Opinion ID: 2633391
Heading Depth: 2
Heading Rank: 1

Heading: Was the claimant entitled to an award of attorney fees?

Text: The State Insurance Fund stopped paying Gooby benefits after receiving the report from the two-physician panel. In that report, the panel stated that Gooby was fixed and stable, that her subjective complaints did not show any clinical or objective findings, that she did not need any further treatment, and that she could return to work without limitations. The Fund later had Gooby examined by Dr. Mackenzie on July 29, 1998, who stated in his report that Gooby could return to work with the restriction that she be able to change her position at will, that she did not need further treatment, but that she will need some ongoing pain medication. After receiving Dr. Mackenzie's report, the Fund did not resume paying Gooby's pain medications. The Commission ultimately found that Gooby was partially disabled until July 29, 1998, and that she was entitled to additional partial disability benefits from April 1, 1998, through July 29, 1998, in the sum of $3,624.55. The Commission declined to award attorney fees under Idaho Code § 72-804 because, Defendants' decision to discontinue temporary disability benefits was reasonably based upon the evaluation of the panel. Despite the award of additional benefits through July 29, 1998, no attorney fees are awarded. Gooby argues that because Dr. Mackenzie stated that Gooby would need some ongoing pain medication and the two-physician panel did not mention that issue, it was undisputed that the State Insurance Fund should have continued paying for Gooby's pain medications and its failure to do so renders it liable for attorney fees under Idaho Code § 72-804. [2] Idaho Code § 72-804 applies only when the employer's or surety's conduct has been unreasonable. Dennis v. School District # 91, 135 Idaho 94, 15 P.3d 329 (2000). Whether or not grounds exist for awarding a claimant attorney fees under Idaho Code § 72-804 is a factual determination that rests with the Industrial Commission. Poss v. Meeker Machine Shop, 109 Idaho 920, 712 P.2d 621 (1985). The Commission's decision regarding the awarding of attorney fees will be upheld if it is based upon substantial, competent evidence. Hoye v. DAW Forest Products, Inc., 125 Idaho 582, 873 P.2d 836 (1994). Gooby contended that she should be entitled to attorney fees under Idaho Code § 72-804 due to the State Insurance Fund's unreasonable conduct in ceasing to pay for her pain medications. An employer or surety is required to provide an injured employee with medical care as needed within a reasonable time after an occupational injury. Harrison v. Osco Drug, Inc., 116 Idaho 470, 776 P.2d 1189 (1989); I.C. § 72-432(1). [3] The obligation to pay for medical services under Idaho Code § 72-432(1) is separate from any obligation to pay temporary disability benefits. Harrison v. Osco Drug, Inc., 116 Idaho 470, 776 P.2d 1189 (1989). Attorney fees can be awarded under Idaho Code § 72-804 if the employer or surety unreasonably refuses to pay the claimant's medical care. Id. Although the Commission found that it was not unreasonable to discontinue temporary disability benefits based upon the panel evaluation, it did not address the issue raised by Gooby that it was unreasonable to discontinue paying for her pain medications. We therefore vacate the denial of attorney fees and remand this case to the Commission for it to determine whether the State Insurance Fund's conduct in ceasing to pay for Gooby's pain medications entitles her to an award of attorney fees under Idaho Code § 72-804. Cantu v. J.R. Simplot Co., 121 Idaho 585, 826 P.2d 1297 (1992).