KALLYS ALBERT, SR., Employee/Appellant, v. DUNGARVIN MINN., LLC, and ZURICH N. AM., Employer-Insurer, and PARK NICOLLET METHODIST HOSP. and PARK NICOLLET HEALTH SERVS., Intervenors.

WORKERS’ COMPENSATION COURT OF APPEALS
FEBRUARY 7, 2014

No. WC13-5609

HEADNOTES

EVIDENCE - ADMISSION.  The compensation judge did not abuse his discretion by excluding certain exhibits as irrelevant to the issues at the hearing or by admitting multiple records from a clinic as a single exhibit.  The judge did not consider the excluded exhibits in making his findings.

CAUSATION - SUBSTANTIAL EVIDENCE.  Substantial evidence supports the compensation judge’s finding that the employee sustained work injuries on December 4, 2005, which had resolved by December 13, 2005.

Affirmed.

Determined by:  Milun, C.J., Wilson, J., and Stofferahn, J.
Compensation Judge:  Danny P. Kelly

Attorneys:  Kallys Albert, Sr., Pro Se Appellant.  Patrick T. Grove, Drawe & Maland, Edina, MN, for the Respondents.

 

OPINION

PATRICIA J. MILUN, Chief Judge

The pro se employee appeals the compensation judge’s denial of temporary total disability benefits, temporary partial disability benefits, prescription expenses, medical expenses after December 13, 2005, medical mileage after December 13, 2005, and penalties, as well as evidentiary issues.  The employer and insurer appeal the judge’s refusal to admit three of their exhibits and the judge’s finding that the employee sustained work-related injuries on December 4, 2005.  We affirm.

BACKGROUND

On December 4, 2005, Kallys Albert, Sr., the employee, was involved in an incident with a resident while working at a group home run by Dungarvin Minnesota, the employer, which was insured for workers’ compensation liability by Zurich North America.  The employee notified his supervisor that he had been injured during the incident and completed an incident report at the end of his shift.  In the incident report, the employee stated that he had been pushed hard in the chest and that his feet had been run over several times by a resident’s wheelchair.  He also indicated that his feet and his left knee were injured.  The employer sent a first report of injury to the insurer indicating that the employee was claiming an injury to his feet.

On December 6, 2005, the employee treated with Dr. William Isaksen at Park Nicollet Clinic for a re-evaluation of a finger contusion and abrasion.  The medical record from that date does not mention any foot or chest injury.  The employee treated with Dr. Kevin Wall at the same clinic the next day, reporting chest discomfort and bilateral foot pain.  X-rays of the feet indicated no acute bony abnormality.  Dr. Wall assessed chest wall strain and bilateral feet contusion, both work-related.  Dr. Wall indicated that the employee could return to work with restrictions for two weeks and could return to work with no restrictions on December 21, 2005.

The employer and insurer served a notice of primary liability determination dated December 8, 2005, denying primary liability for the injury based on insufficient information to support a work-related injury.  The notice was received by the Department of Labor and Industry on December 12, 2005.  A supplemental first report of injury dated December 9, 2005, and filed by the employer indicated that the employee’s feet had been run over several times with a wheelchair.  On December 28, 2005, the insurer filed a report of the injury with the Department of Labor and Industry.

On December 13, 2005, the employee was examined by Dr. Goertz at Park Nicollet Clinic.  Dr. Goertz opined that employee’s chest wall strain and bilateral foot contusion had essentially resolved and that the employee could return to regular work, had 0 percent permanent partial disability, and was at maximum medical improvement.

In July 2009, the employee filed a claim petition for temporary total disability benefits, temporary partial disability benefits, prescription expenses, medical expenses, medical mileage, and penalties related to the December 4, 2005, injury.  The employer and insurer denied primary liability for the claimed injury and filed a motion to dismiss arguing that the employee’s claim was barred by the statute of limitations.  A compensation judge granted the motion to dismiss and the employee appealed.  This court remanded for an evidentiary hearing on the motion to dismiss to address the employee’s contention that his delay in filing was due to actions by the employer and insurer which would provide a basis for tolling the statute of limitations.[1]  After a hearing, Compensation Judge Kelly found that the employee’s failure to file a claim petition within the statutory limitation was not substantially caused by employer or insurer misrepresentation, but since the employee had filed a summons and complaint within the statute of limitations, the employee’s claim petition was not barred.  The judge denied the motion to dismiss and neither party appealed this decision.

