12-0023. VANCE RICHARDSON Employee v. INTERIOR ALASKA ROOFING Employer and ALASKA NATIONAL INSURANCE CO. Insurer Defendants.
Court | Alaska |
Alaska Workers Compensation Decisions
2012.
Workers' Compensation Board
12-0023.
VANCE RICHARDSON Employee v. INTERIOR ALASKA ROOFING Employer and ALASKA NATIONAL INSURANCE CO. Insurer Defendants
Alaska Workers'
Compensation Appeals Commission
VANCE RICHARDSON, Employee, Applicant, v. INTERIOR ALASKA ROOFING, Employer,
and ALASKA NATIONAL INSURANCE CO., Insurer, Defendants.AWCB Decision No.
12-0023Filed with AWCB Fairbanks,
Alaskaon February 7, 2012AWCB Case No. 201010244INTERLOCUTORY DECISION
AND ORDERVance Richardson's (Employee) October 6, 2011 Petition to
strike records from the Second Independent Medical Examination (SIME) binders,
and October 19, 2011 Petition concerning questions for the SIME physician were
heard on January 5, 2012 in Fairbanks, Alaska. Attorney Michael Jensen
represents Employee. Attorney Erin Egan represents Interior Alaska Roofing and
Alaska National Insurance Company (Employer). There were no witnesses. The
record closed at the hearing's conclusion on January 5, 2012.
ISSUES
Employee contends SIME records Bates-stamped #00001-00004
should be stricken from the SIME binders as they are not relevant to Employee's
claim.
Employer contends records #00001-00004 are relevant to
Employee's claim and should therefore remain in the binders to be forwarded to
the SIME physician for review and comment.
1) Shall Bates-stamped records #00001-00004 be stricken from
the SIME binders?
Employee contends Employer's proposed questions #2A-B, 6, 7,
and 8 should not be forwarded to the SIME physician as they fall outside the
scope of the disputes listed on the SIME form and agreed upon by the parties.
Specifically, he contends the SIME physician should comment on the disputed
issues, not on the causative factors related to them. He further contends
Employer's proposed question #5 fails to incorporate the expanded definition of
"medical stability" as interpreted by the Alaska Supreme Court and should thus
be stricken.
Employer contends issues of causation as listed in its proposed
questions are relevant to the issues in dispute and appropriate to be forwarded
to the SIME physician, because causation is always an issue unless parties
stipulate otherwise. It further contends its proposed question #5 cites the
definition of "medical stability" as defined by statute and is thus appropriate
to forward to the SIME physician.
Employer did not file an objection to Employee's proposed
questions. However, the panel on its own motion has concerns about both
Employer's and Employee's proposed SIME questions. As the questions have been
sent to Dr. Diamond for the SIME scheduled for January 7, 2012, the panel
raises the issue whether many of the questions set forth the proper legal and
factual standards and need to be revised. Employee's petition brought the
questions to the panel's attention. But, because the issue of the propriety of
Employee's questions was not squarely raised as an issue at hearing, the panel
raises the issue whether the parties should be given an opportunity to address
Employee's questions before Employee's October 19, 2011 petition is
decided.
2) Shall the record be reopened for additional argument on the
propriety of all questions sent to the SIME physician?
FINDINGS OF
FACT
A review of the available record establishes the following
facts and factual conclusions by a preponderance of the evidence:
1) On October 24, 2009, Employee sought treatment at Fairbanks
Urgent Care Center, reporting "left ankle popping" after a "sprain two months
ago." X-rays taken that day revealed mild tibiotalar spurring and a small
Achilles tendon spur, but no acute bone or joint abnormalities. (Fairbanks
Urgent Care records, SIME #00001-00004, October 24, 2009).
2) On July 29, 2010, while working for Employer, Employee
injured his back "lifting a roll of rubber roofing." (Report of Occupational
Injury or Illness, August 2, 2010).
3) On April 15, 2011, Lance Brigham, M.D., conducted an
Employer's Medical Evaluation (EME). Dr. Brigham opined Employee was medically
stable, had suffered no permanent impairment as a result of his work injury,
and was able to return to work as a finish carpenter as of April 15, 2011. He
further opined Employee would be able to return to work as a roofer by July 15,
2011. (Dr. Brigham EME report, April 15, 2011).
4) On May 5, 2011 and August 8, 2011, Employer filed
controversion notices, denying temporary total disability (TTD) benefits,
permanent partial impairment (PPI) benefits, reemployment benefits, medical
benefits, transportation costs, and attorney's fees and costs, based on Dr.
Brigham's report. (Controversion Notices, May 4, 2011, July 25, 2011).
5) On June 6, 2011, Employee filed a worker's compensation
claim (WCC), seeking a finding of frivolous or unfair controversion.
(Employee's WCC, June 2, 2011).
6) On June 28, 2011, Daniel Kim, M.D., opined Employee was not
medically stable and recommended Employee undergo radiofrequency ablation at
levels L3-S1. (Dr. Kim report, June 28, 2011).
7) On June 28, 2011, Physician's Assistant Graciela Sanabria
opined Employee should "refrain from heavy lifting greater than 10-15 pounds.
He should not climb ladders, no stooping, no bending, and no kneeling as this
may aggravate his symptoms. . . . Once we are able to control his pain he will
be able to return to some of his regular work activities, as long as they do
not place strain on his back." (P.A. Sanabria report, June 28, 2011).
8) On July 6, 2011, Employer filed an Answer to Employee's WCC,
denying all benefits in reliance on Dr. Brigham's April 15, 2011 EME report
(Employer's Answer, June 29, 2011).
9) On July 6, 2011 the parties attended a prehearing conference
(PHC). Employee orally amended his WCC to include claims for TTD, PPI, medical
costs, transportation costs, reemployment benefits, interest, attorney's fees
and costs, and an SIME, and clarified he was no longer seeking a finding of
frivolous or unfair controversion. The parties agreed to conduct an SIME. (PHC
Summary, July 6, 2011).
10) On September 29, 2011, Employer filed a medical summary
including records from Employee's October 24, 2009 visit to Fairbanks Urgent
Care Center for treatment for his left ankle. (Medical Summary, September 27,
2011).
11) On October 6, 2011, Employer filed a completed SIME form
with the board, listing the disputed issues as medical treatment, functional
capacity, medical stability and PPI. As the parties' representatives signed the
form, the parties stipulated the relevant disputes for the SIME physician's
opinion in this case are reasonable and necessary treatment, functional
capacity, and medical stability. (SIME form, October 4, 2011).
12) On October 11, 2011, Employee filed a timely petition
objecting to the September 29, 2011 medical summary, requesting the records
from Employee's October 24, 2009 visit to Fairbanks Urgent Care Center be
removed from the board's file, as they were not relevant to his claim.
(Employee's Objection to September 29, 2011 Medical Summary, October 6,
2011).
13) On October 17, 2011, Employer submitted the following
proposed SIME questions to the board designee, and served them on Employee's
counsel:
11. Please provide your diagnoses.
2. When determining whether or not the disability or need for medical treatment arose out of and in the course of the employment, the Board must evaluate the relative contribution of different causes of the disability or need for medical treatment.
A. On a more probable than not basis, please identify all the different causes which led to the conditions you have diagnosed.
B. With respect to the different causes you have identified, please indicate which, if any, is the substantial cause of the condition. For purposes of this question, please assume that 'the substantial cause' means the cause that plays the greatest role in bringing about the...
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