Chandler v. Atlantic Scrap & Processing
CONNIE CHANDLER, Employee, by her Guardian Ad Litem, CELESTE M. HARRIS v. ATLANTIC SCRAP & PROCESSING, Employer, and LIBERTY MUTUAL INSURANCE COMPANY, Carrier
Attorneys
Walden & Walden, by Daniel S. Walden, for plaintiff appellant, cross-appellee. , Hedrick, Gardner, Kincheloe & Garofalo, L.L.P., by Matthew J. Ledwith, for defendant appellees, cross-appellants.
Full Opinion (html_with_citations)
Plaintiff Connie Chandler (âplaintiffâ) appeals from an opinion and award of the North Carolina Industrial Commission (the âCommissionâ) declining to award interest to plaintiff on an award of unpaid attendant care services. Defendants Atlantic Scrap & Processing (âAtlantic Scrapâ) and Liberty Mutual Insurance Company (âLiberty Mutual,â collectively, âdefendantsâ) cross-appeal the Commissionâs decision awarding plaintiff compensation for attendant care services and attorneysâ fees pursuant to N.C. Gen. Stat. § 97-88.1 (2009). We reverse the Commissionâs order declining to award interest to plaintiff, and we otherwise affirm the Commissionâs order awarding plaintiff compensation for attendant care services and attorneysâ fees. We also grant plaintiffâs motion for attorneysâ fees incurred during the pendency of this appeal pursuant to N.C. Gen. Stat. § 97-88 (2009).
I. Background
Plaintiff began working for Atlantic Scrap, a metal recycling facility, in 1994. Plaintiff was hired to clean Atlantic Scrapâs three buildings. On 11 August 2003, plaintiff began her work duties with Atlantic Scrap at 7:00 a.m. As plaintiff was walking down a flight of concrete steps, she accidentally fell backwards, striking the posterior portion of her head and neck on the steps. When EMS personnel arrived at the scene, plaintiff was confused and agitated and had a
After her fall, during the period from 13 August 2003 through November of that year, plaintiff treated with her primary care physician, Dr. Norman Templon (âDr. Templonâ). Plaintiffâs primary symptoms from her fall continued to be global headaches, right shoulder pain, neck pain, dizziness, and insomnia. Plaintiff also developed depression dire to her injuries.
In October 2003, plaintiffâs husband, Lester Chandler (âMr. Chandlerâ), advised Dr. Templon that plaintiff had been having significant memory problems, sensitivity to light, and some nausea and vomiting almost every day since her fall. On 31 October 2003, a brain MRI revealed that plaintiff had evidence of small vessel ischemic changes in her white matter. By November 2003, plaintiff had constant occipital headaches and frequent crying spells.
In November 2003, Dr. Templon diagnosed plaintiff as suffering from cognitive impairments secondary to post-concussive syndrome. Dr. Templon referred plaintiff to neuropsychologist Cecile Naylor (âDr. Naylorâ) for evaluation of plaintiffâs cognitive functioning and memory. On 3 December 2003, testing by Dr. Naylor revealed that plaintiff had selective deficit in verbal memory, impaired mental flexibility, depression, and a low energy level.
