State ex rel. Koonce v. Industrial Com'n of Ohio

• Court: Ohio Supreme Court
• Writing for the Court: PER CURIAM; CELEBREZZE; HOLMES; CONNORS, J., of the Sixth Appellate District, sitting for WRIGHT; HOLMES
• Citation: State ex rel. Koonce v. Industrial Com'n of Ohio, 479 N.E.2d 876, 18 Ohio St.3d 60 (Ohio 1985)
• Decision Date: 26 June 1985
• Docket Number: No. 84-884,84-884
• Parties: , 18 O.B.R. 93 The STATE, ex rel. KOONCE, Appellant, v. INDUSTRIAL COMMISSION OF OHIO, Appellee, et al.

Page 60

18 Ohio St.3d 60

479 N.E.2d 876, 18 O.B.R. 93

The STATE, ex rel. KOONCE, Appellant, v. INDUSTRIAL COMMISSION OF OHIO, Appellee, et al.

No. 84-884.

Supreme Court of Ohio.

June 26, 1985.

On October 14, 1971, appellant, Joice A. Koonce, was employed by Storer Communications, Inc. as a receptionist for radio station WSPD in Toledo. Sometime that day, a caster broke on her swivel chair and she fell to the floor, sustaining injuries to her neck, upper and lower back. Appellant filed a claim for workers' compensation benefits. The claim was allowed. Appellant later developed a urinary condition resulting in "stress incontinence." Appellant's physician, Dr. Carl Armstrong, credited this condition to the "changes in walking and ambulatory patterns of the patient secondary to the back injury." Pursuant to Dr. Armstrong's report, appellant's workers' compensation allowance was amended to include this condition in September 1973.

Appellant, after her accident, tried to continue working and was treated for her physical problems at various times during 1972 and 1973. Appellant's condition did not improve, and on August 5, 1975 the appellee, Industrial Commission, awarded benefits for permanent and total disability. Benefits were paid retroactive to December 26, 1974. While appellant's permanent and total disability application was pending, appellant received unemployment compensation.

In January 1980, the Industrial Commission, alleging new evidence, ordered appellant to appear for examinations by two medical specialists. A hearing was set for June 23, 1981, at which time the commission continued the matter for further study and discussion. On October 8, 1981, the commission issued an order by its chief hearing officer that appellant's compensation be terminated immediately. The order notwithstanding, appellant's benefits continued through August 1982. The commission, on November 29, 1982, found that appellant was not permanently and totally disabled and terminated her compensation effective February 19, 1980. At the same time, the commission acted to recover what it considered to be an overpayment to appellant in the amount of $6,703.44. This was for compensation paid between February 19, 1980 and August 8, 1982. The commission's conclusion as to appellant's medical state was based on the reports of its two specialists--Drs. William R. Sloan and Mark Bohm--and the fact that in her application for unemployment benefits, appellant had stated that she was available for and able to work.

Appellant thereupon initiated this mandamus action in the Court of Appeals for Franklin County. The court granted the writ prohibiting collection of the alleged overpayment and remanded the matter to the commission for a determination as to whether appellant had fraudulently procured workers' compensation benefits. The court refused to compel the commission to vacate its finding that appellant was not permanently and totally disabled.

The cause is now before this court upon an appeal as a matter of right.

George N. Fell II and Steven E. Marcus, Toledo, for appellant.

Anthony J. Celebrezze, Jr., Atty. Gen., Lee M. Smith and Dennis L. Hufstader, Columbus, for appellee Industrial Com'n of Ohio.

PER CURIAM.

The court of appeals granted a writ of mandamus in this case to require the Industrial Commission to vacate its finding that appellant had fraudulently procured benefits. The court held that "the commission must make a finding that the claimant * * * [appellant] in fact did obtain the benefits through fraud," and remanded the cause for that purpose. ¹ We agree with the court below. Where allegations of fraud are involved in a termination-of-benefits case, the Industrial Commission must make a specific finding as to the fraud issue. Mere conclusory statements in the commission's pronouncement will not sustain an order cancelling benefits where fraud is alleged. ² Without a specific finding, the commission's order terminating compensation will be ordered vacated.

The only remaining question in this case, then, is whether the evidence before the Industrial Commission supports its order that appellant's compensation be terminated because she is not permanently and totally disabled.

As already mentioned, appellant's permanent-and-total-disability claim was allowed because of a back injury and the urinary condition. Benefits later were terminated because of the alleged fraud and the "finding of the Commission that from the reports of medical specialist[s] Dr. William Sloan and Dr. Mark Bohm, that claimant is not permanently and totally disabled at this time."

In State, ex rel. Anderson v. Indus. Comm. (1981), 62 Ohio St.2d 166, at 168, 404 N.E.2d 153 [16 O.O.3d 199], this court held that "where the issue before the commission is whether a claimant is permanently and totally disabled on account of the combined effect of two or more allowed conditions, medical testimony not evaluating the combined effect of those conditions cannot constitute evidence that the claimant is not permanently and totally disabled."

More recently, in State, ex rel. Norman v. Indus. Comm. (1982), 1 Ohio St.2d 263, 265, 438 N.E.2d 1181 the court said: "However, if a physician determines that one is not permanently and totally disabled as the result of one condition the physician must continue and analyze the additional allowed conditions to determine their combined effect upon the injured worker evaluated. This is the real meaning of Anderson, supra [62 Ohio St.2d 166, 404 N.E.2d 153 (16 O.O.3d 199) ]. Obviously, one must look at the person as a whole in evaluating whether [he] can work or not."

In the present case, neither of the medical reports relied upon by the commission covers all of the conditions allowed in appellant's original claim. Dr. Sloan, in his evaluation, only discussed appellant's problem with incontinence; he neglected to mention anything about appellant's back condition and to what degree the two, taken together, have rendered the appellant physically impaired. Under Anderson and Norm...