A hearing on the merits was held on April 23, 2013.  Compensation Judge Kelly found that the employee had sustained work-related injuries including a chest wall strain and bilateral foot contusions on December 4, 2005.  He also found that the work injuries had resolved by December 13, 2005, awarded related medical expenses and mileage, and denied the remainder of the employee’s claims.  The pro se employee appeals; the employer and insurer cross-appeal.

STANDARD OF REVIEW

The Workers’ Compensation Court of Appeals must determine whether the findings of fact and order are clearly erroneous and unsupported by substantial evidence in view of the entire record as submitted.[2]  Substantial evidence supports the findings if, in the context of the entire record, they are supported by evidence that a reasonable mind might accept as adequate.[3]  Fact findings are clearly erroneous if the reviewing court, looking at the entire evidence, is left with a definite and firm conviction that a mistake has been committed.[4]  Findings of fact should not be disturbed, even though the reviewing court might disagree with them, “unless they are clearly erroneous in the sense that they are manifestly contrary to the weight of the evidence or not reasonably supported by the evidence as a whole.”[5]

DECISION

Exhibits

The employee claims the compensation judge erred in the use of various exhibits submitted by the employer and insurer that were not admitted into evidence at the hearing.  Evidentiary rulings are generally within the sound discretion of the compensation judge,[6] and considerable latitude is given to the compensation judge in conducting a workers’ compensation hearing.[7]  Here, the compensation judge sustained the employee’s objections and did not admit Exhibits 1, 13, and 17.[8]  While the employee concedes that these records were not admitted, he argues that the judge nevertheless relied upon those exhibits in making his findings.  We are not persuaded.  First, the transcript clearly shows the compensation judge did not receive these exhibits into the record, but only included them in the case file after offers of proof were made by the employer and insurer.  Regarding Exhibit 1, the judge specifically stated, “I will not read it and it will not be evidence nor will I use it in determining anything.”[9]  Exhibits not admitted into the hearing record should be retained by the compensation judge and transmitted with the hearing record for review on appeal.  Second, contrary to the employee’s assertions, there is no indication in the judge’s decision that he relied on the excluded exhibits in making his findings, and we find no error on appeal.

The employee also argues that the compensation judge erred by admitting the employer and insurer’s “confusing and irrelevant” Exhibit 10, questioning the employer and insurer’s reference to multiple documents during the hearing as “Exhibit 10.”  We note that these documents are all different pages from the employee’s Park Nicollet medical records, which were collectively admitted into evidence as the employer and insurer’s Exhibit 10.  The employer and insurer are permitted to introduce documents that are relevant and material to their defense into the record.  The documents list the date of service and the treating physician, and are easily identified by this court on review.[10]  The judge did not err by admitting Exhibit 10 into evidence.

Substantial evidence

The employee claims that substantial evidence does not support the compensation judge’s denial of temporary total disability benefits, temporary partial disability benefits, as well as medical expenses and medical mileage claims after December 13, 2005.  The employee also argues that the employer and insurer’s assertion that the employee had reached maximum medical improvement on December 13, 2005, is not supported by the medical evidence.  He contends that the medical records are conflicting since the employee continued to receive medical treatment after that date, his condition could have worsened after that date, and he was not served with the notice of MMI.  The employee cites Minn. Stat. § 176.101, subd. 1(j), which relates to cessation of temporary total disability benefits being paid, in support of his argument.  In this case, however, the employer and insurer denied primary liability and had not paid temporary total disability as of the time of the hearing.  Therefore, procedures relating to cessation of temporary total disability payments are not applicable to this matter.  While the evidence indicates that employee continued to receive medical treatment after the claimed date of MMI, the issue for the compensation judge was whether the employee’s disability and need for treatment continued to be causally related to the employee’s work injury.  After reviewing the medical evidence, the judge found that the employee was released to work with restrictions after the injury and the employee’s work injuries to his chest wall and feet had resolved by December 13, 2005.  Based on this finding, the judge determined the employee’s wage loss after December 4, 2005, and his medical expenses after December 13, 2005, were not causally related to his work injuries.  In view of the entire record, substantial evidence supports the compensation judge’s decision, and we affirm.

