STEARNS TEXTILE COMPANY, d/b/a Phoenix Uninsured Employers' Fund v. VIVIAN MOONEY; JOHN PENDLEY, Manager of Uninsured Employers' Fund; ROBERT SPURLIN, Director of Special Fund; DR. MARC DUBICK/ST. JOSEPH PAIN MANAGEMENT CENTER; DONALD G. SMITH, Administrative Law Judge; and WORKERS' COMPENSATION BOARD
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RENDERED:
September 3, 1999; 2:00 p.m.
NOT TO BE PUBLISHED
C ommonwealth O f K entucky
C ourt O f A ppeals
No.
1999-CA-000556-WC
STEARNS TEXTILE COMPANY, d/b/a
Phoenix Uninsured Employers’
Fund
v.
APPELLANT
PETITION FOR REVIEW
OF A DECISION OF
THE WORKERS' COMPENSATION BOARD
WC-95-19287
VIVIAN MOONEY; JOHN PENDLEY,
Manager of Uninsured
Employers’ Fund;
ROBERT SPURLIN,
Director of Special Fund;
DR. MARC DUBICK/ST. JOSEPH
PAIN MANAGEMENT CENTER;
DONALD G. SMITH,
Administrative Law Judge; and
WORKERS’ COMPENSATION BOARD
APPELLEES
OPINION
AFFIRMING
* * * * * * * * * * * * * * * * *
BEFORE:
BUCKINGHAM, HUDDLESTON, AND KNOPF, Judges.
BUCKINGHAM, JUDGE.
Stearns Textiles Company, d/b/a Phoenix
Manufacturing, (Stearns) petitions for review of an opinion of
the Workers’ Compensation Board (the Board) which affirmed an
opinion and order rendered by an administrative law judge (ALJ).
We affirm.
Vivian Mooney (Mooney) was employed by Stearns as a
production worker in its textile plant in June 1994 when she
suffered a back injury while running a cloth winding machine and
attempting to pull a roll of cloth off the line.
An ALJ awarded
Mooney benefits based on a finding that she was totally
occupationally disabled.
After Stearns’s appeal to the Board was
dismissed and the ALJ’s opinion and award was affirmed, Stearns
filed a petition for review with this court.
See 1996-CA-002818-
WC.
While that petition was pending in this court, Stearns
filed a motion to reopen to challenge the necessity of Mooney’s
purchase of a whirlpool spa as a medical expense.
The ALJ
granted Stearns’s motion to reopen to contest the expense, and
Stearns later filed a motion to amend seeking to have the ALJ
determine whether Mooney’s disability had decreased and further
contesting the necessity of more of Mooney’s medical expenses.
The ALJ issued a subsequent order stating that he had no
jurisdiction to determine if Mooney’s disability had decreased
due to the fact that his previous finding concerning Mooney’s
disability was before this court on a petition for review.
The ALJ’s final opinion and order found that all of
Mooney’s medical expenses were reasonable and necessary with the
exception of her purchase of a therapeutic spa.
Stearns then
appealed the ALJ’s ruling regarding the propriety of Mooney’s
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medical expenses and the ALJ’s finding that he had no
jurisdiction to consider a change in Mooney’s disability while a
petition for review to this court was pending.
After the Board
affirmed the decisions of the ALJ, Stearns filed the petition for
review sub judice.
Stearns’s first contention is that the ALJ and the
Board erred in determining that the original opinion and award
concerning Mooney’s disability was not final and precluded
reopening even though there was evidence that Mooney’s
occupational disability had decreased.
In Jerry’s Drive In, Inc.
v. Young, Ky., 335 S.W.2d 323 (1960), a worker was awarded
compensation and the employer appealed.
While that appeal was
pending, the employer moved the old Workers’ Compensation Board
to reopen the award, but the Board refused to do so based upon a
lack of jurisdiction.
The Young court affirmed the Board’s
decision, stating as follows: “This precise question was settled
in 1933.
930.
Farmer Motor Co. v. Smith, 249 Ky. 445, 60 S.W.2d 929,
There it was said:
‘After an appeal is perfected * * the
board’s jurisdiction, right, or authority to take any further
steps in the case ceases, while pending appeal.’”
Id.
As the
case sub judice is indistinguishable from Young, we conclude that
the ALJ and the Board did not err in holding that the reopening
of Mooney’s claim was precluded while the issue of her disability
was still before this court on petition for review.
