Henderson v. McCain Foods, Inc.

• Decision Date: 22 February 2006
• Docket Number: No. 31232.,31232.
• Citation: 130 P.3d 1097,142 Idaho 559
• Parties: Teresa HENDERSON, Claimant-Appellant, v. McCAIN FOODS, INC., Employer, and RSKCO, Surety, Defendants-Respondents.
• Court: Idaho Supreme Court

130 P.3d 1097

142 Idaho 559

Teresa HENDERSON, Claimant-Appellant, v. McCAIN FOODS, INC., Employer, and RSKCO, Surety, Defendants-Respondents.

No. 31232.

Supreme Court of Idaho, Boise, December 2005 Term.

February 22, 2006.

COPYRIGHT MATERIAL OMITTED

Peterson, Parkinson & Arnold, Idaho Falls, for appellant. Bradley D. Parkinson argued.

Moffatt, Thomas, Barrett, Rock & Fields, Boise, for respondents. Glenna M. Christensen argued.

EISMANN, Justice.

This is an appeal from an order of the industrial commission finding that the claimant failed to prove that her neck surgery was caused by her industrial accident, determining that she had a 30% disability rating, and apportioning her disability under Idaho Code § 72-406(1) one-third to the industrial accident and two-thirds to her pre-existing condition. We affirm the Industrial Commission except as to its apportionment of the claimant's disability. We vacate that apportionment and remand for further proceedings.

I. FACTS AND PROCEDURAL HISTORY

Teresa Henderson (Claimant) suffered an injury to her neck in an industrial accident while working for McCain Foods, Inc., (Employer) on August 25, 1999. On January 31, 2000, she filed a claim for compensation seeking medical benefits, temporary and permanent income benefits, and an award of attorney fees. The matter was heard on September 6, 2002, before a Referee. Two months later, the Claimant asked to reopen the record because she had recently been scheduled for neck surgery to be performed on November 20, 2002. By order entered on December 3, 2002, the Referee granted the motion in part, holding that the Claimant could have a second hearing, if necessary, on the issues of total temporary disability and medical benefits for the period beginning after the date of the first hearing. The Referee further held that the previously reserved issue of permanent disability could also be addressed at a second hearing.

On April 30, 2003, the Referee issued his proposed findings of fact and conclusions of law for the first hearing. By order entered on June 6, 2003, the Idaho Industrial Commission (Commission) adopted the Referee's proposed findings of fact and conclusions of law, and it entered a final decision that was conclusive as to all matters adjudicated in the first hearing. That order included a finding that the Claimant had suffered an industrial accident on August 25, 1999, which caused an injury to her neck and exacerbated a pre-existing, irregularly symptomatic condition. The Commission also ordered, among other things, that the Claimant was entitled to reasonable future medical care as deemed necessary by her treating physician.

The Referee held the second hearing on December 10, 2003. He subsequently issued proposed findings of fact and conclusions of law, which the Commission adopted by order entered on June 29, 2004. The Commission found that the Claimant had failed to prove that her neck surgery was causally related to her industrial accident. It held that she was not entitled to medical benefits for the surgery and post-operative recovery; that after the first hearing she did not suffer a temporary disability that was related to the industrial accident; and that she had a 30% permanent disability, of which 10% was related to the industrial accident. The Claimant filed a motion asking the Commission to reconsider its findings, which the Commission denied on August 31, 2004. The Claimant then appealed.

II. ISSUES ON APPEAL

A. Did the Claimant have notice that she would have to prove at the second hearing that her neck surgery was causally connected to her industrial accident?

B. Did the Commission apply an incorrect legal standard when deciding that the Claimant had failed to prove that her neck surgery was causally connected to her industrial accident?

C. Is the Commission's finding that the claimant failed to prove a causal connection between her neck surgery and her industrial accident supported by substantial and competent evidence?

D. Was the Commission's award of 30% permanent partial disability supported by substantial and competent evidence?

E. Did the Commission err when apportioning the Claimant's disability pursuant to Idaho Code § 72-406(1)?

III. ANALYSIS

A. Did the Claimant Have Notice that She Would Have to Prove at the Second Hearing that Her Neck Surgery Was Causally Connected to Her Industrial Accident?

