{
  "id": 6137910,
  "name": "Michael PENNINGTON v. GENE COSBY FLOOR & CARPET",
  "name_abbreviation": "Pennington v. Gene Cosby Floor & Carpet",
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    "judges": [
      "Mayfield, J. and Bullion, S.J., dissent."
    ],
    "parties": [
      "Michael PENNINGTON v. GENE COSBY FLOOR & CARPET"
    ],
    "opinions": [
      {
        "text": "Judith Rogers, Judge.\nThis is an appeal from the Workers\u2019 Compensation Commission\u2019s order affirming and adopting the administrative law judge\u2019s decision. The ALJ found that appellant\u2019s claim for additional benefits was barred by the statute of limitations. On appeal, appellant argues that there is no substantial evidence to support the Commission\u2019s decision. We disagree and affirm.\nThe record reveals that appellant suffered a compensable injury on September 18, 1990. Temporary total disability benefits were paid until December 6, 1991. Appellant had been assessed a five percent permanent partial impairment rating that was paid in full on January 28, 1992. On June 23, 1992, appellant visited Dr. Jay Lipke, who was not his treating physician. Appellee\u2019s carrier, Cigna Insurance, refused to pay for this treatment and was never billed for Dr. Lipke\u2019s treatment. On April 6, 1993, appellant filed a claim for additional benefits. Appellee contested the claim on the basis that the statute of limitations barred appellant\u2019s claim.\nArkansas Code Annotated \u00a7 ll-9-702(b) (Repl. 1993) provides:\n(b) Time for Filing for Additional Compensation. In cases where compensation for disability has been paid on account of injury, a claim for additional compensation shall be barred unless filed with the commission within one (1) year from the date of the last payment of compensation, or two (2) years from the date of the injury, whichever is greater.\nAppellant argues on appeal that Dr. Jay Lipke\u2019s treatment on June 23, 1992, tolled the statute of limitations, and that consequently, his request for additional benefits on April 6,1993, was within the one year statutory period. In support of his position, appellant specifically contends that a nurse who worked for his treating physician referred him to Dr. Lipke, constituting a valid referral. We disagree.\nArkansas Code Annotated \u00a7 11-9-514(a)(1) (Repl. 1993) provides:\nIf the employee selects a physician, the commission shall not authorize a change of physician unless the employee first establishes to the satisfaction of the commission that there is a compelling reason or circumstance justifying a change.\nThe Commission\u2019s authority to characterize a change of physician as a referral has its origin in the Commission\u2019s own Rule 23, which authorizes the Commission to permit deviation from the Commission\u2019s rule when compliance is impossible or impractical. Patrick v. Arkansas Oak Flooring Co., 39 Ark. App. 34, 833 S.W.2d 740 (1992). We held in Electro-Air v. Villines, 16 Ark. App. 102, 697 S.W.2d 932 (1985), that a referral had occurred where the evidence showed that the claimant\u2019s treating physician had referred her to a psychiatrist for specialized treatment. In White v. Lair Oil Co., 20 Ark. App. 136, 725 S.W.2d 10 (1987), we held that a change of physician had occurred when the claimant\u2019s treating physician refused to see him when emergency services were required. We concluded that this refusal effectively released the claimant from his care and that the claimant\u2019s family physician became claimant\u2019s treating physician. Also, in the case of TEC v. Underwood, 33 Ark. App. 116, 802 S.W.2d 481 (1991), we found that a referral occurred when the claimant had moved to Oklahoma, and her treating physician referred her to a physician in Oklahoma. In the above cases, the claimants were referred by their treating physicians or emergency circumstances required a referral for treatment. None of those situations exist in this case.\nHere, the record reveals that on May 26, 1992, Janna Craig from Cigna Insurance wrote to appellant regarding his claim. She stated:\nI am writing you with regard to your workers\u2019 compensation claim. You need to return to the doctor for final medical evaluation, so that we will know if you have received all the benefits you are entitled.\nAt one time Attorney Steve Laney informed me you wanted a change of physician. To date I have not received any written confirmation of that request or any written confirmation that Mr. Laney represents you in this matter. Please advise me if you desire a change of physician. If not, please return to your previous doctor.