Title: State ex rel. Moore v. Internatl. Truck & Engine

State: ohio

Issuer: Ohio Supreme Court

Document:

[Cite as State ex rel. Moore v. Internatl. Truck & Engine, 116 Ohio St.3d 272, 2007-Ohio-
6055.] 
 
 
 
THE STATE EX REL. MOORE, APPELLANT, v. INTERNATIONAL  
TRUCK & ENGINE ET AL., APPELLEES. 
[Cite as State ex rel. Moore v. Internatl. Truck & Engine,  
116 Ohio St.3d 272, 2007-Ohio-6055.] 
Workers’ compensation – Temporary total disability – Maximum medical 
improvement – Exacerbation occurring after maximum medical 
improvement may justify reinstatement of compensation, even if 
exacerbation follows, rather than precedes, treatment. 
(No. 2006-2396 — Submitted September 18, 2007 — Decided 
November 20, 2007.) 
APPEAL from the Court of Appeals for Franklin County, 
No. 06AP-28, 2006-Ohio-6222. 
__________________ 
Per Curiam. 
{¶ 1} Appellee Industrial Commission of Ohio terminated the temporary 
total benefits of appellant, Sally A. Moore, on the basis that she had reached 
maximum medical improvement.  Moore later sought further temporary total 
disability compensation.  We must determine whether the commission abused its 
discretion in refusing to award compensation.  For the reasons to follow, we 
return the case to the commission for further consideration and an amended order.  
{¶ 2} Moore worked in the molding department of appellee International 
Truck & Engine (“ITE”).  As part of her duties, she sanded truck hoods in 
preparation for painting, which resulted in dust throughout Moore’s immediate 
work area. 
{¶ 3} The dust was made up of an IMC coating.  The chemical 
composition of this substance is not disclosed in the record, but it is undisputed 
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that Moore quickly developed white blister-like spots on her face, neck, and arms.  
Unfortunately, the condition, ultimately diagnosed as “prurigo nodularis,” is 
accompanied by — as one doctor describes — an “incredible itching sensation” 
that even the “most potent medicines” cannot help.  Dr. Alan J. Parks noted that 
“[t]ypically the patients excoriate these areas even to the point of causing 
scarring.”  Moore did, after years of exposure, end up with scarring on the 
affected areas.  The scarring was also accompanied by hypopigmentation and 
eventually lichenification, which is a “thickening of the skin [with] exaggeration 
of the normal skin markings, giving the skin a leathery bark-like appearance.”  
MedicineNet.com, at http://www.medterms.com/script/main/art.asp?articlekey= 
10131. 
{¶ 4} Medical opinion was unanimous that Moore’s condition was 
directly related to her exposure to IMC dust.  A workers’ compensation claim was 
initially allowed for “prurigo nodularis and lichenification” and later for 
“depressive disorder.” 
{¶ 5} In approximately 2002, Moore began treatment with a plastic 
reconstructive surgeon, Dr. Haroon A. Aziz.  Dr. Aziz describes Moore’s course 
of treatment in a November 19, 2004 letter: 
{¶ 6} “Over the course of the last couple of years, we have been trying to 
treat her intensively with manipulation of the skin pigment and preparation of the 
skin for laser resurfacing primarily with the Erbium laser.  The approach and the 
objects of the procedure has [sic] been to even the skin, at the depth to which 
making the depressed scars less noticeable and also to some extent dealing with 
the hyper/hypopigmentation.  Over the last couple of years, Ms. Moore’s face and 
both upper extremities has [sic] been treated a couple of times with the Erbium 
laser.  The net result to date is definite improvement in the overall smoothness of 
the upper extremities and the face and neck area.  There is much more even 
‘depth’ to the uninjured skin and the injured skin where there has been dermal 
January Term, 2007 
3 
loss.  The patient, her husband and my staff concur there has been definite 
improvement following the several treatments Ms. Moore has endured. 
