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Angela Miller v. Anderson Merchandisers

Decision date: August 30, 201316 pages

Summary

The Labor and Industrial Relations Commission affirmed the administrative law judge's award of workers' compensation benefits to Angela Miller for her back injury, despite a dissenting opinion arguing that her continued smoking constituted unreasonable refusal of medical treatment. The majority upheld the original award and approval of attorney's fees, though the dissent contended the employee's nicotine use rendered her ineligible for surgery that could reduce her disability.

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Caption

FINAL AWARD ALLOWING COMPENSATION

(Affirming Award and Decision of Administrative Law Judge)

Injury No.: 06-135790

Employee: Angela Miller

Employer: Anderson Merchandisers

Insurer: New Hampshire Insurance Company

The above-entitled workers' compensation case is submitted to the Labor and Industrial Relations Commission (Commission) for review as provided by § 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 Law. Pursuant to § 286.090 RSMo, the Commission affirms the award and decision of the administrative law judge dated November 6, 2012. The award and decision of Administrative Law Judge Vicky Ruth, issued November 6, 2012, 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 $30^{\text {th }}$ day of August 2013.

LABOR AND INDUSTRIAL RELATIONS COMMISSION

John J. Larsen, Jr., Chairman

DISSENTING OPINION FILED

James G. Avery, Jr., Member

Curtis E. Chick, Jr., Member

Attest:

Employee: Angela Miller

DISSENTING OPINION

Based on my review of the evidence and consideration of the relevant provisions of the Missouri Workers' Compensation Law, I am convinced that the majority errs in affirming the administrative law judge's award in favor of the employee.

Dr. Coyle, Dr. Polinsky, and Dr. Woiteshek indicate that employee's condition and disability would improve if she were to have a surgical fusion of her L4-5. Employee previously underwent that surgery at the expense of employer, however the union was unsuccessful. Dr. Coyle and Dr. Polinsky opined that the first surgery was likely unsuccessful because of employee's nicotine use from smoking cigarettes. Dr. Coyle, Dr. Polinsky, and Dr. Bartlett recommend that employee discontinue smoking so that the second surgery will be more successful. Dr. Polinsky states that the success rate for the fusion surgery would only be 10-20\% if she continues to smoke, but it would be as good as 70-80 % if she quits smoking first. For this reason, Dr. Coyle refuses to perform the second surgery, and Dr. Polinsky would not recommend the second surgery, until employee discontinues her nicotine usage. Based on these medical opinions, employer agrees to pay for the second surgery but only if employee stops smoking first. Given the low chances of success if employee were to continue smoking, I find that employer's position is reasonable.

Employee testified that she wants to quit smoking and she wants to have this second surgery. However, employee contends that she is unable to quit smoking because she is addicted. Employer contends that employee's continuing usage of nicotine constitutes an unreasonable refusal of medical treatment, and therefore it should only be liable for permanent partial disability rather than permanent total disability. Thus, the issue in this case is whether employee's continuing use of nicotine, against the recommendation of all medical experts, thereby rendering herself ineligible for a surgery that could alleviate her condition and lessen her disability, reduces employer's liability for employee's permanent disability benefits.

Section 287.140.5 RSMo ${ }^{1}$ states that "No compensation shall be payable for the death or disability of an employee, if and insofar as the death or disability may be caused, continued or aggravated by any unreasonable refusal to submit to any medical or surgical treatment or operation, the risk of which is, in the opinion of the division or the commission, inconsiderable in view of the seriousness of the injury."

Since employee's ongoing use of nicotine is the reason employee is not able to have surgery at this time with any reasonable chance of success, I find that she is continuing and aggravating her own disability. The question then becomes whether employee's continuing use of nicotine is equivalent to an unreasonable refusal to submit to medical or surgical treatment pursuant to $\S 287.114 .5$.

I am not persuaded that employee is absolutely unable to overcome her smoking addiction. Although employee listed numerous cessation techniques she has tried,

[^0]

[^0]: ${ }^{1}$ All statutory references are to Revised Statutes of Missouri (2005) unless otherwise indicated.

Injury No.: 06-135790

Employee: Angela Miller

- 2 -

there is insufficient testimony and evidence as to when each of the techniques were tried, how long she tried each technique, and whether there were other factors contributing to the attempts being unsuccessful. Further, none of the medical experts opined that employee was unable to quit smoking.

I also do not believe it is unreasonable to require employee to quit smoking for this surgical procedure. There are no risks or negative outcomes to smoking cessation. Instead, not only would employee be able to have this surgery which could greatly improve her disability and condition, but also her health in general would likely improve after becoming a non-smoker. And, employer has offered and continues to offer to pay for smoking cessation treatments.

Importantly, employee has not alleged any concerns about the risks of surgical intervention. Her position is only that she cannot quit smoking to be able to get this surgery. Again, I am not persuaded by that. I find that employer has done everything it can to optimize employee's disability and condition, and at this point it is employee who must take the next step forward. It was employee's smoking which likely caused the failure of the first surgery, and her disability continues and is aggravated now because she has not quit smoking.

