Alabama Workers' Comp Blawg

Alabama Court Addresses Proper Way to Question Medical Treatment after Indemnity and Vocational Benefits are Settled

On September 23, 2016, the Alabama Court of Civil Appeals released its opinion inAugmentation, Inc. v. Harris. Debra Harris alleged injuries to her neck, back, and left shoulder while working for Augmentation on April 3, 2011. Harris’ authorized treating physician, Dr. James Bailey, diagnosed Harris with "recurrent cervical and lumbar strains", and prescribed conservative treatment that consisted primarily of injections and pain medications. Augmentation disputed that the "recurrent strains" were related to Harris’ alleged accident, and Harris filed a Complaint for workers’ compensation benefits in the Circuit Court of Tuscaloosa County. At the outset of the case, Augmentation filed a motion seeking an independent medical examination, and that motion was denied. After the depositions of Harris and Dr. Bailey, the parties agreed to a settlement of Harris’ indemnity and vocational benefits. The settlement agreement presented to the trial court clearly stated that compensability of Harris’ alleged injuries was disputed, and that the issue of "future medical benefits shall remain open, subject to all medical necessity, causation, and pre-authorization requirements as provided by The Alabama Workers’ Compensation Act." The trial court approved the settlement in April 2014.

Subsequent to the settlement, in 2015, Dr. Bailey prescribed a lumbar epidural steroid injection and prescription pain medications to treat Harris’ lumbar strain. The workers’ compensation adjuster wrote to Dr. Bailey, asking him to address whether the need for said treatment was related to the April 2011 injury or some other cause, and if so, what the basis for his opinion was. According to Augmentation, Dr. Bailey did not respond to the letter. The adjuster then contacted two other orthopedic specialists, and asked for their respective opinions on the matter. Both of those physicians penned reports in which they stated that the cervical and lumbar strains Harris sustained in the April 2011 accident most certainly would have resolved after nearly four years, and the need for further treatment would not be related to the accident. Based on this information and the fact that Dr. Bailey had not provided any information to the contrary, the treatment prescribed by Dr. Bailey was not approved. Harris then filed a petition asking the Court to hold Augmentation in contempt of the April 2014 Order approving the settlement. Augmentation responded to Harris’ petition, asserting that the April 2014 Order did not require it to provide the treatment prescribed by Dr. Bailey unless Harris could prove that the treatment was related to the 2011 accident. Citing § 25-5-88 of The Alabama Workers’ Compensation Act, Augmentation pointed out that Harris was entitled to have a trial on the issue to resolve the dispute, and that Harris would have the burden of proof. Augmentation also argued that even if it should have approved the treatment recommended by Dr. Bailey, it’s failure to do so was not willful and contumacious based on the language of the settlement agreement. The court set the matter for hearing, and Augmentation sought leave of court to obtain the deposition testimony of the two orthopedic specialists who provided written opinions prior to the hearing on Harris’ contempt petition, which the trial court denied.

The trial court held a hearing, and found Augmentation in contempt "for its willful, continuing failure or refusal to comply with the Court’s Settlement Order dated April 3, 2014, wherein the Court ordered that future medical benefits shall remain open." The trial court further stated that Augmentation failed to present evidence that the treatment prescribed by Dr. Bailey was not reasonably necessary, and that it failed to present good and valid reasons for its refusal to authorize that treatment. The court ordered Augmentation to pay Harris’ attorney’s fees, and ordered Augmentation to approve all treatment prescribed by Dr. Bailey. Augmentation appealed, arguing that it was not in contempt because the settlement order put limitations on its liability for future medical treatment; that any violation of the settlement order was not willful and contumacious; and that the trial court erred by failing to allow meaningful discovery or conduct a trial on the merits of the case.

The Court of Appeals found that while the settlement order only required Augmentation’s to provide future medical care subject to medical necessity, causation, and pre-authorization requirements, the trial court had concluded that the treatment prescribed by Dr. Bailey satisfied those requirements. The Court of Appeals further held that it was Augmentation’s duty to contest its liability (prior to Harris filing her contempt petition), citingTotal Fire Prot., Inc. v. Jean, 160 So.3d 795, 799 (Ala.Civ.App. 2014). The Court noted that Augmentation did not seek a judicial determination in accordance with § 25-5-88 prior to Harris filing her petition, and it did not resort to the utilization review process outlined in § 25-5-293(g). As a result, the Court of Appeals held that the trial court did not abuse its discretion in finding that Augmentation’s failure to approve the treatment "without just cause" was willful and contumacious.

The Court of Appeals affirmed the trial court’s ruling, and Augmentation petitioned the Supreme Court of Alabama for a Writ of Certiorari. On December 9, 2016, the Supreme Court denied the Petition for Writ, without a written opinion.

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About the Author

This article was written by Charley M. Drummond, Esq. of Fish Nelson & Holden, LLC. Fish Nelson & Holden is a law firm located in Birmingham, Alabama dedicated to representing employers, self-insured employers, and insurance carriers in workers’ compensation cases and related liability matters. Drummond and his firm are members of The National Workers’ Compensation Defense Network (NWCDN). The NWCDN is a national and Canadian network of reputable law firms organized to provide employers and insurers access to the highest quality representation in workers’ compensation and related employer liability fields. If you have questions about this article or Alabama workers’ compensation issues in general, please feel free to contact the author at cdrummond@fishnelson.com or (205) 332-3414.