Court Opinion

ID: 9702370
Source: CourtListenerOpinion
Date Created: 2023-08-25 23:08:46.716839+00
Date Added: 2024-06-11T18:21:37.051061
License: Public Domain

FLANDERS, Justice,
dissenting.
Because I believe that the Workers’ Compensation Court erred as a matter of *1133law when it permitted this employee to recover benefits for an alleged recurrence of an incapacity to work, I would quash the decision of the Appellate Division and remand this case to the Workers’ Compensation Court with instructions for it to enter judgment in favor of the employer.
In this case, no competent evidence showed that the employee’s post-surgical incapacity to work bore any causal relationship to her previous work-related injury. On the contrary, the evidence that the trial court accepted indicated that the employee’s incapacity to work arose from her treating doctor’s decision to perform unnecessary surgery on her nearly two years after her incapacity to work had ended. Even if the employee had relied in good faith on her treating doctor’s advice to undergo this surgery — and the evidence suggests that she did not do so — this reliance, in and of itself, would be insufficient to establish a causal relationship between her resulting incapacity and her original work-related injury, especially in the absence of any evidence showing that her original injury created the putative need for this surgery. Given that the Workers’ Compensation Court previously determined that her incapacity to work had ended, the employee’s post-surgical incapacity was not compensable absent some showing of a causal nexus between that incapacity and her original injury. But the employee introduced no competent evidence to establish such a nexus. On the contrary, the trial judge rejected the testimony of the employee’s treating physician on this issue and accepted the employer’s medical evidence indicating that the employee’s subsequent complaints did not incapacitate her from work until she underwent the unnecessary surgery.
The employee suffered her work-related injury on October 29, 1996. Shortly thereafter, she began collecting workers’ compensation benefits for partial incapacity. On May 14, 1998, however, the Workers’ Compensation Court entered a pretrial order finding that her incapacity for work had ended. Because the employee did not pursue this issue further, this order became final. Nevertheless, even though her incapacity for work had ended, plaintiff said that she still was experiencing pain; as a result, in 1999, her treating physician recommended surgery. But when the employer’s physician scheduled an appointment to examine her, the employee failed to keep the appointment, fearing that the employer would not agree to the surgery. Nevertheless, on February 2, 2000, the employee’s treating physician performed surgery on the employee’s back, after which her condition worsened, causing her to experience pain that was even greater than what she said she had suffered before the surgery. Eventually, a trial judge in the Workers’ Compensation Court found that the employee suffered a recurrence of her incapacity for work. But in doing so, he rejected the testimony of the employee’s treating physician that the surgery was required to treat the effects of her original injury. Instead, the court accepted the testimony of the employer’s physician that the surgery was unnecessary.
An injured employee seeking to recover workers’ compensation benefits for an alleged recurrence of an incapacity to work bears the burden of proving that the incapacity has increased or returned by introducing evidence showing a relationship or nexus between the previous injury and the alleged recurrence of an incapacity to work. See LaFazia v. D. Moretti Sheet Metal Co., 692 A.2d 1206, 1208 (R.I.1997) (citing G.L.1956 § 28—38—20.1(b)); see also Grant v. Leviton Manufacturing Co., 692 A.2d 685, 687-88 (R.I.1997). The employee satisfies this burden by proving that he or she “is once again incapacitated and that the incapacity is causally related to *1134the earlier compensated injury.” Grant, 692 A.2d at 688. “When determining whether the employer is liable for the subsequent period of disability, the sole question to be answered is whether the new period of disability is related to the original compensable injury.” George E. Healy & Maureen H. Aveno, Professional Guide for Attorneys, Physicians and Other Health Care Practitioners, Guidelines for Cooperation at 6 (Sept. 2003) (hereinafter Healy & Aveno). But this employee failed to produce the requisite evidence demonstrating a recurrence of her incapacity to work because she did not introduce competent evidence showing a causal relationship between her work-related injury on October 29, 1996, and her post-surgical incapacity that she experienced four years after injuring herself. Instead, the evidence showed that whatever incapacity she suffered after undergoing surgery in February 2000 was caused not by her previous work-related injury in 1996 but by her unwarranted decision to undergo the surgery itself, based solely on the erroneous recommendations of her treating physician. Although the employee said that she was experiencing pain before the surgery, the uncontroverted evidence at trial showed that she intentionally refused to keep her appointment with the employer’s physician, and thereby thwarted any pre-surgery opportunity for the employer to ascertain whether a causal nexus existed between her previous work injury and the employee’s putative need for surgery, Instead of establishing a causal relationship, the evidence at trial demonstrated that the unnecessary surgery, not the original work injury, caused her current incapacity. Therefore, the employee did not satisfy her burden of proving a compensable recurrence of her incapacity to work.
Nevertheless, the majority affirms the award to this employee of workers’ compensation benefits, reasoning that her good-faith reliance on her treating physician’s advice to undergo surgery somehow sufficed to provide a causal nexus between the previous work injury and her post-surgical incapacity to work. To support this conclusion, the majority relies upon Perron v. ITT Wire and Cable Din, 103 R.I. 336, 343, 237 A.2d 555, 559 (1968), which says that:
“An injured employee is entitled to a physician or surgeon of his choice * * * and submission in good faith to a course of treatment prescribed by the. doctor of his choice in the interest of curing or relieving a work-connected injury establishes any incapacity for work resulting from such course of treatment as causally related to the work-connected injury.”
