Opinion ID: 2110037
Heading Depth: 1
Heading Rank: 6

Heading: inhome nursing care expenses

Text: Section 48-120 provides: The employer shall be liable for all reasonable medical, surgical, and hospital services ... not to exceed the regular charge made for such service in similar cases.... .... The Nebraska Workers' Compensation Court shall have the authority to determine the necessity, character, and sufficiency of any medical services furnished or to be furnished.... Generally, pursuant to § 48-120, an employee may be reimbursed for nursing care in the employee's home or at a nursing home, when such care is necessitated by a work-related injury, so long as the cost of the care is fair and reasonable. Spiker v. John Day Co., 201 Neb. 503, 270 N.W.2d 300 (1978). See, also, S & S LP Gas Co. v. Ramsey, 201 Neb. 751, 272 N.W.2d 47 (1978). Bituminous submits that Deyle is not entitled to compensation for services which include simply being present in the household, ordinary housekeeping tasks, cleaning, preparation of meals, washing and mending of clothes. Brief for appellant at 12. Bituminous bases its argument on Currier v. Roman L. Hruska U.S. Meat Animal Res. Ctr., 228 Neb. 38, 45, 421 N.W.2d 25, 30 (1988), in which we stated that [o]rdinary, noncompensable housekeeping tasks include cleaning, preparation of meals, and washing and mending clothes. Compensable tasks include serving meals in bed, bathing and dressing, administering medication, and assisting with sanitary functions. The substance of Bituminous' argument, as we interpret the argument, is that Bituminous is not liable for services received by Deyle which might have been rendered by nonnursing personnel. Consistent with Currier, charges for services by the nursing personnel hired by Deyle are compensable under § 48-120 notwithstanding that the services could have been performed by nonnursing personnel. In S & S LP Gas Co. v. Ramsey, supra 201 Neb. at 752, 272 N.W.2d at 47, this court recognized the compensability of nursing care expenses incurred by a claimant for whom it was not essential that the [nursing] assistance ... be furnished by a doctor, nurse, or other medical person. Bituminous also argues that Deyle should not be reimbursed for expenses attributable to the nursing personnel's simply being present in the household. Brief for appellant at 12. However, as we stated in Currier v. Roman L. Hruska U.S. Meat Animal Res. Ctr., supra at 45-46, 421 N.W.2d at 30, a person rendering necessary medical services on an `as-needed' basis need not render the services during each moment of compensated time but, rather, must be available to perform the needed services during the times when needed. Bituminous further argues that the charges for Deyle's nursing care are not fair and reasonable and, thus, are unrecoverable under § 48-120, which provides that the medical expenses recoverable pursuant to the Workers' Compensation Act must not exceed the regular charge made for such service in similar cases. As Bituminous correctly points out, an employee has the burden to prove compensability of a claim against an employer under the Nebraska Workers' Compensation Act. Fees v. Rivett Lumber Co., 228 Neb. 617, 423 N.W.2d 483 (1988); Mendoza v. Omaha Meat Processors, 225 Neb. 771, 408 N.W.2d 280 (1987). However, we cannot justifiably ignore the longstanding rule established for nearly 70 years in Nebraska: Where the evidence shows that certain hospital and nurse expenses have been incurred by the injured employee, a prima facie case is made out, and in the absence of any showing that the expenses so incurred were unreasonable, such proof will be held to be sufficient. Gourley v. City of Grand Island, 168 Neb. 538, 546, 96 N.W.2d 309, 314 (1959). See, also, Schoenrock v. School Dist. of Nebraska City, 179 Neb. 621, 139 N.W.2d 547 (1966); Pavel v. Hughes Brothers, Inc., 167 Neb. 727, 94 N.W.2d 492 (1959); Crable v. Great Western Sugar Co., 166 Neb. 795, 90 N.W.2d 805 (1958); Gilmore v. State, 146 Neb. 647, 20 N.W.2d 918 (1945); Nosky v. Farmers Union Cooperative Ass'n, 109 Neb. 489, 191 N.W. 846 (1922). As we recently recognized in State v. Kipf, 234 Neb. 227, 450 N.W.2d 397 (1990), prima facie proof is evidence sufficient to submit an issue to the fact finder and