Penalties

The employee claims a penalty under Minn. R. 5220.2570, subp. 10.A.(1).  An employer and insurer are, as a general rule, required to file a denial of liability within 14 days of notice of an injury,[11] and must “state facts indicating that an investigation has been completed or that a good faith effort to investigate has been attempted . . . .”[12]  In this case, the notice of liability determination stated the reason for denial as:  “The claim was reported as frostbite, then it was changed to a run over foot and the MD diagnosis was chest pains.  Insufficient information to support any work related injury.”[13]  The statement shows that questions had been asked about the incident and that there were enough discrepancies for the employer and insurer to question liability at that time.  Whether or not this statement would later be proven true or false does not render the denial frivolous or lacking in good faith.  As the judge noted, the notice “does not misrepresent the nature of the employee’s injury on December 4, 2005, just restates the underlying disputes of whether an injury occurred and the extent of said injury.”[14]  The employee had the opportunity to dispute this initial liability determination through the litigation process.[15]  The compensation judge did not err by failing to find that the employer and insurer frivolously denied liability for the employee’s injury.

The employee also disputes the compensation judge’s finding that the employee was not entitled to a penalty for intentional delay of the payment of medical expenses.  The judge denied the penalty claim on the basis that the employer and insurer presented “viable and good faith defenses”[16] to the employee’s claim.  The employee contends that this finding is inconsistent with the judge’s finding that the employee had sustained work-related injuries.  The compensation judge, as the finder of fact, determined each party had valid arguments for his consideration and decision.  A good faith defense need not be successful in order for a penalty claim to be denied.[17]  The judge’s choice of one side’s arguments over the other side’s arguments does not automatically render the losing party liable for penalties.  We affirm the compensation judge’s denial of a penalty in this case.

Cross-appeal

The employer and insurer appeal the compensation judge’s refusal to admit their Exhibits 1, 13, and 17 into evidence on the record.  A compensation judge is not bound by the common law or statutory rules of evidence.[18]  As we noted above, rulings on the admissibility of evidence are generally discretionary.[19]  The employer and insurer argue that these exhibits would have shown the judge a pattern of behavior by the employee, motivated by ill will, which would have lessened his credibility.  In this case, the compensation judge determined that these exhibits were not relevant to the issues presented at the hearing, and we see no evidence establishing that the judge abused his discretion or that the employer and insurer were thereby prejudiced.  There is no basis for reversal of the compensation judge on these facts.

The employer and insurer also argue that substantial evidence does not support the judge’s finding that the employee sustained work injuries to his chest wall and feet on December 4, 2005.  The employer and insurer point to the fact that the employee did not report these injuries when he treated for his right hand and long finger on December 6, 2005, as evidence that he had not sustained any injuries on December 4.  This appointment was for a re-evaluation of the hand and finger with Dr. Isaksen.  The employee treated with Dr. Wall on December 7, 2005, regarding the work injuries.  Dr. Wall diagnosed chest wall strain and bilateral feet contusions, which is consistent with the employee’s report of the injuries.  He also assigned the employee work restrictions for two weeks.  Inconsistencies in the evidence are reconciled by the finder of fact at hearing.  The employee’s failure to mention his work injuries at an appointment for an unrelated injury does not mandate that the compensation judge find the work injuries did not occur.  The judge chose to give such indirect inferential evidence little weight.  It is not the role of this court to choose different inferences from the evidence than the compensation judge.[20]  Substantial evidence supports the compensation judge’s finding that the employee sustained work-related injuries on December 4, 2005, and we affirm.



