Thomas J. England SSN: XXX-XX-XXXX Plaintiff,
v.
General Motors Corporation, Self-Insured Defendant,
No. 7314
Michigan Workers Compensation
State of Michigan Department of Licensing and Regulatory Affairs Michigan Office of Administrative Hearings and Rules Workers’ Compensation Board of Magistrates
May 21, 2019
The
social security number and dates of birth have been redacted
from this opinion.
TRIAL
DATE: May 10, 2019
David
J. Cooper (P12202) for Plaintiff
Thomas
J. Ruth (P44434) for Defendant
OPINION
JOHN
M. SIMS, MAGISTRATE (256G) JUDGE.
WITNESSES
TESTIFYING PERSONALLY
Plaintiff:
Thomas
J. England
Defendant:
None
WITNESSES
TESTIFYING BY DEPOSITION
Plaintiff:
Michael
L. Fox, D.O., taken on February 7, 2018
Defendant:
None
EXHIBITS
Joint:
1.
Deposition of Michael L. Fox, D.O.
Plaintiff:
2.
Medical records of Evelyn Eccles, M.D.
3.
Letter authored by Attorney David Cooper to the claimant
dated November 26, 2018 with an attached copy of the report
of Dr. Michael L. Fox dated October 17, 2017.
4.
Letter to Attorney David Cooper consisting of six handwritten
pages authored by the claimant, Thomas England. The document
is signed by Mr. England.
5. A
one-page handwritten note by Thomas England addressed to Dr.
Eccles.
6. A
one-page document directed to the adjuster for the Defendant
by Mr. England.
7. A
set of billings and receipts identified as the complete
billings incurred by Mr. England as a result of the
nonpayment by Defendant.
All of
the Plaintiff’s Exhibits were admitted and the Joint
Exhibit was admitted without any objection.
Defendant
B. Then
entire medical record of the treating physician Dr. Eccles
along with original medical concerning the treatment of the
claimant at the time of his original injury. These include
the records of the treating physicians and examining
physicians at the time of that original injury in 1992.
All
Exhibits were admitted without objection.
EVIDENCE
PRESENTED LAY TESTIMONY THOMAS ENGLAND,
PLAINTIFF
Thomas
J. England testified that he was born xx/xx/xx, making him 67
years of age as of the date of trial. He indicated that he
was hired by General Motors Corporation in November of 1975
and his last day of work for this company was March 1, 1993.
He further testified that he had a work-related injury at
General Motors Corporation and that he redeemed liability for
wage loss benefits as of June 7, 2016. That redemption left
medical open with regards to his low back condition and a
herniated disc at L5-S1.
Plaintiff
testified that in February of 2017 a prescription that he
received from his doctor; Dr. Evelyn Eccles, was denied. This
prescription was for OxyContin, a drug that he had been
taking for many years at the direction and prescription of
his treating physician for low back pain associated with his
alleged work-related injury. He further indicated that the
Defendant and its administrator had paid prescription
medicine bills regularly (Plaintiff testified that there had
been other instances when the Defendant refused to pay a bill
but eventually paid it).
Plaintiff
indicated that he contacted the administrator for General
Motors, to wit, Sedgwick, and requested that this
prescription be paid and was advised that they would not pay
it. He put the prescription on his Visa card and paid the
prescription cost himself for approximately two months. He
then applied to his Blue Cross Blue Shield coverage, pursuant
to his retirement under his contract with the UAW and General
Motors for payment of this prescription. Thereafter, and up
to the point of time of trial, the health insurance carrier,
Blue Cross Blue Shield, as part of his UAW retirement, has
continued to pay for this medication, leaving him with a
deductible to pay each month in the amount of roughly
$111.30.
Plaintiff
testified that on October 17, 2017 he met with Michael L.
Fox, D.O., at the request of the Defendant for the purposes
of an Independent Medical Examination. (Dr. Fox’s
report is attached to various exhibits in this matter, as
well as the deposition of the doctor, all of which were
admitted into evidence at the time of trial.)
Plaintiff
testified that Dr. Fox had suggested that he try getting off
Oxycontin, abstain from alcohol and marijuana, and that he
try other types of drugs. He testified he tried two different
types of drugs, including Morphine Sulfate and those attempts
were unsuccessful. He was also put on another drug which he
said caused him to have headaches and did not improve his
pain at all.
Plaintiff
testified that Dr. Fox had recommended that he enter into
detoxification. It was also suggested he begin using
(Buprenorphine) as a substitute for the medications that he
was receiving. He indicated that he was willing to try what
the doctor suggested, but he had not been offered that
opportunity.
Plaintiff
strongly contested the characterization of Dr. Fox that he is
an alcoholic. He testified that he does drink. He
understands, based on something he claimed his father’s
doctor told him, that it was good for him to have a couple of
beers a day for his heart condition. He testified that at the
present time he drinks at least two beers a day.
Plaintiff
further testified that he uses marijuana and has for most of
his life. (He testified he started drinking alcohol at age 17
and that he started smoking marijuana back in the 1970s.)
Plaintiff indicated that he has never been in a
detoxification center for alcohol. He has quit drinking on
several occasions, the purpose of his quitting drinking was
to save money, and he never experienced any delirium tremors
or any other type of withdrawal when he stopped drinking
alcohol.
Plaintiff
denied that he ever threatened an adjuster with regards to
the denial of his prescription medications. He requested
reimbursement and he indicated that those requests were
denied. He pointed out to the adjuster that he felt the
adjuster did not understand how difficult it was for a person
who was taking pain medications for a long time to be
abruptly stopped in their treatment regimen. He was adamant
that he never threatened anyone.
Plaintiff
further testified that he paid for the Morphine Sulfate after
it was rejected by the administrator, indicating that the
administrator initially paid for the Morphine Sulfate when he
attempted to take it, but then stopped paying for it.
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