Title: State ex rel. Cambridge Home Health Care, Inc. v. Indus. Comm.

State: ohio

Issuer: Ohio Supreme Court

Document:

[Until this opinion appears in the Ohio Official Reports advance sheets, it may be cited as 
State ex rel. Cambridge Home Health Care, Inc. v. Indus. Comm., Slip Opinion No. 2010-
Ohio-651.] 
 
 
NOTICE 
This slip opinion is subject to formal revision before it is published in 
an advance sheet of the Ohio Official Reports.  Readers are requested 
to promptly notify the Reporter of Decisions, Supreme Court of Ohio, 
65 South Front Street, Columbus, Ohio 43215, of any typographical or 
other formal errors in the opinion, in order that corrections may be 
made before the opinion is published. 
 
SLIP OPINION NO. 2010-OHIO-651 
THE STATE EX REL. CAMBRIDGE HOME HEALTH CARE, INC. v. INDUSTRIAL 
COMMISSION OF OHIO ET AL. 
[Until this opinion appears in the Ohio Official Reports advance sheets, it 
may be cited as State ex rel. Cambridge Home Health Care, Inc. v. Indus. 
Comm., Slip Opinion No. 2010-Ohio-651.] 
Workers’ compensation — Hearing officer’s reliance on a physical therapy report 
to award compensation for loss of use was an abuse of discretion — Loss-
of-use award must be supported by a physician’s report — Limited writ 
granted. 
(No. 2008-1464 — Submitted January 12, 2010 — Decided March 3, 2010.) 
IN MANDAMUS. 
__________________ 
Per Curiam. 
{¶ 1} Respondent Industrial Commission of Ohio awarded respondent 
Laura Horvat 175 weeks of compensation under R.C. 4123.57(B) for the total loss 
of use of her right hand.  It based that award solely on the report of a physical 
therapist.  Relator, Cambridge Home Health Care, Inc., has brought this original 
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action asserting that a loss-of-use award must be based, at least in part, on a 
licensed physician’s report and that it may never be based solely on a report by a 
physical therapist.  We agree. 
{¶ 2} Horvat’s 2004 workers’ compensation claim was allowed for a 
right wrist sprain with arthritis.  She later moved for scheduled-loss compensation 
under R.C. 4123.57(B) for the loss of use of her hand.  In support, she submitted a 
functional-capacities evaluation prepared by physical therapist Barbara Hornbeek.  
The report noted that Horvat’s right hand was incapable of performing maneuvers 
that required dexterity or repetition.  Hornbeek felt that these restrictions were 
permanent, although she reported that Horvat’s performance was not entirely 
substantiated by objective findings and that at points, her performance may have 
been self-limited. 
{¶ 3} The physical therapy report did not comment on the degree of loss 
or whether Horvat had a total loss of use of her hand.  Cambridge Home Health 
Care had the physical therapy report reviewed by Dr. Scott E. Singer, a licensed 
physician, who concluded that Horvat’s level of function, as recorded by 
Hornbeek, did not meet the standard for loss of use. 
{¶ 4} A staff hearing officer awarded Horvat 175 weeks of compensation 
for total loss of use, relying exclusively on the physical therapy report.  
Reconsideration was denied, and Cambridge Home Health Care commenced this 
original action in mandamus. 
{¶ 5} At issue is the hearing officer’s exclusive reliance on a physical 
therapy report to award 175 weeks of scheduled-loss compensation.  Cambridge 
Home Health Care argues that a loss-of-use award must be supported by a 
physician’s report and cannot be based solely on a physical therapy report.  The 
commission now agrees that the hearing officer erred and joins Cambridge Home 
Health Care in asking us to vacate the award.  Horvat responds that the hearing 
officer did not rely simply on the physical therapist’s report and that even if he 
January Term, 2010 
3 
 