On 23 December 2003, Dr. Templon recommended that plaintiff also see a neurologist. Defendants directed plaintiff to see neurologist Carlo P. Yuson (âDr. Yusonâ). Plaintiff presented to Dr. Yuson on 14 January 2004, complaining primarily of frequent headaches and memory problems since her fall. Dr. Yuson diagnosed plaintiff as suffering from post-concussive syndrome from her fall, along with depression secondary to her fall. Plaintiff continued to see Dr. Yuson throughout March, April, and May 2004, presenting the following continuing symptoms: severe headaches, memory problems, dizziness, crying spells, insomnia, cognitive problems, and depression. Dr. Yuson
On 3 May 2004, Liberty Mutual assigned Nurse Bonnie Wilson (âNurse Wilsonâ) to provide medical case management services for plaintiffâs claim. Nurse Wilson arranged for plaintiffâs cognitive functioning and memory to be re-evaluated by Dr. Naylor. Plaintiff presented to Dr. Naylor for testing on 28 June 2004, tearful and clinging to Mr. Chandler. Testing revealed the following: (1) plaintiffâs intellectual functioning had fallen from the borderline to impaired range; (2) plaintiffâs memory functioning revealed a sharp decline into the impaired range in all areas; (3) plaintiff had a significant compromise in her conversational speech, i. e., plaintiff only spoke when spoken to, her responses were often short and often fragmented and confused, and plaintiff had difficulty responding to questions. Plaintiff also exhibited the following symptoms: (1) inability to answer questions; (2) fearful and reliant on Mr. Chandler; (3) hears people in the home without any basis; (4) is afraid to go anywhere alone, even in her own home; (5) is easily upset; (6) has significant confusion, as her speech makes no sense; (7) has poor concentration and memory; (8) her moods change quickly; (9) is incapable of performing even simple tasks of daily living; (10) is unable to cook anything; (11) takes naps during the day due to frequent insomnia at night; (12) has decreased appetite and poor energy; (13) cries easily; and (14) feels worthless. All of these test results and symptoms indicated that as of 28 June 2004, plaintiff suffered from severe and global cognitive deficits in higher cortical functioning, all as a result of her 11 August 2003 fall at work.
Beginning on or before 28 June 2004, plaintiff has been incapable of being alone and has been unable to perform most activities of daily living without assistance from Mr. Chandler. Plaintiff has required constant supervision and attendant care services on a 24-hours-a-day/7-days-a-week basis, including at night, due to her severe cognitive impairments, insomnia, paranoia, and fear of being alone. Mr. Chandler has provided the required constant attendant care services to plaintiff for the period beginning at least 28 June 2004 and continuously thereafter, without any compensation for his services.
On 20 July 2004, Dr. Naylor reported plaintiffâs severe cognitive and memory impairments to Nurse Wilson, discussing Dr. Naylorâs written evaluation report and conclusions with Nurse Wilson. Dr. Naylor informed Nurse Wilson that plaintiffâs cognitive and mental condition had greatly deteriorated since prior testing in early Decern
On 27 October 2004, plaintiff presented to Dr. Yuson, accompanied by Nurse Wilson. Dr. Yuson notified Nurse Wilson that, in his opinion, plaintiff would never get any better mentally than she was as of 23 August 2004, when plaintiff was determined to have reached maximum medical improvement. Dr. Yuson again discussed Dr. Naylorâs 20 July 2004 report with Nurse Wilson, including that plaintiff required constant attendant care services due to her cognitive and emotional impairments resulting from her fall. However, defendants elected not to secure attendant care services or pay Mr. Chandler for the attendant care services he provided to plaintiff.
In the period from January 2005 through October 2007, plaintiffâs cognitive and emotional condition continued to slowly become worse, regressing to that of a four-year-old child due to her brain injury from her fall at work. In April 2008, Dr. Yuson opined in a written note that plaintiff was permanently totally disabled due to her brain injury from her fall at work.
In March 2009, Dr. Yuson again noted that plaintiff had continued to get worse in her cognitive and emotional conditions. On 3 April 2009, occupational therapist and life care planner Vickie Pennington (âMs. Penningtonâ) prepared a life care plan concerning plaintiff. Ms. Penningtonâs recommendations concerning plaintiffâs care included, inter alia, that plaintiff needs constant attendant care for her lifetime, that plaintiff needs attendant care services in her home rather than in an institution or outside facility, and that it is not healthy or reasonable or best for plaintiff that Mr. Chandler continue to care for plaintiff exclusively. Dr. Yuson reviewed Ms. Penningtonâs life care plan, which he opined was medically necessary and reasonable for plaintiff.
