2009-121. Kinley's Restaurant and Bar Republic Indemnity Company and Northern Adjusters Inc. Appellants vs. Michael S. Gurnett Appellee.
Case Date | November 24, 2009 |
Court | Alaska |
Alaska Workers Compensation Decisions
2009.
Workers' Compensation Appeals Commission
2009-121.
Kinley's Restaurant and Bar Republic Indemnity Company and Northern Adjusters Inc. Appellants vs. Michael S. Gurnett Appellee
Alaska Workers' Compensation Appeals Commission Kinley's Restaurant and Bar, Republic Indemnity
Company, and Northern Adjusters, Inc., Appellants, vs. Michael S. Gurnett,
Appellee.Decision No.
121 November 24,
2009AWCAC Appeal No. 09-008AWCB Decision Nos. 08-0263 and 09-0017AWCB Case No. 200716426Final Decision
Appeal from Alaska Workers' Compensation Board Decision No.
08-0263, issued on December 31, 2008, at Anchorage by southcentral panel
members Judith DeMarsh, Chair, Janet Waldron, Member for Industry, and Tony
Hansen, Member for Labor, and, on reconsideration, Decision No. 09-0017, issued
on January 30, 2009, at Anchorage by southcentral panel members Judith DeMarsh,
Chair, Janet Waldron, Member for Industry, and Tony Hansen, Member for
Labor.
Appearances: Richard L. Wagg, Russell, Wagg, Gabbert and
Budzinski, for appellants Kinley's Restaurant and Bar, Republic Indemnity
Company, and Northern Adjusters, Inc. Steven Constantino, Esq., for appellee
Michael S. Gurnett.
Commission proceedings: Appeal filed March 2, 2009. Oral
argument presented August 4, 2009.Appeal Commissioners: Jim Robison,
Philip Ulmer, andKristin Knudsen.By: Kristin Knudsen, Chair.
Michael Gurnett, a server at Kinley's Restaurant, was injured
when he was struck on the head by a cooler door. Kinley's insurer paid
compensation and benefits until it controverted compensation based on Gurnett's
neurosurgeon's statement that he could return to work. The board decided the
controversion was not made in good faith and ordered payment of a penalty.
Kinley's and its insurer filed an unopposed petition for reconsideration of the
award of a penalty against the employer for late payment of compensation
without a good faith controversion.(fn1) The board modified its decision on
reconsideration, but maintained the award of a penalty based on compensation
not paid from February 14, 2008, through April 30, 2008. Kinley's, its insurer,
and its adjuster appeal the penalty award.
Appellants argue that reliance on a physician's release to
return to work protects them from imposition of a penalty under AS
23.30.155(e).(fn2) Appellants argue that the board's decision requires
appellants to predict that a physician will not later change his opinion,
requires appellants to obtain unanimity in physician opinion before
controversion, and disregards the evidence that the physician had a job
description from the employee. They argue the board imposed standards that
exceed the requirements of the statute and the Supreme Court's decisions in
Harp v. Arco Alaska, Inc.,(fn3) and Dougan v. Aurora
Electric, Inc.(fn4) Appellee opposes and contends that appellants had
a duty to obtain additional information regarding other aspects of his injury
before controverting disability benefits.
The parties' contentions require the commission to address the
question, "When is a controversion of temporary disability compensation based
on a physician's statement that an injured worker is able to return to work
made invalid?" The facts of this case, and the parties' arguments on appeal,
also compel the commission to address the question, "Is the employer's insurer
bound by the position adopted by the employer regarding the employee's ability
to return to work?" Finally, the commission considers whether the board's
decision imposes duties on an insurance adjuster that are inconsistent with its
obligations to its insured and compliance with the Alaska Workers' Compensation
Act (hereafter "Act").
The commission concludes that the board erred as a matter of
law by weighing evidence in support of a controversion against evidence
presented against it before determining if the controversion was valid. The
commission holds that a notice of controversion's validity is assessed based on
the evidence in the issuing adjuster's possession at the time the
controversion was mailed. Therefore, a controversion based on the
original physician opinion is not retroactively converted to a "bad faith"
controversion because later the opinion was withdrawn. The commission concludes
the board erred as a matter of law by assessing a penalty for nonpayment
without a valid controversion retroactively to the date of the
controversion.
