Duren v. Effex Mgmt. Solutions, LLC
| Citation | 342 So.3d 481 |
| Decision Date | 07 June 2022 |
| Docket Number | 2021-WC-00337-COA |
| Parties | J.W. DUREN, Appellant v. EFFEX MANAGEMENT SOLUTIONS, LLC and Great American Alliance Insurance Company, Appellees |
| Court | Court of Appeals of Mississippi |
ATTORNEY FOR APPELLANT: J.W. DUREN (PRO SE)
ATTORNEY FOR APPELLEES: GINGER MOORE ROBEY, Jackson
BEFORE CARLTON, P.J., LAWRENCE AND McCARTY, JJ.
CARLTON, P.J., FOR THE COURT:
¶1. J.W. Duren sustained a back injury while working for Effex Management Solutions LLC (Effex). Duren sought workers' compensation benefits from Effex and its insurance carrier, Great American Alliance Insurance Company (collectively, "the Employer/Carrier"). After a hearing on the matter, the administrative judge (AJ) entered an order denying Duren's claim for permanent partial disability benefits and additional temporary total disability benefits. The AJ found that Duren failed to meet his burden of showing that he sustained a permanent disability or a loss of wage-earning capacity. The AJ also denied Duren's request for the Employer/Carrier to pay for additional medical expenses incurred by Duren after he reached maximum medical improvement (MMI). Duren filed a petition for review, and the Mississippi Workers' Compensation Commission (Commission) affirmed and adopted the AJ's decision.
¶2. Duren now appeals and asserts, among other things, that the Commission's decision is not supported by substantial credible evidence. After our review, we find that the Commission's decision is supported by substantial credible evidence, and we therefore affirm.
¶3. Duren worked as a general laborer for Effex, a temporary staffing agency. Effex placed Duren at Luvata, a manufacturing company. On July 14, 2016, while building an airconditioning coil at Luvata, Duren stepped down from a table, fell down, and injured his back.
¶4. Four days after his injury, Duren went to the Dr. Arenia C. Mallory Community Health Center Inc. (Mallory Health Center) in Lexington, Mississippi, reporting back and leg pain. Duren was seen by Dana Roberts, a nurse practitioner. Roberts eventually referred Duren to Dr. Graham Calvert, an orthopaedic surgeon in Jackson, Mississippi.
¶5. Dr. Calvert first started treating Duren in September 2016. Dr. Calvert ordered an MRI of Duren's lumbar spine, which indicated a disc herniation at L3-L4 and L4-L5. Dr. Calvert recommended that Duren receive steroid injections, and he placed Duren on a light sedentary work restriction, noting that if Duren's employer could not accommodate him, then he should be off work until further notice.
¶6. Duren returned to Dr. Calvert in October 2016. Dr. Calvert's notes from that appointment reflect that Duren reported feeling significant relief after receiving the steroid injections and that his leg pain had significantly improved. Duren reported that he still suffered a little bit of back pain. Dr. Calvert kept Duren limited to modified work duties.
¶7. In December 2016, Duren followed up with Dr. Calvert. At his appointment, Duren reported that the effect of his steroid injections had worn off and that he suffered continuous pain down his left leg. Dr. Calvert compared Duren's updated MRI results to the September 2016 MRI results and observed that the L4-L5 herniation was resolving and "appears improved." However, Dr. Calvert noted that the L3-L4 disc herniation had not significantly changed since September and was now at a "symptomatic" level.
¶8. Based on Duren's updated MRI results, Dr. Calvert performed an L3-L4 microdiscectomy
on Duren in December 2016. At a follow-up appointment on March 10, 2017, Dr. Calvert reported that Duren's pain caused by the L3-L4 disc herniation "has completely gone." Dr. Calvert placed Duren at MMI with a whole-body impairment rating of three percent, and he released him to return to work with no restrictions.
¶9. Duren returned to work on March 14, 2017. After working for a few hours that day, Duren informed his supervisor that he was in pain. Duren's supervisor advised him to go see his doctor. Duren attempted to make an appointment with Dr. Calvert, but he was unsuccessful. Duren instead went to Mallory Health Center, complaining of numbness and tingling in his left leg. Roberts prescribed Duren anti-convulsant and anti-inflammatory medications to help with his pain.
¶10. Duren returned to work the next day, but after working several hours, he advised his supervisor that he was again suffering pain. Duren reportedly did not show up for work on March 16, 2017, and on March 17, 2017, Effex contacted Duren by telephone and terminated his employment.
¶11. The record shows that the Employer/Carrier paid Duren temporary total disability benefits at the rate of $332.37 per week from July 14, 2016, the date of his injury, through March 10, 2017, the date that Dr. Calvert placed Duren at MMI and released him to return to work without restrictions.
