ARMANDO CEJA-CISNEROS, aka ISAIAS GONZALEZ, Employee/Appellant, v. COLD SPRING GRANITE, SELF-INSURED/ARTHUR J. GALLAGHER RISK MGMT., Employer.
WORKERS’ COMPENSATION COURT OF APPEALS
NOVEMBER 29, 2010
No. WC10-5132
HEADNOTES
ATTORNEY FEES - RORAFF FEES; ATTORNEY FEES - GENUINE DISPUTE. Where two medical bills were presented to the self-insured employer well before the hearing, and were not paid, the bills were in dispute and the compensation judge erred in denying a contingent Roraff fee for obtaining these benefits.
ATTORNEY FEES - GENUINE DISPUTE; PRACTICE & PROCEDURE - RECORD. In contested attorney fee cases, this court will consider only exhibits submitted to the judge and admitted into evidence at the hearing. Unidentified documents in the imaged file will not be considered on appeal. Where no evidence was submitted to establish the employer was provided with a bill or charges for certain medical expenses prior to the day before the hearing, the compensation judge properly concluded the employee failed to establish there was a genuine dispute with respect to these medical expenses.
ATTORNEY FEES - RORAFF FEES. Where the employee did not prevail on any contested issues at the hearing, and recovered only medical benefits stipulated to at the hearing, of which two only were proved to be in dispute prior to the hearing, the compensation judge reasonably denied Roraff attorney fees for obtaining payment of medical expenses.
Affirmed in part and reversed in part.
Determined by: Johnson, C.J., Pederson, J., and Stofferahn, J.
Compensation Judge: Peggy A. Brenden
Attorneys: Richard C. Lund, Law Offices of Donald F. Noack, Jr., Mound, MN, for the Appellant. Gregg A. Johnson and Joseph A. P. Mitchell, Heacox, Hartman, Koshmrl, Cosgriff & Johnson, St. Paul, MN, for the Respondent.
OPINION
THOMAS L. JOHNSON, Judge
The employee appeals the compensation judge’s denial of Roraff[1] attorney fees based on medical expense benefits ordered paid by the compensation judge pursuant to a pre-hearing stipulation of the parties. We affirm in part and reverse in part.
BACKGROUND
Armando Ceja-Cisneros, the employee, sustained a personal injury on September 5, 2001,[2] arising out of his employment with Cold Spring Granite, the employer, then self-insured for workers’ compensation liability with claims administered by Arthur J. Gallagher Risk Management. The self-insured employer admitted liability for the employee’s personal injury and paid certain workers’ compensation benefits to the employee including temporary total and permanent partial disability benefits.
In January 2009, the employee filed a claim petition seeking penalties for failure to timely pay temporary total disability benefits. The employee sought these benefits as a result of the admitted September 5, 2001, personal injury and alleged a second personal injury arising out of his employment with the employer on March 2, 2007. In June 2009, the employee filed a second claim petition seeking temporary total, temporary partial, and permanent partial disability benefits arising out of the September 5, 2001, and March 2, 2007, dates of injury. In addition, the employee claimed entitlement to medical benefits at Injured Workers Pharmacy in the amount of $334.52. In its answer, the self-insured employer denied liability for the claimed benefits.
By letters and facsimile dated March 19, 2009, September 15, 2009, October 8, 2009, and December 14, 2009, counsel for the employee contacted counsel for the employer requesting payment of medical mileage expenses incurred by the employee from March through September 2009, including documentation of dates, locations, and mileage for each trip. (Ee Ex. B-E.)
