Sprague v. Caldwell Transp., Inc.

• Decision Date: 12 May 1989
• Docket Number: No. 17081,17081
• Parties: Gary E. SPRAGUE, Claimant-Appellant, v. CALDWELL TRANSPORTATION INC., Employer, and Aetna Casualty & Surety, Surety, Defendants-Respondents.
• Court: Idaho Supreme Court

Page 395

779 P.2d 395

116 Idaho 720

Gary E. SPRAGUE, Claimant-Appellant, v. CALDWELL TRANSPORTATION INC., Employer and Aetna Casualty & Surety, Surety, Defendants-Respondents.

No. 17081.

Supreme Court of Idaho.

May 12, 1989.

On Denial of Rehearing

Sept. 7, 1989.

Gigray, Miller, Downen, Weston & Pasley, Caldwell, for appellant. William F. Gigray III, argued.

Imhoff & Lynch, Boise, for respondents. Thomas P. Baskin III, argued.

BISTLINE, Justice.

The Commission concluded that claimant's medical treatment occurring subsequent to April 10, 1985, was not "reasonable," and therefore the surety was not obligated to pay such costs under I.C. § 72-432(1). We reverse.

A.

Claimant Gary Sprague suffered a back injury on June 5, 1984, which arose out of and in the course of his employment with Caldwell Transportation Company. While fueling a vehicle, Sprague fell backward from the third step of a gasoline tank when his feet got tangled in a gasoline hose. He fell about three feet, landing on his back and head. Sprague immediately consulted with Dr. John Downey, a chiropractic physician from Caldwell.

Dr. Downey diagnosed Sprague's injury as a compression fracture of the 12th thoracic vertebrae and a subluxation complex of the lumbar spine. Dr. Downey treated Sprague on a frequent basis, submitting periodic reports and billings to the surety, Aetna Casualty. In September 1984, the surety arranged for a consultation with Dr. Floyd Johnson, an orthopedic surgeon. The surety subsequently notified Dr. Downey and claimant Sprague that further chiropractic treatment would not be authorized because Dr. Johnson indicated that Sprague should not receive manipulative treatment, but only passive treatment (e.g., ultrasound and traction). However, Dr. Johnson later reported that chiropractic treatment would be appropriate. Sprague continued to receive treatment from Dr. Downey.

The surety subsequently arranged consultation with another orthopedic surgeon, Dr. Keith Taylor, in April of 1985. Dr. Taylor concluded Sprague had received enough chiropractic therapy and that Sprague should engage in back exercises. Thereafter, the surety requested that Dr. Downey send his final report and bill. On April 15, 1985, Dr. Downey sent a report stating the "patient has been finalized and has reached his MMI" (maximum medical improvement). The surety paid all of Dr. Downey's charges through April 10, 1985, in the total amount of $5108.71.

Sprague nevertheless returned to Dr. Downey a week later for further treatment of back pain. This appeal focuses on the treatment received after April 10, 1985. Sprague received 34 additional treatments in 1985 and 13 in 1986. The bill for this treatment totalled $1,848.96. The referee found that during the period of treatment after April 10, 1985, Sprague "made gradual improvement." The referee further found that the post April 10, 1985, "charges were fair, reasonable and similar to others in the same profession." Surprisingly, however, the referee also concluded that the treatment was not reasonable under I.C. § 72-432(1), and therefore the surety was not obligated to make payment therefor. The Commission adopted the Findings of Fact, Conclusions of Law, and Order of the referee in their totality.

B.

Our scope of review in appeals of this kind is well established. The Idaho Constitution mandates that review of the Industrial Commission is limited to questions of law. Idaho Const. art V, § 9. The findings of the Commission will not be disturbed on appeal when supported by substantial and competent evidence. Nenoff v. Culligan Soft Water, 97 Idaho 243, 542 P.2d 837 (1975).

The provisions of the Worker's Compensation Law are to be liberally construed in favor of the employee. Jones v. Morrison-Knudsen Co., 98 Idaho 458, 567 P.2d 3 (1977); Burch v. Potlatch Forests, Inc., 82 Idaho 323, 353 P.2d 1076 (1960). Liberal construction in favor of the worker is required to enable the act to serve the humane purposes for which it was promulgated, "leaving no room for narrow, technical construction." Hattenburg v. Blanks, 98 Idaho 485, 485, 567 P.2d 829, 829 (1977).

C.

The sole issue presented on this appeal is whether the treatment Sprague received from his physician subsequent to April 10, 1985, was "reasonable" under I.C. § 72-432(1). In pertinent part, that code provision states:

"The employer shall provide ... reasonable medical ... treatment ... as may be required by the employee's physician...."

