising since the last prior order and (2) a heart transplant is an organ substitution procedure that is not comprised within the terms of the last prior (October 20) order requiring the employer to pay all "reasonable and necessary medical expenses incurred."
The worker asserts that the expenses of transplant procedure were correctly found, in the order on review, to have been included within the sweep of health services directed to be furnished by the terms of the October 20 award, inasmuch as that order was treated below by the parties as one which authorized continuing postaward medical treatment. We reject this argument as unfounded and unsound.
A permanent disability award constitutes a solemn adjudication that the worker's healing period has come to an end and his condition or state of health has reached the very optimum that is then medically attainable. 6 The law assumes that a condition of health, once adjudged to be permanent, is stationary. Stationary conditions generally require no medical care or maintenance. The moment permanent disability begins, the right to receive medical treatment ceases by operation of law except, of course, for certain limited, tightly structured and explicitly authorized situations. 7 Permanent disability, partial or total, is presumed to continue until recurrence of temporary disability is established. 8 In contrast, temporary disability, once shown, is not presumed to extend for any length of time; its duration must be proved from the beginning to its very end. 9 Once adjudged to have permanent disability, a worker is entitled to medical attention only upon establishing recurrence of the postaward healing period in a reopening proceeding under 85 O.S.1981 § 28. 10
The October 20 award for permanent disability cannot serve as authority for medical treatment beyond its date. The worker's postaward quest for additional medical care--now on review--is in law but a § 28 reopening claim, which must be based on a changed condition that necessitates heart transplant surgery. In that proceeding the worker was required to establish an after-occurring (postaward) need for the requested medical procedure. The § 28 reopening relief cannot be employed to correct either mistakes or deficiencies in a prior award or order. 11
The claimant's postaward request for organ substitution surgery may not be treated as but a definitional clarification of the October 20 award, insofar as the latter authorizes medical services. This case differs from Orrick Stone Company v. Jeffries, 12 where a postaward proceeding for determination of services that were due was sanctioned. We do not deal here with a stationary paraplegic or quadriplegic patient found to require day-to-day, long-term maintenance care.
The Orrick Stone category of health or nursing service claims affordable under § 14 embraces day-to-day maintenance care. These services do not call for an alteration or improvement of a worker's physical condition. Recurrence of temporary disability is not required for an order directing the employer's provision of day-to-day maintenance care. The law authorizes that type of health services without a need for showing a postaward change of conditions. Because this postaward claim cannot be regarded as one for day-to-day maintenance care but is rather to be treated as one for an invasive surgical procedure designed to produce an anatomical change, it must meet the same standards of proof as those which are applicable to a § 28 reopening proceeding for additional medical services on recurrence of an injured worker's healing period. 13
ABSENCE OF EVIDENCE TO SHOW A CHANGED CONDITION IS AT BEST A
The Workers' Compensation Court has exclusive original jurisdiction over all proceedings for compensation which is legally due for an on-the-job injury. 14 This statutory cognizance includes all conceivable § 28 proceedings. 15 The trial tribunal's power to reopen a claim over which it already has acquired jurisdiction cannot be drawn into question. 16
The § 28 requirement that a reopening claim be predicated on a worker's subsequently changed condition is not to be viewed as a jurisdictional barrier in the sense that the necessary elements of proof cannot be supplied by agreement or be waived by the parties; rather, it should be regarded as an essential or indispensable evidentiary component--a sine qua non of the required proof. A stipulation by the parties that is intended to dispense with proof of that indispensable element in a reopening claim does not extend beyond the tribunal's jurisdiction. It is hence fully effective. 17 An award of the Workers' Compensation Court in a § 28 proceeding in which there was no proof of a changed condition is not fraught with jurisdictional infirmity. It is simply erroneous for want of essential proof and subject to vacation on direct review. 18 To the extent that our past decisions may have inadvertently referred to proof of a changed condition in a § 28 proceeding as "a jurisdictional prerequisite," their language is hereby withdrawn and disapproved. 19 Failure of critical proof to support a cognizable claim does not affect the tribunal's jurisdiction over the proceeding before it.
Because we find the worker's quest for organ substitution should be viewed as one to reopen the original claim and hence within the compensation court's cognizance, we must next decide whether there was a failure of proof to show a changed condition or whether the employer's in-court stipulation was sufficiently broad to dispense with this probative requirement.
THE EMPLOYER'S IN-COURT STIPULATION IS SUFFICIENT TO
While employer's counsel agreed at the hearing that the "nature of the [reopening] claim is for additional medical [services]," he challenged the sufficiency of the expert evidence to bring the heart transplant claim within the purview of the compensation law. 20
Stipulations made in open court are solemn admissions of fact. They are binding and conclusive on the parties as well as on the court. 21 Withdrawal of a stipulation without the consent of the opposing party may be allowed only by leave of court upon a showing of good cause. 22 A stipulation of fact between an employer and employee must conform to the Workers' Compensation Act, as well as to the rules of the tribunal, and must be approved by the judge as binding on the parties. 23 Neither the trial judge nor the three-judge panel...
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