Opinion
NO. 2019-CA-001314-WC
02-07-2020
KEN ISAACS INTERIORS, INC. APPELLANT v. DELBERT RADER; HONORABLE MONICA RICE-SMITH, ADMINISTRATIVE LAW JUDGE; AND WORKERS' COMPENSATION BOARD APPELLEES
BRIEF FOR APPELLANT: Johanna F. Ellison Lexington, Kentucky BRIEF FOR APPELLEE DELBERT RADER: Juliana B. Coffey McKee, Kentucky
NOT TO BE PUBLISHED PETITION FOR REVIEW OF A DECISION OF THE WORKERS' COMPENSATION BOARD
ACTION NO. WC-17-60412 OPINION
AFFIRMING
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BEFORE: GOODWINE, TAYLOR, AND K. THOMPSON, JUDGES. THOMPSON, K., JUDGE: The sole question asked by Ken Isaacs Interiors, Inc. is whether a claimant is automatically entitled to future medical benefits when found to have a permanent disability by an administrative law judge (ALJ). We again hold that the answer is yes.
The relevant facts are simple. Appellee Delbert Rader filed a claim for benefits due to a back injury and an ALJ ultimately found Rader had a permanent disability and a 7% impairment. The ALJ awarded Rader future medical benefits, seemingly as a matter of course. Ken Isaacs sought reconsideration, arguing Rader had not established an entitlement to future medical benefits. The ALJ denied reconsideration, after which Ken Isaacs appealed to the Workers' Compensation Board (the Board) raising only the propriety of the future medical benefits award. Ken Isaacs argued Rader had presented no medical evidence showing he would need future treatment, which it believed precluded a future medical benefits award. The Board disagreed and affirmed the ALJ, after which Ken Isaacs filed this petition for review.
We may reverse a decision of the Board only if it has overlooked or misconstrued binding authority or has committed a flagrant error in assessing the evidence. Kentucky Employers' Mut. Ins. v. Burnett, 432 S.W.3d 733, 738 (Ky.App. 2014). Because Rader carried his burden of proof at the administrative level, the issue now is whether the ALJ's findings are supported by substantial evidence, id., with the caveat that we review questions of law de novo. Bowerman v. Black Equipment Co., 297 S.W.3d 858, 866 (Ky.App. 2009).
Ken Isaacs' sole argument is that there is no automatic entitlement to future medical benefits if a claimant is found to have a permanent disability, a position it contends is supported by FEI Installation, Inc. v. Williams, 214 S.W.3d 313 (Ky. 2007), and Mullins v. Mike Catron Construction/Catron Interior Systems, Inc., 237 S.W.3d 561 (Ky.App. 2007). And, absent the automatic entitlement, Ken Isaacs posits the future medical benefits award was improper because there was no medical evidence showing Rader would need additional treatment.
The issue in FEI Installation and Mullins was whether a claimant could recover future medical benefits without also having been found to have a permanent disability. In FEI Installation, our Supreme Court held that a claimant could receive future medical benefits in such situations because Kentucky Revised Statutes (KRS) 342.020 "does not state that eligibility for medical benefits requires proof of a permanent impairment rating, of a permanent disability rating, or of eligibility for permanent income benefits." FEI Installation, 214 S.W.3d at 318. In Mullins, we held that a worker without a permanent disability who suffers a temporary exacerbation of a pre-existing condition and fails to show a need for future medical attention is not automatically entitled to a future medical benefits award. Mullins, 237 S.W.3d at 563. See also Kroger v. Ligon, 338 S.W.3d 269, 273-74 (Ky. 2011) (construing FEI Installation and Mullins). In sum, FEI Installation and Mullins explain when a claimant who does not have a permanent disability can be awarded future medical benefits. But those cases are inapplicable here because Ken Isaacs does not challenge Rader's 7% permanent impairment.
Despite the obvious dissimilarity between Rader's situation and that in FEI Installation, Ken Isaacs persists in arguing Rader's future medical benefits award is improper because Rader allegedly has not sufficiently shown he would need future treatment. Specifically, Ken Isaacs stresses a comment by our Supreme Court in FEI Installation that the claimant was entitled to future medical benefits because, among other things, "no medical evidence indicated that future medical treatment would be unreasonable or unnecessary." FEI Installation, 214 S.W.3d at 319. We disagree.
First, FEI Installation is inapplicable because Rader has a permanent disability. Second, that snippet from FEI Installation logically only means that a future medical benefits award in cases not involving a permanent disability is dependent upon the evidence. That conclusion is consistent with our holding in Mullins that the ALJ there did not err by denying future medical benefits because there was evidence no future treatment was needed. Mullins, 237 S.W.3d at 562-63.
