Case Name: Randy POSS, Claimant-Appellant, v. MEEKER MACHINE SHOP, Employer, and Argonaut-Northwest Insurance Company, Surety, Defendants-Respondents
Court: Idaho Supreme Court
Jurisdiction: Idaho
Decision Date: 1985-12-24
Citations: 109 Idaho 920
Docket Number: No. 15811
Parties: Randy POSS, Claimant-Appellant, v. MEEKER MACHINE SHOP, Employer, and Argonaut-Northwest Insurance Company, Surety, Defendants-Respondents.
Judges: SHEPARD, BAKES and HUNTLEY, JJ., concur.
Reporter: Idaho Reports
Volume: 109
Pages: 920–933

Head Matter:
712 P.2d 621
Randy POSS, Claimant-Appellant, v. MEEKER MACHINE SHOP, Employer, and Argonaut-Northwest Insurance Company, Surety, Defendants-Respondents.
No. 15811.
Supreme Court of Idaho.
Dec. 24, 1985.
Steven C. Verby, Esq., of Grudem, Verby, Elsaesser & Jarzabek, Sandpoint, for claimant-appellant.
John W. Barrett, of Moffatt, Thomas, Barrett & Blanton Chartered, Boise, for defendants-respondents.
Jon M. Steele, and Lynn M. Luker, Boise, for amicus curiae, Idaho Trial Lawyers Ass’n.

Opinion:
DONALDSON, Chief Justice.
On March 11, 1982, appellant, Randy Poss, was working for his employer when a piece of sheet iron weighing between 300 and 400 pounds fell on his back. He sustained injury to his back, neck and shoulders. He was treated by Dr. Frank Cipriano, an orthopedic surgeon in Sandpoint, Idaho.
Poss returned to work in May of 1982, but since he was unable to move or lift heavy objects, he left work in July and was placed on temporary total disability.
Dr. Cipriano referred Poss to a neurosurgeon in Spokane. Thoracic outlet syndrome was diagnosed and Poss underwent surgery on October 5, 1982. The surgery involved removal of a portion of Poss's left first rib.
Poss continued to have considerable pain in his spine and was prescribed pain medication by Dr. Cipriano. Poss was also referred to a physical therapist, Steven Heinrich, who treated Poss from October 21, 1982 through June 1, 1983. Dr. Cipriano has diagnosed Poss's condition as a chronic strain syndrome. Although there is little objective evidence to explain Poss's continued complaints of severe back pain, Dr. Cipriano has noted some muscle spasms in Poss's back and mild scoliosis or curvature in Poss's thoracic spine. It is uncertain whether this is specifically attributable to Poss's injury. Dr. Cipriano rated Poss's permanent physical impairment at between 25% and 30% of the whole man.
On February 7, 1983, at the request of the employer's insurance company, respondent, Argonaut-Northwest Insurance Company (Argonaut), Poss was examined by a panel of three Spokane doctors. The panel rated Poss's impairment as 6% of the whole man secondary to the thoracic outlet sur gery, and 5% of the whole man for the dorsal spine injury. The panel concluded that because of the limitation on his activities Poss could not return to the same line of work, but he could engage in other lines of work. The psychiatrist on the panel found no psychiatric problems.
On December 20, 1983, a second panel of doctors from Spokane examined Poss. It made no changes in Poss's impairment rating and noted very few objective manifestations of Poss's pain. The panel also found Poss's condition was stable and further treatment was unnecessary. The panel found that physical therapy could not provide any cure for Poss's chronic condition. Dr. Luther, a member of the second panel, testified that any tenderness in Poss's spine was probably not connected with such an old injury.
Poss is limited in his activities at home and on his farm in that, he cannot lift or pull heavy objects. His personality has changed somewhat since the injury and he has lost about 35 pounds. He has difficulty riding in motor vehicles, particularly on the rough country road to his house.
Argonaut ceased paying for any of Poss's medical expenses after the first panel examination on February 7, 1983. On September 13, 1983, Poss filed a petition for an emergency hearing before the Industrial Commission requesting that Argonaut pay his outstanding medical bills, primarily for pain medication and physical therapy. Poss also requested an order directing Argonaut to cover all future medical bills. The petition for an emergency hearing was denied.-
On October 12, 1983, Argonaut notified the providers of Poss's medical services of its decision to stop paying Poss's bills, but did pay all bills incurred up to that date. Poss incurred bills of $171.80 between October 12 and December 20, 1983, the date of the second panel's examination. Poss has incurred further expenses for medical services since that date.