{¶ 7} “My current plan of action with Ms. Moore is continued treatments 
with the Erbium laser.  In hopes of essentially smoothing out the skin, removing 
the raised area in small increments to even out the entire surface of the skin.  
Thereby making less of a contrast on her skin and more smooth and even 
appearance. 
{¶ 8} “There is a potential for scarring with the laser, particularly if 
depth of the surface area is too deep, such as significantly into the reticular 
dermis.  As a result, we really do not have much choice but to proceed with 
carefully graduated treatments in increments so as to produce an optimal result 
without any unnecessary secondary scarring. 
{¶ 9} “Typically, treatment consists of preparation of the skin several 
weeks prior to the Erbium treatment with use of hydrocodone, Retin-A and 
topical steroids.  This preparatory treatment is followed by the laser resurfacing 
treatment and then subsequent healing/regeneration of the skin over the course of 
the next week or two.  Subsequent follow-up and assessment examinations will 
continue for roughly two to three months.  At that point, depending upon the 
degree of improvement and the overall status, a decision would be tentatively 
made whether additional treatments would be required or not. 
{¶ 10} “Whereas the course of treatment has been prolonged and tedious, 
I feel the end results certainly has [sic] justified the rather intolerable situation she 
has endured with severe scarring following the chemical injury.  Furthermore, in 
my opinion, I feel additional treatments will benefit her overall end result 
particularly since maximum medical improvement has not yet been achieved.” 
{¶ 11} During this time, Moore was receiving temporary total disability 
compensation, but the record does not indicate whether it was continuous or 
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intermittent.  On October 8, 2004, Moore was examined on ITE’s behalf by Dr. 
Homer E. Williams, who reported: 
{¶ 12} “On examination, multiple hypopigmented and atrophic scars were 
present on her face, upper extremities, neck and anterior trunk.  No hypertrophic 
scars or excoriations are present. 
{¶ 13} “Answers to your questions follow: 
{¶ 14} “1.)  The claimant does exhibit severe scarring as a result of her 
physical conditions. 
{¶ 15} “2.)  The condition is expected to be permanent. 
{¶ 16} “3.)  Maximum medical improvement is believed to have been 
reached. 
{¶ 17} “4.)  Dr. Aziz’s course of treatment has been appropriate.  I am not 
of the opinion that any further surgical procedures are indicated.” 
{¶ 18} Dr. Williams’s report generated a motion from ITE to stop 
Moore’s temporary total disability compensation based on maximum medical 
improvement (“MMI”).  The district hearing officer had before her the November 
19, 2004 report from Dr. Aziz and the Williams report.  The hearing officer, based 
on the Williams report, found that MMI had occurred and terminated temporary 
total disability compensation.  That order became final. 
{¶ 19} In 2005, further laser treatment was approved for Moore.  That 
procedure was performed in May.  Moore sought to reinstate temporary total 
disability compensation, but it is unclear for what period.  C-84 “Requests for 
Temporary Total Compensation” forms show an ongoing disability, although Dr. 
Aziz’s May 11, 2005, and July 5, 2005 forms certify a postoperative disability 
period of May 16 through September 5, 2005.  The district hearing officer denied 
temporary total disability compensation:  
{¶ 20} “The claimant has not proved by a preponderance of the evidence 
that the allowed conditions in the claim have rendered her, once again, 
January Term, 2007 
5 
temporarily and totally disabled.  The District Hearing Officer notes that the 
allowed conditions in the claim were found to have reached maximum medical 
improvement pursuant to the District Hearing Officer order dated 11/23/2004.  
 
