12-0089. RANDY C. HESTER Employee v. TandM ENTERPRISES INC. d/b/a SPIRITS OF ALASKA Uninsured Employer And THE ALASKA WORKERS' COMPENSATION BENEFITS GUARANTY FUND Defendants.
Court | Alaska |
Alaska Workers Compensation Decisions
2012.
Workers' Compensation Board
12-0089.
RANDY C. HESTER Employee v. TandM ENTERPRISES INC. d/b/a SPIRITS OF ALASKA Uninsured Employer And THE ALASKA WORKERS' COMPENSATION BENEFITS GUARANTY FUND Defendants
ALASKA WORKERS' COMPENSATION
BOARDP.O. Box 115512 Juneau, Alaska 99811-5512RAKDY C. HESTER, Employee, Applicant,
v. TandM ENTERPRISES, INC., d/b/a SPIRITS OF ALASKA, Uninsured Employer, And
THE ALASKA WORKERS' COMPENSATION BENEFITS GUARANTY FUND,
Defendants.AWCB
Decision No. 12-0089Filed with AWCB Anchorage,
Alaska on May 22, 2012AWCB
Case No. 200920443FINAL DECISION AND ORDERRandy C. Hester's (Employee) May 25, 2011 workers' compensation
claim (WCC or claim) was heard on November 2, 2011, in Anchorage, Alaska.
Attorney Michael Flanigan represented Employee who testified. Attorney Greg
Oczkus represented Employer. Bridgett Thompson, president and 100% shareholder
in Enterprises, Inc., d/b/a Spirits of Alaska (Employer) appeared and
testified. Velma Thomas, Program Coordinator, State of Alaska, Department of
Labor and Workforce Development, Workers' Compensation Division, and Joanne
Pride, Claims Supervisor, Wilton Adjustment Service, appeared representing the
Alaska Workers' Compensation Benefits Guaranty Fund (fund). Ms. Pride, Paul
Starrish, Jr., and Karen Decker-Brown, ANP, testified.
The record was held open sixty days for the parties to file
evidence not in the record at the time of hearing but deemed necessary by the
board to determine the issues before the board. Employee was directed to file
the receipt book he maintained showing evidence of his earnings from odd jobs
performed, any receipts for out of pockets expenses for medications,
transportation, or other items related to the claim, and any medical records
not filed with the board or generated within the sixty day period in which the
record was held open. Employer was directed to make available to Employee's
counsel all of the 2009 "day sheets" for inspection and review, to file
evidence of any medical bills paid directly to providers, and any employer's
medical examination records generated. At hearing Employer stipulated Employee
was injured in the course and scope of his employment and agreed to pay for an
MRI of Employee's abdomen/chest to determine, if possible, the source of
continuing chest/thoracic pain. The record closed when the time passed for all
parties to file post-hearing evidence, as directed at hearing, and upon further
deliberation by the board on January 25, 2012. Upon the filing of petitions by
Employee a prehearing was convened by the chair on February 23, 2012, at which
it was determined the record needed to be reopened to allow Employer to file
twelve day sheets which Employer was ordered to file at hearing and to allow
each party to file any additional medical records in their possession due to
miscommunication regarding what post-hearing diagnostic testing and evaluation
had been performed. The hearing record was reopened for ten days and closed
again when the board met to deliberate on March 6, 2012.
ISSUES
Employee contends he was hurt on the job working for Employer.
He contends he was disabled as a result of his work-related injury and is
entitled to temporary total disability (TTD) and/or temporary partial
disability (TPD), past and future medical and related transportation costs,
interest, penalties, partial permanent impairment (PPI), attorneys fees and
costs, and he requests a finding Employer's controversion in fact was unfair or
frivolous. Employee seeks an order awarding him benefits against Employer as
supported by his testimony and medical records.
Employer concedes Employee was injured in the course and scope
of his employment, and is entitled to temporary total disability (TTD) from May
26, 2009 to August 25, 2009. Employer contends Employee's further requests for
TTD and TPD are speculative and not supported by any documentation of wages
earned making it difficult to determine a compensation rate in this case.
Employer further contends Employee became medically stable when he returned to
work for Employer, his limitations were accommodated, and Employee chose not to
continue working and is not entitled to time loss benefits after that point.
Employer also contends Employee lacks standing to seek interest and penalties
on behalf of medical providers, and no medical providers are owed interest or
penalties because Employer has not been billed for care as required by the Act.
