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Patsy Ellis v. Brad and Laura Erwin, d/b/a Tri-State Medical Enterprises, Inc. and/or Erwin Medical Supplies and Uniforms

Decision date: December 10, 200812 pages

Summary

The Commission affirmed the administrative law judge's award of workers' compensation benefits to Patsy Ellis for injuries sustained in a motor vehicle accident on December 10, 2004, while employed. The award includes unpaid medical expenses of $165,459.99, 121 weeks of temporary disability, 244 weeks of permanent partial disability, and future medical benefits.

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Third-Party Injury Check

This workers' comp decision may point to a separate injury claim.

  • A driver, contractor, property owner, or equipment company may share fault.
  • The injury involved a vehicle, unsafe premises, defective equipment, or a non-employer vendor.
  • A serious injury or death may need both benefits review and civil-claim analysis.

Caption

Employee:Patsy Ellis
Employer:Brad and Laura Erwin, d/b/a Tri-State Medical Enterprises, Inc. and/or Erwin Medical Supplies and Uniforms
Insurer:Uninsured
Additional Party:Treasurer of Missouri as Custodian of Second Injury Fund
Date of Accident:December 10, 2004
Place and County of Accident:Jasper County, Missouri

The above-entitled workers' compensation case is submitted to the Labor and Industrial Relations Commission (Commission) for review as provided by section 287.480 RSMo. Having reviewed the evidence and considered the whole record, the Commission finds that the award of the administrative law judge is supported by competent and substantial evidence and was made in accordance with the Missouri Workers' Compensation Act. Pursuant to section 286.090 RSMo, the Commission affirms the award and decision of the administrative law judge dated July 11, 2008. The award and decision of Administrative Law Judge Karen Wells Fisher, issued July 11, 2008, is attached and incorporated by this reference.

The Commission further approves and affirms the administrative law judge's allowance of attorney's fee herein as being fair and reasonable.

Any past due compensation shall bear interest as provided by law. Given at Jefferson City, State of Missouri, this 10th day of December 2008. LABOR AND INDUSTRIAL RELATIONS COMMISSION William F. Ringer, Chairman

Alice A. Bartlett, Member John J. Hickey, Member

AWARD

Employee: Patsy Ellis

Injury No. 04-145448

Before the <br> DIVISION OF WORKERS' <br> COMPENSATION <br> Department of Labor and Industrial Relations of Missouri <br> Jefferson City, Missouri

Dependents: N/A

Employer: Brad and Laura Erwin, d/b/a Tri-State Medical

Enterprises, Inc. and/or Erwin Medical Supplies

And Uniforms

Additional Party: Second Injury Fund

Insurer: Uninsured

Hearing Date: February 25, 2008

Checked by:

FINDINGS OF FACT AND RULINGS OF LAW

  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: DECEMBER 10, 2004
  5. State location where accident occurred or occupational disease was contracted: JASPER COUNTY, MO
  6. Was above employee in employ of above employer at time of alleged accident or occupational disease? YES
  7. Did employer receive proper notice? YES
  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? UNINSURED
  11. Describe work employee was doing and how accident occurred or occupational disease contracted: INVOLVED IN MOTOR VEHICLE ACCIDENT
  12. Did accident or occupational disease cause death? NO
  13. Part(s) of body injured by accident or occupational disease: BODY AS A WHOLE
  1. Compensation paid to-date for temporary disability: NONE
  2. Value necessary medical aid paid to date by employer/insurer? NONE
  3. Value necessary medical aid not furnished by employer/insurer? 641.40
  4. Employee's average weekly wages: $\ 625.00
  5. Weekly compensation rate: $\$ 416.67 / \ 354.05

- Method wages computation: STIPULATED

COMPENSATION PAYABLE

  1. Amount of compensation payable:

Unpaid medical expenses: $\ 165,459.99

121 weeks of temporary total disability (or temporary partial disability)

244 weeks of permanent partial disability from Employer

-0- weeks of disfigurement from Employer

  1. Second Injury Fund liability: YES

Total: $\ 165,459.99

  1. Future requirements awarded: FUTURE MEDICAL

Said payments to begin IMMEDIATELY and to be payable and be subject to modification and review as provided by law.

