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Billy Hood v. Michael Menech

Decision date: July 19, 2017Injury #12-10713531 pages

Summary

The Commission modified the Administrative Law Judge's award, determining that Michael Menech was the employer operating subject to Missouri Workers' Compensation Law and was liable for temporary total disability benefits of $60,332.73 from August 20, 2012 to February 8, 2016, plus permanent partial disability benefits of $23,333.10 for a 50% left eye disability. The Second Injury Fund was ordered to reimburse reasonable medical expenses totaling $51,183.42 incurred as a result of the August 20, 2012 injury.

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

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Caption

TEMPORARY AWARD ALLOWING COMPENSATION (Modifying Award and Decision of Administrative Law Judge by Separate Opinion)
Employee:Billy Hood
Employers:Michael Menech (alleged) Vandalia Area Historical Society (alleged)
Insurer:None
Additional Party:Treasurer of Missouri as Custodian of Second Injury Fund
This workers' compensation case is submitted to the Labor and Industrial Relations Commission (Commission) for review as provided by § 287.480 RSMo. We have reviewed the evidence, read the briefs, heard the parties’ arguments, and considered the whole record. Pursuant to § 286.090 RSMo, the Commission modifies the award of the administrative law judge with this separate opinion.
Preliminaries
The parties asked the administrative law judge to resolve the following issues: (1) whether on or about August 20, 2012, alleged employer Vandalia Area Historical Society and/or alleged employer Michael Menech were operating subject to the Missouri Workers’ Compensation Law; (2) whether employee gave any alleged employer proper notice; (3) whether the accident caused the injuries and disabilities for which benefits are now claimed; (4) whether employee has sustained injuries that will require future medical care in order to cure and relieve employee of the effects of the injuries; (5) what is the proper rate of compensation; (6) whether temporary total disability benefits are owed to the employee; (7) the nature and extent of any permanent partial disabilities; and (8) the liability of the Second Injury Fund for uninsured medical expenses.The administrative law judge determined as follows: (1) there is substantial and competent evidence that Vandalia Area Historical Society was not an employer of employee on August 20, 2012; (2) Michael Menech was employee’s employer on August 20, 2012, and was operating subject to the Missouri Workers’ Compensation Law; (3) employee gave proper notice of the injury and employer had actual knowledge of employee’s injury on August 20, 2012; (4) there is substantial and competent evidence that employee’s accident of August 20, 2012, caused the need for treatment and further that the accident caused the injuries and disabilities for which benefits are now being claimed, with the exception of the treatment sought and administered on November 23, 2012; (5) employee incurred medical expenses for treatment necessary to cure and relieve the effects of his injuries in the sum of $51,183.42; (6) there is substantial and competent evidence that employee has sustained his burden of proof that there is a reasonable probability that employee will require medical treatment in the future in order to cure and relieve the effects of the injury sustained on August 20, 2012; (7) employer, Michael Menech, is responsible to provide all medically reasonable medical care in order to cure and relieve the effects of employee’s injury with regard to both employee’s past medical expenses and any future medical treatment;

(8) employee's average weekly wage was $\ 500.00 per week, sufficient to establish a compensation rate of $\ 333.33 for temporary total and permanent partial disability benefits; (9) there is substantial and competent evidence that employee was not available on the open labor market because of his injury from August 20, 2012, until February 8, 2016, and employer, Michael Menech, is liable to employee for a total of $\ 60,332.73 in temporary total disability benefits; (10) employee has suffered a 50 % disability referable to the left eye, and employer, Michael Menech, is liable to employee for a total of $\ 23,333.10 in permanent partial disability benefits; and (11) employer, Michael Menech, was not insured for workers' compensation liability at the time of employee's injury, and thus the Second Injury Fund is ordered to reimburse employee for reasonable medical expenses incurred as a result of the injury in the sum of $\ 51,183.42, and is further ordered to provide employee such future medical treatment as may be necessary to cure and relieve the effects of the injury, as may be recommended from time to time by the physician(s) selected by employee.

On August 23, 2016, the Commission received an application for review from employer, Michael Menech. On October 7, 2016, the Commission issued an order returning the application for review to Michael Menech as if it had never been filed, because it was not accompanied by proof that Michael Menech had secured a bond as required pursuant to § 287.480.2 RSMo and 8 CSR 20-3.070.

The Second Injury Fund filed a timely application for review alleging the administrative law judge erred: (1) in finding that employee's accident caused the injuries for which benefits are sought, because employee did not meet his burden of proof on causation in that he did not offer any expert opinion and his injury is beyond layperson understanding; (2) in finding employee incurred fair, reasonable, and necessary medical expenses for treatment necessary to cure and relieve the effects of the injury, in that employee did not offer any expert opinion; (3) in finding there is a reasonable probability that employee will require treatment in the future to cure and relieve the August 20, 2012, injury, in that no physician has recommended future medical care, and employee did not offer any expert opinion; and (4) in ordering that employee select future healthcare providers, because the Second Injury Fund assumes the duties of the employer in an uninsured case and § 287.140.10 entitles employers to select physicians and healthcare providers.

