Helmig v. Springfield R-12 Sch. Dist.

• Court: Missouri Court of Appeals
• Writing for the Court: MARY W. SHEFFIELD, J.
• Citation: 688 S.W.3d 315
• Docket Number: SD 38181
• Decision Date: 10 May 2024
• Parties: Cynthia HELMIG, Appellant, v. SPRINGFIELD R-12 SCHOOL DISTRICT, Respondent.

688 S.W.3d 315

Cynthia HELMIG, Appellant,

v.SPRINGFIELD R-12 SCHOOL DISTRICT, Respondent.

No. SD 38181

Missouri Court of Appeals, Southern District, In Division.

Filed: May 10, 2024

APPEAL FROM THE LABOR AND INDUSTRIAL RELATIONS COMMISSION

ATTORNEY FOR APPELLANT - PATRICK J. PLATTER, Springfield, MO.

ATTORNEY FOR RESPONDENT - CATHERINE D. GOODNIGHT, Springfield, MO.

MARY W. SHEFFIELD, J.

Cynthia Helmig ("Claimant") appeals from a final award issued by the Labor and Industrial Relations Commission ("the Commission") in a workers’ compensation case, modifying the decision of the Administrative Law Judge ("ALJ").¹ In its final award, the Commission modified the award of the ALJ by: (1) finding that Springfield R-12 School District ("Employer") (rather than Claimant) has the right to select the health care providers for Claimant’s future medical care; (2) by ordering Employer to resolve Claimant’s past medical bills with the providers directly or by issuing payment to Claimant; (3) by ordering Employer to hold Claimant harmless for past medical expenses, rather than simply ordering Employer to pay those expenses to Claimant; and (4) by removing $152,935.67 in past medical expenses from the scope of the 25% attorney’s fee granted to Claimant’s counsel. Claimant raises seven points on appeal.

In point 1, Claimant argues the Commission misapplied the law when it modified the ALJ’s award and ruled Employer had a right to select future medical providers because Employer waived its right to select future medical providers. Points 2-7 argue the Commission acted in excess of its powers when it modified the ALJ’s award by: (1) allowing Employer to resolve Claimant’s past medical expenses with the providers directly ("the direct payment finding") or to pay Claimant directly; and (2) ordering Employer to hold Claimant harmless ("the hold harmless finding") from liability to her medical providers because: the Commission was bound by the parties’ stipulations of contested issues, under 8 CSR 50-2.010(14), to decide only contested issues (points 2, 3); the Commission does not have authority to review nonappealed issues, under 8 CSR 20-3.030 (points 4, 5); and it denied Claimant and her attorneys due process of law (points 6, 7). Finding no merit in the first point, that aspect of the final award is affirmed. Finding merit in points 6 and 7, and because that error affected the Commission’s decision with respect to the rulings challenged in points 2-7, we vacate those aspects of the final award and remand for further proceedings consistent with this opinion.

Factual and Procedural Background

Claimant works for Employer as a counselor at an elementary school. During October 2010, Claimant was injured on two separate occasions arising out of and in the scope of her employment. During the first incident, a kindergarten student jumped from a chair onto Claimant’s shoulders and neck. During the second incident, Claimant stubbed her foot in a dip in a parking lot while chasing a runaway student and tripped. Following the incidents, Claimant completed an incident report and requested medical treatment.

Employer authorized Claimant’s medical treatment and referred Claimant to Dr. Scott Galligos, who treated Claimant until she was discharged from treatment in February 2011. Following discharge, Claimant was still experiencing pain and symptoms, so she called Dr. Galligos’ office to schedule an appointment. Dr. Galligos’ office told Claimant she would need to contact Employer because she had been discharged from treatment. Claimant contacted Employer and requested additional treatment, but Employer denied Claimant’s request for further treatment because Dr. Galligos had discharged her.

Because Claimant was still experiencing symptoms, Claimant sought additional medical treatment using her health insurance. She was eventually referred to Dr. Robert Thompson who diagnosed Claimant with thoracic outlet syndrome, "a relatively rare condition [that] is often overlooked … by physicians and specialists who may not be familiar or experienced with this problem." Claimant received surgery for that condition, and has had continuing therapy to manage pain and to maintain her mobility and functioning.

In October of 2012, Claimant filed a workers’ compensation claim related to her injuries. The parties stipulated that Claimant’s injuries arose out of and were in the course of her employment, that Claimant notified Employer of her injuries as required, that the claim was timely filed, and that Employer had provided medical treatment to Claimant in the amounts of $3,355.69, for one injury, and $3,650.25, for a second injury. The parties further agreed the following disputed issues needed to be decided:

(1) Whether the employer and insurer are obligated to pay for certain past medical care and expenses in the amount of $184,957.24.