The commission holds that an employee must select one attending
physician for the injury, not one physician for each condition caused by the
injury. The employee's direction to his employer to contact a physician
regarding an ability to return to work is a selection of the attending
physician. In this case, the adjuster was not required to inquire of all
consulting physicians before controverting compensation. But, if a physician
specifically qualifies an opinion on return to work by deferring to the
attending physician, or the selected physician declines to serve as the
attending physician, then the insurer must inquire of the default attending
physician.
The commission holds that (1) if the employment has not been
terminated and an employee's position is still available, (2) if the employer
refuses in writing to accept the employee's physician's release to return to
work in the employee's position, and (3), if the employer's refusal is based on
a belief the employee cannot, because of the work injury, perform the essential
functions of the position, then the employer's refusal to accept its employee's
attending physician's release to return to work is an acceptance of liability
for disability compensation that is binding on the insurer. If the insurer has,
or when the insurer obtains, other substantial evidence that the employee can
return to the same or other employment at similar wages or other evidence that
the employee is not disabled, the insurer may assert a defense to liability
based on that evidence. This holding does not apply when the employer offers
temporary limited duty, alternate positions, or limitations on hours or duties
consistent with medical advice or safety rules, even if it results in reduction
in pay.
The commission finds that the record lacks evidence to apply
these holdings. Therefore, the commission reverses the board's decision
awarding a penalty under AS 23.30.155(e) and remands the case to the board for
further proceedings in light of this decision.
1. Factual background.
Michael Gurnett worked part-time at Kinley's Restaurant and Bar
as a server. On September 26, 2007, he was filling ketchup containers near the
door to a walk-in cooler. A chef kicked the door open, striking Gurnett on the
forehead, causing blood to run into his eye and swelling. He developed
headaches and dizziness, and went to the Providence Hospital emergency room two
days later. A CT scan found no abnormality and he was told to see his physician
in a week, but to return to the hospital if new symptoms appeared. On the
fourth day after the injury, Gurnett went to a regularly scheduled eye exam.
His optometrist, Dr. Brinkerhoff, referred him to a neuro-opthalmologist, Carl
Rosen, M.D. Dr. Rosen ordered an MRI scan and additional scans were recommended
by the radiologist, Dr. Moeller, including an MRI angiogram. On October 11,
2007, Dr. Rosen evaluated Gurnett. He referred Gurnett to Marshall Tolbert,
M.D., a neurosurgeon, for evaluation and to rule out dissection of the carotid
artery. Dr. Tolbert saw Gurnett on October 15, 2007, and diagnosed a traumatic
dissection of the left distal cervical internal carotid artery, resulting in
Horner's syndrome, but no abnormalities consistent with stroke. He recommended
surgery to place a stent in the artery, which was nearly occluded.
The employer's physician, neurosurgeon Paul Williams, M.D., saw
Gurnett on October 29, 2007. He agreed that the work injury was the substantial
cause of the Horner's syndrome and stenosis of the carotid artery. He agreed
that surgery, or anticoagulant therapy, were appropriate. On November 5, 2007,
Dr. Tolbert announced he would perform surgery the next week. A second
angiogram in preparation for the surgery revealed that the occlusion had healed
itself; that is, that while it revealed a dissection had occurred, the artery
showed no significant stenosis or pseudoaneurysm. Therefore, surgery was no
longer needed. Dr. Tolbert later sent Gurnett back to Dr. Rosen to evaluate the
Horner's syndrome.
On January 10, 2008, the adjuster wrote Dr. Tolbert to ask when
Gurnett could return to work, if he was medically stable. A copy of a
Department of Labor occupational description form for server/waiter was
attached, as well as the employer's job description. On January 19, 2008,
Gurnett telephoned Dr. Tolbert, wanting to know when he could go back to work,
and, according to Dr. Tolbert's office chart note, Gurnett was told he had no
restrictions.(fn5) On February 12, 2008, Gurnett wrote to Dr. Tolbert,
describing the hazards of his job in detail.(fn6) The next day, February 13,
2008, the adjuster received a letter from Dr. Tolbert, indicating that Gurnett
was able to return to work: "Mr. Gurnett may resume his job. His restrictions
include no chiropractic manipulations or activities with high impact to
cervical region, such as snow machining, ATV riding . . ."(fn7) Temporary
disability compensation was controverted based on this statement.
On February 26, 2008, Solomon Loosli at Kinley's Restaurant
sent an e-mail to...
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