The compensation awarded to the claimant shall be subject to a lien in the amount of 25 PERCENT of all payments hereunder in favor of the following attorney for necessary legal services rendered to the claimant:

Tom Carlton

MORRISON \& WEBSTER

FINDINGS OF FACT and RULINGS OF LAW:

Employee: Patsy Ellis Injury No. 04-145448

Dependent:N/A
Employer:Brad and Laura Erwin, d/b/a Tri-State Medical Enterprises, Inc. and/or Erwin Medical Supplies And Uniforms
Additional Party:Second Injury Fund
Insurer:Uninsured
Hearing Date:February 25, 2008

AWARD ON HEARING

A hearing in this matter was held on February 25, 2008, before the undersigned. The employee, Patsy Ellis, appeared personally and through her attorney Tom Carlton. The Second Injury Fund, an additional party to this claim, appeared through its attorney Assistant Attorney General Christina Hammers. The employer, Brad and Laura Erwin d/b/a Tri State Medical Enterprises, Inc. and/or Erwin Medical Supplies and Uniforms (henceforth Employer), did not appear at hearing; however, the records of the Division of Workers' Compensation show notice of the hearing was sent to the employer's last known address. All parties present stipulated that on or about Dec. 10, 2004, Employer was operating subject to Missouri Workers' Compensation law. The Employer, however, did not carry workers' compensation insurance as required under Chapter 287 RSMo. (SIF Ex. II). On the alleged injury date of Dec. 10, 2004, Patsy Ellis was an employee of Employer and was working subject to Missouri Workers' Compensation law. The parties agreed that on or about Dec. 10, 2004, Ms. Ellis was involved in a motor vehicle crash while working in the course and scope of employment for Employer. The parties agreed that venue in the Joplin Division office, which is situated in Newton County, was appropriate. Ms. Ellis notified Employer of her injuries as required by Section 287.420, and her Claim for Compensation was filed within the time prescribed by Section 287.430. At the time of the claimed accident, Ms. Ellis' average weekly wage was $\ 625, sufficient to allow for compensation rates for temporary total disability of $\ 416.67 and for permanent partial disability of $\ 354.05. The issues to be resolved at final hearing include:

  1. Employer and/or Second Injury Fund's liability for past medical treatment.
  2. Employer and/or Second Injury Fund liability for future medical.
  3. Employer's liability for 121 weeks of unpaid temporary total disability for the dates of December 10, 2004, to January 3, 2006.
  4. Nature and extent of Employee's permanent disability, if any.
  5. Liability of the Second Injury Fund.

DISCUSSION

Employee Patsy Evonne Ellis appeared and testified on her behalf. She is 58 years of age, having been born on April 26, 1949, and lives in Neosho, MO. Ms. Ellis completed the 9th grade; she does not have a G.E.D. She has spent most of her adult career employed in outside sales.

Ms. Ellis was hired by Brad and Laura Erwin d/b/a Tri State Medical Enterprises, Inc. and/or Erwin Medical Supplies and Uniforms in October 2002 as Director of Marketing. Every day she worked on the road visiting clients in Missouri, such as hospitals, nursing homes, doctor's offices and nursing schools, selling medical equipment, uniforms and jewelry. She testified that on Dec. 10, 2004, she was one of six employees employed by Employer. Ms. Ellis testified that on Dec. 10, 2004, she was driving to Cox Monett Hospital, where she was scheduled to host a uniform fair, when she was involved in a motor vehicle crash at the junction of Missouri highways 69 and 400 sometime after 5:20 a.m. near her home. She has no memory of the crash. Police reports indicate Ms. Ellis drove her personal vehicle into a dirt embankment. She was taken by ambulance to Freeman

Medical Center in Joplin, where she underwent CT scans on multiple parts of her body. A CT scan of her abdomen and pelvis revealed transverse process fractures on the right at L4 and L5. A CT scan of her head showed early diffuse cerebral edema associated with a head injury. A CT scan of her right ankle identified a comminuted right ankle fracture/dislocation, including the distal fibula, distal tibia and talus. A CT scan of her left ankle revealed a comminuted calcaneal fracture with lateral displacement of multiple fragments that did extend into the subtalar joint, as well as a distal tibial fracture that included a non-displaced medial malleolar component as well as a posterolateral component. There was evidence of rib fractures and right pneumothorax as well.