….

(4) Whether the employee has sustained injuries that will require additional or future medical care in order to cure and relieve the employee from the effects of the injuries.

A hearing was held, where Claimant and her husband testified, and thousands of pages of medical records were admitted into evidence. "All three physicians who submitted complete medical reports or testified, … agreed that the past medical treatment was reasonably necessary to cure or relieve [Claimant’s] conditions." Two of those physicians recommended continuing treatment, while one did not.

The ALJ found Claimant was entitled to unpaid medical expenses in the amount of $152,935.67 as well as future medical treatment. In support of its ruling on past medical expenses, the ALJ found:

[Claimant] made a prima facie case for the payment of the expenses when she testified the treatment was due to her injuries, she described the treatment, and the treatment records and bills were admitted into evidence. Martin v. MidAmerica Farm Lines, 769 S.W.2d [105] 111 (Mo. banc 1989). The Supreme Court later held that the amount which can be recovered consists of medical expenses paid by third-party payors (such as health insurance companies), amounts paid by the patient, and pending balances …. Further, [Employer] had full opportunity to provide treatment but declined to do so. An employer who refuses to provide treatment when provided the opportunity to do so is then liable for the costs of medical treatment of work-related injuries. Stephens v. Crane Trucking, Inc., 446 S.W.2d 772, 779-782 (Mo. 1969)[;] Wiedower v. ACF Industries, Inc., 657 S.W.3d 71, 74 (Mo. App. E.D. 1983). When an employer denies liability, it then denies medical treatment as a benefit. Wiedower, supra;Beatty v. Chandeysson Electric Co., 190 S.W.2d 648, 656 (Mo. App. 1945). This rule also applies in more recent cases. Dierks v. Kraft Foods, 471 S.W.3d 726, 735, 736 (Mo. App. S[W].D. 2015); Martin v. Town & Country Supermarkets, 220 S.W.3d 836, 844 (Mo. App. S.D. 2007). It cannot be said that [Claimant] selected her medical providers as an independent choice. "If the employee desires, he shall have the right to select his own physician, surgeon, or other such requirement at his own expense." Section 287.140.1. However, [Claimant] did not "select" one provider over another. [Employer] gave her no choice. And, the definition of "select" is "v.tr. choose, esp. as the best or most suitable. adj. 1 chosen for excellence or suitability; choice. 2 (of a society, etc.) exclusive; cautious in admitting members." The Oxford American Dictionary of Current English, p. 730 (Oxford University Press 1999). The plain meaning of the word cannot be construed to mean that [Claimant] has "selected" medical providers over the past 11 years.

As to future medical treatment, the ALJ designated Claimant’s medical providers as the authorized treating physicians:

These physicians have been treating [Claimant] for over five years at the least and eight years at most. It would be inappropriate to designate different physicians to commence treatment. Section 287.140.2. In addition, there is no evidence to believe that [Employer] even offers a choice of treatment even now, since it apparently takes the position that no further treatment is necessary. It has not offered, by any qualified physician, a choice in treatment. This is not to say that this choice would be appropriate, given the qualifications and continuing evaluations of Dr. Thompson and the interventional anesthesiologists in St. Louis and Springfield who have treated [Claimant].

Finally, Claimant’s law firm was "allowed a fee of 25 percent of all sums awarded under the provisions of this award for necessary legal services rendered to [Claimant]" and "shall constitute a lien" on the award.

Employer timely filed an application for review with the Commission. The application alleged, among other things, that the ALJ erred in not allowing Employer to direct future medical care, if appropriately awarded, and that the ALJ erred in awarding Claimant past medical by considering in error the opinion of two medical experts. Claimant filed a response to the application for review. Both parties filed briefs articulating their positions before the Commission.

Following submission of the case to the Commission, the Commission modified the award and decision of the ALJ and adopted the ALJ’s findings, conclusions, decision and award to the extent they were not inconsistent with the Commission’s modifications. Relevant to the issues raised in this appeal, the Commission concluded:

Past Medical Treatment

We affirm the ALJ’s finding that [Claimant] incurred fair, reasonable, and customary charges in the amount of $152,935.67 for medical treatment she sought on her own after [Employer] stopped authorizing treatment for her work injuries. We hold [Employer] responsible for the medical bills detailed on pages 12 and 13 of the ALJ’s award. We modify the ALJ’s award to the extent that it requires [Employer] to pay this amount directly to [Claimant], Instead, we order [Employer] to resolve these

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