On February 27, 1984, the Industrial Commission heard Poss's case. Poss and four of his witnesses were present in person, and all other evidence, primarily the medical testimony, was presented through deposition and other documents. The commission issued its Findings of Fact and Conclusions of Law on October 31, 1984.
The commission stated that in this case it was inclined to give greater weight to the recommendations of the medical panels which examined Poss, than to Dr. Cipriano, Poss's treating physician, since he may be biased by his feelings towards his patient. The commission found little in the way of objective evidence to explain Poss's complaints of chronic pain, and adopted the panels' finding that Poss has a permanent physical impairment of 11% of the whole man caused by the accident.
The commission found there were a number of jobs within a 50-mile radius available at the time which Poss could perform. These included retail sales and certain service work. Poss would suffer some wage loss at first, since he had been making $6 an hour when the accident occurred, as well as some limitations based on his subjective complaints of pain and his inability to drive long distances. Therefore, the commission awarded Poss an additional 15% of the whole man as a permanent disability award for these nonmedical factors.
The commission concluded that Poss did not require any further medical treatment, rejecting . Dr. Cipriano's recommendation for continuing pain medication. It did, however, award Poss expenses for medical services rendered up until December 20, 1983, the date of the second panel examination (a total of $171.80).
Based on Poss's permanent partial disability of 26% of the whole man, the commission awarded Poss $133.10 per week for 130 weeks commencing from February 17, 1983. Although Poss was awarded $171.80 for medical expenses incurred prior to the date of the second panel's examination, the commission found Argonaut had not acted unreasonably in terminating or delaying payment of medical bills upon receipt of the first medical panel's evaluation. Poss, therefore, was not entitled to attorney fees under I.C. § 72-806.
I.
[1] Poss first argues that since most of the evidence, including all of the medical testimony, before the Industrial Commission was presented by written record rather than through personal appearances, this Court is not bound by the fact findings of the commission. Hence, Poss argues, this Court can review the facts and reach its own conclusion with respect to an impairment rating. Poss cites Graves v. American Smelting & Refining Co., 87 Idaho 451, 394 P.2d 290 (1964) for this purpose.
Poss's citation is correct, however, that rule has long since been abandoned by this Court. Most recently in Nigherbon v. Ralph E. Feller Trucking, Inc., 109 Idaho 233, 706 P.2d 1344 (1985) we held that "[rjegardless of whether witnesses have personally appeared before the Industrial Commission, this Court's review is restricted to determining whether findings of fact by the Industrial Commission are supported by substantial competent evidence." Id. at 234, 706 P.2d at 1345; Horner v. Ponderosa Pine Logging, 107 Idaho 1111, 1113-14, 695 P.2d 1250, 1252-53 (1985); Mager v. Garrett Freightlines, Inc., 100 Idaho 469, 471, 600 P.2d 773, 775 (1979); Booth v. City of Burley, 99 Idaho 229, 580 P.2d 75 (1978); Gradwohl v. J.R. Simplot Co., 96 Idaho 655, 534 P.2d 775 (1975). We stated in Booth, in fact, that decisions suggesting a contrary result, such as Poss argues in the present case, were overruled. Booth, supra, at 232, 580 P.2d at 78.
II.
Poss next argues that the Industrial Commission erred by not taking into consideration the subjective factors of pain and Poss's unique living conditions and lifestyle when it arrived at its permanent impairment evaluation. He claims in particular that the panel of Spokane doctors misinterpreted Idaho Worker's Compensation Law, specifically I.C. § 72-424, when it excluded from its evaluation these subjective factors. The commission's conclusions, Poss argues, were, therefore, tainted by the medical panels' erroneous assumptions.
