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HomeMy WebLinkAbout96-02932 ~ , ti ~ I ~ ~ ~ I I q 1 1 ~ \ , i \.~ " ~ II. ' , ., ,. . " ,,' " " ' , ,. , I ~ J , I I I , I ~I , \ " <:::r , , , ~ <0 .,J .... .....' ...... 'N ~ ~ ~ '~ '....... v--, h~ ,~ .......' ,I:'.. I llll , \~'0 , , I' [': . ! ,;;.) '... i '-I . ,~ /, " ~ , j I;' , '" ~ " ,....., ': 1 l\j <:::J....l -- '~ " - , , ,''I ,':n.rl', '~H'" ad~oal?,Id B~l?.:mde5 eLH '~t.I/l\ xepu, OJ. . ..art Jo:.' sar;!')o :mo,:;: l:Tddn3 '.an l.Hl?UOs.:IecI h4~6ue1 .n . (6'-'T( 'ON . d' J' i'!i,i I (!qS.:IilIJt>lO .10 H^PPHJl? ;;0 hdoo pltP Dlur6po ltP pltP s.ualfiilNJ.:Iciu']: 6111pnFJUl LIe' .dt:::,ap JO Giltdoo X)'s I..'[ddns ,'l...:IadO.:Id L'IlB.:I.n 'se~ON , ' " {':; 1;.- i ,. I \I ~ , '"' .'; l~:: ' " l'" j, c..i; : r;:' 1 , " I. ,; '. , l~.. '1 <- .. .1_ , , .~ i ..:,', ..' " I, , , , " ,1" " ...:~ '0 i I , ~:J ' , ,. , {"". '-." ,. " l' '- .r< ". L'. .. 'i '. I l I ., ...1 " " , I I THE ATTACHED DECISION OF THE JUDGE IS FINAL UNLESS AN APPEAL IS TAlCEN TO T~E WORKMEN'S COMPENSATION APPEAL BOARD AS PROVIDED BY LAW. IF YOU 00 NOT AOREE WITH THIS nECISION AN APPEAL MUST BE FILED WITH fHE WORK- MEN'S COMPENSATION APPEAL BOARD WITHIN 20 DAYS or THE DATE OF THIS NOTICE. FORMS FOR AN APPEAL MAY BE OBTAINED FROM THE WO~~EN'S COMPENSATION APPEAL BOARD, 117 1 SOU'1'H CAMERON STREET, ROOM JOS, HARRISBURG, PA 17104-2S11 t' ,~ . ',- COMMONWEALTH OF PENNSYLVANIA DEPARTM~NT OF LABOR AND INDUST~Y BUREAU or WORKERS' COMPF.NSATIQN 1171 South Cameron Street, Roo~ 103 Harr~.burg, PA 17104-2S01 (717)783-4419 .! 003-32-0991 CLAIM ITEIlHINAttON CUMBERLAND COUNTY 02l2}/95 DATE or CIRCULATION CHARLES OWENSBY 26 RAYS DRIVE NEWVILLE PA 17241 VI E E JACOBY COMPANY 81 1<UTZ ROAD CARLISLE PA 17013 NATIONAL MOFII, ADJtISTHAlIT CO 8630 EAST VIADEVENTURA SUITE 100 SCOTTSDALE AZ 85258 KENNETH WISE, ESQ. 126 LOCUST STREET HARRISBURG PA 17101 j, JEFFREY SIDEBOTTOM, ESQ. 125 EAST KING STREET LANCASTER PA 17602 "i JUDGE ELIZABETH A CRUM - jlft , , Charles Owensby 55 100J.J:2.099l paqa 2 HBARIliGS , 11-01,-94 05-0J-95 10.31-95 Cancelled Testimony Taken . Continued Testimony Taken - Continued CLAIMANT'S WITNESSBS AND ZXHIBITS, Charles Owensby, witness Dr. Ronald D. Hoben. witness C'1 Fee Aqreement c-2 Leqal Bill C-J Costs C-4 Dr. Hoben's bills EMPLOYBR'S WITNBSSBS AND ZXHIBITS, Charles Owensby, witness (as on cross) Dr. Ronald D. Hoben, witness (as on cross) D.l Deposition of J. Joseph Danyo, M.D. BUREAU'S EXHIBITS: B.l Aqreement for compensation B-2 Peer Review RICORD, On or about Auqust 4, 1994, Claimant, Charles Owensby, filed a Claim petition. Defendant, E. E. Jacoby Truckinq company, filed a timely answer. On or about April 1J, 1995, Defendant filed a Petition to Tenninate the Compensation Benefits of Claimant. Claimant filed a timely answer. Supersedeas was denied and attorney fees approved by Interlocutory Order circulated May 16, 1995. FINDINGS or FACT, 1. Subsequent to t.he assiqnment of the underlyinq Claim Petition, the parties herein executed an Aqreement for COmpensation (Aqreement) , marked and admitted into evidence as Bureau Exhibit 1. The Aqreement is dated October J1, 1994, and provides in pertinent - Charles owensby 5S 11003.32.0991 paqe 3 part that on March 2, 1994. the Claimant sustained an injury in the nature \)f a "cervical strain/sprain with herniated disca", for which disability beqan on March 3, 1994. The Aqreement provide. further for an averaqe weekly waqe of $371.16 and a weekly compensation rate of $257.45 beqinninq on March 3, 1994. 