\nAppellant testified that he attempted to see Dr. Amal O\u2019Laimey, his authorized treating physician, on June 20, 1992. Appellant said that Dr. O\u2019Laimey was not available so the nurse referred him to Dr. Lipke. Appellant admitted that he did not try to reschedule a time to see Dr. O\u2019Laimey. Interestingly, the record also indicates that appellant was the only one to testify that the nurse at Dr. O\u2019Laimey\u2019s office referred him to Dr. Lipke. Appellant concluded that he saw Dr. Lipke on June 23, 1992, which was three days after he sought treatment by Dr. O\u2019Laimey.\nThe record indicates that Dr. Lipke\u2019s office contacted Ms. Craig concerning the bill. Ms. Craig testified, however, that she refused to authorize payment for Dr. Lipke\u2019s treatment. She said that she sent the Commission\u2019s Form A-ll to appellant\u2019s attorney on October 12, 1992, and received no response. Ms. Craig testified further that she never received a bill from appellant or from Dr. Lipke\u2019s office. She also stated that she never received a referral slip showing that Dr. O\u2019Laimey\u2019s office had referred appellant to Dr. Lipke. The record contains one letter from Dr. Lipke\u2019s office which does not mention that appellant was referred from Dr. O\u2019Laimey\u2019s office.\nWhether treatment is a result of a \u201creferral\u201d rather than a \u201cchange of physician\u201d is a factual determination to be made by the Commission. Patrick v. Arkansas Oak Flooring Co., supra. When the Commission\u2019s findings of fact are challenged on appeal, we affirm if they are supported by substantial evidence. Substantial evidence means such relevant evidence as a reasonable mind might accept as adequate to support a conclusion. We do not reverse the Commission\u2019s decision unless we are convinced that fair-minded persons with the same facts before them could not have arrived at the conclusion reached by the Commission. Id.\nThe Commission found that appellant received unauthorized treatment from Dr. Lipke. After reviewing the record, we cannot say that there is no substantial evidence to support the Commission\u2019s findings that appellant\u2019s treatment by Dr. Lipke was not based on a valid referral and that appellant\u2019s claim was barred by the statute of limitations.\nAffirmed.\nMayfield, J. and Bullion, S.J., dissent.",
        "type": "majority",
        "author": "Judith Rogers, Judge."
      },
      {
        "text": "Melvin Mayfield, Judge,\ndissenting. I cannot agree that the statute of limitations has barred the appellant\u2019s claim for additional worker\u2019s compensation benefits in this case.\nArkansas Code Annotated \u00a7 ll-9-702(b) (1987) provides that where compensation has been paid, a claim for additional compensation must be made within one (1) year from the date of the last payment, or within two (2) years from the date of injury.\nIn this case, the date of injury was more than two (2) years before the additional claim was made on April 6, 1993. However, the appellant testified that he saw a doctor on June 23, 1992. Therefore, unless this visit to the doctor was unauthorized by the appellant\u2019s employer and its insurance carrier, Cigna Insurance Company, the appellant\u2019s claim for additional compensation was not barred by limitations. This is true because, for statute of limitations purposes, the date that medical benefits are furnished is deemed to be payment of compensation \u2014 not the date that payment for the medical services is actually made. See Heflin v. Pepsi Cola Bottling Co., 244 Ark. 195, 424 S.W.2d 365 (1968); Cheshire v. Foam Molding Co., 37 Ark. App. 78, 822 S.W.2d 412 (1992).\nAt the hearing before the administrative law judge it was stipulated that the treatment rendered to appellant for his on-the-job injury by Doctors Olaimey, Williams, Arnold, and Doyle was authorized and that Janna Craig, an adjuster for Cigna Insurance Company, received notice on June 25, 1992, of Dr. Lipke\u2019s medical treatment of the appellant on June 23, 1992. The appellant testified that he attempted to see his treating physician, Dr. Olaimey, in June of 1992, but he was unavailable and Dr. Olaimey\u2019s nurse told appellant to see Dr. Lipke, who in turn referred him to Dr. William Saer. The Commission found, and the majority opinion agrees, that this referral from Dr. Olaimey\u2019s staff was not a valid referral. I do not think the evidence and the law will support that finding.