On 27 August 2008, plaintiff filed a Form 33 Request that Claim be Assigned for Hearing, seeking âpayment of attendant care services by [her husband] Lester Chandler beginning [20 July 2004] forward,â and
An initial hearing was held before Deputy Commissioner Robert Wayne Rideout, Jr. (âDeputy Commissioner Rideoutâ) on 13 April 2009. Plaintiff presented the testimony of Ms. Pennington and Mr. Chandler, as well as the deposition testimony of Dr. Yuson. Defendants presented no evidence or testimony at the hearing. On 10 August 2009, Deputy Commissioner Rideout filed his opinion and award, finding and concluding that plaintiffs injuries were caused by her August 2003 fall at work; that plaintiff is permanently totally disabled; and that plaintiff is entitled to have defendants provide all medical compensation due to her accident, including the constant around-the-clock attendant care services provided by Mr. Chandler for the period beginning 28 June 2004 and the services set out in the life care plan. Deputy Commissioner Rideout also concluded that defendants had defended the matter without reasonable ground and ordered defendants to pay attorneysâ fees for plaintiffâs attorney pursuant to N.C. Gen. Stat. § 97-88.1. Deputy Commissioner Rideout awarded Mr. Chandler the rate of $15.00 per hour for the constant attendant care services he has provided to plaintiff for the period beginning 28 June 2004 and each day thereafter.
On 25 August 2009, defendants appealed Deputy Commissioner Rideoutâs opinion and award to the Full Commission. On 20 November 2009, plaintiff moved the Commission to award interest on the past due attendant care pursuant to N.C. Gen. Stat. § 97-86.2 (2009), to be paid by defendants directly to Mr. Chandler. On 25 February 2010, the Commission filed its opinion and award, generally affirming Deputy Commissioner Rideoutâs opinion and award, but changing the hourly rate for attendant care services payable to Mr. Chandler to $11.00 per hour for 15 hours per day, rather than $15.00 per hour for 24 hours per day. The Commission declined to award interest to Mr. Chandler âin its discretion.â
On 26 February 2010, plaintiff filed a motion to amend the Commissionâs 25 February 2010 opinion and award, this time seeking an order of mandatory payment of interest to plaintiff, instead of to
II. Standard of Review
Review of an opinion and award of the Industrial Commission âis limited to consideration of whether competent evidence supports the Commissionâs findings of fact and whether the findings support the Commissionâs conclusions of law.â Richardson v. Maxim Healthcare/Allegis Grp., 362 N.C. 657, 660, 669 S.E.2d 582, 584 (2008). âA finding of fact is conclusive and binding on appeal so long as there is some evidence of substance which directly or by reasonable inference tends to support the findings, . . . even though there is evidence that would have supported a finding to the contrary.â Byrd v. Ecofibers, Inc., 182 N.C. App. 728, 731, 645 S.E.2d 80, 81 (2007) (omission in original) (internal quotation marks and citations omitted). Thus, â[t]his âcourtâs duty goes no further than to determine whether the record contains any evidence tending to support the finding.â â Richardson, 362 N.C. at 660, 669 S.E.2d at 584 (quoting Anderson v. Lincoln Constr. Co., 265 N.C. 431, 434, 144 S.E.2d 272, 274 (1965)). We review the Commissionâs conclusions of law de novo. McRae v. Toastmaster, Inc., 358 N.C. 488, 496, 597 S.E.2d 695, 701 (2004).
III. Plaintiffâs appeal
A. Interest on award of unpaid medical expenses
Plaintiffâs sole issue on appeal is whether the Commission erred as a matter of law in denying interest to plaintiff on the award of unpaid attendant care, accruing from the date of the initial hearing until paid by defendants. Plaintiff contends payment of such interest by defendants is mandatory pursuant to N.C. Gen. Stat. § 97-86.2. We agree.
N.C. Gen. Stat. § 97-86.2 provides:
In any workersâ compensation case in which an order is issued either granting or denying an award to the employee and where there is an appeal resulting in an ultimate award to the employee, the insurance carrier or employer shall pay interest on the final award or unpaid portion thereof from the date of the initial hearing on the claim, until paid at the legal rate of interest provided in G.S. 24-1.