The Commission found that the Claimant's neck surgery on November 20 2002, was not causally related to her industrial accident three years earlier, and it therefore denied her compensation for the surgery and her post-surgical care. The Claimant contends that she was denied due process of law because she was not on notice that she would have to prove a causal connection between her industrial accident and her neck surgery. She argues that the issue of causation had been previously decided by the Commission's order entered after the first hearing and she was not given notice that it would be an issue at the second hearing.

Based upon the evidence presented at the first hearing, the Commission found, "Claimant suffered an industrial accident on August 25, 1999, which caused an injury to her neck that exacerbated a preexisting, irregularly symptomatic, condition." It ordered, "Claimant is entitled to medical care to the date of the hearing and for reasonable future medical care, including efforts to discontinue her use of narcotic pain medication, as deemed necessary by her treating physician." The Claimant contends that this finding and order established that her later neck surgery was caused by her industrial accident. We disagree.

On November 20, 2002, the Claimant had neck surgery consisting of a decompression and fusion at C5-6. The first hearing was held over two months earlier. At the first hearing, the Claimant had alleged that her industrial accident was causing various symptoms involving her neck, face, back, and left leg. The Commission did not find that those symptoms were caused by the industrial accident. It found, "Claimant's complaints beyond some transitory neck pain are not likely related to the accident." Prior to the first hearing, degenerative changes (spondylosis), abnormal bony outgrowths (osteophytes), and a disc bulge had been identified in the Claimant's neck at C5-6. The Commission did not find that those conditions were caused by the Claimant's industrial accident. It found that the Claimant's neck pain was a "longstanding" symptom prior to the accident, that the bony outgrowths pre-existed the accident, and that her slight disc bulge was of uncertain age. The Commission concluded, "Claimant suffered an industrial accident on August 25, 1999, which caused an injury to her neck that exacerbated a preexisting, irregularly symptomatic, condition." Because the Claimant had not yet had her neck surgery at the time of the first hearing, the Commission did not address whether the surgery was compensable.

The Claimant asked to re-open the record of the first hearing in order to present evidence regarding her scheduled surgery. The Referee denied that request, but did rule that "[q]uestions regarding . . . medical care. . . for the period beginning after September 6, 2002, may be raised again at a second hearing if necessary." The Claimant wanted a second hearing, and on July 2, 2003, the Referee sent the parties written notice that the second hearing would be held on December 10, 2003, and that the issues for determination would include "[p]ost-hearing medical care." Thus, the second hearing addressed whether the Claimant could recover benefits for the medical expenses she incurred after the first hearing, which would include in her neck surgery and post-operative care.

"A worker's compensation claimant has the burden of proving, by a preponderance of the evidence, all the facts essential to recovery." Evans v. Hara's, Inc., 123 Idaho 473, 479, 849 P.2d 934, 940 (1993). One of the facts essential to the recovery of medical expenses is that the expenses were incurred as a result of an industrial accident. An employee's "employer and surety are only liable for medical expenses incurred as a result of `an injury' (i.e., an employment related accident), or `disability from an occupational disease.' I.C. § 72-432(1). An employer cannot be held liable for medical expenses unrelated to any on-the-job accident or occupational disease." Sweeney v. Great West Transp., 110 Idaho 67, 71, 714 P.2d 36, 40 (1986). The fact that an employee suffered a covered injury to a particular part of his or her body does not make the employer liable for all future medical care to that part of the employee's body, even if the medical care is reasonable.

For example, in Matthews v. Department of Corrections, 121 Idaho 680, 827 P.2d 693 (1992), the employee injured his back in a 1985 industrial accident, for which he received medical and income benefits. Eighteen months later he sought additional compensation, including medical benefits for subsequent medical care to his back. We upheld the Commission's finding that he had failed to prove the subsequent medical care was incurred as a result of his covered back injury, stating, "We agree with the Commission that Matthews is not entitled to payment, pursuant to I.C. § 72-432(1), because `no evidence indicate[s] that these bills were directly incurred as a result of his [1985] back injury.'" 121 Idaho at 682, 827 P.2d at 695 (brackets in original). In Cole v. Stokely Van Camp, 118 Idaho 173, 795 P.2d 872 (1990), the employee injured his back in 1982 and received some medical care at the employer's expense. Five years later he sought compensation, including medical benefits, contending that his continuing pain was caused by that industrial accident. One physician said it was, one said it was not, and a third said too much time had passed to be certain. We affirmed the Commission's finding that the employee had failed to prove that his current...