Melissa Lane v. Costco Wholesale Corporation

(in part) that certain of the awarded charges are not shown on the record to correspond to treatment related to the work injury.

Employee, in her brief, fails to respond to employer's argument that certain of the charges are not supported by corresponding treatment records. We have carefully reviewed the transcript, and we agree that certain of the charges awarded by the administrative law judge are not shown to correspond to treatment that was reasonably required to cure and relieve the effects of the work injury. Accordingly, we must modify the award of the administrative law judge as follows.

The administrative law judge awarded $\ 37,928.41 in charges from St. Luke's Regional Medical Center - Boise. The bills themselves (which, we note, are nearly illegible owing to the poor quality of the copies submitted by employee) suggest to us that employee incurred numerous charges with this provider for dates of service between January 21, 2007, and September 1, 2008. Transcript, pages 320-48. The administrative law judge did not provide her calculations or otherwise explain how she reached the awarded amount of $\ 37,928.41 from St. Luke's Regional Medical Center - Boise; it appears that she may have simply relied on the first page of employee's Exhibit E, which constitutes a mere summary of the total charges employee claims from each provider, and which does not include any itemization as to the specific dates of services or treatments claimed. Employee, in her brief, does not provide any itemization or other explanation identifying the particular charges she believes are compensable from St. Luke's Regional Medical Center - Boise. ${ }^{1}$

Turning to the medical treatment records from this provider, we find four dates of service for conditions not shown on this record to have resulted from the work injury. Specifically, on May 5, 2007, employee received treatment for a diagnosis of Raynaud's syndrome; on November 11, 2007, employee received treatment for complaints of a sore throat and congestion; on April 16, 2008, employee received treatment for complaints of pelvic pain and a possible urinary tract infection; and on September 1, 2008, employee received treatment for complaints of abdominal pain possibly referable to gallbladder pathology. Transcript, pages 1760-62, 1747-51, 1732-42, and 1722-31. The bills suggest that this provider billed employee a total of $\ 6,937.52 for the treatment she received on these dates. Transcript, pages 325, 347, 344, and 320. Because employee has failed to respond to employer's argument these charges are unrelated to the work injury, and because employee's expert, Dr. Koprivica, did not specifically identify any of these treatments as flowing from the work injury, we find that the treatment employee underwent in connection with these conditions was not reasonably required to cure and relieve any effect of the work injury. Accordingly, we must modify the award of charges from St. Luke's Regional Medical Center - Boise from \$37,928.41 to \30,990.89.

The administrative law judge also awarded \ 124,148.93 in charges from Eastern Idaho Regional Medical Center. The bills themselves suggest to us that employee incurred numerous charges with this provider for dates of service between March 15, 2009, and January 2, 2014. Transcript, pages 478-583. The administrative law judge did not provide her calculations or otherwise explain how she reached the awarded amount of $\ 124,148.93 from Eastern Idaho Regional Medical Center; once again, it appears that she may simply have relied on the summary contained in employee's Exhibit E. Nor has employee, in her brief, provided any

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[^0]: ${ }^{1}$ If the bills from this provider were any less legible, we would be inclined to view employee's failure to identify the particular charges she claims as a tacit admission that none of the charges from this provider are compensable. As it turns out, we were able to parse the bills and treatment records to arrive at what we believe is a fair and reasonable result, but we wish to make clear that it constitutes a rather severe imposition upon the fact-finder whenever the parties fail to itemize disputed expenses in a medically complex case.

itemization or other explanation identifying the charges she believes are compensable from Eastern Idaho Regional Medical Center.

Turning to the medical treatment records from this provider, it appears that employee has, once again, included bills for treatment that had no relation to the work injury. Specifically, on September 21, 2010, employee received emergency treatment for complaints of abdominal pain of unknown etiology, suspected to have been related to a common bile duct stone. Transcript, pages 2797-2835. The bills suggest that this provider billed a total of $\ 32,442.87 for the treatment employee received for these complaints. Transcript, pages 530-35. Because employee has failed to respond to employer's argument that these charges are unrelated to the work injury, and because Dr. Koprivica did not identify abdominal pain as a result of the work injury, we find that the treatment employee underwent in connection with this complaint was not reasonably required to cure and relieve any effect of the work injury. Accordingly, we must modify the award of charges from Eastern Idaho Regional Medical Center from $\ 124,148.93 to $\ 91,706.06.

In its brief, employer does not specifically cite any other bills that it argues were incurred in connection with conditions unrelated to the work injury. ${ }^{2}$ Employer does, however, argue in general that any treatment employee received in connection with complaints of headaches should be deemed non-compensable. We are not persuaded. Dr. Koprivica specifically identified intractable headaches as one of the sequelae resulting from the work injury. Employer's expert, Dr. Carabetta, did not rebut this opinion, and thus it appears to us that the uncontested expert medical opinion evidence compels a finding that the numerous treatments employee received for complaints of intractable headaches were reasonably required to cure and relieve the effects of the work injury; we so find.

As a result of the foregoing modifications, we conclude that employee is entitled to, and employer is obligated to pay, a total of $\ 483,640.36 in past medical expenses, rather than the amount of $\ 523,020.75 identified by the administrative law judge.

Employer argues, and we agree, that employee's claim for permanent total disability benefits turns, to a considerable degree, upon an evaluation of employee's credibility. In its brief and at oral argument, employer rather persuasively identified evidence to support its contention that employee's testimony should be deemed lacking persuasive force in light of her addiction to prescription pain medications. Having said that, we note that the administrative law judge, who was able to view employee as she testified, ultimately found her to be a credible witness with regard to the nature and extent of her disability.

In light of the opinion from employer's medical expert that employee suffered a compensable injury by accident; given that employer did not dispute, at the hearing before the administrative law judge, the issue of accident; and in the absence of any evidence that employee suffered from a preexisting disabling opiate addiction, we are not persuaded to substitute our own judgment with regard to employee's credibility for that of the administrative law judge. For this reason, we will defer to her findings and we hereby adopt them as our own.

We modify the award of the administrative law judge as to the issue of past medical expenses.

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[^0]: ${ }^{2}$ We acknowledge, of course, employer's global argument that none of employee's past medical expenses should be compensable because employee lacks credibility and thus cannot satisfy her burden of proof with regard to the disputed issues.

Employer is liable for $\ 483,640.36 in past medical expenses.

The award and decision of Administrative Law Judge Paula A. McKeon, issued December 18, 2015, is attached hereto and incorporated herein to the extent not inconsistent with this decision and award.

We approve and affirm 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 $\underline{5 \mathrm{TH}}$ day of August 2016.

LABOR AND INDUSTRIAL RELATIONS COMMISSION

John J. Larsen, Jr., Chairman

DISSENTING OPINION FILED

James G. Avery, Jr., Member

Curtis E. Chick, Jr., Member

Attest:

Secretary

Based on my review of the eviden