\nJanna Craig testified that in March 1992, she received a call from Steve Laney, a Camden attorney, stating he represented the appellant and was seeking a change of physicians for appellant to Dr. John Wilson. She said she told him that was improper procedure and instructed him that he would need to apply to the Workers\u2019 Compensation Commission for a change of physicians. Ms. Craig said the next she heard about appellant\u2019s claim was when she received a telephone call from Dr. Lipke\u2019s office on June 25, 1992, asking that she authorize payment for charges-created when appellant was examined by Dr. Lipke, and she refused the charges. She then sent Attorney Laney an A-ll form setting forth the statute of limitations and, after getting no response, closed the file on November 16, 1992.\nThe appellant testified that Mr. Laney first represented him, but he later retained Robert B. Buckalew of Little Rock, and there is a letter in the record dated July 15,1993, from Dr. Olaimey to appellant\u2019s attorney, Mr. Buckalew, which states:\nFollowing our conversation per telephone, it was nice talking to you about Mr. Michael Pennington. It is out [sic] policy when I\u2019m not available to refer our patient\u2019s [sic] to Dr. Jay Lipkie [sic] for evaluation and reatment [sic] for their orthropedic [sic] care.\nThere is also a form entitled \u201cPatient Information\u201d in the record. This form is signed \u201cMichael Pennington\u201d and contains handwritten information about the appellant. It states, in part, that he had a \u201cherniated disk\u201d and that it happened on the job. It states that the visit was \u201crelated to a workers\u2019 compensation injury,\u201d that the employer was \u201cGene Cosby,\u201d and that the bill would be paid by \u201cCigna Ins. Co.\u201d The form also states that the patient was referred by Doctor Olaimey. And there is a handwritten note, across the blanks for information about the insurance company, which states that \u201cCigna would not authorize.\u201d\nAlso in the record is a letter from Dr. Lipke to Dr. Olaimey, dated June 23, 1992, stating that Michael Pennington has \u201cbeen seen by Dr. Ronald Williams and Dave Arnold and apparently had a personality conflict with Dr. Arnold.\u201d The letter also states that Mr. Pennington relates that he \u201cwants to have his back fixed via surgery\u201d and \u201cI\u2019ve suggested he see Dr. Ted Saer, Dr, Arnold\u2019s former associate, for further evaluation.\u201d\nAnd the record contains a letter from Janna Craig to the appellant, dated May 5, 1992, in which she states:\nI am writing you in regard to your workers\u2019 compensation claim. You need to return to the doctor for a final medical evaluation, so that we will know if you have received all benefits to which you are entitled.\nAt one time Attorney Steve Laney informed me you wanted a change of physician. To date I have not received any written confirmation of that request or any written confirmation stating that Mr. Laney represents you in this matter. Please advise me if you desire a change of physician. If not, please return to your previous doctor.\nNow it is perfectly clear from the record that after the appellant had sustained a work-related injury, had been treated by doctors authorized by Cigna Insurance Company, and had been paid some temporary and some permanent disability benefits, he then received a letter from Janna Craig, an adjuster for the insurance company, telling him to return to his doctor for a final medical evaluation \u201cso that we will know if you have received all the benefits to which you are entitled.\u201d This letter was written on May 5, 1992, and on June 23, 1992, the appellee \u2014 in keeping with the suggestion of Cigna\u2019s adjuster \u2014 went to see an authorized doctor, Dr. Olaimey. The doctor was not available and his nurse \u2014 in keeping with the doctor\u2019s policy \u2014 referred the appellant to Dr. Lipke. That doctor\u2019s office personnel had the appellant fill out a form, and Dr. Lipke saw the appellant on June 23, 1992. Dr. Lipke also wrote Dr. Olaimey that same day reporting what he had told the patient. And Ms. Craig testified that on June 25, 1992, Dr. Lipke\u2019s office called her asking that she authorize payment for the appellant\u2019s visit to Dr. Lipke and that she refused to do so.\nThere is no dispute about the above events. The law judge\u2019s opinion was adopted by the full Commission \u201cincluding all findings and conclusions therein,\u201d and the law judge\u2019s opinion does not indicate that any of these events were in doubt factually. His discussion assumes that these events occurred and is based on two conclusions of law. First, the opinion states:\nFor statute of limitations purposes, compensation for medical benefits is deemed to be the date on which treatment is furnished, not the date on which the medical bill is paid. Heflin v. Pepsi Cola Bottling Co., 244 Ark. 195, 198, 424 S.W.2d 365 (1968). Implicit in this rule is that conclusion that the furnished treatment cannot be considered compensation unless it has been paid.