Under these circumstances, I find that employer should not be liable for the continued and aggravated disability caused by employee's ongoing smoking. I would reverse the award of permanent total disability and instead award only permanent partial disability pursuant to § 287.114.5. Because the majority has determined otherwise, I respectfully dissent.

James G. Avery, Jr., Member

AWARD

Employee: Angela Miller

Injury No. 06-135790

Dependents: N/A

Before the

Employer: Anderson Merchandisers

DIVISION OF WORKERS' COMPENSATION

Additional Party: None

Department of Labor and Industrial

Relations of Missouri

Innurer: New Hampshire Insurance Company, Jefferson City, Missouri c/o Specialty Risk Services

Hearing Date: August 2, 2012

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: June 15, 2006.
  5. State location where accident occurred or occupational disease was contracted: In or about Marion 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? 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? Yes.
  11. Describe work employee was doing and how accident occurred or occupational disease contracted: Claimant was lifting a box of books when she sustained an injury to her low back.
  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: Body as a whole/low back.
  14. Nature and extent of any permanent disability: Permanent and total disability.
  15. Compensation paid to-date for temporary disability: $\ 41,163.31.
  16. Value necessary medical aid paid to date by employer/insurer? $\ 105,871.03.
  17. Value necessary medical aid not furnished by employer/insurer? N/A.
  1. Employee's average weekly wages: $\ 642.46.
  2. Weekly compensation rate: $\$ 428.31 / \ 365.08.
  3. Method of wages computation: By agreement.

COMPENSATION PAYABLE

  1. Amount of compensation payable from employer:

Permanent and total disability benefits of $\$ 428.31 /$ week from March 1, 2010, and forward for claimant's lifetime as provided by law.

  1. Second Injury Fund liability: N/A.
  2. Future medical awarded: Yes, by agreement of the parties future medical care is left open.

Said payments to begin immediately and to be payable and 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 20 % of all payments hereunder in favor of the following attorney for necessary legal services rendered to the claimant: Mark Moreland.

FINDINGS OF FACT and RULINGS OF LAW:

Employee: Angela Miller

Injury No. 06-135790

Dependents: N/A

Employer: Anderson Merchandisers

Additional Party: None

Insurer: New Hampshire Insurance Company, c/o Specialty Risk Services

Before the

DIVISION OF WORKERS' COMPENSATION

Department of Labor and Industrial

Relations of Missouri

Jefferson City, Missouri

On August 2, 2012, Angela Miller, Anderson Merchandisers, and New Hampshire Insurance Co., c/o Specialty Risk Services, appeared for a final award hearing in Hannibal, Missouri. Angela Miller (the claimant) was represented by attorney Mark Moreland. Anderson Merchandisers (the employer) and New Hampshire Insurance Co, c/o Specialty Risk Services (the insurer) were represented by attorney Ben Shelledy. Claimant testified in person at the trial. Dr. Michael Polinsky and Dr. Dwight Woiteshek testified by deposition. The Administrative Law Judge set a deadline of August 27, 2012, for the filing of briefs, which was extended by request to September 5, 2012. The employer/insurer submitted a brief on or about September 5, 2012. After requesting and receiving an extension, claimant submitted her brief on September 14, 2012; the record closed at that time.

STIPULATIONS

At the trial, the parties stipulated to the following:

  1. On June 15, 2006, claimant sustained an accident, and that accident that arose out and in the course of her employment with Anderson Merchandisers (the employer).
  2. At all relevant times, the employer was operating subject to the provisions of Missouri Workers' Compensation Law.
  3. The employer's liability for workers' compensation was insured by New Hampshire Insurance Company, c/o Specialty Risk Services (the insurer).
  4. The Missouri Division of Workers' Compensation has jurisdiction, and the parties agree that venue in Marion County is proper.
  5. Notice is not an issue.
  6. Claimant filed a Claim for Compensation within the time prescribed by law.
  7. Claimant's average weekly wage was $\ 642.46, yielding a weekly compensation rate of $\ 365.08 for permanent partial disability benefits and $\ 428.31 for permanent total disability benefits.
  8. The employer/insurer paid temporary total disability benefits in the amount of $\ 41,163.31, for the periods of June 19, 2006 to June 20, 2006, October 24, 2006 to

November 2, 2006, November 7, 2006 to April 27, 2008, and November 1, 2009 to February 28, 2010.

  1. The employer/insurer paid medical benefits in the amount of $\ 105,871.03.
  2. The employer/insurer has agreed to leave future medical treatment open for the purpose of providing back surgery; such treatment is to be at the direction of the employer/insurer.
  3. Claimant initially underwent some conservative treatment after the injury. On January 9, 2007, she came under the treatment of Dr. James Coyle. Dr. Coyle noted from an MRI that claimant had a foraminal disc herniation at L4-5 on the right with a compensatory shift on L4-5 on the right as well. Dr. Coyle recommends that claimant not undergo surgery at that particular time, and that she should attempt to seek additional conservative ca

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

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