Ms. Ellis was treated orthopedically by Drs. Schwab and Smith. Dr. Schwab performed open reduction and internal fixation on both Ms. Ellis' right and left ankles. Dr. Schwab also performed an open reduction and internal fixation for the lateral tibial plateau fracture below her right knee. Dr. Smith performed an open reduction and internal fixation of her calcaneal fracture. During her hospitalization, Ms. Ellis developed hospital-acquired pneumonia associated with her chest trauma. After being released from the hospital, Ms. Ellis received outpatient and in-home care, as well as pain management.

Ms. Ellis testified she is in pain every day, and because of her pain she limits the time she is on her feet and takes pain medication. She is able to ambulate for short periods of time without an assistive device, but she uses a wheelchair if she must walk long distances, such as at the Mall or Wal-Mart. In her kitchen, Ms. Ellis uses a seat with wheels in order to cook because she cannot be on her feet for long periods of time. She has trouble balancing on her feet. She no longer can baby-sit her grandchildren or do outside sales or volunteer work due to her pain and lack of mobility. She, however, currently works as a customer service representative for AT\&T.

Ms. Ellis testified that the majority of her medical bills have been paid by her personal insurance. She also testified she believes her insurance falls under ERISA, and she may be required to pay back her insurance under that federal law. Under cross examination, she admitted, however, she has no personal knowledge of whether her insurance was covered by ERISA, and no person or entity has contacted her about any subrogation interest.

The Second Injury Fund presented SIF Ex. I, an itemized bill provided by Ms. Ellis of bills related to her medical treatment and amounts currently owed. According to the itemized list, she is claiming:

ProviderAmountPaid
Outstanding
Dr. Brent Koprivica (IME)\$1,250.00$\ 1,250.000
Cherokee County Ambulance\$803.00$\ 803.00 (Farmers Ins.)0
METS\$1,079.00$\begin{gathered} \$ 100.00 \text { (Farmers) } \\ \$ 784.00(\mathrm{BC} / \mathrm{BS}) \\ \$ 195.00 \text { (Hospital Contract) } \end{gathered}$0
Dr. Schwab\$8,226.00$\begin{gathered} \$ 3,168.00(\text { Managed Care) } \\ \$ 107.00(\text { Insurance }) \\ \$ 4,951.00 \text { (Man. Care Adjust.) } \end{gathered}$0
Ferrell Duncan Clinic\$12,307.00$\begin{gathered} \$ 6,174.10(\mathrm{BC} / \mathrm{BS}) \\ \$ 5,966.00(\mathrm{BC} / \mathrm{BS} \text { Adj. }) \end{gathered}$\$166.90
Mercy Health Systems/ <br> St. Mary's Home Care\$3,204.50$\begin{gathered} \$ 2,102.79 \text { (Health Adv.) } \\ \$ 627.21 \text { (Health Adv. Adj.) } \\ \$ 60.00 \text { (Employee) } \\ \$ 10.00 \text { (Insurance) } \end{gathered}$$\ 404.50
Cox South Medical Center/$\ 38,237.56$\ 25,574.51 (BC/BS)0
Cox Walnut Lawn$\ 12,663.05 (St. Louis Ins.)
Freeman Hospital$\ 99,246.93$\ 17,957.73 (Blue Choice)0
$\ 80,610.40 (Blue Choice Adj.)
$\ 6,788.80 (Farmers)
Health South Rehab Center$\ 1,106.00$\ 1,096.00 (Insurance)$\ 10.00

Ms. Ellis had total medical bills in the amount of $\ 165,459.99. Of that total amount, her insurance companies (Blue Cross/Blue Shield, Farmers Insurance, Managed Care, Health Advantage, St. Louis Insurance, and Blue Choice) paid $\ 77,328.98. She personally paid $\ 60 in co-pays. There were insurance adjustments with the health care providers in the amount of $\ 92,349.61. Finally, only $\ 581.40 remains outstanding of

Full decision text continues in the plain-text archive copy.

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