Darryl Davis v. Deffenbaugh Industries, Inc.

Additional Party: Drisko, Fee \& Parkins PC (Medical Fee Provider) (Medical Fee Dispute Number 04-00394)

Insurer: Self through Zurich North American, c/o Sedgwick Claims Management

Hearing Date: January 8, 2007

Checked by: RBM

1. Are any benefits awarded herein? Yes.
2. Was the injury or occupational disease compensable under Chapter 287? Yes.
3. Was there an accident or incident of occupational disease under the Law? Yes.
4. Date of accident or onset of occupational disease: Cumulative through January 14, 2004.
5. State location where accident occurred or occupational disease was contracted: Platte County, Missouri.
6. Was above employee in employ of above Employer at time of alleged accident or occupational disease? Yes.
7. Did Employer receive proper notice? N/A.
8. Did accident or occupational disease arise out of and in the course of the employment? Yes.
9. Was claim for compensation filed within time required by Law? Yes.
10. Was Employer insured by above insurer? Yes.
11. Describe work employee was doing and how accident occurred or occupational disease contracted: Employee drove a dumpster truck, climbed in and out of the truck, hooked up dumpsters to the truck with a hook and chain, placed tarps over the truck, opened and closed the doors of the dumpster with forceful pushing and pulling, and picked up debris, which caused repetitive cumulative trauma, resulting in injury to his back, hips, and legs.
12. Did accident or occupational disease cause death? No Date of death? N/A.
13. Part(s) of body injured by accident or occupational disease: Back, hips, and legs.
14. Nature and extent of any permanent disability: Permanent and total disability.
15. Compensation paid to-date for temporary disability: None.
16. Value necessary medical aid paid to date by Employer/insurer? None.
17. Value necessary medical aid not furnished by Employer/insurer? None.
18. Employee's average weekly wages: $\ 1,226.81.
19. Weekly compensation rate: $\ 662.55 for temporary total disability and permanent total disability, and $\ 347.05 for permanent partial disability.
20. Method wages computation: Section 287.250, RSMo.

Amount of compensation payable:

Unpaid medical expenses: $\$ 17,405.02 .{ }^{[1]}$

request, and the request was granted. However, counsel for Employer/Insurer did not offer any additional medical records into evidence during that thirty day period, and the record in this case was closed on February 7, 2007. The Administrative Law Judge disclosed that he had represented the medical fee provider (but not in this case) prior to being appointed an Administrative Law Judge effective January 1, 2006. Counsel for Employer and Insurer advised that they and their clients consented to the Administrative Law Judge handling the hearing in this case. The representatives of DFP present at the hearing also consented to the Administrative Law Judge handling the hearing in this case.

Timothy M. Alvarez requested a 25\% attorney's fee from all compensation awarded, other than any amounts awarded relating to the medical fee requests of DFP.

It was stipulated between Claimant and Employer/Insurer that:

1. On or about January 14, 2004, Deffenbaugh Industries, Inc. was an employer operating under the provisions of the Missouri Workers' Compensation law and that their liability under said Law was fully self-insured through Zurich North America, c/o Sedgwick Claims Management.
2. On or about January 14, 2004, Darryl Z. Davis was an employee of Deffenbaugh Industries, Inc. and was working under the provisions of the Missouri Workers Compensation Law.
3. A claim for compensation was filed within the time prescribed by law.
4. No compensation had been paid and no medical aid had been furnished by Employer/Insurer.
5. The charges of DFP contained in Exhibit A were reasonable and necessary.

It was also stipulated between Claimant and Employer/Insurer that the issues in dispute to be determined in this case were:

1. Whether Claimant sustained an injury by accident or occupational disease arising out of and in the course of his employment for Employer, and whether Claimant's alleged injury was medically causally related to an accident or occupational disease arising out of and in the course of his employment for employer.
2. What is the nature and extent of Claimant's permanent disability, if any, including whether Claimant is permanently and totally disabled as a result of an injury by accident or occupational disease arising out of and in the course of his employment for Employer?
3. Whether Employer had notice of the alleged injury and whether notice was required?
4. What is Claimant's average weekly wage, and what are the compensation rates?
5. What is Employer/Insurer's liability for past temporary total disability from January 15, 2004 through May 24, 2004?
6. What is Employer/Insurer's liability for past medical bills, including the direct pay requests of DFP?
7. What is Employer/Insurer's liability for future medical aid?

Claimant offered the following Exhibits which were admitted in evidence:

Exhibit A-Drisko, Fee and Parkins, P.C. medical records and bills.

Exhibit B-North Kansas City Hospital records and bills.

Exhibit C-Wyandotte Center records and bills.

Exhibit D-Dr. Brent Koprivica deposition.

Exhibit E-Michael Dreiling deposition.

Exhibit F-Dr. David Mouille deposition.

Exhibit G-Payroll printouts.

Exhibit H-Medical bill summary.

Employer/Insurer offered the following Exhibits which were admitted in evidence:

Exhibit 1-Dr. John Ciccarelli deposition.

Exhibit 2-Dr. Allen Parmet deposition.

Exhibit 3-Terry Cordray deposition.

Exhibit 4-Dr. Michael Pronko deposition.

Exhibit 5-Darryl Davis deposition.

Exhibit 6-Darryl Davis deposition.

Exhibit 7-Child support lien.

Exhibit 8-Child support lien.

Exhibit 9-Letter from Deffenbaugh.

Exhibit 10-Letter from Deffenbaugh.

Darryl Davis stated that he was born on July 13, 1952 and was fifty-four years old. He and his wife, Roseanne, had been married for twelve years. They had no children. He had children from a prior marriage. He was not employed. He did not graduate from high school or obtain a GED. His last grade completed was ninth grade. He did not have typing or computing skills. He had no licenses except for a commercial driver's license. He said he was not very good at reading and writing and could not read the paper. He had driven a truck for about twenty years. He drove for an Employer, a meat company, and others. He was last employed as a roll-off driver for Employer. He worked there almost five years. His last day of work for Employer was January 14, 2004. His job title was the same during the time he worked there, that being roll-off driver. His route was near the airport. He picked up large dumpsters. He was paid by the load and earned about $\ 30.00 per load. He worked between twelve and fourteen hours per day, six to seven days a week. His weekly income was approximately $\ 1,200.00, and he earned about $\ 50,000 per year. He was shown Claimant's Exhibit G and noted that he had earnings of $\ 1,662.00 for the week of August 16, 2003 and $\ 880.00 and for the week of August 23