The employee’s claim for benefits was heard before a compensation judge at the Office of Administrative Hearings (OAH) on January 6, 2010. At the hearing, the compensation judge received into evidence a claim summary prepared by the employee’s counsel, Employee Exhibit A. The claim summary enumerates unpaid medical bills from Injured Workers Pharmacy and other medical providers, a claim for medical mileage, and a claim for certain out-of-pocket expenses of the employee. The exhibit reflects the self-insured employer’s agreement to pay these expenses. At the attorney fee hearing, both counsel testified they verbally agreed on January 5, 2010, that the employer would pay the medical expenses outlined in Exhibit A. In a Findings and Order filed February 1, 2010, the compensation judge found the symptoms for which the employee received treatment on March 2, 2007, were a continuing consequence of the September 5, 2001, personal injury and did not reflect a new injury. The compensation judge denied the employee’s claims for temporary total, temporary partial, and permanent partial disability benefits, but ordered that the medical expenses identified in Exhibit A be paid in conformity with the fee schedule. There was no appeal from the judge’s findings and order.
The employee’s attorney filed a Statement of Attorney’s Fees on April 22, 2010, seeking payment of Roraff attorney fees of $12,773.50. The self-insured employer filed an objection to the attorney fee request. Following a hearing, in a Findings and Order filed June 21, 2010, the compensation judge found that of the time documented in the employee’s Statement of Attorney Fees prior to June 4, 2009, only .4 hours were related to contested medical issues. The judge further found the only medical expenses identified by the employee’s counsel prior to January 5, 2010, were prescription expenses from the Injured Workers Pharmacy and employee mileage expenses. The judge also found medical expenses were not an issue of primary importance in the January 2010 hearing, the medical issues presented were neither novel nor complex, and the medical issues presented did not present any difficult proof problems. Finally, the compensation judge found the employee failed to establish there was any genuine dispute regarding entitlement to medical benefits and denied the employee’s claim for attorney fees. The employee appeals.
DECISION
The compensation judge found that on or about January 5, 2010, for the first time, the employee’s attorney provided to counsel for the employer a detailed summary of the medical expenses the employee intended to claim at the January 6, 2010, hearing, and that the only medical expenses identified by counsel prior to that date were medical mileage claims and a bill from the Injured Workers Pharmacy. The judge further found that upon receipt of the January 5, 2010, medical bill summary, the employer agreed to pay the medical expenses. The judge concluded there was no genuine dispute regarding the payment of medical expenses within the meaning of Minn. Stat. § 176.081, subd. 1.(c), and denied the claim for attorney fees.
Minnesota Statutes § 176.081, subd. 1.(a), provides for contingent attorney fees for the recovery of disputed medical benefits. Subdivision 1.(c) of the statute states that attorney fees may not be calculated on “any undisputed portion of compensation awards” and “shall be based solely upon genuinely disputed claims or portions of claims.” The employee contends there was a genuine dispute with respect to all of the medical expenses claimed entitling counsel to a fee for obtaining the medical benefits, and that the judge erred in denying the requested fees.
1. Injured Workers Pharmacy, Medical Mileage. Medical expenses at the Injured Workers Pharmacy in the amount of $334.52 were set forth in the June 2009 claim petition. The employee’s claim for medical mileage in the amount of $1,172.71 was outlined in Employee Exhibits B through E. These medical expenses were presented to the employer well before the January 2010 hearing and were not paid and were, therefore, in dispute. We, accordingly reverse the judge’s denial of attorney fees for these expenses. The employee’s counsel is entitled to, and is awarded, a contingent fee on these benefits pursuant to Minn. Stat. § 176.081, subd. 1, payable by the self-insured employer.
2. Other Medical Expenses. Employee Exhibit A lists additional medical expenses from Central Minnesota Emergency Physicians, St. Cloud Orthopedics, St. Cloud Hospital, the Injured Workers Pharmacy, and Regional Diagnostic Radiology. The employee argues these medical expenses were presented to the employer, with documentation, through a combination of the claim petition, letters and faxes, and intervention papers many months before the hearing. However, no evidence was submitted to establish the employer was advised of these outstanding claims or provided with a copy of charges from these medical providers prior to January 5, 2010.