precludes a directed verdict in a jury trial, or dismissal for a failure of proof in a bench trial or case tried without a jury, on an issue in the proceedings. See State v. Copple, 224 Neb. 672, 401 N.W.2d 141 (1987). Consequently, as the result of prima facie proof on an issue, an adversary has the burden of producing evidence to the contrary or risks an adverse finding on the issue for which there is prima facie proof. See Speas v. Bank, 188 N.C. 524, 530, 125 S.E. 398, 401 (1924): [W]hen such prima facie case is made out, the duty of going forward with evidence in reply, if the opposing party would not hazard the chance of an adverse verdict, is shifted or rather cast upon the opposite side. See, also, 9 J. Wigmore, Evidence in Trials at Common Law § 2487 (J. Chadbourn rev. 1981). Therefore, when an employee presents evidence of medical expenses resulting from a work-related injury, the employee has presented prima facie proof of fairness and reasonableness for the expenses, while the employer has the burden of producing evidence, or going forward with evidence, that the expenses incurred are not fair and reasonable charges. See, Gourley v. City of Grand Island, supra ; Schoenrock v. School Dist. of Nebraska City, supra ; Pavel v. Hughes Brothers, Inc., supra ; Crable v. Great Western Sugar Co., supra ; Gilmore v. State, supra; Nosky v. Farmers Union Cooperative Ass'n, supra . Deyle presented evidence that Dr. Rosenlof prescribed 24-hour-a-day care for Deyle and that inhome care was the preferred method of treatment for serious back and spinal injuries such as those sustained by Deyle as the result of his 1984 work-related injury. There was also evidence that Deyle was paying the going rate for his inhome care. Thus, Deyle has made a sufficient showing for the compensation court's conclusion that Deyle incurred the inhome nursing expenses as a result of his 1984 compensable injury. Evidence supports the finding that Deyle needs 24-hour assistance every day, even if the nursing personnel in attendance are not performing services which are medical in nature each moment of the entire 24 hours everyday. Deyle's evidence concerning nursing expenses is sufficient proof that the charges for the inhome care are fair and reasonable. Bituminous also contends that some of Deyle's expenses for nursing care are unnecessary because Deyle was hospitalized during part of the period when he paid for inhome nursing care. The third quarter of 1987 consisted of 92 days, of which Deyle was hospitalized 35 days, or 38 percent of the period. Expenses for a nurse's aide during the third quarter of 1987 were $3,000. Similarly, in the second quarter of 1988, which consisted of 91 days, Deyle was hospitalized for 66 days, or 73 percent of 1988's second quarter, for which Deyle paid $3,000 regarding care by a nurse's aide. Although nursing personnel required in a patient's home on an as needed basis need not perform medically related tasks during each moment of their presence in the patient's home, it does seem somewhat plausible, and we conclude, that Bituminous should not have to reimburse Deyle for the expenses pertaining to care by a nurse's aide while Deyle was absent from his home during his hospital confinement. Consequently, we determine that the Workers' Compensation Court's order that Bituminous reimburse Deyle for $56,412.05 is clearly incorrect. Utilizing the percentages based on the periods of Deyle's hospitalization when he continued paying for care by a nurse's aide, the allowable nursing expenses for the third quarter of 1987 are reduced by $1,140 ($3,000 times 38 percent), and the allowable nursing expenses for the second quarter of 1988 are reduced by $2,190 ($3,000 times 73 percent), which results in an overall reduction of $3,330 ($1,140 plus $2,190) concerning the recoverable medical expenses for the nursing care received by Deyle. Thus, Deyle's recoverable medical expenses, pursuant to § 48-120, are $53,082.05, not $56,412.05 as ordered by the Workers' Compensation Court. For that reason, the Order on Rehearing is hereby modified to require that Bituminous reimburse Deyle, or otherwise satisfy Deyle's medical expenses, in the amount of $53,082.05 as otherwise provided in the order of the Workers' Compensation Court.