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St. Edward Mercy Medical Center v. Howard
Citations: 424 S.W.3d 881; 2012 Ark. App. 673; 2012 WL 5942748; 2012 Ark. App. LEXIS 790Docket: No. CA 12-546
Court: Court of Appeals of Arkansas; November 28, 2012; Arkansas; State Appellate Court
St. Edward Mercy Medical Center and its insurance carrier, Sister of Mercy Health System, appealed a Workers’ Compensation Commission decision that awarded Jimmie Howard additional medical services and temporary-total disability benefits for the period from November 16, 2010, to February 7, 2011, without offsetting vacation pay. The Commission affirmed the decision based on undisputed facts established by the Administrative Law Judge (ALJ). Howard, employed since May 2000, sustained a work-related injury on August 18, 2010, while lifting a table, resulting in low-back pain radiating to his left leg. There was consensus on the medical services provided prior to November 15, 2010. The dispute arose over surgery performed by Dr. Jorge Alvernia on November 16, 2010, and the associated disability benefits. Howard claimed his condition necessitating surgery stemmed from the work injury, as he had no prior issues. Following surgery, Howard was off work for ten weeks, receiving vacation benefits equivalent to his salary while his medical expenses were covered by health insurance. Medical evaluations indicated grade I spondylolisthesis at L5-S1 and foraminal stenosis. Dr. Alvernia recommended surgery, attributing Howard’s condition to both degenerative processes and trauma. Post-surgery follow-ups indicated significant improvement in Howard’s condition. The ALJ's findings and the medical evidence were pivotal in affirming the Commission’s decision. Testimony from a doctor indicated that the claimant suffered from an L5-S1 disc herniation and degenerative spondylolisthesis, with the latter potentially aggravated by heavy lifting. Despite an underlying degenerative condition, surgery was deemed necessary due to symptomatic progression related to a job-related accident. The doctor affirmed that a ten-week recovery period post-surgery was reasonable, and the claimant returned to work on February 7, 2011. The review process for the Workers’ Compensation Commission's decision focuses on substantial evidence supporting its findings. The Commission is responsible for weighing evidence and determining credibility. In appeals, the court affirms the Commission's conclusions if reasonable minds could agree with them. Legal interpretations of Arkansas statutes are reviewed de novo, and the agency's interpretations are persuasive unless clearly erroneous. The court applies strict construction to workers’ compensation statutes, adhering to their plain meaning. The appellants contested the Commission’s application of Arkansas Code Annotated section 11-9-807(b), arguing that the claimant should not receive temporary-total disability benefits since he received full wages during recovery by using vacation time. The court found no relevant Arkansas appellate case addressing this matter, noting the lack of precedent and the existence of two conflicting Commission decisions on the issue. Arkansas Code Annotated section 11-9-807(b) states that an injured employee receiving full wages during disability is not eligible for compensation during that period. 'Wages' are defined as the monetary compensation for services rendered, including benefits like board and tips. Appellants argue that 'wages' equate to an employee's pay rate, asserting that Howard's vacation pay, matching his regular pay rate, constitutes 'full wages' during his disability. However, the interpretation is deemed misleading; 'full wages' refers to compensation for services rendered, while vacation pay is considered an employee benefit for periods without work. This distinction aligns with legal commentary indicating that payments like sick or vacation pay are based on past service, not directly tied to the injury. On a second appeal point, appellants contest the Commission's decision regarding Howard's entitlement to additional medical treatment by Dr. Alvernia, arguing the treatment was not necessary in relation to his compensable injury. The Administrative Law Judge (ALJ) found sufficient evidence that Howard's work-related injury exacerbated a previously asymptomatic degenerative back condition, necessitating surgery. Dr. Alvernia's testimony supported this, explaining that while Howard had a degenerative condition, the injury from heavy lifting could have aggravated it, leading to the surgery. Thus, the ALJ concluded that the need for surgery was reasonably related to the compensable injury. Dr. Alvernia testified that symptoms appearing within twenty-four hours of a traumatic event likely indicate that the trauma caused those symptoms, as in Howard's situation. He deemed the recommended surgery medically necessary. The ALJ accepted Dr. Alvernia's testimony, emphasizing that credibility determinations and evidence weighing fall under the Commission's jurisdiction. Statutory obligations require employers to provide reasonably necessary medical services for work-related injuries, and the injured employee must prove the necessity of additional treatments by a preponderance of the evidence. The definition of what is reasonable and necessary is a factual matter for the Commission. The decision to award additional medical benefits was affirmed, as reasonable minds could support the Commission's findings. Furthermore, the appellants argued that there was insufficient evidence to support the Commission's determination of Howard's entitlement to temporary-total disability benefits from November 16, 2010, to February 7, 2011, asserting that the disability stemmed from unrelated surgery. This argument was rejected, as Dr. Alvernia indicated that a ten-week recovery period was reasonable. The affirmation of the Commission's decision also upheld the temporary-total disability benefits for the specified period. Additionally, the ALJ ruled that payments received from a paid-leave program during the claimant's disability were considered 'full wages' under statute 11-9-807(b).