{¶ 21} “The District Hearing Officer recognizes the fact that the claimant 
underwent a Cosmetic surgical procedure on 05/27/2005.  However, it is unclear 
to the District Hearing Officer based on the available medical evidence how this 
cosmetic surgical procedure rendered the claimant, once again, temporarily and 
totally disabled.  The C-84 of Dr. Aziz dated 08/05/2004 (C-84 on file prior to the 
maximum medical improvement finding) and the present C-84 of Dr. Aziz dated 
07/05/2005 contain the exact objective finding. 
{¶ 22} “Since the same objective finding has been present since 2004, the 
District Hearing Officer does not find any new and changed circumstances that 
would render the claimant temporarily and totally disabled.  Dr. Aziz has not 
provided any current narrative explanation as to how this current cosmetic 
surgical procedure prevented the claimant from working from 11/23/2004 
forward.” 
{¶ 23} Dr. Aziz responded with a September 8, 2005 letter: 
{¶ 24} “[Ms. Moore] has been under my care for about two years now.  I 
am a little disturbed at general feelings about her overall clinical situation. 
{¶ 25} “In my humble opinion, I believe Ms. Moore had a serious skin 
loss with damage and scarring following her chemical burns at the place of her 
employment.  The areas involved are both upper extremities and face.  The 
resultant areas of scarring have been areas of deep dermal loss down to the 
reticular dermis with hypopigmentation and depression of the areas as well as scar 
formation.  Over the last several years, we have been trying diligently to improve 
her overall situation.  She has had multiple peels and several laser resurfacing 
procedures.  These procedures have been primarily directed towards smoothing 
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out the skin and reducing the surrounding raised areas to match up with the 
valleys and depressions. 
{¶ 26} “Her treatment has been complicated by the fact that she is prone 
to skin infections, which certainly delay and interfere with surgical treatment.  
The other problem we are dealing with is a problem of hypopigmentation of the 
scarred areas.  The effort is to try to normalize the re-pigmentation of the upper 
extremities and the facial areas so the overall end result is improved. 
{¶ 27} “Whereas the residual of the injury has a significant cosmetic 
component, one must never forget the stigma the scarring has and the effect of 
that stigma on the personal well-being and self-image of the individual is 
significant. 
{¶ 28} “In my opinion, she has had several laser treatments with 
continued improvement following each treatment both objectively on my part and 
subjectively on the part of the patient and her husband.  I really feel maximum 
medical improvement has not been reached because she still has potential to be 
improved upon even further. 
{¶ 29} “In my opinion, we are definitely making headway though slowly 
but surely.  I feel additional laser treatments are in order in an effort to achieve the 
early goal and objective of having a maximally improved upper extremity skin 
and facial skin, so the patient feels better overall about her self-image.  This 
would require pre-operative preparation, the surgical treatment as well as 
protection from the environment in terms of soil, etc. so that the healing process is 
not interfered with.” 
{¶ 30} The following day, a staff hearing officer affirmed the district 
hearing officer: 
{¶ 31} “The injured worker was found to have reached maximum medical 
improvement * * *.  The Staff Hearing Officer now finds no new or changed 
circumstances that would render the injured worker again temporarily and totally 
January Term, 2007 
7 
disabled due to the allowed conditions in this claim.  The Staff Hearing Officer 
finds that the cosmetic surgical procedure that the injured worker underwent on 
5/16/2005 is not a new and changed circumstance, or ‘flare-up’ in order to render 
the injured worker again temporarily and totally disabled. 
{¶ 32} “All evidence was reviewed and considered, including the report of 
Dr. Aziz dated 9/08/2005.  The staff hearing officer notes that the injured 
worker’s current request is for temporary total disability compensation from 
5/16/2005 to present, and to continue upon submission of medical evidence, and 
not merely a two week period of time in which the injured worker was bandaged 
due to the surgical cosmetic surgery.” 
{¶ 33} That order became final. 
{¶ 34} Moore filed a complaint in mandamus in the Court of Appeals for 
