Court Opinion

ID: 9712465
Source: CourtListenerOpinion
Date Created: 2023-08-26 04:54:33.809963+00
Date Added: 2024-06-11T18:23:12.197849
License: Public Domain

BAKER, Judge,
dissenting.
I respectfully dissent with the majority's determination that the Board's denial of payment for Daugherty's knee replacement surgery was supported by sufficient evidence. To the contrary, the undisputed evidence establishes, and the Board so found, that "Dr. Brooks' recommended care and treatment," which included the surgery, was "reasonable and appropriate." Appellant's Br. p. 4. It is also undisputed that as a result of the surgery Daugherty was able to return to near normal work duties in the service of ICE. Thus, the only evidence to support the Board's denial of payment is its determination that Daugherty failed to get pre-ap-proval for the surgery. While I fully acknowledge the need for prior approval, I believe that Daugherty's failure to secure such approval is greatly outweighed, if not negated, by the incontrovertible evidence and specific finding that the surgery was medically appropriate and effective.
In disregarding such evidence, the Board in effect penalizes Daugherty for rejecting the diagnosis by ICE's and the Board's doctors that would have left him with debilitating knee pain, incapable of returning to meaningful employment, and unable to adequately support his family and lead a physically unimpaired life. Moreover, the Board's decision unjustly rewards the employer, which receives the benefit of a fully capable employee at the employee's expense, and also unjustly punishes the employee for his resolve to recover full mobility and return to gainful employment. In my view, such an outcome is fundamentally unjust and does not serve the humane purposes of the Act.
Turning to the relevant statute, Indiana Code Section 22-3-8-4(d) provides, among other things, that:
If, because of an emergency, or because of the employer's failure to provide an attending physician or surgical, hospital, or nursing services and supplies ... or because of any other good reason, a physician other than that provided by the employer treats the injured employee during the period of the employee's temporary total disability ... the reasonable cost of those services and supplies shall, subject to the approval of the workers compensation board, be paid by the employer.
"The thrust of this provision is that in the absence of an emergency or other good reason, an employee is not free to simply elect, at the employer's expense, additional treatment or other physicians than those tendered by the employer." Perez v. U.S. Steel Corp., 172 Ind.App. 242, 244, 359 N.E.2d 925, 926 (Ind.Ct.App.1977) (emphasis added). In this instance, Daugherty elected to undergo the knee surgery after *1287his employer refused to approve the surgery and after his employer's and the Board's authorized physicians indicated that he had reached a state of maximum recovery and would not be restored to nearly full functioning. In my view, the fact that the employer's physicians may have been incorrect in their assessment of Daugherty's injury and that this was not apparent until after the surgery took place, should not negate his ability to recover for its costs. If the Board had determined that the surgery was unnecessary, even after the fact, then Daugherty would not have been eligible for reimbursement. However, once the Board found that the procedure was necessary and proper, it is apparent to me that the requisite "good reason" for the treatment was established and required the Board to approve payment of the associated costs. Thus, I vote to reverse the Board's decision.