State ex rel. Navistar Internatl. Transp. Corp. v. Indus. Comm., 2005 Ohio 3284 (OH 6/28/2005)
| Decision Date | 28 June 2005 |
| Docket Number | No. 04AP-638.,04AP-638. |
| Citation | 2005 Ohio 3284 |
| Parties | State ex rel. Navistar International Transportation Corporation, Relator, v. The Industrial Commission of Ohio (REGULAR CALENDAR) et al., Respondents. |
| Court | Ohio Supreme Court |
Joseph A. Brunetto and Gina R. Russo, for relator.
Jim Petro, Attorney General, and Dennis H. Behm, for respondent Industrial Commission of Ohio.
Robert Bumgarner, for respondent Thomas A. Clifford.
DECISION
ON OBJECTIONS TO THE MAGISTRATE'S DECISION
{¶1} Relator, Navistar International Transportation Corporation, has filed an original action in mandamus requesting this court to issue a writ of mandamus ordering respondent, Industrial Commission of Ohio ("commission"), to vacate its order authorizing respondents, Toney Adams, Thomas A. Clifford, and Arthur W. Cason ("claimants") to receive physical therapy at a facility other than relator's on-site physical therapy facility ("on-site facility") and ordering the commission to require claimants to receive their physical therapy at relator's on-site facility.
{¶2} This court referred the matter to a magistrate, pursuant to Civ.R. 53(C) and Section (M), Loc.R. 12 of the Tenth District Court of Appeals, who rendered a decision including findings of fact and conclusions of law. (Attached as Appendix A.) The magistrate concluded that this court should deny relator's request for a writ of mandamus.
{¶3} Relator has filed objections to the magistrate's decision, arguing that the magistrate: (1) misunderstood the issues and arguments presented; and (2) erroneously concluded that the commission did not abuse its discretion in finding that the claimants' requests for physical therapy at an off-site facility satisfied the criteria set forth in State ex rel. Miller v. Indus. Comm. (1994), 71 Ohio St.3d 229. Relator contends it has not argued for a blanket rule requiring its injured employees to always receive necessary physical therapy at its on-site facility, but has argued that injured workers do not have an unfettered right to choose where they receive treatment and that the commission must consider the employer's interests, including the employer's costs, when applying the Miller criteria. The commission and claimant Thomas A. Clifford filed memoranda in opposition to relator's objections and in support of the magistrate's decision.
{¶4} For the reasons below, we sustain relator's first objection and overrule relator's second objection.
{¶5} The magistrate's decision includes detailed findings of fact, and we adopt those findings as our own. As indicated therein, claimants sustained work-related injuries while employed by relator. Claimants' treating physician, Dr. Paul Nitz, completed C-9 forms requesting relator to authorize a certain period of physical therapy for each claimant. Relator approved the requests, conditioned on the claimants receiving their physical therapy at relator's on-site facility rather than at Springfield Physical Therapy ("Springfield") as Dr. Nitz recommended in the C-9 forms. Because claimants did not agree to receive physical therapy at relator's on-site facility, relator denied claimants' C-9 requests.
{¶6} Claimants filed motions with the Ohio Bureau of Workers' Compensation ("BWC") requesting approval of their requests to receive physical therapy at Springfield. As claimants' motions proceeded through the administrative process, a District Hearing Officer, Staff Hearing Officer, and the commission heard each claimant's motion. In unanimous decisions, the commission determined that claimants were entitled to receive physical therapy at Springfield. The commission's decision provides, in relevant part, as follows:
The issue in this case is whether the injured worker has the right to have the physical therapy performed at a private therapy facility — in this case Springfield Physical Therapy — or whether the therapy can be performed only at the on-site physical therapy facility of the employer. Physical therapy is a medical service and the employer has cited no authority that would allow the employer to control where the injured worker receives medical services. Therefore, as with any request for medical services, the Commission finds that this decision simply comes down to an interpretation of the test enunciated in the case of State ex rel. Miller v. Indus. Comm. (1994), 71 Ohio St.3d 229. In Miller, the Supreme [C]ourt fashioned a three-pronged test for the authorization of medical services:
1) are the medical services reasonably related to the industrial injury that is the allowed condition?