Franklin County, alleging that the commission abused its discretion in refusing to 
reinstate temporary total disability compensation.  The court of appeals disagreed 
and denied the writ, prompting Moore’s appeal as of right. 
{¶ 35} When a claimant reaches maximum medical improvement, 
payment of temporary total disability compensation is barred.  R.C. 4123.56(A).  
The commission’s continuing jurisdiction, however, allows for reinstatement of 
temporary total disability compensation after an MMI determination if new and 
changed circumstances warrant.  State ex rel. Bing v. Indus. Comm. (1991), 61 
Ohio St.3d 424, 575 N.E.2d 177, syllabus.  Bing held that the temporary “flare-
up” or exacerbation of an allowed condition was a new and changed circumstance 
supporting renewed compensation.  Id. at 427, 575 N.E.2d 177.  This approach 
derives from recognition that “claimants who had previously been declared as 
MMI could experience temporary exacerbation of their condition that justified 
further treatment or even temporary total disability compensation as the claimant 
struggled to recover his or her previous level of well-being.”  State ex rel. Conrad 
v. Indus. Comm. (2000), 88 Ohio St.3d 413, 415-416, 727 N.E.2d 872. 
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{¶ 36} Moore argues that surgery can also constitute a new and changed 
circumstance, citing State ex rel. Chrysler Corp. v. Indus. Comm.  (1998), 81 
Ohio St.3d 158, 689 N.E.2d 951.  In Chrysler  we did find that surgery could be a 
new and changed circumstance sufficient to reinstate temporary total disability 
compensation in an individual previously declared MMI.  Id. at 169, 689 N.E.2d 
951.  We did not, however, state that surgery was automatically a new and 
changed circumstance.  Equally important, Chrysler was followed by State ex rel. 
Josephson v. Indus. Comm., 101 Ohio St.3d 195, 2004-Ohio-737, 803 N.E.2d 
799, in which we held:  
{¶ 37} “Unless there is a worsening of an allowed condition, a mere 
prospect of improvement beyond the level previously declared MMI will not 
justify a new recognition of temporary total disability. 
{¶ 38} “ * * * Absent a worsening of claimant’s allowed condition, she is 
in effect saying no more than that the earlier declaration of MMI was premature.”  
Id. at ¶ 17-18. 
{¶ 39} There is no evidence that Moore’s May 2005 laser treatment was 
precipitated by a worsening of her condition.  To the contrary, Dr. Aziz explained 
in 2004 that treatment would consist of an ongoing series of these procedures.  
The record does suggest, however, that Moore’s condition was temporarily 
worsened after the May 2005 procedure took place.  The magistrate reports that 
Moore’s face was covered in gauze for approximately two weeks after the 
procedure.  The magistrate describes this fact as undisputed, and both the 
commission’s brief and the September 9, 2005 staff hearing order mention it.  The 
May 15, 2005 postoperative report and the postoperative photos support the fact 
that protective dressing was applied. 
{¶ 40}  In Josephson we sought to establish a prerequisite that would help 
preserve the integrity of an MMI declaration.  By requiring that a claimant’s 
condition be exacerbated before temporary total disability compensation may 
January Term, 2007 
9 
resume, the Josephson standard reduces the incentive for claimants to return to 
the commission every time their doctors suggest that new or renewed treatment 
could generate improvement.  But the instant case poses a question that we did 
not answer in Josephson:  May benefits resume if the exacerbation follows, rather 
than precedes, treatment?  The answer is yes. The commission is therefore 
ordered to determine whether Moore is entitled to any temporary total disability 
compensation due to postsurgical exacerbation. 
{¶ 41} Accordingly, the judgment of the court of appeals is reversed and 
the commission is ordered to consider the claim further and issue an amended 
order. 
Judgment reversed 
and limited writ granted. 
 
MOYER, 
C.J., 
and 
PFEIFER, 
LUNDBERG 
STRATTON, 
O’CONNOR, 
O’DONNELL, LANZINGER, and CUPP, JJ., concur. 
__________________ 
 
Larrimer & Larrimer and Thomas L. Reitz, for appellant. 
 
Vorys, Sater, Seymour & Pease, L.L.C.,  Joseph A. Brunetto, and Corrine 
S. Carman, for appellee International Truck & Engine. 
 
Marc Dann, Attorney General, and Douglas R. Unver, Assistant Attorney 
General, for appellee Industrial Commission. 
______________________