2. A provision typed onto the Aqreement which indicates that the Employer will pay all submitted medical bill. in full up to January 3. 1995. is null and void where inconsistent or in contravention of the Act. 3. The Claim Petition and the Termination petition each provide that the Employer does not have workers' compensation insurance. The Aqreement provides that payment is beinq made pursuant to an "International Association of Entrepreneurs of America Benefit Trust" to be processed by Realistic Adjustment Company, Inc. The Employer failed to provide any evidence that it is insured for purposes of workers' compensation in pennsylvania pursuant to Section 305 of the Act, or to provide evidence of exemption from such insurance or self-insurance status. 4 _ The Claimant testH ied credibly to the followinq, which testimony is found to be the facts in this matter: la) On about March 2, 1994, while operatinq a tractor trailer riq for the Defendant/Employer, his riq hit a severe bump in the road. causinq him to hit his head aqainst the roof of the cab of his riq; lb) He felt immediate neck pain and drove himself to the Carlisle Hospital where he received treatment and was released; subsequent thereto, he souqht treatment from Drs. Townsend and samuels, who treated him with medication and modalities; Ie) Subsequently, he scuqht treatment from Dr. Hoben in about April, 1994, at which time he saw Dr. Hoben about three to four times per week for heat, electronic stimulation, and ultrasound; ld) lie experienced improvement throuqh the treatment that Dr. Hoben provided, such that he was not in constant pain and could move about a bit more freely; Ie) He does not feel that he could return to work as a truck driver. 5. In support of the Termination peti tion, the Employer presented the medical testimony of J. Joseph Danyo, M.D., who examined the Claimant on January 11, 1995. Based upon his examination of the Charles Owensby 55 .003.32.0991 paqe 4 Claimant, review of various medical records and reports, and the Claimant's history, Dr. Oanyo offered an equivocal opinion reqardinq the Claimant's recovery. On one hand, he stated that he was unable to state that the Claimant had recovered based upon his history, and followed that comment up specifically with testimony tha t "I don't know whether he has recovered." He further explained that from an "objective" standpoint, the Claimant had recovered. When asked whether the Claimant is SUffering from any residual disability as a result of the work injury, the doctor indicated that he is not suffering from any disability. He further indicated that he would offer the Claimant no restrictions with respect to work and would recommend no further treatment. He specifically opined that the treatment the Claimant is undergoing with chiropractor Hoben is not reasonable or necessary. He opined that the Claimant can function in a job that is light to medium, but should not go back to work as a truck driver based upon his history only_ He concluded that the Claimant was magnifying his symptoms. 