2) are the services reasonably necessary for treatment of the allowed conditions? and
3) is the cost of such service medically reasonable?
Id. at 32, citing State ex rel. Campbell v. Indus. Comm. (1971), 28 Ohio St.2d 154. This is otherwise known as the Miller test.
In this case, there is no dispute by the employer that the first two prongs of the Miller test are met. The employer disputes only the third prong. The injured worker has argued that Dr. Nitz's request to have the therapy performed at Springfield Physical Therapy meets the requirement of this test, as the facility is a BWC approved provider, and the cost would, therefore, be subject to the UCR guidelines of the BWC, which by definition would be a medically reasonable cost. The employer does not argue that the costs at Springfield Physical Therapy are medically unreasonable per se, as even the employer approves requests to have physical therapy performed at Springfield Physical Therapy in certain situations. The employer, rather, has argued that the injured worker should be required to undergo the therapy at their onsite therapy facility in this case, as to hold otherwise will, in effect, result in a double billing for the therapy, as the employer has already paid for the equipment and services of a licensed physical therapist at their on-site facility.
The Commission finds the injured worker's position on this issue to be more persuasive. The charges at the requested facility, Springfield Physical Therapy, are found to be medically reasonable, in that they are within the approved fee structure as established by the BWC for authorized providers of such services. As such, the Commission finds that the request satisfies the third prong of the Miller Test. Therefore, the C-9 request for authorization of physical therapy treatment at Springfield Physical Therapy, submitted by Dr. Nitz on 08/07/2003, is approved.
{¶7} In the instant mandamus action, relator argues that the commission abused its discretion by failing to consider the additional cost to relator of treatment at Springfield and by essentially granting injured workers a free choice, not provided by Ohio law, to select their medical services provider.
{¶8} To be entitled to a writ of mandamus, the relator must demonstrate that: (1) the relator has a clear legal right to the relief requested; (2) respondents are under a clear legal duty to perform the acts requested; and (3) relator has no plain and adequate remedy at law. State ex rel. Stafford v. Indus. Comm. (1989), 47 Ohio St.3d 76, 77-78. A clear legal right to a writ of mandamus exists when the relator establishes that the commission abused its discretion, which occurs when the commission enters an order not supported by any evidence in the record. State ex rel. Elliott v. Indus. Comm. (1986), 26 Ohio St.3d 76, 78-79. Conversely, where the record contains some evidence to support the commission's finding, there has been no abuse of discretion and mandamus is inappropriate. State ex rel. Lewis v. Diamond Foundry Co. (1987), 29 Ohio St.3d 56, 58. Questions of credibility and the weight to be given evidence are clearly within the commission's discretion. State ex rel. Teece v. Indus. Comm. (1981), 68 Ohio St.2d 165, 169. Because the commission must have a clear legal duty to act before a writ will issue, "where the evidence is conflicting, a court cannot substitute its judgment for that of the commission and find that the commission abused its discretion." State ex rel. Marshall v. Keller, Admr. (1968), 15 Ohio St.2d 203, 205.
{¶9} Relator initially objects to the magistrate's characterization of its argument. In her decision, the magistrate wrote, "[r]elator contends that all of its employees who need physical therapy, as a result of work-related [injuries], must be required to receive that physical therapy at relator's on-site facility." (Emphasis sic.) The magistrate further explained relator's argument as "where an employer provides medical services for its injured employees, Miller mandates that the commission order the employee to have his/her treatment rendered at the employer's facility because that is the only way to meet the third prong of Miller." Relator states that it has not advocated for a blanket rule forcing injured employees of self-insured employers to treat at a particular facility. Rather, relator argues that the commission must apply the Miller criteria to the particular facts of each case, taking into account the employer's interests, including the employer's costs.
{¶10} Review of relator's brief and objections confirms that relator is not arguing for a blanket rule giving it complete control over where its injured employees receive treatment. Relator routinely approves an employee's use of an off-site facility when its on-site facility is unable to provide the employee's necessary treatment. Were the commission to consider relator's interests when applying the Miller test, relator would likely argue that the commission should not find the costs of an off-site facility medically reasonable if its on-site facility was equipped to provide the requested services. However, relator first argues that the commission must be required to consider the employer's interests and balance the costs to the employer of both facilities, rather than...
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