Jobe v. American Legion# 7

• Citation: 32 P.3d 860,2001 OK 75
• Decision Date: 18 September 2001
• Docket Number: No. 95,229.,95,229.
• Parties: Evelyn Serena Hamilton JOBE, Petitioner, v. AMERICAN LEGION # 7, the State Insurance Fund and the Workers' Compensation Court, Respondents.
• Court: Supreme Court of Oklahoma

32 P.3d 860

2001 OK 75

Evelyn Serena Hamilton JOBE, Petitioner, v. AMERICAN LEGION # 7, the State Insurance Fund and the Workers' Compensation Court, Respondents.

No. 95,229.

Supreme Court of Oklahoma.

September 18, 2001.

Walt Brune, Walt Brune, P.C., and Fred L. Boettcher, Boettcher Law Offices, Inc., Ponca City, OK, For Petitioner.

H.A. Bud Carter, Oklahoma City, Oklahoma For Respondents.¹

OPALA, J.

¶ 1 The dispositive question on certiorari is whether the Court of Civil Appeals erred in accepting as judicially reviewable the three-judge panel's adoption of the trial judge's order that denied prescription drugs' reimbursement without the critical § 26² findings of fact and conclusions of law. We answer in the affirmative.

I

THE ANATOMY OF LITIGATION

Jobe I

¶ 2 The claimant, Evelyn Serena Hamilton Jobe [Jobe or claimant], was adjudicated permanently partially disabled in 1987 from a back injury sustained while working for the employer, American Legion # 7 [American Legion or employer]. On 10 December 1991, after the trial tribunal's award of temporary total disability benefits in 1988 and 1990, claimant was determined to have suffered a change of condition for the worse, resulting in increased permanent partial disability [PPD] occasioned by the back injury, depression and psychological overlay.

¶ 3 Several medical providers filed Form 19 claims for services rendered to claimant during the period between 1992 and 1993. These were approved by the Workers' Compensation Court's 7 December 1993 order. Claimant also sought reimbursement for prescriptions she had bought in the amount of $749.93. The trial judge's 17 January 1995 order denied Jobe's reimbursement claim because (1) these medications were purchased after the 1991 PPD determination, (2) the 10 December 1991 order contained no provision for continuing medical maintenance, nor (3) had claimant, after the 1991 order, moved to reopen for a change of condition for the worse. The order was adopted by a three-judge review panel of the Workers' Compensation Court and the panel's decision sustained by the Court of Civil Appeals.³

Jobe II

¶ 4 On 6 March 1996 claimant moved to reopen based on a changed condition for the worse. She sought authorization for medical treatment for a period from 28 April 1992 to the present. The employer's response denied that claimant's condition had changed. The report by an independent medical examiner, Dr. H., who was appointed to determine if she had suffered a change of condition for the worse, stated that no change had occurred.

¶ 5 Claimant's reopening motion was pending when the parties settled the case by joint petition dated 29 July 1997. According to the terms of their agreement, the claimant received $10,000, which was to be "in addition to the authorized, reasonable and necessary medical . . . expenses heretofore incurred by claimant by reason of said accidental personal injury." (emphasis added).

¶ 6 On 5 September 1997 claimant filed a Form 13 (titled Request for Rehearing Conference) for reimbursement of prescription expense ($4,283.06). The claimed prescriptions were purchased during the period between 21 December 1993 and 25 July 1997.⁴

The Trial Judge's First Denial of Claimant's Postsettlement Request

¶ 7 The trial judge summarily denied claimant's request for reimbursement of prescriptions by its 25 September 1998 order that is barren of any findings of fact or conclusions of law.⁵ The panel's 5 March 1999 decision vacated the trial judge's September 25 order and directed that on remand she is to

address the claimant's demand for the payment of charges based upon the claimant's filing of a motion to reopen on a change of condition prior to the filing of a Joint Petition Settlement and to address the respondent's defense to the claimant's demands based upon the statute of limitations as well as any and all other demands and defenses raised.⁶

¶ 8 The employer then sought corrective relief from the panel's order. The Supreme Court dismissed its petition for review on the ground that the order was not final (hence not reviewable) and remanded the claim for further proceedings.⁷

The Trial Judge's Second Denial of Claimant's Postsettlement Request

¶ 9 On remand the trial judge again denied claimant's request for reimbursement. Her 7 April 2000 order states in pertinent part:

The Court having considered the evidence and records on file, and being well and fully advised in the premises FINDS AND ORDERS AS:

-1.-

THAT on remand from the three judge panel, the Court finds claimant's request for reimbursement of prescription expenses in the amount of $3,057.59 covering period from DECEMBER 21, 1993 to JULY 25, 1997 is DENIED.

