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Aguayo v. Franklin Mushroom Farms, Inc.

CASE NO. 3697 CRB-02-97-01

COMPENSATION REVIEW BOARD

WORKERS’ COMPENSATION COMMISSION

JANUARY 28, 1999

ELIZABETH AGUAYO

CLAIMANT-APPELLEE

v.

FRANKLIN MUSHROOM FARMS, INC.

EMPLOYER

and

WAUSAU INSURANCE CO.

INSURER

RESPONDENTS-APPELLANTS

and

SECOND INJURY FUND

RESPONDENT-APPELLANT

APPEARANCES:

The claimant was represented by Stephen F. McEleney, Esq., McEleney & McGrail, 363 Main Street, Hartford, CT 06106.

The respondents were represented by Timothy Welch, Esq., McGann, Bartlett & Brown, 281 Hartford Turnpike, Suite 401, Vernon, CT 06066.

The Second Injury Fund was represented by Michael Giammatteo, Esq., Assistant Attorney General, 55 Elm Street, P.O. Box 120, Hartford, CT 06141-0120.

This Petition for Review from the October 2, 1997 Finding and Award of the Commissioner acting for the Second District was heard May 29, 1998 before a Compensation Review Board panel consisting of the Commission Chairman Jesse M. Frankl and Commissioners Donald H. Doyle, Jr. and Michael S. Miles.

OPINION

JESSE M. FRANKL, CHAIRMAN. The respondent employer and its insurer (hereinafter “respondents”) and the Second Injury Fund (“Fund”) have petitioned for review from the October 2, 1997 Finding and Award of the Commissioner acting for the Second District. In that decision the trial commissioner found that both the respondents and the Fund unreasonably contested the claimant’s claim of temporary total disability and medical treatment in contravention of § 31-300. Furthermore, the trial commissioner concluded that the failure of both the Fund and the respondents to make any payments constituted unreasonable delay pursuant to § 31-300, and thus awarded attorney’s fees. In support of their appeal, the respondents contend that the medical evidence regarding the cause of the claimant’s temporary total disability was contradictory and thus that it was not unreasonable to contest liability. The Fund makes a similar argument on appeal.

The trial commissioner found the following relevant facts. The claimant suffered a compensable back injury on October 20, 1983 when she fell at work. The claimant’s back injury was transferred to the Fund effective September 8, 1986. On April 1, 1993, a previous trial commissioner issued a Finding and Award in which he found that on October 20, 1983 the claimant also sustained a head injury which caused severe episodic headaches and nausea. That commissioner ordered Wausau to be responsible for the claimant’s debilitating headaches, including the payment of temporary total disability benefits and all medical benefits. During the formal hearings in the instant case, the claimant claimed temporary total disability from December of 1994 forward and unpaid medicals. The claimant also requested attorney’s fees and interest pursuant to § 31-300 due to unreasonable contest and undue delay.

In the instant case, during the formal hearing the respondent Wausau argued that the claimant’s headaches alone did not cause the claimant to be totally disabled, and that if the claimant was totally disabled it was caused by her back injury. Similarly, the Fund argued at the formal hearing that the claimant’s total disability was due to the disabling headaches rather than to her back condition, and thus denied liability for temporary total disability.

The trial commissioner found that the medical restrictions due to the claimant’s low back are extensive, and that the claimant testified that her back pain is constant. The claimant’s headaches occur two to three times per week and can be severe, lasting twenty-four to forty-eight hours, and cause the claimant to be bedridden in a dark room, applying ice to her head. The claimant treats with Dr. Vildozola for her back and with Dr. Reik, a neurology/headache specialist, for her headaches. The claimant was referred by Dr. Vildozola to Dr. Essack, a psychiatrist, for treatment of her depression, which was related to her inability to function due to her work injuries and the pain that she endures from her failed back surgery and debilitating headaches. Wausau denied any responsibility for payment to Dr. Essack and refused to pay for medications ordered by Dr. Essack and Dr. Reik, the claimant’s authorized headache treater. The Fund also denied responsibility for Dr. Essack’s treatment.

Despite the previous trial commissioner’s order that Wausau be responsible for the claimant’s debilitating headaches, including the payment of temporary total disability benefits and all medical benefits, Wausau stopped paying for the claimant’s headache medications, causing her to become “more disabled both physically and emotionally.” (Finding No. 21). The claimant has received no indemnity benefits since May of 1993. However, the claimant’s treating neurologist, Dr. Reik, opined that the claimant was temporarily totally disabled in a December 1994 report, and so noted again in February of 1996. The claimant’s treater for her back, Dr. Vildozola, noted that the claimant was temporarily totally disabled in March of 1996 and continuing. Dr. Vildozola opined that the claimant was temporarily totally disabled due to a combination of her back injury, her headaches, and depression. The claimant was examined by a Commissioner’s examiner, Dr. Selig, who opined that the claimant was totally disabled due to both the back injury, the head injury, along with the depression caused by said injuries. The claimant’s treaters, Dr. Vildozola and Dr. Reik, along with Dr. Selig, do not find the claimant to be a malingerer.

The trial commissioner concluded that the claimant was temporarily totally disabled commencing December of 1994, and that said disability was caused by both the back injury for which the Fund is liable and by the headache condition for which Wausau is liable, together with the depression caused by both of these conditions. The trial commissioner further found that Dr. Essack’s treatment was authorized, and ordered said treatment costs to be split equally between the Fund and Wausau. The trial commissioner concluded that the respondents’ positions constituted unreasonable contest because both respondents “reargued the positions previously found by” the original trial commissioner in his Finding and Award of April 1, 1993. (Finding I). The trier emphasized that “no new definitive medical [evidence] was obtained by either respondent and the Commissioner’s examiner, Dr. Selig, confirmed claimant’s claims and position with regard to medical treatment and her on-going temporary total disability which was easily discerned to be due to the combination of claimant’s failed low back surgery and its sequelae, along with claimant’s debilitating headaches.” Id. The trial commissioner further found that the respondents unreasonably failed to pay for her medication and treatment of authorized treaters.