Employer contends Employee has not been rated for PPI so none is owed. Finally,
Employer contends Employee's attorney's fees and costs are excessive and should
be reduced.
The fund contends Employee is not entitled to TTD benefits from
the date of injury until August 24, 2009, because he received compensation in
the form of rent from his landlord who is a second employer. The fund contends
Employee is not entitled to TPD benefits after he returned to work on August
25, 2009, since the Employer offered work with accommodations and Employee
chose not to continue working. The fund also contends the record does not
contain enough information to accurately determine a compensation rate at which
to pay any time loss benefits which may be owed, and that Employee's subjective
explanation of income of $700 per month is too speculative to be the basis of
his compensation. Finally, the fund contends medical benefits, including those
for cervical pain, not reasonably related to the work injury are not
compensable.
1) Is Employee's work injury the substantial cause of
his left sided chest pain, broken ribs, neck, and left arm
pain?
2) Is Employee entitled to an award of temporary total
disability (TTD)?
3) Is Employee entitled to an award of temporary
partial disability (TPD)?
4) If Employee is entitled to an award of TTD or TPD,
what is his compensation rate?
5) Is Employee medically stable? If so, on what date
was medical stability reached?
6) Is Employee entitled to transportation
costs?
7) Is Employee entitled to an award of permanent
partial impairment benefits?
8) Is Employee entitled to interest on any benefits
awarded?
9) Is Employee entitled to a penalty?
10) Is Employee entitled to a finding of an unfair or
frivolous controversion?
11) Is Employee entitled to reasonable attorney's fees
and costs?
FINDINGS OF FACT
A review of the entire record establishes the following
relevant facts and factual conclusions by a preponderance of the
evidence:
1) The parties stipulated at hearing Employee was Employer's
Employee and there was a legal "Employer/Employee" relationship between them on
May 26, 2009, when Employee was injured in the course and scope of his
employment. (Record; observations).
2) Employer, as an "Employer" using "Employee" labor, came
under the Alaska Workers' Compensation Act on May 26, 2009, and failed to file
evidence of compliance with the Act's requirement to insure its employees for
work-related injuries. (Record; observations).
3) Employer had actual notice of Employee's May 26, 2009 injury
within 24 hours of the injury. (Starrish; Thompson).
4) Employer never provided Employee with an injury report,
never completed one, and never filed one with the board. (Hester; Thompson;
record).
5) Employee was injured on May 26, 2009, at approximately 11:15
p.m., when he followed two shop lifters out of the store and was beaten by the
two shop lifters and a third man in the alley/parking lot of the store.
Employee was acting in the course and scope of his employment when he was
injured. (Hester; Thompson; record).
6) Employee was seriously injured by the three men who knocked
him to the ground and kicked him repeatedly. (Hester; Starrish; Anchorage
Police Report). APD photos taken on the day of the attack show cuts and
abrasions on the face, head and neck of Employee. (Disc of APD photos).
7) Employee declined medical treatment and ambulance transport
to a hospital from paramedics on the scene for financial reasons, and completed
his shift on the day of injury. (Hester; Starrish).
8) Employee's pain became severe enough that he sought
treatment at the Providence Alaska Medical Center (PAMC) Emergency Room (ER)
early the next morning, on May 27, 2009. Employee's chief complaints were chest
pain and shortness of breath. He also had swelling along his neck and left
axilla, and reported being hit in the head several times. Tim Silbaugh, MD,
noted Employee was reluctant to seek medical care because he had no insurance
and was "not on the payroll of the liquor store where he was working." A chest
x-ray showed notable rib fractures at four through eight with presumed small
pneumothorax. Employee was treated with morphine and Toradol for pain. Dr.
Silbaugh recommended admission to the hospital to monitor the pneumothorax and
for pain control, but Employee refused for "financial reasons," and agreed to
return if his symptoms worsened. Employee was discharged against medical advice
(AMA) with a refrerral to Jeffrey Sedlack, MD, of general surgery, and
prescriptions for Ibuprofen and Percocet. (Dr. Silbaugh, PAMC ER note,
5/27/2009).
9) APD photos taken in follow up on May 27, 2009, show swelling
of Employee's face, neck, shoulders, and back, as well as discoloration and
bruising. (Disc of APD photos).
10) Employee returned to PAMC at approximately 2:30 a.m. on May
28, 2009, and was admitted with a diagnosis of traumatic pneumothorax,
subcutaneous emphysema, and four left-side rib fractures. A chest tube was
inserted to...
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