Opinion ID: 2070871
Heading Depth: 1
Heading Rank: 5

Heading: mendoza's cross-appeal

Text: Section 48-125 of the Nebraska Workers' Compensation Act in part provides: (1) Except as hereinafter provided, all amounts of compensation payable under the provisions of this act shall be payable periodically in accordance with the methods of payment of wages of the employee at the time of the injury or death; Provided, fifty per cent shall be added for waiting time for all delinquent payments after thirty days' notice has been given of disability. Whenever the employer refuses payment, or when the employer neglects to pay compensation for thirty days after injury, and proceedings are held before the compensation court, a reasonable attorney's fee shall be allowed the employee by the court in all cases when the employee receives an award. As construed by this court, § 48-125 authorizes a 50-percent payment for waiting time involving delinquent payment of compensation and an attorney fee, where there is no reasonable controversy regarding an employee's claim for workers' compensation. See Novotny v. City of Omaha, 207 Neb. 535, 299 N.W.2d 757 (1980). In considering the application of § 48-125, we stated in Smith v. Fremont Contract Carriers, 218 Neb. 652, 657, 358 N.W.2d 211, 216 (1984): The reasonable controversy rule is still viable. Whether a reasonable controversy exists pertinent to § 48-125 is a question of fact. McGee v. Panhandle Technical Sys., 223 Neb. 56, 387 N.W.2d 709 (1986); Mulder v. Minnesota Mining & Mfg. Co., 219 Neb. 241, 361 N.W.2d 572 (1985). Illustrative cases where a reasonable controversy was found to exist in reference to § 48-125 include: Novotny v. City of Omaha, supra : Resolution of a question of law (construction of a statute) was necessary to determine whether benefits paid under a municipal disability plan were in lieu of workers' compensation and benefits; Mulder v. Minnesota Mining & Mfg. Co., supra : Physicians testified concerning varying degrees of an employee's permanent disability; and Wheeler v. Northwestern Metal Co., 175 Neb. 841, 124 N.W.2d 377 (1963): Conflicting medical evidence on the question whether an employee's injuries prevented return to work as a laborer, resulting in permanent total disability. Included among the decisions of this court reflecting an absence of a reasonable controversy in reference to § 48-125 are the following: Smith v. University of Nebraska Medical Center, 201 Neb. 730, 271 N.W.2d 852 (1978), supp. op. 202 Neb. 493, 276 N.W.2d 86 (1979): Delay in payment of disability benefits was attributable to the employer's erroneous understanding of current law of the State of Nebraska. 201 Neb. at 735, 271 N.W.2d at 855. See, also, Abel Construction Co. v. Goodman, 105 Neb. 700, 181 N.W. 713 (1921); Minshall v. Plains Mfg. Co., 215 Neb. 881, 341 N.W.2d 906 (1983): An employer's unilateral determination that the employee's total disability had ceased and was followed by permanent partial disability, resulting in a reduction of disability benefits; and Franklin v. Pawley, 215 Neb. 624, 340 N.W.2d 156 (1983): Employer contended that a third party was a statutory employer, see Neb.Rev.Stat. § 48-116 (Reissue 1984), and, therefore, jointly and severally liable for payments due an injured employee, but this court reasoned that the employer's contention would not in any manner have affected [employer's] independent liability. 215 Neb. at 630, 340 N.W.2d at 160. Thus, for the purpose of § 48-125, and as some criteria to determine whether a reasonable controversy exists between an employer and employee, a reasonable controversy may exist: (1) if there is a question of law previously unanswered by the Supreme Court, which question must be answered to determine a right or liability for disposition of a claim under the Nebraska Workers' Compensation Act, or (2) if the properly adduced evidence would support reasonable but opposite conclusions by the Nebraska Workers' Compensation Court concerning an aspect of an employee's claim for workers' compensation, which conclusions affect allowance or rejection of an employee's claim, in whole or part. To avoid the payments assessable under § 48-125, an employer need not prevail in opposition to an employee's claim for compensation, but must have an actual basis, in law or fact, for disputing the employee's claim and refraining from payment of compensation. Unless the character of an injury is objective, that is, an injury's nature and effect are plainly apparent, an injury is a subjective condition, requiring an opinion by an expert to establish the causal relationship between an incident and the injury as well as any claimed disability consequent to such injury. See, Hamer v. Henry, 215 Neb. 805, 341 N.W.2d 322 (1983); Mack v. Dale Electronics, Inc., 209 Neb. 367, 307 N.W.2d 814 (1981); McCann v. Holy Sepulchre Cemetery Assn., 205 Neb. 444, 288 N.W.2d 45 (1980); Eiting v. Godding, 191 Neb. 88, 214 N.W.2d 241 (1974). Neither Tower nor Wausau denies that Mendoza was industrially injured on November 7, 1983, and August 1, 1985, in