did, that reliance was not fatal.  We agree with the position of Cambridge Home 
Health Care. 
{¶ 6} Contrary to Horvat’s representation, the hearing officer did rely 
exclusively on the physical therapy report.  The closing boilerplate language, “all 
proof on file was reviewed and considered,” is not, as Horvat claims, proof that 
the hearing officer implicitly relied on other evidence in file. See State ex rel. 
Mitchell v. Robbins & Myers, Inc. (1983), 6 Ohio St.3d 481, 483-484, 6 OBR 531, 
453 N.E.2d 721. 
{¶ 7} The reliance on a single physical therapy report is an abuse of 
discretion for several reasons.  First, regardless of whether a loss-of-use award is 
considered as an impairment award or as a disability award – it has elements of 
both – a physical therapist is prohibited from giving an opinion on either.  The 
General Assembly has prohibited physical therapists from issuing disability 
conclusions. R.C. 4755.40(A) specifically forbids a physical therapist from 
making a “medical diagnosis of a patient’s disability.”  And we have restricted 
impairment determinations to doctors. State ex rel. Stephenson v. Indus. Comm. 
(1987), 31 Ohio St.3d 167, 171, 31 OBR 369, 509 N.E.2d 946 (“impairment is the 
amount of a claimant’s anatomical * * * loss of function and is to be determined 
by the doctors and set forth in the medical reports” [Emphasis added]). 
{¶ 8} Second, while R.C. 4123.57(B) is silent as to the proof required, 
review of that statute in its entirety favors Cambridge Home Health Care’s 
position.  R.C. 4123.57 covers both scheduled-loss and smaller permanent partial 
disability awards.  Under the statute, every claimant who applies for permanent 
partial disability compensation must have an agency medical examination.  
“Medical examination,” in turn, means a physician’s exam, based on a cumulative 
reading of R.C. 4123.53 (the Industrial Commission may require any employee 
claiming compensation to submit to a medical examination) and 4121.38 (the 
Industrial Commission shall implement impairment evaluation programs for its 
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physicians, shall designate medical-legal analysts, and may establish a medical 
section).  It defies logic to suggest, for example, that a 2 percent permanent partial 
disability award must be supported by a physician’s report, but a loss-of-use 
award generating 175 weeks of benefits does not. 
{¶ 9} A physical therapist, of course, is not a physician.  A physician is 
defined as an individual authorized under Chapter 4731 to practice medicine, 
osteopathic medicine, or podiatry. R.C. 4730.01(B).  The Ohio Administrative 
Code defines the term similarly for purposes of the workers’ compensation health 
partnership program, but adds psychologists, dentists, and doctors of chiropractic 
and mechanotherapy as physicians. Ohio Adm.Code 4123-6-01(D). 
{¶ 10} The Tenth District Court of Appeals has relied on this 
administrative provision to reject an effort to expand the class of professionals 
able to certify workers’ compensation disability.  In State ex rel. Fries v. Bur. of 
Workers’ Comp., Franklin App. No. 01AP-721, 2002-Ohio-3252, the claimant 
argued that because both physicians and licensed clinical counselors were defined 
in Ohio Adm.Code 4123-6-01(F) as “practitioners,” the two had the same rights. 
Id. at ¶ 19.  The appellate court, in adopting the magistrate’s report, disagreed: 
{¶ 11} “While a physician is a practitioner under the [Health Partnership 
Program], those terms are obviously not equivalent.  In other words, even if Ms. 
Schwartz, as a licensed professional clinical counselor, can claim ‘practitioner’ 
status under the [Health Partnership Program] definition, she clearly is not a 
physician.” (Emphasis sic.) Id. at ¶ 111. 
{¶ 12} This holding is notable because a physical therapist is also a 
“practitioner” under Ohio Adm.Code 4123-6-01(F).  This implies that a physical 
therapist, as a nonphysician, is also foreclosed from issuing a disability opinion. 
{¶ 13} Other jurisdictions have also disqualified physical therapists from 
offering disability or impairment conclusions.  In Bolton v. CNA Ins. Co. (1991), 
821 S.W.2d 932, the Tennessee Supreme Court ruled that a physical therapist’s 
January Term, 2010 
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permanent partial impairment assessment could not be used as evidence in a 
workers’ compensation case. Id. at 938.  Health professionals, the court began, 
were competent “to testify as an expert only as to matters within the limited scope 
of his or her expertise and licensure.” Id. at 935.  This scope, in turn, was defined 
by the state’s Occupational and Physical Therapy Practice Act, Tenn.Code Ann. 
Chapter 13 – a statute with requirements similar to ones contained in R.C. 
Chapter 4755. 
{¶ 14} Tennessee’s statute permitted physical therapists to evaluate and 
treat individuals “using specific means and narrowly defined methods.” Id. at 936.  
The act specifically prohibited the practice of medicine and, with only a very 
limited exception, authorized physical therapy treatment only upon referral by a 
physician.1  This referral requirement prompted the court to conclude that 
physical therapy is a narrow health specialty limited in scope. 
{¶ 15} “[A] physical therapist is not qualified to form and express an 
expert opinion as to the permanent impairment or permanent physical restrictions 
of an injured person.  * * * [A] physical therapist’s testimony must be limited to 
objective findings and cannot encompass an opinion on ultimate disability.” Id. at 
938. 
{¶ 16} Citing Bolton, a United States Court of Appeals reached the same 
result in an automobile negligence action.  Stutzman v. CRST, Inc. (C.A.7, 1993), 
997 F.2d 291, held that a physical therapist could not testify that she had a 
rehabilitation plan that could improve the patient’s strength and coordination 
enough to permit light work. Id. at 298.  The court characterized her statements as 
“a medical prognosis that a physical therapist was not qualified to render.” Id. 
{¶ 17} Federal regulations have long excluded physical therapists from 
the list of “[a]cceptable medical sources” authorized to “provide evidence to 
                                                 