6. The Claimant presented the testimony of treating chiropractor, Dr. Hoben. Dr. Hoben first examined the Claimant on May 6, 1994, after which he diagnos~d him as suffering from a cervical disc disorder, cervical myofascitis, cervical sprain/strain and cervical subluxation. He treated the Claimant with traction, ultrasound, adjustments, trigger point treatments and interferential therapy. He continued to treat the Claimant on a regular basis thereafter and referred him to Dr. Sanderson, an orthopedist, and also to Dr. Samuels, a neurOlogist who performed an EMG on October 31, 1994. The Claimant was referred back to Or. Hoben for continued care. The chiropractor gradually decreased the frequency of visits from the Claimant from three times per week to one time per week, and then on a "prn" basis. He opinea to a reasonable degree of chiropractic certainty that the Claimant will never be able to return driving a truck and recommended that he obtain a functional evaluation and gradual employment beginning with very light duty. He opined that his care of the Claimant was both reasonable and necessary. 7. In about November, 1994, the Defendant filed a Petition for Utilization Review of Dr. Hoben's bills. Utilization Review determined that his bills were not reasonable or necessary. No appeal of this determination was filed; however, Judge Niven took juriSdiction of the issue as she had pending litigation. She then referred the issue for Peer Review under the Act. S. A Peer Review completed by Stephen Marini, D. C., concluded that the chiropractic treatment rendered by Dr. Hoben to the Claimant from October 3, 1994 to the present is reasonable and necessary, as were the medical referrals initiated by Dr. Hoben. 9. The testimony and opinions of Ora. Hoben and Marini are - Charles owensby SS 11003'32-0991 paqe 5 accepted U credible and persuasive, and adopted as the findinqs in this matter. The contradictory testimony and opinions of Dr. Danyo are rejected as less than credible or convincinq. 10. The Claimant has incurred reasonable medical and treatment expenses, includinq expenses incurred for treatment by Dr. Hoben, which treatment is reasonable and necessary. There is no indication in the record that the bills submitted by Dr. Hoben or any other medical providers have been adjusted in accordance with the requirements of Act 44. 11. The Claimant has incurred reasonable costs in litiqatinq this matter in the amount of $270.40. 12. The Claimant has entered into a fee aqreement with Kenneth Wise, Esquire, providinq for payment of 20\ of his workers' compensation benefits for ~eqal services provided in this matter, which fee aqreement is fair and reasonable. 13. The Claimant has requested an award of attorney fee for an alleqed unreasonable cuntest in this matter, for which he has submitted billinq as Claimant'S Exhibit 2, as supplemented in his Proposed Findinqs of Fact and Conclusions of Law. considerinq the amount of time expended, the difficulty of the work and skill required, the complexity of the issues and the duration of the proceedinqs, an attorney fee in the amount of $2,947.00 is fair and reasonable. CONCLUSIONS OF LAW: 1. The parties are bound by the provisions of the pennsylvania Workers' Compensation Act. as amended. 2. The Claimant has sustained his burden of proof in the Claim petition, as evidenced by the Aqreement for Compensation. 3. The Defendant has failed to sustain its burden of proof in the Petition for Termination that the Claimant is no lonqer disabled or that any disability from which he suffers is not the result of his work injury. 4. The Defendant/Employer is responsible for payment of the Claimant'S reasonable and necessary medical and treatment expenses incurred for treatment and services provided for his work injury pursuant to Section 306(f.l) of the Act. includinq, but not limited to, expenses incurred for treatment provided by Dr. Hoben which has been found to be fair and reasonable. 