incidents arising out of and in the course of his employment with OMP. On the one hand, Tower maintains it has no liability for Mendoza's condition after August 1, 1985, and attempted to show an exonerating break in causation, an independent intervening cause, from the testimony and diagnosis by Dr. Bowman. On the other hand, Wausau apparently accepted Dr. Bowman's diagnosis concerning Mendoza's condition. As a resolution of the question concerning causation determinative of liability on the part of one of the insurance companies, the proceedings in the compensation court took on the character of a declaratory judgment action between two insurance companies, seeking to determine a legal issue of liability for an undisputed loss ostensibly indemnifiable under provisions of each company's policy. For such declaration, Mendoza was required to participate as a litigant and retry his case in the rehearing before the compensation court. Tower sought to build its case through Mendoza's expert witness and failed on the issue of an independent intervening cause. However, there is an indication that Wausau paid some benefits regarding Mendoza's disability. Of course, if Mendoza has received compensation and benefits otherwise payable on his compensable claim, an additional payment of 50 percent, authorized by § 48-125, would not be required, because there would have been no delinquency in payments due Mendoza. The record before us does not indicate that all payments, to or on behalf of Mendoza, have been made. For that reason, we remand this matter to the Nebraska Workers' Compensation Court with direction to determine whether there is any delinquency in payment of compensation or benefits and, if such delinquency exists, to make the proper computation of an additional payment in accordance with § 48-125, which additional amount shall be paid by Tower to Mendoza, inasmuch as there was no factual basis for dispute on the issue of causation in reference to the industrial incidents of November 7, 1983, and August 1, 1985. Regarding an attorney fee assessable under § 48-125, Tower contended that Mendoza's disability was caused by some event outside the industrial accident of November 7, 1983. After rehearing, the compensation court concluded that the plaintiff may have injured his back in September, 1985, while moving furniture to a new residence. There is also a mention of a long drive to Mexico by the plaintiff as a possible cause. (Emphasis supplied.) Regarding the issue of a reasonable controversy between employer and employee, the conclusion reached by the compensation court suffers from the same fallacious premise suggested by Tower: Conjecture or speculation justified the delay in payment of compensation. The compensation court's conclusions about a reasonable controversy, reflecting speculative or conjectural causes after November 7, 1983, and causes unsubstantiated by any evidence, are not supported by permissible findings of fact. As we have previously pointed out in this opinion pertinent to Tower's assertion of an independent intervening cause, Dr. Bowman's diagnosis of Mendoza's condition contained the only expression of a causal relationship between the disk pathology, a subjective condition, and a specific event, the industrial accident on November 7, 1983. We find nothing internally inconsistent or self-contradictory in Dr. Bowman's testimony about causation in relation to the industrial accident of November 7, 1983. Without evidence from Tower contradicting Dr. Bowman's opinion on causation as reflected in the record which we have reviewed, we are compelled to conclude that conjecture or speculation about causality was the basis for any assertion or conclusion that a reasonable controversy existed between Mendoza and OMP. If denial predicated on conjecture and speculation, or mere possibility asserted by an employer, creates a reasonable controversy within the meaning this court has ascribed to § 48-125, an employer's denial of a claim by an employee would necessarily and automatically include a reasonable controversy. Based on the record brought to this court, we find that no reasonable controversy existed between Mendoza and Tower. The compensation court's finding on rehearing that a reasonable controversy existed is clearly erroneous and is, therefore, set aside. Under the circumstances, Mendoza is entitled to an attorney fee authorized by § 48-125. Consequently, we remand this matter to the Nebraska Workers' Compensation Court with direction that the compensation court shall determine and award to Mendoza a reasonable attorney fee for services rendered by Mendoza's lawyer for the rehearing before the Workers' Compensation Court, which attorney fee shall be paid by Tower. See Smith v. University of Neb. Medical Ctr., 201 Neb. 730, 271 N.W.2d 852 (1978), supp. op. 202 Neb. 493, 276 N.W.2d 86 (1979). Also, because Tower has failed to reduce the award after rehearing, Mendoza is allowed $1,000 for services of his attorney in this court. See § 48-125. AFFIRMED IN PART, AND IN PART REVERSED AND REMANDED WITH DIRECTION.