For the reasons set forth below, we issue this separate opinion modifying the award of the administrative law judge.

Findings of Fact

On August 20, 2012, employee was working as a carpenter on a construction project for the Vandalia Area Historical Society. The project involved converting two separate buildings into a single building. Michael Menech, an individual who described himself at the hearing as "self-employed," oversaw and had the right to control employee's day-today activities on this project. For example, Mr. Menech told employee when to report for work, kept track of his hours, inspected his work, directed activities on the jobsite, had the authority to hire and fire workers including employee, and distributed checks to the workers.

Employee: Billy Hood

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Employee had worked for Mr. Menech on other projects before. For purposes of this project, however, all of the checks that Mr. Menech conveyed to employee were drawn upon an account owned by the Vandalia Area Historical Society. Specifically, the Vandalia Area Historical Society provided Mr. Menech with a book of pre-signed checks, and Mr. Menech simply filled in the name of the worker and the amount to be paid before distributing them to the workers. The Vandalia Area Historical Society paid employee $12.50 per hour for his services. In the weeks leading up to the work injury, employee worked between 20 and 50 hours per week, depending upon Mr. Menech's instructions.

As of August 20, 2012, Mr. Menech had not insured his liability pursuant to the Missouri Workers' Compensation Law. Mr. Menech believed he was not an employer, and that he therefore did not need workers' compensation insurance. As of August 20, 2012, the Vandalia Area Historical Society also had not insured its workers' compensation liability.

While employee was using a power saw to cut a used piece of lumber on August 20, 2012, some metal debris from a nail or screw flew out of the board and into his left eye. Employee suffered immediate severe pain and diminished vision in his left eye in connection with this event. Soon thereafter, employee also developed a headache and photophobia. Prior to August 20, 2012, employee had never had vision problems, had never suffered an injury to his left eye or left eye pain, and had never received medical treatment for any issues with his left eye.

Employee immediately informed Mr. Menech that he had been injured. Mr. Menech had actual notice of employee's injury at the time that it occurred. There is no evidence on this record that Mr. Menech was prejudiced, in any fashion, by employee's failure to provide him a written notice of the injury. We find that Mr. Menech was not prejudiced by employee's failure to provide him a written notice of the August 20, 2012, injury.

After trying, without success, to remove the debris from his eye with the help of Mr. Menech, employee sought emergency medical treatment with Dr. Crisanto Gualberto, who recommended employee see an ophthalmologist immediately. Employee then went to University Hospital, where a CT scan revealed a metallic foreign body in employee's left eye, and treating physicians diagnosed a ruptured globe and full-thickness corneal laceration. The attending physicians decided to perform an emergency surgery to repair the ruptured globe and corneal laceration in employee's left eye, and then admitted employee to the hospital for observation. The next day, employee underwent a second surgery owing to continued leakage from the eye. The surgeries involved placement of an implanted contact lens.

Following the emergency medical services employee received on August 20 and 21, 2012, employee underwent some follow-up treatment at University Hospital for several months. Then, on November 23, 2012, employee fell down two flights of stairs after drinking one and a half bottles of Jack Daniels whiskey. He went to the emergency room with complaints of headache, neck pain, and left rib pain. Attending physicians took CT scans and placed a new contact lens in employee's left eye, as the surgically implanted lens had been dislodged and lost in the fall down the stairs.

Employee:Billy HoodInjury No.: 12-107135
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On November 17, 2015, employee reported to the University Physicians Mason Eye Institute complaining that both eyes had been exposed to bleach fumes the previous day. A doctor removed the sutures from employee's left eye. Another contact lens was applied to stop leakage after the procedure. At a follow-up visit on November 19, 2015, the doctor noted a corneal scar and traumatic cataract, and recommended surgery. On February 8, 2016, employee underwent surgery to address a corneal scar, conjunctival neoplasm, and uveitic cataract in his left eye.

Employee has not advanced expert medical testimony to delineate whether, following the emergency treatment and surgery he underwent immediately following the accident, he reasonably required any additional treatment to cure and relieve the effects of any diagnosis, medical condition, or injury referable to that accident. Especially in light of the intervening fall down stairs of November 2012 and bleach incident of November 2015, we are not persuaded to make any finding at this time that any treatment, other than the emergency treatment and surgery employee received on August 20 and 21, 2012, was reasonably required to cure and relieve the effects of the work injury.

At the May 5, 2016, hearing before the administrative law judge, employee indicated he is still undergoing active treatment for his left eye, and that his vision is getting better, but that he has good days and bad days. The parties have not advanced any expert medical opinion or other evidence that would support a finding that employee has reached maximum medical improvement from the effects of the accident on August 20, 2012. At oral argument in this matter, counsel for the employee conceded that it is his position that employee has not yet reached maximum medical improvement. We find insufficient evidence on this record to support a finding that employee has reached maximum medical improvement from the effects of the accident on August 20, 2012.

Medical bills

Employee testified that the medical records and billings offered

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

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