In contested attorney fee cases, this court will consider only exhibits submitted to the judge in paper form and admitted into evidence at the hearing before the compensation judge. Unidentified documents in the “imaged file” will not be considered on appeal. Moore v. University of Minn., No. WC07-195 (W.C.C.A. Nov. 30, 2007); Beckwith v. Sun Country Airlines, 63 W.C.D. 511 (W.C.C.A. 2003). In reviewing the exhibits in this case, we find only documentation of presentation to the employer - - prior to January 5, 2009 - - of the medical mileage claims and the previously referenced portion of the Injured Workers Pharmacy claim. Absent proof the employer was provided reasonable notice of an outstanding claim and given an opportunity to make payment prior to presentation of the January 5, 2010, claim summary, the compensation judge properly found the employee failed to establish there was a genuine dispute with respect to these medical expenses within the meaning of Minn. Stat. § 176.081, subd. 1.
3. Calculation of Roraff Fee. Finally, the employee claims the compensation judge erred in denying his claim for attorney fees in excess of the statutory contingent fee. The appellant asserts that all, or substantially all, of the time spent on this case by the employee’s counsel should be used to calculate the Roraff attorney fee due.[3] We are not persuaded.
The claim at the January 6, 2010, hearing was for temporary total, temporary partial, and permanent partial disability benefits as a result of a work injury on September 5, 2001, and an alleged second injury on March 2, 2007. Primary liability for the September 2001 injury was never in dispute. The compensation judge found the employee did not sustain a second personal injury and denied all of the employee’s claims, other than payment of the medical expenses stipulated to by the parties prior to the hearing. As noted above, the only medical benefits proven to have been actually in dispute were a bill from the Injured Workers Pharmacy and medical mileage.
The employee cites Peterson v. Everything Clean, Inc., 55 W.C.D. 126 (W.C.C.A. 1996) for the proposition that all of the time spent by counsel in obtaining an award of benefits for an employee must be included in calculating the fee. We do not interpret Peterson so broadly. In the Peterson case, the employee’s attorney successfully established disputed primary liability resulting in an award of indemnity and medical benefits. This court held that in such circumstances, the effort required to establish primary liability is properly included in calculating the attorney fee. In this case, the employee failed to prove liability for the alleged second injury and did not obtain any disputed benefits other than the two medical bills previously discussed, payment for which was stipulated to by the parties prior to the hearing. The employee also cites Stark v. Heritage Communications, slip op. (W.C.C.A. May 10, 2000). In Stark, the injury was admitted, but the reasonableness and necessity of certain medical treatment was disputed at the hearing. The compensation judge accepted the attorney’s estimate that he spent fourteen hours solely on the medical issues on which he prevailed. In this case, the employee’s counsel failed to provide any estimate of the time spent to present and prepare the two disputed medical bills. The compensation judge found that, had the employer not stipulated to payment of the medical expenses, preparation and presentation of all of the medical expenses stipulated to by the parties reasonably would have required less than 8 hours of attorney time. The judge further found the medical issues presented were neither novel nor complex and did not present any difficult proof problems.
Attorney fees may be awarded only on “compensation awarded to the employee” and “solely upon genuinely disputed claims or portions of claims.” Minn. Stat. § 176.081, subd. 1. Because each case is factually unique, this court generally defers to the compensation judge’s judgment and discretion in determining an award of Roraff fees. Dimon v. Metz Baking, 64 W.C.D. 143 (W.C.C.A. 2003). Based on the facts of this case, we cannot conclude that the compensation judge’s denial of Roraff attorney fees was unreasonable, and the judge’s denial of attorney fees is affirmed as modified above.
[1] Roraff v. State, Dep’t of Transp., 288 N.W.2d 15, 32 W.C.D. 297 (Minn. 1980).
[2] The employee’s claim petitions list September 2, 2001, as the date of the admitted injury. Based on the notice of injury and the facts stipulated to by the parties at the January 6, 2010, hearing, the date of injury was September 5, 2001.
[3] The parties agree the compensation judge improperly applied a “primary importance” standard contrary to John v. Suburban Air Conditioning, 62 W.C.D. 285 (W.C.C.A. Feb. 21, 2002).