1.  Ohio has a similar requirement in R.C. 4755.48(F). 
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establish an impairment” in social security disability cases.  C.F.R. 404.1513(a). 
C.F.R. 404.1513(d) instead includes physical therapists among “other sources” on 
which the agency may rely to “show the severity of [an] impairment[ ] and how it 
affects [an individual’s] ability to work.”  Accordingly, physical therapist 
opinions cannot be used to establish the existence of a disability; they can only be 
considered in conjunction with a doctor’s report to help determine the disability’s 
severity.  Rigby v. Astrue (Sept. 17, 2009), M.D. Tenn. No. 3:08-CV-519, 2009 
WL 3048668, * 7-8.  They are “entitled to consideration as additional evidence, 
but are not entitled to controlling weight.”  Hatton v. Social Sec. Administration 
(C.A. 3, 2005), 131 Fed. Appx. 877, 878, 2005 WL 1220840. 
{¶ 18} In the case at bar, the staff hearing officer relied solely on a 
physical therapy report to award 175 weeks of scheduled loss compensation for an 
alleged loss of the use of a hand.  The commission now concedes that this was an 
abuse of discretion, and our review supports that conclusion. 
{¶ 19} We accordingly issue a limited writ of mandamus that vacates the 
commission’s order and orders the commission to further consider Horvat’s 
motion and issue a new order. 
Limited writ granted. 
MOYER, 
C.J., 
and 
PFEIFER, 
LUNDBERG 
STRATTON, 
O’CONNOR, 
O’DONNELL, LANZINGER, and CUPP, JJ., concur. 
__________________ 
Millisor & Nobil Co., L.P.A., and Michael J. Reidy, for relator. 
Richard Cordray, Attorney General, and Charissa D. Payer, Assistant 
Attorney General, for respondent Industrial Commission. 
Thomas C. Mays & Associates and Mark M. Sturik, for respondent Laura 
Horvat. 
______________________