5. As the Claimant has prevailed in this matter. his reasonable " Charles Owensby SS 1I003.3:a.0991 paqe 6 costs in litiqatinq this matter are to be reimbursed by the Defendant pursuant to Section 440 of the Act. 6. Interest at the rate of 10\ per annum is due and payable on all deferred payments of compensation. inCluding medical and treatment expenses. 7. The fee agreement between the Claimant and Kenneth Wise. Esquire. beinq fair. reasonable and in accordance with the Act is hereby approved. 8. The Employer'S contest in this matter has been unreasonable, for which the Employer is liable for payment of an attorney fee in the amount of $2.947.00. 9. The D~fendant did not violate the Act by failinq to pay Dr. Hoben'S bills through January of 1995. The Defendant had filed a Utilization Review, for which it received a determination that such bills were not reasonable or necessary. The statement which appears on the Agreement is null and void. and not enforceable. ORDERs AND NOW, the Claimant's Claim petition is hereby GRANTED in accorda~ce with this decision. The Defendant's Petition for Termina tion is hereby DENIED and DISMISSED. The Defendant shall continue to pay workers I compensation benefits to the Claimant j,n the amount of $257.45 per week. continuing into the indefinite future, unless or until otherwise altered pursuant to the Act. The Defendant shall pay the Claimant'S reasonable and . necessaxy medical. and treatment expenses incurred as the re!'ult of his work injury, such payments to be made in accordance with Section 306(f.1) of the Act, and to include payments of expenses incurred for treatment by Dr. Hoben as set forth in this decis~on. The Defendant shall pay the Claimant'S reasonable costs in litigating this matter in the amount of $270.40. The Defendant shall pay an attorney fee in the amount of $2,941.00 directly to Kenneth Wise. Esquire. as an attornijY fee in this matter, such payment not to be deducted from payments of compensation to the Claimant. The Defendant shall pay twenty percent (20\) of the Claimant's - " .~ .. , .. '" .,\ . , . . .'I' , . , . .' '. . '. UIC,4J1 ~.V 1HZ , ' ". COMMONWEALTH or PENNSYLVANIA DEPARl'MENT OF LABOR AND INDUSfRY BUREAU or WORKERS' COMPENSAnON HARRISBURG. PA 17104021101 Hay 17, 1996 'The forelOl... I. hereby certified to be . true and correct copy of_ Judge Elizabeth A. Crum's Decision Circulated February 23. 1996 In the cue of Charles Owensby va. E. E. Jacoby Company, 5.S. H003-32-0991J~3/2/94 u fuU, entire, and complete u the .ame remaine on file in the Bureau of Worke.,.' Compen.atlon of the Deputment of Labor and II'dUllry. Certified thi. 17th day of Hay 19 96 --;c . ~. c... IICa Chief Record. Manapment Divlalon ATrESn I h.reby certify that F. J. Woodward . who .Ipled the forellOi",. we. at the time of .lpli.... Chlef, Record. Manapment Dlvl.ion. Bureau of Worker.' Compen.alion. and a. .uch, _ the I.pl cu.todlan of the abov1I.de.crlbed record.. IN TESl'IMONY WIIEREOF, I have hereunto ..t Iby hand and ceu.ed the ..al of the Department of Labor and Indu.try to be affixed on thl. 17th day of Hay 19..2!-. S.al of Ihe Department of Labor and Indu.try / u7 " I" /_?___-' I.' ,{ L Snodrn J. N~al WRIT OF EXECUTION .nd/or ATIA(;HMENT COMMONWEAl. TH OF PENNSYLVANIA) COUNTY OF CUMBERLAND) NO, _96- 2932 CIVIL19_ CIVIL ACTION. LAW TO THE SHERIFF OF CUMBERLAND COUNTY: Charles R. Owensby, Sr. To satisfy Ihe debt. Inleresl and cosls due PLAINTIFF(S) trom E. E. Jacoby Company, 81 Kutz Road, Carlisle PA 17013. DEFENDANT(S) (1) You are directed to levy upon Ihe property ollhe delendant(s) and to sell Personal property. (2) You are alllO directed to allach Ihe property 01 Ihe delendanl(s) nollevled upon In Ihe possession 01 Farmers Trust Co., 1 W. HIgh St., Carlisle PA 17013. ~____~_.