We agree that I.C. § 72-424, which must be read in conjunction with I.C. § 72-422, clearly suggests that such factors should be taken into account in arriving at a permanent impairment evaluation. The employee cannot be evaluated in objective isolation since the rating must accurately reflect how this particular employee has been affected in his ability to conduct his customary lifestyle. However, we find no merit in Poss's argument that the panel of doctors completely misinterpreted Idaho law, and therefore, their recommendation tainted the commission's conclusion. The testimony of Dr. Luther, who was on the first panel of examining physicians, clearly indicates that the panel did take into consideration Poss's subjective complaints of pain. In his deposition, when asked about the permanent physical impairment, Dr. Luther said,
"Well, it is not strictly impairment. It is supposed tp be strictly impairment but we take in subjective things which we feel belong in it. We don't take other factors that you do when you are talking about disability, such as education, age, training. We don't take those things. We take the subjective complaints."
It is also clear from the record that Dr. Luther and his fellow doctors on the panel relied on the same American Medical Association guidelines that an Idaho doctor would have relied on in arriving at an impairment evaluation. Those guidelines include the consideration of subjective factors such as complaints of pain.
It is clear from the record that the commission also independently considered these subjective and nonmedical factors when it added a permanent disability award to Poss's impairment rating. The commission stated:
"In addition to the Claimant's permanent impairment from a medical standpoint, the Commission concludes that some nonmedical factors need to be taken into consideration. The Claimant does experience some difficulty in accomplishing travel from his home to Sandpoint and Bonners Ferry and has subjective complaints of pain which tend to restrict his activities. However, the Claimant has a number of skills which lend themselves to employment in his labor market area. Considering all of the evidence, the Commission will award the Claimant an additional 15% of the whole man as a permanent disability award for nonmedical factors over and above the rating of 11% of the whole man for medical impairment as determined by the panel examinations."
There was substantial and competent evidence to support the commission's findings on this issue which we refuse to disturb on appeal.
Although the commission did consider Poss's complaints of ongoing pain in its evaluation, it found that by December 20, 1983, Poss's condition was stable. Therefore, the commission found there was no need for additional compensation for pain medication and physical therapy after December 20, 1983, over and above the compensation Poss would receive under his impairment rating and disability award. The commission's findings are supported by the medical examinations of the two panels of Spokane doctors which found no change in Poss's condition between the two examinations. The panels noted as well that the physical therapy Poss had been receiving was only useful in the early stages of the injury.
The commission did not automatically exclude compensation for any medication or treatment because it was only palliative and of little curative value. In fact, the commission has found the employer's surety is liable for all such medication and treatment rendered prior to December 20, 1983. Pain-killing treatments can be compensable even though they will not necessarily cure the employee's condition. Hamilton v. Boise Cascade Corp., 84 Idaho 209, 215-16, 370 P.2d 191, 194 (1962). In this case, however, because of the stability of Poss's condition and the lack of substantive evidence of Poss's continued complaints of pain subsequent to the second panel's evaluation, the commission found that additional medication and therapy would be unnecessary. The commission's denial of additional medical benefits for pain medication and physical therapy incurred after December 20, 1983, is supported by substantial and competent evidence.
III.
With respect to the specific evidence in this case, the Industrial Commission noted that it was inclined to give greater weight to the report and testimony of the panel of doctors which examined Poss than to the testimony of Poss's treating physician, Dr. Cipriano. The commission found these panels, consisting of entirely separate groups of physicians, were quite consistent in their findings although the examinations occurred several months apart.
Poss and the Idaho Trial Lawyers Association (ITLA), which filed an amicus curiae brief in this case, argue that the commission is making a basic departure from the rule that the reports of the physicians who treat an injured employee should be given at least as great, if not greater weight, than those of the physicians who examine the employee on only one occasion. Graves v. American Smelting & Refining Co., 87 Idaho 451, 456, 394 P.2d 290, 293-94 (1964); Stralovich v. Sunshine Mining Co., 68 Idaho 524, 533, 201 P.2d 106, 111 (1948).
It is obvious that both parties in a civil case involving an injured claimant or plaintiff have a legitimate interest in acquiring the medical diagnoses and opinions of doctors of their own choosing. Because of the medical aspects of worker's compensation cases, the Industrial Commission must rely on the knowledge of medical experts, and its findings must be supported by medical testimony. Comish v. J.R. Simplot Fertilizer Co., 86 Idaho 79, 86, 383 P.2d 333, 337-38 (1963). It would be an improper invasion into the fact finding discretion of the Industrial Commission for this Court to hold that the commission must always give greater weight to one party's medical experts over the other. It would also be improper for the commission to follow a self-imposed rule to that effect.