In Childress v. Trion, Inc., 125 N.C. App. 588, 481 S.E.2d 697 (1997), this Court reiterated the three goals of awarding interest to workersâ compensation claimants, as announced by our Supreme Court: â â(a) [T]o compensate a plaintiff for loss of the use value of a damage award or compensation for delay in payment; (b) to prevent unjust enrichment to a defendant for the use value of the money, and (c) to promote settlement.â â Id. at 592, 481 S.E.2d at 699 (quoting Powe v. Odell, 312 N.C. 410, 413, 322 S.E.2d 762, 764 (1984)). In Childress, we explained that â[a]ll of these goals are met by the payment of interest on an award of medical expenses to workersâ compensation claimants.â Id. Therefore, âany award of medical compensation for the plaintiffâs benefit is covered by G.S. 97-86.2.â Id. at 591, 481 S.E.2d at 699.
The term âmedical expensesâ encompasses attendant care services rendered by an injured workerâs family members. See London v. Snak Time Catering, Inc., 136 N.C. App. 473, 480, 525 S.E.2d 203, 208 (2000) (âOur Supreme Court has . . . authorized payment to family members for attendant care provided to an injured family member.â). Moreover, this Court has expressly upheld an award of interest on a plaintiffâs outstanding medical expenses in the form of attendant care services where the Commission awarded the benefits directly to the family members who were taking care of the plaintiff, instead of to the plaintiff himself. See Palmer v. Jackson, 161 N.C. App. 642, 649, 590 S.E.2d 275, 279 (2003). In Palmer, this Court stated that âthe fact that the money is going directly to the two relatives who are taking care of a worker in a vegetative state, rather than the worker himself, does not preclude the Full Commission from awarding interest.â Id.
In the present case, after the initial hearing on 13 April 2009, Deputy Commissioner Rideout awarded plaintiff the cost of attendant care services, from which defendants appealed to the Full Commission. The Commission likewise awarded plaintiff the costs of attend
IV. Defendantsâ appeal
A. Award to plaintiff for attendant care services
Defendantsâ first argument on appeal is that the Commission erred in awarding plaintiff compensation for attendant care services. Defendants contend that pursuant to the Commissionâs âMedical Fee Schedule,â plaintiff was required to obtain written authority from the Commission to recoup fees associated with the rendition of attendant care services by Mr. Chandler. Defendants further contend they were not advised of plaintiffâs attendant care needs, and nevertheless, Mr. Chandler was not forced to give up other employment to care for plaintiff. Defendantsâ arguments have no merit.
First and foremost, in Boylan v. Verizon Wireless, 201 N.C. App. 81, 685 S.E.2d 155 (2009), this Court expressly rejected defendantsâ argument âthat plaintiff never requested prior approval for such services in violation of the fee schedule established by the Industrial Commission pursuant to N.C. Gen. Stat. § 97-26(a) and was therefore not entitled to attendant care benefits.â Id. at 85, 685 S.E.2d at 158. Rather, in Boylan, this Court upheld the Commissionâs ordering the defendants to pay benefits for attendant care services provided to the plaintiff by her family members, reasoning that N.C. Gen. Stat. § 97-90(a) is the applicable statute requiring preauthorization for medical fees and that, based on our prior holding in Ruiz v. Belk Masonry Co., 148 N.C. App. 675, 559 S.E.2d 249 (2002), an award of attendant care benefits provided by the injured plaintiffâs family member did not require preauthorization under that statute. Boylan, 201 N.C. at 86, 685 S.E.2d at 158-59.
Finally, defendantsâ argument that they were given no notice of plaintiffâs need for attendant care services is also without merit. On this issue, defendants do not specifically challenge any of the Commissionâs findings of fact, and therefore, they are binding on this Court.
The Commission made the following pertinent findings of fact:
15. On May 3, 2004 carrier Liberty Mutual assigned its Nurse Bonnie Wilson to provide medical case management services in plaintiffâs claim. Nurse Wilson arranged for plaintiff to be reevaluated by Dr. Naylor on June 28, 2004.