~___________._____ GARNISHEE(S) as lollows: All bank accounts of Defendant. Kindly serve Interrogatories. .. and 10 nol~y Ihe garnlshee(s) that: (a) an altachmenl has been Issued; (b) Ihe garnlshee(s) ISlare enjoined Irom paying any debito or lor the account 01 the defendant(s) and from delivering any property 01 the delendant(s) or olherwlse disposing thereol; (3) It property 01 the delendant(s) not levied upon an s'Jbjecl to allachmentls found In the possession 01 anyone ether than a named garnishee, you are dlrecled to nolify hlrrvherthat he/she has been added as a garnishee and Is enjoined as above slated, Amount Due $11,910.46 --._._--~.-._-_..,.,---_._-- LL. $.50 .--------.---- $1.00 Intere" Ally's Comm Any Paid Ptalnllll Paid % Due Prolhy _.__.___ Other Costs $32.50 Date: May 24, 1996 Law~ence E. Welker . prOlhrotarr, Civil Division by: _~) ,) ; CI-'\ L~1J Deputy REQUESTING PARTY: Name Kenneth A. Wis.:, Eeq. Address: 126 Lc:cust St. Harrisburg PA 17101 Anorneylor: _ Plaintiff T.lephone: ( 717) 238 - 3 8 3.!!..,___ Supr.rneCourtlDNo, __161~,____ STATE OF TENNESSEE COUNTY OF /'1" N I- 0 E : SS ~o ':3 - ;~ J - C' '1 '( ( ~I'IDAVI'l' 01' CIlAIlL.B R. O..IfBn. BR. AND NOW, comes Charles R. Owensby, Sr., and, being duly sworn according to law, depose. and says as follows: 1. My name is Charles R. Owensby, Sr. I currently live in Madisonville, Tennessee. My Social Security Number is 003-32-0991. 2. I am the Claimant in a certain proceeding under the Pennsylvania Workmen'. compens3tior. Act before the Pennsylvania Workmen's Compensation Appeal Board, captioned Charles R. Owensby, Sr., v. E. E. Jacoby Company. 3. Previously I had been receiving II-weekly benefit checks tor work loss in the "weekly amount of $257.45. These checks are at lent thirty (30) days overdue. L fJ ~ ( (I, ,.: (It J I I . 1't 4. I have not received the following amounts due me under the term. of the Referee's Decision, nor have they been paid on my behalf : A. B. C. Attorneys fees awarded -- Medical Bills - Dr. Hoban Legal costs -- $2,947.00 $6,733.00 $ 270.40 :)~); ft Date I ~~....~, O.4>t!--J!-......L' ~ Char les R. Owensby, Sr. t:7 Sworn to and subscribed 0' day .f ,1/ . ~?y . _. -..:-, II,. " , I' Unpaid Medical Bills " , , " Exhibit A " , ,,-,, I' .' 'l,t ,", " ,. ::,il:.'J : :; ~1594 ! ('I,: 7'; 4 :00794 100794 . ,., ~. " 11l1l7'H : _ ~ ,; 'J ; IOIOH 11' I "., I "" : '~ . "'') . .....,.t' 4'", t """" " ~ - . I.".....n' " . - . . . ". :' ,~ ...~: ;1('\' ,'.:'. : . .1*1"" . ..... . " , , ~ " ','-,ll .. ': ;'3.1. ~ 1: .\. ... l : . . . ~; .. .' d, " ..; >-. '" "" ,,",' .. :-; j.' ~ ;,:- ." . ..' , .' ,j .,., ;! :' l: t ~ IIi. .[' 1 ~;' ,..::;. 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Meyer (Dr. Danyo Deposition 5/24/95) $132.20 TOTAL $138.20 $210.40 '" " i' \ ' '- ') -......:. ... ; ". ~ 'j, " :t \ '" ".' , " ., ;~ ~ -.. , , ~~~ a ~ '\~ ~ Ii. , L: ' , I. j '- , , .'. " ,...,.- :'-l YJ', ...... ~, -" 'J ., ~ ,""' """-i 1 1"-' 'y ~ . .. ~ In ,J .. ~ 1'1 ~ ~'"' ~ <j - ~~~,,~ "--.\..:... ''-..J ..; ~ \ ..... '::>C "-J..'\\ ".-' ~ . '-' r- -,..;.j ~ ~ - 1- ~~!~~ I;:e !'!!:..l :.! - ;., ...:!;:"",::tll ' ' '" >: iii ~ ~~ij&l~ ~;: ~~gq~ E~ ;;0: ~ ~ ~ <.:i ..: ~o(_ ~ ! , . , , , ,