(Emphasis added.) ¹ The clearly expressed intent of the legislature must be given effect; there is no occasion for construction where language is unambiguous. Ottesen v. Bd. of Comm'rs of Madison Co., 107 Idaho 1099, 695 P.2d 1238 (1985). Thus, the mandate of the statute requires the employer to pay for the costs of reasonable medical treatment required by the employee's physician. Chiropractic physicians are recognized and acceptable professionals able to provide treatments for industrial accidents. See I.C. § 72-102(20) (" 'Physician' means medical physicians and surgeons, ... chiropractic physicians."). Furthermore, chiropractic is a licensed profession the practice of which without a license is illegal. See I.C. § 54-702. Our review requires an examination of the record.

First, as noted, the Commission found that "during the period of treatment by Dr. Downey subsequent to April 10, 1985, Sprague made gradual improvement." ² (Emphasis added.) Second, the uncontradicted evidence establishes that Dr. Downey was of the unequivocal opinion that in his judgment the medical treatment Sprague received was required. ³ Third, the Commission found that the treatment Sprague received "was within the standard of the practice of chiropractic. The charges were fair, reasonable and similar to charges of others in the same profession." ⁴ These facts are beyond cavil or dispute.

The Commission determined, however, in the conclusions of law that the chiropractic treatment was "unreasonable" under I.C. § 72-432(1) and therefore the surety was not obligated to make payment therefor. While we do not disturb findings of fact supported by the evidence, whether the conclusions of law are supported by the facts presents a question of law over which we exercise free review. As stated in O'Loughlin v. Circle A Construction, 112 Idaho 1048, 739 P.2d 347 (1987):

But here the pertinent facts are uncontroverted. Instead, the issues turn upon the proper application of the law to the undisputed [or found] facts.... Hix v. Potlatch Forests, Inc., 88 Idaho 155, 159, 397 P.2d 237, 241 (1964), citing Johnston v. A.C. White Lumber Co., 37 Idaho 617, 217 P. 979 (1923); Ybaibarriaga v. Farmer, 39 Idaho 361, 228 P. 227 (1924). The standard is one of free review. The Honorable Donald L. Burnett, Jr., of our Court of Appeals, has written: 'An appellate court is expected to declare the law and may substitute its view for that of a trial court or agency upon a legal issue.' Standards of Appellate Review in State and Federal Courts, § 3.2, p. 3-3, Idaho Appellate Handbook (Idaho Law Foundation, Inc., 1985).

112 Idaho at 1051, 739 P.2d at 350.

The Commission's finding that Sprague's accident and injury "did not necessitate the type of care provided to [Sprague] by Dr. Downey subsequent to April 10, 1985" incorrectly focuses on the necessity of the treatment, rather than on whether it was reasonable and was required by Sprague's physician. I.C. § 72-432(1) obligates the employer to provide treatment, if the employee's physician requires the treatment and if the treatment is reasonable. It is for the physician, not the Commission, to decide whether the treatment is required. The only review the Commission is entitled to make of the physician's decision is whether the treatment was reasonable. Here, the Commission's attempt to premise a conclusion that the treatment was not reasonable on a finding that it was not necessary exceeded the Commission's authority.

Under the circumstances of this case, there is no dispute that: a) the claimant made gradual improvement from the treatment received; b) the treatment was required by the claimant's physician; and c) the treatment received was within the physician's standard of practice the charges for which were fair, reasonable and similar to charges in the same profession. We hold that in light of these facts a legal conclusion that the treatment was unreasonable under I.C. § 72-432(1) cannot stand. Accordingly, we reverse and remand to the Commission to enter an order consistent with this opinion.

Reversed. Costs to claimant; no attorney fees on appeal.

SHEPARD, C.J., and HUNTLEY and JOHNSON, JJ. concur.

BAKES, Justice, dissenting:

A.

The majority opinion reverses the Industrial Commission, exercising so-called "free review" of what is supposedly the Commission's conclusion of law that the chiropractic treatment provided by Dr. Downey after April 10, 1985, was "unreasonable." Being a conclusion of law, according to the majority opinion, we are not bound by the constitutional prohibition in Art. 5, § 9, of the Idaho Constitution which prohibits this Court from reviewing the factual determinations of the Industrial Commission. ⁵ However, the majority opinion does not acknowledge, much less discuss, the Commission's Finding of Fact IX in which the Commission found as a fact "that the claimant's accident and injury did not necessitate the type of care provided to the claimant by Dr. Downey subsequent to April 10, 1985, and that therefore such care and treatment was not reasonable, not necessary, and not within the obligation of the employer and surety to provide for the claimant." Commission Finding of Fact IX. That finding in Finding of Fact IX was made only after acknowledging that "there was a conflict in the evidence as to whether or not the chiropractic care received by the claimant subsequent to April 10, 1985, was reasonable care which the claimant needed as a result of the accident of June 5,...