16. On June 28, 2004 Dr. Naylor re-evaluated plaintiffâs cognitive functioning and memory. Plaintiff was tearful and clinging to her husband. . . .
18. On July 20, 2004, Dr. Naylor gave her written evaluation report concerning plaintiffâs severe cognitive and memory impairments to carrierâs nurse Bonnie Wilson and also discussed the report and its conclusions with her. Dr. Naylor informed Ms. Wilson that plaintiffâs cognitive and mental condition had greatly deteriorated since prior testing in early December 2003, and that plaintiff was no longer capable of caring for herself and needed constant supervision which out of necessity was being provided by her husband.
19. By at least July 20, 2004, the carrier was well aware that plaintiff required constant attendant care services, and that plaintiffâs husband was providing constant attendant care services to plaintiff without any compensation for his services.
*427 24. On October 27, 2004, plaintiff saw Dr. Yuson, with Ms. Wilson in attendance. By this date, Dr. Yuson notified Ms. Wilson that, in his opinion, plaintiff would never get any better mentally than she was as of August 23, 2004. At this meeting, Dr. Yuson discussed Dr. Naylorâs July 20, 2004 report with Ms. Wilson, including that plaintiff required constant attendant care services due to her cognitive and emotional impairments resulting from her fall.
25. On October 27, 2004, the carrier was well aware that plaintiff required constant attendant care services as provided by her husband due to her traumatic brain injury resulting from her August 11, 2003 fall. Defendants elected not to secure attendant services or pay plaintiffâs husband for the attendant care services he provided plaintiff.
28. By early December 2004, Dr. Yuson again notified defendant Liberty Mutual that plaintiff required constant supervision due to her cognitive and emotional impairments resulting from her brain injury due to her fall.
Significantly, defendants argue only that Nurse Wilson, as a medical professional, is not an agent of defendants and cannot be considered such for purposes of notice. Nonetheless, defendants neglect Finding of Fact number 28, in which the Commission expressly found as a fact that plaintiffâs treating physician notified Liberty Mutual regarding plaintiffâs need for constant supervision. As defendants do not challenge this finding of fact on appeal, it is binding on this Court, and supports the Commissionâs conclusion that defendants had notice of plaintiffâs required attendant care services, which out of necessity, were being provided by Mr. Chandler. Thus, the Commission did not err in concluding that plaintiff was entitled to compensation for the attendant care services being provided by her husband, Mr. Chandler.
B. Amount of compensation for attendant care services
Defendants argue that the Commission erred in determining that plaintiffâs husband should be compensated at a rate of $11.00 per hour, for 15 hours per day. In particular, defendants take issue with the following finding of fact:
*428 38. Based on a review of the evidence of record, the Full Commission, in its discretion, finds that the reasonable hourly-rate of pay for plaintiffs husband to be compensated for providing the necessary attendant care services to plaintiff in the period beginning June 28, 2004 and thereafter is eleven dollars ($11.00) per hour, for fifteen hours per day.
Defendants argue this finding of fact is not supported by competent evidence in that the rate determination did not reflect the cost of care for an unskilled health care provider in the area where plaintiff actually lived and that the number of hours of compensation is unreasonable, given the time that plaintiff sleeps.
We hold there is competent evidence to support the Commissionâs finding in this regard. At the hearing, Ms. Pennington was certified as an expert âin the field of rehabilitation management with individuals with closed head brain trauma,â including âa specialty in life care planningâ and expert knowledge on the âcost for attendant care.â Ms. Pennington testified that she had contacted three home health care agencies based in the Charlotte, North Carolina, area. However, Ms. Pennington testified that all three agencies provide services regionally, including the relevant area where plaintiff lives. Ms. Pennington testified that the base rate of the three agencies for attendant care with no special skills would be $17.00 per hour, with holidays and weekends averaging between $20.00 and $21.00 per hour. Ms. Pennington further testified that one of the home health care agencies paid an attendant $10.00 to $14.00 per hour. Ms. Pennington also testified that an attendant performing the kinds of services provided by Mr. Chandler could expect to receive more than $10.00 per hour in the area where plaintiff lives. Thus, the rate of $11.00 per hour, determined by the Commission, was supported by competent evidence in the record.