Simply put, neither FEI Installation nor Mullins answers the question presented here, but Max & Erma's v. Lane, 290 S.W.3d 695 (Ky.App. 2009), does. In Max & Erma's, which curiously was not cited by the ALJ, the Board or the parties, an ALJ awarded Lane permanent partial disability benefits based upon a functional impairment rating of 2% but declined to award future medical benefits. Id. at 696. The Board reversed, holding that a claimant with a permanent disability is always entitled to future medical expenses. Id.
We affirmed, and quote our holding at length because it dooms Ken Isaacs' functionally indistinguishable arguments:
Here, neither party disputes the ALJ's finding that Lane has a 2% whole body impairment rating. In assigning Lane a 2% whole body impairment rating, the ALJ found as a matter of law that Lane is permanently impaired as a result of her work-related injury to her knees, i.e., her bilateral knee condition. A disability exists so long as there is impairment from the work-related injury; because the impairment is permanent, so is Lane's disability. KRS 342.020(1) obligates Max & Erma's to pay for any reasonable and necessary medical treatment for the cure and relief of Lane's disability. Thus, as Lane's disability is permanent, so too is Max & Erma's duty to pay for medical treatment reasonable and necessary for its cure and/or relief. As such, it was error for the ALJ to hold otherwise, and the Board correctly reversed.
Max & Erma's offers two contrary arguments, both of which misinterpret the controlling law under these circumstances.
First, Max & Erma's contends that an employer paying a disabled employee permanent income benefits should not be, in all circumstances, automatically obligated to pay for a disabled employee's future medical benefits relating to a work-related injury. In support, Max & Erma's incorrectly relies upon Mullins v. Mike Catron Construction/Catron Interior Systems, Inc., 237
S.W.3d 561 (Ky.App. 2007), wherein we held that while "medical benefits can be awarded in the absence of a permanent disability award, there is nothing . . . which suggests that such benefits must be awarded in all cases." Id. at 563. Our holding in Mullins was based entirely upon the Supreme Court's holding in FEI Installation, Inc. v. Williams, 214 S.W.3d 313 (Ky. 2007); there, the Supreme Court held that an award of medical benefits is permissive in the absence of a permanent disability award if certain factors exist. The case at bar is entirely distinguishable from Mullins , in that it includes an award of permanent disability, making an award of future medical benefits mandatory, rather than permissive, pursuant to the plain language of KRS 342.020(1).
Second, Max & Erma's contends that Lane is not entitled to future medical benefits because the ALJ did not find, as a matter of law, that future medical treatment would be "reasonably required." Max & Erma's favors this Court with no authority directly supporting this proposition, but states that no medical treatment was required or even available to cure, relieve or treat the effects of Lane's injury at the time of the hearing. In so arguing, Max & Erma's necessarily confuses one distinct type of proceeding with another: a proceeding to grant an award of future medical benefits, versus a proceeding to reopen an existing award of medical benefits on the grounds of a medical fee dispute. An award of future medical benefits creates the obligation of the employer to pay for medical treatment that is reasonable and necessary for the cure and relief from the effects of a work-related injury. In contrast, a proceeding to reopen an award of medical benefits provides an employer the opportunity to contest whether certain medical treatment sought by the employee to treat the work-related injury is, in fact, reasonable and necessary. The rationale is stated more succinctly by the [Kentucky] Supreme Court:
[A]n employer which is obligated to pay . . . benefits is also obligated to pay, in accordance with KRS 342.020(1), for medical treatment reasonably required either at the time of the award or in the future even if it is true, as appellant asserts here, that at the time of the award no medical treatment was required or even available to cure, relieve or treat the effects of the claimant's occupational disease. If nothing else, it appears that in the event that a claimant's occupational disease worsens over time, such an award of medical benefits serves the laudable purpose of permitting the claimant to promptly obtain medical treatment as it reasonably becomes required, rather than possibly forcing the claimant to forego the receipt of needed treatment due to a lack of financial resources. Meanwhile, if the claimant in this matter should make any claim for medical treatment which is not reasonably required, appellant may certainly file a motion to reopen and show that the claim is unwarranted.
Id. at 697-98 (footnote omitted) (bold emphasis added).
Peabody Coal Co. v. Hicks, 824 S.W.2d 411, 412-413 (Ky. 1992).
For the foregoing reasons, we affirm.
ALL CONCUR. BRIEF FOR APPELLANT: Johanna F. Ellison
Lexington, Kentucky BRIEF FOR APPELLEE
DELBERT RADER: Juliana B. Coffey
McKee, Kentucky
See also University of Louisville/American Interstate Ins. Co. v. Matz, No. 2009-CA-001004-WC, 2009 WL 3806154, at *5 (Ky.App. Nov. 13, 2009) ("A finding that a work-related injury produces a permanent impairment rating, which was present in this case, compels a finding that the worker is entitled to an award of future medical benefits."). We cite Matz only as an illustrative example of how the law on this point is settled.