\nAnd the second conclusion of law given by the law judge to support his decision is stated as follows:\nHere, the claimant\u2019s claim for additional benefits came too late, falling outside the statute of limitations since he obtained treatment without approval (within the limitation period) and this was not accepted or paid by the carrier.\nThe problem is that both conclusions contain errors of law; however, there is no problem about the occurrence of the events involved. Thus, I do not agree with the majority opinion\u2019s conclusion that the law judge\u2019s conclusion (adopted by the Commission) is supported by substantial evidence. The problem is really not the evidence. It is the law that is applied to the evidence.\nThe appellant contends that because a nurse in Dr. Olaimey\u2019s office told him to go see Dr. Lipke, this was a valid referral. In support of this argument he cites White v. Lair Oil Co., 20 Ark. App. 136, 725 S.W.2d 10 (1987), and TEC v. Underwood, 33 Ark. App. 116, 802 S.W.2d 481 (1991).\nIn a case cited by both of the above cases, Electro-Air v. Villines, 16 Ark. App. 102, 697 S.W.2d 932 (1985), this court held that a referral had indeed occurred where the evidence showed that a claimant\u2019s treating physician had referred her to a psychiatrist. We observed:\n[W]e believe the commission erred in characterizing the treatment by Dr. Butts as a change of physicians rather than a referral. In its opinion the commission stated:\nThere is some indication that Dr. Ledbetter, who was treating claimant, wished to have claimant examined by Dr. Butts. However, the record also indicates that claimant was initially referred to Dr. Butts by her attorney. Therefore, we believe claimant\u2019s treatment by Dr. Butts should be characterized as a change of physicians rather than as a referral.\nDr. Ledbetter stated in his deposition that he had referred the appellee to Dr. Butts who provided her with psychological treatment and profiling as well. We think it immaterial that appellee\u2019s attorney also recommended Dr. Butts. We believe the record is clear that this was a referral and that the commission, although it improperly labeled it as a change of physicians, correctly approved the referral.\n16 Ark. App. at 105, 697 S.W.2d at 934.\nIn White, supra, we required the employer to cover the appellant\u2019s medical expenses after his treating physician refused to see him. We stated:\nWhen Dr. Tsang refused to assist appellant when emergency services were required, he effectively released his patient from his care. At that point, Dr. Dunaway [appellant\u2019s family physician] stepped into Dr. Tsang\u2019s shoes and became appellant\u2019s treating physician. Because the change was not of appellant\u2019s seeking but was instead prompted by exigent circumstances, we cannot conceive that a reasonable mind could reach the conclusion that a change of physician had occurred.\n20 Ark. App. at 138, 725 S.W.2d at 12.\nIn TEC, supra, the claimant had moved to Oklahoma and had been seeing a doctor there. The appellant argued that this constituted an unauthorized change of physician and cited cases to support its position. We said:\nHowever, these cases have no application here because Dr. Mertz\u2019s treatment was a \u201creferral\u201d rather than a \u201cchange of physician.\u201d Appellee testified that she had telephoned the office of Dr. Wolfe and asked for a referral \u201cover there,\u201d that she was told \u201cthey\u201d would talk to Dr. Wolfe and he would refer her to someone; that she was given the name of Dr. Mertz; that Dr. Wolfe sent her \u201crecords and everything to Dr. Mertz and let him know that I was going to be seeing him.\u201d The record also contains a letter from Dr. Mertz to Dr. Wolfe thanking him for referring appellee. The law judge held that appellee\u2019s request for a referral was not \u201cdoctor shopping under the circumstances.\u201d The full Commission made the same factual determination and adopted the law judge\u2019s finding. We think the Commission\u2019s decision is supported by substantial evidence and the law. See Electro-Air v. Villines, 16 Ark. App. 102, 697 S.W.2d 932 (1985).\n33 Ark. App. at 120, 802 S.W.2d at 484.