Stearns’s second argument is that the ALJ and the Board
erred in finding that the treatment provided for Mooney,
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including chiropractic care and the prescription of narcotic pain
medication, was reasonable.
KRS 342.020 governs medical
treatment at the expense of an employer.
KRS 342.020(1) provides
that
[i]n addition to all other compensation
provided in this chapter, the employer shall
pay for the cure and relief from the effects
of an injury or occupational disease the
medical, surgical, and hospital treatment,
including nursing, medical, and surgical
supplies and appliances, as may reasonably be
required at the time of the injury and
thereafter during disability . . . .
The ALJ found that the treatments were reasonable based upon
Mooney’s testimony that they provided her some minor pain relief
and Dr. Dubick’s testimony that the procedures were reasonable
and necessary, and the Board affirmed the ALJ’s decision based
upon this testimony.
“The burden of proving that a treatment is unreasonable
is on the employer.”
308, 309 (1993).
Square D Co. v. Tipton, Ky., 862 S.W.2d
The fact that the treatments in question
afforded Mooney only temporary relief does not mean that the
treatments were unreasonable under KRS 342.020, as an employer
must pay for “any reasonable and necessary medical treatment for
relief whether or not the treatment has any curative effect.”
National Pizza Co. v. Curry, Ky. App., 802 S.W.2d 949, 951
(1991).
When the medical testimony is conflicting, “the question
of which evidence to believe is the exclusive province of the
ALJ.”
Tipton, supra at 309.
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When the fact finder finds against the party with the
burden of proof (i.e., Stearns), an appellate body may not
reverse the fact finder’s decision unless the evidence compels a
different result.
643 (1986).
Special Fund v. Francis, Ky., 708 S.W.2d 641,
“To be compelling, evidence must be so overwhelming
that no reasonable person could reach the same conclusion as the
ALJ.”
Daniel v. Armco Steel Co., L.P., Ky. App., 913 S.W.2d 797,
800 (1995).
The ALJ chose to rely upon the testimony of Mooney and
Dr. Dubick rather than the contrary testimony of Dr. Goodman.
Thus, as there was evidence in the record to support the ALJ’s
decision, the record does not compel a contrary result.
Accordingly, the Board properly affirmed the ALJ on this issue.
Stearns also argues that the medical expenses should
not be approved since Dr. Dubick failed to comply with 803 KAR
25:096 § 5.
That regulation requires a physician to provide a
treatment plan if a patient undergoes certain procedures.
Stearns contends that Dr. Dubick was required to provide a
treatment plan since he had treated Mooney with “passive
modalities” as set forth in 803 KAR 25:096 § 5(1)(b).
803 KAR
25:096 § 5(2) provides that a treatment plan for a patient being
treated with passive modalities “shall be provided within fifteen
(15) days following a request by the medical payment obligor.”
However, as noted by the Board, “[t]here is no indication in the
record that either Stearns, or its workers’ compensation carrier,
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has made a request for a treatment plan from Dr. Dubick.”
In
short, we find no error in this regard.
Finally, Stearns argues that the ALJ and the Board
should not have found the medical expenses in question incurred
by Mooney to be reasonable and necessary, since the doctors
treating Mooney have admitted that their treatment methods were
not recognized by the American Medical Association.
However,
Stearns has failed to cite to any specific portion of the
voluminous record in support of this statement.
Furthermore,
Stearns has not cited the content, context, or title of the AMA
guidelines in question.
It is true that an employer is not required to pay for
treatments which are “outside the type of treatment generally
accepted by the medical profession as reasonable in the injured
worker’s particular case.”
Tipton, supra at 310.
However, as
noted by the Board, Stearns has provided insufficient expert
testimony to demonstrate that the treatment prescribed for Mooney
“reflect[s] an extreme position that is not supported by the
medical community at large.”
Stearns has failed to show that “the Board has
overlooked or misconstrued controlling statutes or precedent, or
committed an error in assessing the evidence so flagrant as to
cause gross injustice.”
Western Baptist Hosp. v. Kelly, Ky., 827
S.W.2d 685, 687-88 (1992).
Thus, the opinion of the Board is
affirmed.
ALL CONCUR.
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BRIEF FOR APPELLANT:
BRIEF FOR VIVIAN MOONEY:
Jill A. Campbell
Cincinnati, OH
Marilyn Benge McGhee
London, KY
John F. Kelley, Jr.
London, KY
BRIEF FOR SPECIAL FUND:
David W. Barr
Louisville, KY
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