Applying Perron to this case, the majority holds that the requisite causal relationship existed because the employee relied in good faith on her doctor’s recommendation that her condition necessitated surgery. But here, unlike Perron, the employee’s incapacity for work had ended before the surgery occurred and no competent evidence showed that, before the employee underwent surgery, the incapacity had returned or recurred or that the original injury required surgical treatment.
Thus, the facts of Perron are readily distinguishable from this case. In Perron, 103 R.I. at 337, 237 A.2d at 556, the employee suffered a work-related injury. After this injury failed to heal in a timely fashion, plaintiffs treating doctor suggested surgery, believing that a previous wrist fracture was hindering plaintiffs recovery. Id. at 338, 237 A.2d at 557. The employer’s doctor, however, denied permission for this surgery, deeming it unnecessary. Id.
Unlike this case, Perron did not involve a situation in which the employee’s incapacity for work ended before the surgery occurred. In Perron, both doctors agreed *1135that the employee’s initial injury was work related, and that this initial injury caused him to be at least partially incapacitated from work. See Perron, 103 R.I. at 338, 343, 237 A.2d at 556-57, 559. Their opinions differed only as to whether surgery constituted an appropriate course of treatment for the injury in question. As the Perron Court aptly noted, “the divergence of opinions * * * goes not to the question of a causal relationship between the [work injury] and surgery. Rather, [the] differing opinion[s] go to the course of treatment to be preferred in curing or relieving the work-connected [injury].” Id. at 343, 237 A.2d at 559. (Emphasis added.)
In this case, however, the treating doctor and the employer’s doctor disagreed about whether plaintiffs pre-surgical condition had anything to do with her work-related injury or whether it constituted mere subjective complaints that were unrelated to the original injury. “The basic question which must be answered by the expert witness is whether the work-related injury is a substantial contributing factor to the development of the present disability.” Healy & Aveno, at 6-7. Here, the trial judge rejected the employee’s expert medical evidence and believed the employer’s physician, who concluded that the employee’s complaints were subjective and did not show any recurrence of an incapacity to work. Therefore, unlike the Perron doctors, the parties’ physicians in this case did not merely disagree on the course of treatment, but also on whether any causal relationship existed between the need for surgery and the employee’s previous work-related injury. The employer’s doctor disagreed with the employee’s treating physician and believed that surgery was not necessary to cure, relieve, or rehabilitate the employee from the injury she sustained at work in 1996. Her incapacity for work ended in 1998 and no competent evidence showed that she had reinjured herself or that her incapacity for work had recurred before the surgery itself incapacitated her.
Furthermore, according to the employer’s physician, no diagnostic evidence revealed any type of structural damage or permanent change in the employee’s back as a result of her 1996 work injury. Indeed, consistent with the finding of the Workers’ Compensation Court on May 14, 1998, that the employee’s incapacity for work had ended, the diagnostic tests revealed no return or recurrence of any incapacitating injury. Thus, unlike Perron, the physicians in this case disagreed about the causal relationship between the employer’s work injury and the cause of the incapacity that resulted after her surgery on February 2, 2000. Moreover, the trial justice rejected the testimony of the employee’s physician as incredible and accepted the evidence presented via the testimony of the employer’s physician.
In addition, the evidence indicated that, unlike the employee in Perron, this employee did not proceed in good faith when she relied on her treating doctor’s belief that her condition necessitated surgery. Instead, the evidence showed that she actively attempted to conceal the surgery from her employer until it was a fait ac-compli. To accomplish this deception, she intentionally failed to keep her pre-surgery appointment with the employer’s doctor because she knew that he would conclude that surgery was unnecessary and she did not “want him to cancel the surgery.” In addition, rather than requesting the employer to pay for the cost of the surgery, she paid for it herself. Thus, her conduct in attempting to conceal her plans for surgery from the employer undermines the majority’s conclusion that she possessed the requisite good-faith belief that the surgery was warranted.
*1136Finally, Perron not only requires good faith on the part of the employee, but also the treating physician. Perron, 103 R.I. at 343, 237 A.2d at 559 (“Dr. Spindell’s opinion as to the advisability of surgery to cure or relieve the [work injury] was held in good faith.”). Here, I can hardly construe the treating doctor’s decision to perform surgery as having been made in good faith when the trial judge characterized the decision as “reckless” and referred the matter to the Medical Advisory Board. Therefore, for all these reasons, Perron does not control the result in this case.
In sum, the majority’s opinion allows employees to prove a recurrence of an alleged incapacity to work without showing a causal relationship between the incapacity and the original work-related injury. Henceforth, it is now sufficient for an injured employee to simply allege that his or her recurrence of incapacity resulted from good-faith reliance on a treating doctor’s advice. This is true even if, as here, the employee deliberately concealed information about his or her medical condition from the employer’s doctor before undergoing the surgery in question, and even if, as here, no competent medical evidence established a causal nexus between the original injury and the recurrence of an incapacity for work.
Because this result and the court’s reasoning is inconsistent with the applicable workers’ compensation law, I respectfully dissent.