-2.-

THAT in reaching this decision, the Court considered: (1) claimant's motion to reopen on change of condition for the worse filed MARCH 9, 1996 which was not further pursued; (2) transcripts of joint petition with attachments dated JULY 24, 1997 and executed joint petition on JULY 24, 1997, respondent's statute of limitations defenses, and prior orders rendered in this claim on DECEMBER 10, 1991 and JANUARY 17, 1995.

Claimant appealed from the negative order. Upon its adoption by the three-judge panel, she brought a petition for review.

The Court of Civil Appeals' Opinion

¶ 10 The Court of Civil Appeals [COCA] sustained the three-judge panel's order. According to COCA, claimant's assertions that (a) the employer is obligated under the joint-petition settlement to pay "authorized, reasonable and necessary medical ... expenses heretofore incurred by the claimant" and that (b) she need only show the medical expenses were "reasonable and necessary" ignores the requirement that the expenses be "authorized." COCA reasoned that because the 1987 and 1991 orders adjudicating PPD neither addressed nor preserved as a viable issue claimant's continuing medical maintenance, she was required to show a change of condition for the worse before medical treatment could be authorized.⁸ Contrary to the claimant's position, COCA opines that the employer did not enter into an agreement to withhold from the § 84 settlement the reimbursement of prescription medicine. COCA disagrees with claimant's view that the March 1996 motion to reopen on change of condition for the worse and the July 1997 joint-petition settlement are "prima facie evidence" that her condition did in fact undergo a change for the worse that would entitle her to reimbursement of prescription medication expense that stood incurred before the settlement. COCA observes that neither the settlement order nor the transcript of the hearing refers to the pending motion to reopen. COCA reasons that (a) if the claimant intended to rely on a change of condition for the worse as the basis for reimbursement, she had the burden to include the change of condition as part of the settlement and to so inform the approving court; (b) by agreeing to the joint-petition settlement, she gave up any right to pursue a change-of-condition demand; and (c) without such adjudication, she was not eligible for "authorized" medical treatment after the 1991 PPD determination, even if the treatment was reasonable and necessary.

¶ 11 We granted the claimant's certiorari petition and now vacate the Court of Civil Appeals' opinion and the panel's order; the claim is remanded for further proceedings to be consistent with today's pronouncement.

II

WORKERS' COMPENSATION ORDERS THAT ARE DEVOID OF FINDINGS OF FACT AND CONCLUSIONS OF LAW ARE NOT CAPABLE OF JUDICIAL REVIEW

A. The Statutory Mandate

¶ 12 In compensation cases the issues are ordinarily formed by the evidence.⁹ The Workers' Compensation Court is required to make specific, on-the-record¹⁰findings of ultimate facts responsive to the issues shaped by the evidence as well as conclusions of law upon which its order is to be rested. 85 O.S.Supp.1994 § 26.¹¹Findings and conclusions are an indispensable prerequisite for judicial review. When these elements are not present in the trial tribunal's order (or are too vague and uncertain for judicial interpretation), this court will not hypothesize about the evidence or law upon which the tribunal may have relied to arrive at its decision but will vacate the order and remand the claim for further proceedings to be followed by an order that meets the law's standards of a judicially reviewable decision.¹²

¶ 13 Not only was the trial judge duty-bound to obey here the statutory mandate, she was also required to follow the explicit directions given her in the three-judge panel's order.

B.

The trial judge's order is devoid of the requisite fact findings and legal conclusions.

¶ 14 The trial judge's second (7 April 2000) order adds but a few more details to those contained in its first (25 September 1998) summary disposition. By its April 7 order we are informed only of the amount of the claim, the period of time that it covers and the paperwork that the trial judge considered in reaching her decision.¹³ No other information is shown of record. The § 26 requirement for findings and conclusions was once again violated and the panel's explicit mandate ignored.

¶ 15 Because the trial judge's second (April 7) order now under review is devoid of the critical findings of fact and conclusions of law, the three-judge panel erred in not vacating that order and remanding the claim to the trial judge for an inquiry into and determination of the tendered fact and law issues that stand shaped by the evidence and the panel order.¹⁴

C. Issues of Fact and Law Tendered by the Evidence

¶ 16 On this record, the unsettled issues of fact and law to be resolved on remand appear to be:¹⁵

(1) What is the nature of the claim? Is it a presettlement motion whose pendency continued in force after the approved joint petition or a postsettlement claim for prescription medications reimbursement that survived the § 84 settlement approval or are both theories tendered?

(2) Is the language of

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