[1] Albert v. Dungarvin Minn., No. WC10-5056 (W.C.C.A. Aug. 10, 2010).

[2] Minn. Stat. § 176.421, subd. 1.

[3] Hengemuhle v. Long Prairie Jaycees, 358 N.W.2d 54, 59, 37 W.C.D. 235, 239 (Minn. 1984).

[4] Northern States Power Co. v. Lyon Food Prods., Inc., 304 Minn. 196, 201, 229 N.W.2d 521, 524 (1975).

[5] Id.

[6] Cici v. Methodist Hosp., 63 W.C.D. 421, 426 (W.C.C.A. 2003).

[7] See Minn. Stat. § 176.411, subd. 1, which provides that

Except as otherwise provided by this chapter, when a compensation judge makes an investigation or conducts a hearing, the compensation judge is bound neither by the common law or statutory rules of evidence nor by technical or formal rules of pleading or procedure.  Hearsay evidence which is reliable is admissible.  The investigation or hearing shall be conducted in a manner to ascertain the substantial rights of the parties.
Findings of fact shall be based upon relevant and material evidence only, as presented by competent witnesses, and shall comport with section 176.021.

[8] Exhibit 1 is a list of the employee’s litigation history involving the employee and the employer as well as the employee’s litigation with other parties in other matters, Exhibit 13 is documentation of the employer’s investigation into the resident incident at the time of the work injury, and Exhibit 17 is the employer’s senior director’s affidavit regarding the resident incident.

[9] T. 16.

[10] At the hearing, the employee was questioned regarding a December 7, 2005, medical evaluation form labeled with the employee’s name and identification information which purported that the employee had been approved for work without restrictions by Dr. Wall after a pre-placement evaluation for employment at the Hennepin County Public Works.  The employee objected to the evaluation form, stating that he had never applied for a position with Hennepin County and that he was not released to work without restrictions.  This evaluation form is inconsistent with other medical records from Dr. Wall from the same day assessing the work injuries and assigning the employee work restrictions for two weeks.  Since the judge found the employee had been released to work with restrictions on that date, we conclude the judge did not rely on the form in making his determination.  There is no evidence in the record to conclude that the evaluation form was forged or fraudulent.

[11] Minn. R. 5220.2570, subp. 7.A.

[12] Minn. R. 5220.2570, subp. 10.A(1).

[13] Employer and insurer’s Ex. 12.

[14] Finding 20.

[15] The employee questions the employer and insurer’s motives for changing their defenses on various pleadings and argues the compensation judge was biased in his rulings.  The issues and defenses involved in a case often change throughout the litigation process without violating procedural rules.  We see nothing in the record that would indicate the employee failed to receive a full, fair, and impartial hearing.

The employee also made several references to the employer and insurer’s failure to prove that the employee was not entitled to benefits.  Under Minn. Stat. § 176.021, subds. 1 and 1a, the employee has the burden of proof to establish entitlement to benefits by a preponderance of the evidence.  The judge correctly applied the burden of proof in this case.

[16] Finding 28.

[17] See Heise v. Honeywell, Inc., 48 W.C.D. 523, 540 (W.C.C.A. 1993) (an award of penalties reversed where the employer and insurer interposed a good faith defense); Greene v. Indep. Sch. Dist. No. 202, 36 W.C.D. 601, 602 (W.C.C.A. 1984) (the fact that the employer and insurer did not ultimately prevail on their defense to a claim does not necessarily create a basis for the imposition of penalties).

[18] Minn. Stat. § 176.411, subd. 1.

[19] Cici, 63 W.C.D. at 426.

[20] See Redgate v. Sroga’s Standard Serv., 421 N.W.2d 729, 734, 40 W.C.D. 948, 957 (Minn. 1988) (where more than one inference may reasonably be drawn from the evidence, the findings of the compensation judge are generally upheld if supported by substantial evidence).