¶12. On April 5, 2017, Duren filed a petition to controvert alleging that he suffered a work-related injury to his back, his left-lower extremity, and his body as a whole while working for Effex. On April 14, 2017, the Employer/Carrier admitted that Duren suffered a compensable injury to his back. The parties stipulated that Duren had an average weekly wage of $498.47 at the time of the injury.
¶13. After filing his petition to controvert, Duren returned to the Mallory Health Center complaining of low-back pain and left-lower extremity numbness and tingling. Roberts prescribed Duren pain medication and referred him to a pain management specialist. Roberts also recommended that Duren receive an MRI of his cervical, thoracic, and lumbar spine.
¶14. Duren filed a motion to compel medical treatment, requesting that the AJ compel the Employer/Carrier to approve and pay for his pain management treatment and medications prescribed by Roberts. Duren claimed that Roberts referred Duren to pain management for his continued back pain and numbness and tingling in his leg but that the Employer/Carrier denied authorization for the pain management referral. The record reflects an e-mail from the Employer/Carrier's counsel denying authorization of the referral for pain management. In the e-mail, counsel explained that Dr. Calvert is Duren's treating physician, and the pain management referral was from a nurse practitioner at Mallory Health Clinic and not from Dr. Calvert. Counsel stated that as far as she knew, "Dr. Calvert has not indicated that pain management is medically necessary."
¶15. In July 2017, the AJ determined that an independent evaluation would be helpful, and he ordered Dr. Philip Blount, a physical medicine and rehabilitation physician, to perform an independent medical examination (IME) of Duren. Dr. Blount evaluated Duren and issued his IME report. Dr. Blount agreed that Duren's disc herniations at L3-L4 and L4-L5 were related to his fall at work in July 2016. Dr. Blount disagreed with Dr. Calvert's three-percent whole-body impairment rating, explaining that he would instead assign an eight-percent whole-body impairment rating because the three-percent impairment rating only took into account Duren's L3-L4 disc herniation and not his L4-L5 disc herniation. Dr. Blount agreed that Duren reached MMI on March 10, 2017.
¶16. On November 11, 2017, the AJ entered an order denying Duren's motion to compel medical treatment. The AJ explained that Duren's "request for pain management is hereby denied as the provider who referred claimant to pain management is outside the scope of medical providers in this claim, and pain management is also not reasonable and necessary as opined by Dr. Philip Blount in his Independent Medical Examination report[.]" The AJ also ordered Duren to undergo a comprehensive evaluation of his condition by Dr. Angela Koestler, a psychologist.
¶17. In April 2018, Duren's counsel requested that Dr. Blount clarify the opinions from his IME report. In response, Dr. Blount issued an additional report clarifying his findings. Dr. Blount opined that Roberts's recommendation that Duren receive a post-surgery MRI to diagnose the cause of his continued pain, as well as the prescribed pain medications, were all reasonable and medically necessary to treat Duren's work injury. Regarding Roberts's pain management referral, Dr. Blount stated that chronic pain from a work injury should be managed by a medical professional trained in pain management, and he agreed with transferring Duren from Roberts to a "higher level of care."
¶18. In May 2018, Duren filed another motion to compel medical treatment, temporary total disability benefits, and payment of medical bills. In this motion, Duren referenced Dr. Blount's report clarifying his opinions and opining that a post-surgery MRI and the pain medications were reasonable and necessary to treat Duren's work injury. Duren accordingly requested that the AJ order the Employer/Carrier to pay for Duren's medical bills from Mallory Health Center, asserting that this continued treatment was related to his work injury. Duren also requested that the AJ order the Employer/Carrier to (1) approve and pay for the past and future expenses of his pain medicine, as well as an evaluation and treatment pain management, and (2) render temporary total disability benefits until Duren has been placed at MMI by his pain management physician.
¶19. At the request of the Employer/Carrier, Dr. John Davis, a neurosurgeon, performed an "Employer's Medical Evaluation" on Duren. Dr. Davis performed his evaluation and issued his report opining that as far as Duren's disc herniation at L3-L4, he "indeed was and remains at maximum medical improvement as of March 10, 2017." Dr. Davis also testified that he agreed with Dr. Calvert's treatment protocol. Dr. Davis recommended a post-surgery MRI of Duren's lumbar spine to determine if there was any remaining L5 nerve root compression
.
¶20. On October 25, 2018, Duren underwent a lumbar MRI scan. Dr. Calvert and Dr. Davis reviewed the updated MRI and issued a report detailing their findings....
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