\nI agree with the appellant\u2019s contention that when the nurse in Dr. Olaimey\u2019s office referred him to Dr. Lipke because Dr. Olaimey was unavailable, this was a valid referral, not a change of physicians; therefore, the furnishing of medical services by Dr. Lipke tolled the statute of limitation. Although I view this as an issue of law because the facts involved are really not in dispute, even if the issue is one of substantial evidence I think this court must still hold that the appellant\u2019s visit to Dr. Lipke was a referral rather than a change of physicians. Our rule is clear. We view the evidence in the light most favorable to the Commission\u2019s decision and affirm that decision if it is supported by substantial evidence; but substantial evidence exists only if reasonable minds could have reached the conclusion reached by the Commission, and we will reverse the Commission if we are convinced that fair-minded persons with the same facts before them could not have reached the conclusion reached by the Commission. Deffenbaugh Industries v. Angus, 313 Ark. 100, 852 S.W.2d 804 (1993); Price v. Little Rock Packaging Co., 42 Ark. App. 238, 856 S.W.2d 317 (1993). Here, I do not think the law judge\u2019s finding (adopted by the Commission) that appellant\u2019s visit to Dr. Lipke was obtained without approval is supported by substantial evidence. Under the law and the evidence fair-minded men would conclude that the visit to Dr. Lipke was a referral by a doctor who was authorized to treat the appellant.\nThe other error made by the law judge (and adopted by the Commission) is the statement that implicit in the Heflin v. Pepsi Cola case, supra, is, \u201cThe conclusion that the furnished treatment cannot be considered compensation until it has been paid.\u201d That case clearly holds that with regard to the limitations period it is the furnishing of medical services that constitutes payment of compensation within the meaning of the workers\u2019 compensation act and not the payment of the charges therefor. It is true that the employer or its insurance carrier must have reason to know that the medical services are being furnished the injured worker. Superior Federal Savings & Loan Ass\u2019n v. Shelby, 265 Ark. 599, 580 S.W.2d 201 (1979); McFall v. United States Tobacco Co., 246 Ark. 43, 436 S.W.2d 838 (1969). But those cases do not hold that furnished treatment cannot be considered compensation until it has been paid for as the law judge in the case at bar stated in his decision.\nIn our case of Cheshire v. Foam Molding Co., 37 Ark. App. 78, 822 S.W.2d 412 (1992), we referred to the Heflin case and said, \u201cIn that case, the court held that the furnishing of medical services constitutes payment of compensation within the meaning of Ark. Code Ann. \u00a7 ll-9-702(4)(b) (1987) [formerly Ark. Stat. Ann. \u00a7 81-1318(b) (Repl. 1960)], based upon reasoning that the claimant is \u2018compensated\u2019 by the furnishing of medical services and not by the payment of the charges therefore.\u201d And in Plante v. Tyson Foods, Inc., 319 Ark. 126, 131, 890 S.W.2d 253, 255 (1994), the court cited Heflin as authority for the statement that \u201cit is the furnishing of the services that tolls the statute, not the payment therefor.\u201d The court also stated that \u201cregardless of whether the respondent had actual knowledge of the 1989 and 1990 visits, the respondent should have known they would occur, . . . .\u201d\nIn the present case, Cigna Insurance Company certainly knew or should have known of appellant\u2019s visit to Dr. Lipke. His office called and asked if Cigna\u2019s adjuster, Ms. Craig, would authorize the payment. While Ms. Craig said she would not authorize payment for the visit, she had written the appellant and suggested that he \u201cneeded to return to the doctor for a final medical evaluation.\u201d That is exactly what he did. And in keeping with the policy of the doctor that the insurance company had authorized to treat the appellant, the appellant was referred to Dr. Lipke. On April 6, 1993, within one year after the appellant\u2019s visit to Dr. Lipke on June 23, 1992, the appellant filed a claim for additional compensation. Under this evidence and the law, the appellant\u2019s claim is not barred by limitations because the appellant was referred to Dr. Lipke by the doctor that Cigna Insurance had authorized to treat appellant, the visit to Dr. Lipke was made within the time limitations of the statutes, and Ms. Craig knew or should have known of the visit.\nI am authorized to state that Special Judge Bruce Bullion joins in this dissent.",
        "type": "dissent",
        "author": "Melvin Mayfield, Judge,"
      }
    ],
    "attorneys": [
      "Robert B. Buckalew, for appellant.",
      "Friday, Eldredge & Clark, by: James C. Baker, Jr. and John C. Fendley, Jr. for appellee."
    ],
    "corrections": "",
    "head_matter": "Michael PENNINGTON v. GENE COSBY FLOOR & CARPET\nCA 94-812\n911 S.W.2d 600\nCourt of Appeals of Arkansas En Banc\nOpinion delivered December 13, 1995\n[Petition for rehearing denied January 17, 1996.]\nRobert B. Buckalew, for appellant.\nFriday, Eldredge & Clark, by: James C. Baker, Jr. and John C. Fendley, Jr. for appellee."
  },
  "file_name": "0128-01",
  "first_page_order": 150,
  "last_page_order": 161
}