Whether the respondents unreasonably contested their liability for the claimant’s permanent partial disability and benefit rate was a factual question for the trial commissioner. See Robinson v. Allied Grocers Cooperative, Inc., 1 Conn. Workers’ Comp. Rev. Op. 132, 135, 68 CRD-1-81 (July 13, 1982), affirmed, 39 Conn. Sup. 386, 388-89 (1983). Moreover, an award of interest and attorneys’ fees is within the discretion of the trial commissioner. Hicks v. Department of Administrative Services, 21 Conn. App. 464, 466-67 (1990); Wheeler v. Bender Plumbing Supply of Waterbury, Inc., 10 Conn. Workers’ Comp. Rev. Op. 140, 141, 1186 CRD-5-91-3 (June 5, 1992). We find no abuse of that discretion. In Muldoon v. New England Installation, 3552 CRB-4-97-3 (August 24, 1998) we held that where the carrier and the Fund each argued that the other should pay benefits pending appeal “nevertheless it [was] unreasonable and unconscionable for neither to pay thereby leaving the dependent widow with no benefits.”

In support of its appeal, the Fund acknowledges that this Board may not retry the facts of the case, and further acknowledges that there is sufficient medical evidence to support the trial commissioner’s conclusion that the claimant’s total disability was caused by both her back injury and her headache condition. (Fund’s Brief at p. 4). The Fund does not dispute that trial commissioner’s finding that the respondents’ positions constituted unreasonable contest because both respondents “reargued the positions previously found by Commissioner Waller” in his Finding and Award of April 1, 1993. (Finding I). Neither does the Fund dispute the trial commissioner’s finding that “no new definitive medical [evidence] was obtained by either respondent and the Commissioner’s examiner, Dr. Selig, confirmed claimant’s claims....” Id. We find no error in the trial commissioner’s conclusion that the Fund’s position constituted unreasonable contest and undue delay in violation of § 31-300.

In support of their appeal, the respondent employer and its insurer, Wausau, contend that there was sufficient contradictory medical evidence to support their denial of temporary total disability. Specifically, the respondents contend that there was medical evidence which indicated that the claimant’s headaches were not the sole cause of her total disability. We note that in their brief, the respondents cite evidence which predated Commissioner Waller’s 1993 decision, and which was not entered as exhibits. In addition, the respondents cite the opinion of Dr. Fredericks, who performed an independent medical examination at the request of the respondents, that the claimant was a malinger. The trial commissioner specifically found that Dr. Fredericks’ opinion was initially made in 1989, which predates the 1993 Finding and Award. In further support of their appeal, the respondents cite portions of two office notes from Dr. Reik regarding the claimant’s headaches. It was within the discretion of the trial commissioner, as the finder of fact, to find that said notes do not support the respondents’ contention that their contest was reasonable. Moreover, the respondents’ arguments on appeal fail to acknowledge the trial commissioner’s finding that it was egregious for neither party to pay temporary total disability benefits and medical costs even though it was clear that one or both of them would be held liable for said payments. See Muldoon, supra.1 In the instant case, we conclude that the trial commissioner’s findings of unreasonable contest and unreasonable delay of payments are fully supported by the record.

Finally, we will address the respondents’ contention that the trial commissioner erred in ordering the respondents to pay the cost of the claimant’s expert witness, Dr. Cohen, a vocational rehabilitation expert. Section 31-298 (Rev. to 1997) provides in pertinent part: “Witnesses subpoenaed by the commissioner shall be allowed the fees and traveling expenses that are allowed in civil actions, to be paid by the party in whose interest the witnesses are subpoenaed.” Subsequently, § 31-298 was amended by P.A. 97-106 which added the following language: “When liability or extent of disability is contested by formal hearing before the commissioner, the claimant shall be entitled, if he prevails on final judgment, to payment for oral testimony or deposition testimony rendered on his behalf by a competent physician, surgeon or other medical provider, including the stenographic and videotape recording costs thereof, in connection with the claim, the commissioner to determine the reasonableness of such charges.” Because § 31-298 does not allow for the costs of a vocational expert, we must reverse the trial commissioner’s order that the respondents pay said cost.

The trial commissioner’s award of attorney’s fees and interest against the respondents and the Fund is affirmed. We reverse only as to the order that the respondents pay for the cost of the claimant’s vocational expert, Dr. Cohen.

Commissioners Donald H. Doyle, Jr. and Michael S. Miles concur.

1 In Muldoon, supra, we explained that the “principle that the Workers’ Compensation Act is remedial in nature and should be construed to accomplish its humanitarian purpose.” Schiano v. Bliss Exterminating, 16 Conn. Workers’ Comp. Rev. Op. 189, 3315 CRB-4-96-4 (May 16, 1997) (citing Dubois v. General Dynamics Corp., 222 Conn. 62, 67 (1992)). “A necessary element of this principle is the idea that relief under the Act will be provided as quickly and efficiently as possible. A claimant who is disabled from employment by a work-related injury is usually in need of prompt financial attention as well as medical attention, for the inability to earn wages has an immediate negative impact on the lives of most claimants. Yet, this concept often becomes lost in the partisan battles between employers, employees, insurers, medical providers, and their numerous attorneys.” Id. BACK TO TEXT

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State of Connecticut Workers' Compensation Commission, John A. Mastropietro, Chairman
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