In addition, although there is ample evidence in the record to support the Commissionâs finding of fact that plaintiff required âconstant supervision and attendant care services, that is, on a 24 hours a day, 7 days a week basis, including at night,â the Commission could also reasonably find that Mr. Chandler should be compensated for such required care at least 15 hours per day, given the testimony by Dr. Yuson that plaintiff needs attendant care services âdefinitely when sheâs awakeâ and the testimony by Mr. Chandler that plaintiff suffers from insomnia, that her sleep periods may vary depending on whether she takes her medication, and that she requires supervision when she wakes during the night to go to the bathroom. Thus, this
C. Attorneysâ fees
Finally, defendants argue the Commission erred in awarding plaintiff attorneysâ fees pursuant to N.C. Gen. Stat. § 97-88.1. We disagree.
N.C. Gen. Stat. § 97-88.1 provides the Commission with discretionary authority to assess costs and attorneysâ fees for prosecuting or defending a hearing without reasonable grounds. Id. (âIf the Industrial Commission shall determine that any hearing has been brought, prosecuted, or defended without reasonable ground, it may assess the whole cost of the proceedings including reasonable fees for defendantâs attorney or plaintiffâs attorney upon the party who has brought or defended them.â). â â[T]he Commissionâs determination [of matters within its sound discretion] will not be reviewed on appeal absent a showing of manifest abuse of discretion.â â Sprinkle v. Lilly Indus., Inc., 193 N.C. App. 694, 702, 668 S.E.2d 378, 383 (2008) (alteration in original) (quoting Lynch v. M.B. Kahn Constr. Co., 41 N.C. App. 127, 131, 254 S.E.2d 236, 238 (1979)), disc. review denied, 363 N.C. 130, 673 S.E.2d 363 (2009).
In the present case, we find no abuse of discretion in the Commissionâs determination that defendants unreasonably defended plaintiffâs claim. Most notably, defendants filed a Form 60 on 21 September 2004, accepting plaintiffâs 11 August 2003 âconcussion to the back of the headâ as compensable. As detailed in the Commissionâs unchallenged findings of fact, prior to defendantsâ filing the Form 60, plaintiffâs treating physicians had documented that plaintiffâs extensive cognitive impairments were attributable to her 11 August 2003 fall and concussion, that plaintiff required constant attendant care services as a result, and that plaintiff had reached maximum medical improvement. Nonetheless, defendants defended against plaintiffâs claim for permanent total disability compensation and attendant care services. Defendants challenged any causal connection between plaintiffâs condition and her compensable fall, as well as whether plaintiffâs husband was entitled to any attendant care benefits. Given the extensive medical documentation of plaintiffâs condition and its causal relationship with plaintiffâs 11 August 2003 fall, defendantsâ acceptance of plaintiffâs claim via filing of a Form 60 after plaintiff had reached maximum medical improvement, and the recent holdings of this Court expressly establishing that attendant
V. Conclusion
We hold the Commissionâs award to plaintiff of attendant care benefits for the services rendered by her husband at the rate of $11.00 per hour for 15 hours per day is both supported by the competent evidence in the record and the Commissionâs findings of fact. Because our case law expressly allows for an award of such benefits to family members, the Commission did not err in its award. We further hold the Commission did not abuse its discretion in determining that defendants have unreasonably defended against plaintiffâs current claim, thereby awarding attorneysâ fees pursuant to N.C. Gen. Stat. § 97-88.1. For these reasons, we affirm the Commissionâs opinion and award as to those issues.
However, because N.C. Gen. Stat. § 97-86.2 provides for a mandatory allowance of interest when the statutory conditions are present, as in the present case, we must reverse the Commissionâs order denying such interest award. We remand to the Commission for a determination as to the proper award of interest to plaintiff on the unpaid portion of attendant care services pursuant to the terms of N.C. Gen. Stat. § 97-86.2.
Affirmed in part, reversed in part, and remanded.