It would not be unusual for a medical expert to have a bias in favor of the party who is paying his expert witness fee. For this reason, cross-examination as to who is paying for the expert is almost always allowed when the expert is testifying. In cases before the Industrial Commission, the commissioners have no illusions as to who is paying the various medical experts, and whether the expert is appearing before the commission in person or through deposition is irrelevant to whether he may or may not be biased. It would be error for the commission to adopt a general rule applicable to all cases that it will give greater weight to the testimony of the examining physicians retained by the employer or his surety over the testimony of the employee's treating physician. Such a rule would unnecessarily restrict the fact-finding function of the commission.
In this case, we do not believe the commission has adopted such a rule. Because of the substance and consistency of the two panels' evaluations and the perceived bias on the part of Poss's treating physician, the commission, in its discretion, found the former to be of greater weight than the latter. In the next case, the commission may find quite the opposite.
In fact, we would agree with Poss arid the ITLA that in many cases the commission should give greater weight to the testimony of the employee's treating physician since he or she would have a much better opportunity to become acquainted with the claimant and the nature of the claimant's problem. This is exactly what the commission did in the recent cases of Stephens v. U.P.S., 83 IWCD 28 (April 8, 1983) and Bybee v. Lamb-Weston, 84 IWCD 31 (March 28, 1984). The opportunity to observe the patient over a period of time on a regular basis is an important factor, but not the only factor, to be considered in determining the weight which should be given to expert medical testimony. See Zipp v. Seattle School Dist. No. 1, 36 Wash.App. 598, 676 P.2d 538 (1984). However, it would again be error for the commission to adopt a general rule applicable to all cases that it will give greater weight to the testimony of treating physicians retained by the employee over the testimony of the employer's examining physicians. Such a rule would unnecessarily restrict the fact-finding function of the commission.
In evaluating the medical evidence in a given case, the commission must consider many factors such as those noted above. Which factors should be given greater weight is within the discretion of the commission. Absent evidence of abuse of discretion in weighing the evidence and so long as the commission's findings are supported by substantial and competent evidence, we will not disturb those findings on appeal.
IV.
Poss finally argues that Argonaut acted unreasonably when it stopped payment of Poss's medical expenses following the first panel's examination. Therefore, Poss argues, he is entitled to an award of attorney fees under I.C. § 72-804. Poss claims that the unreasonableness of Argonaut's conduct is found in their failure to give notice within 15 days to Poss or his physician that payment of Poss's medical expenses were being terminated. Such notice is required under I.C. § 72-806.
It is apparent from the record that Argonaut did, in fact, notify Dr. Cipriano when it forwarded to him a copy of the first medical panel's report which contained that panel's recommendations. Furthermore, by paying Poss's medical expenses up to October 12, 1983, Argonaut did not, thereby, admit liability for unreasonable conduct. The commission stated,
"The Commission concludes that the Claimant has failed to establish that the Surety acted unreasonably in terminating the payment of medical benefits to the Claimant upon receipt of the medical panel evaluation. The Commission recognizes that there is some uncertainty and doubt as to the responsibility of the Surety for such benefits in'the period between the two medical panel evaluations and has given the Claimant the benefit of the doubt in this matter. However, the necessity of continued medication and physical therapy during this period is sufficiently uncertain that the Commission cannot find that the Surety unreasonably denied or delayed payment of such benefits. Therefore, the Claimant is not entitled to an award of attorney fees pursuant to Section 72-806, IDAHO CODE.
In light of the foregoing discussion, the conclusion of the Industrial Commission that Argonaut acted reasonably is supported by the record and will not be disturbed on appeal. Attorney fees are not granted to a claimant as a matter of right under Idaho's worker's compensation laws, but must be recovered only under the circumstances set forth in I.C. § 72-804. The decision that grounds exist for awarding a claimant attorney fees is a factual determination which rests with the commission. Troutner v. Traffic Control Co., 97 Idaho 525, 528, 547 P.2d 1130, 1133 (1976).
The findings of fact, conclusions of law and award of compensation by the Industrial Commission are affirmed.
Costs to respondent.
No attorney fees on appeal.
SHEPARD, BAKES and HUNTLEY, JJ., concur.