Anders v. Industrial Comm'n

Case Date: 07/16/2002
Court: Industrial Commission
Docket No: 4-01-0839WC, 4-01-0840WC Cons. NRel

NO. 4-01-0839WC and 4-01-0840WC, cons.

IN THE APPELLATE COURT OF ILLINOIS

FOURTH DISTRICT

Industrial Commission Division

BOBBY L. ANDERS, 
                      Appellant,
                      v.  No. 4-01-0839WC
THE INDUSTRIAL COMMISSION, et al.
(OTR Wheel, Appellee).

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OTR WHEEL ENGINEERING, INC.,
                      Appellant,
                      v.  No. 4-01-0840WC
INDUSTRIAL COMMISSION, et al.
(Bobby Anders, Appellee).

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Appeal from
Circuit Court of
Adams County
No. 00MR57






Honorable
Mark A. Schuering,
Judge Presiding.
 

PRESIDING JUSTICE McCULLOUGH delivered the opinion of thecourt:

In separate appeals, respondent employer OTR WheelEngineering and claimant Bobby Anders appeal from an order of thecircuit court of Adams County confirming in part a decision of theIllinois Industrial Commission (Commission). On reconsideration,we now grant respondent's motion to consolidate these appeals.

The arbitrator awarded claimant $193.85 per week for 49weeks for total temporary disability (TTD) and $22,433.98 formedical expenses. 820 ILCS 305/8(a), 8(b) (West 2000). On review,the Commission affirmed the arbitrator's award in all respects withthe exception of (1) modifying the TTD award to $210.19 per weekfor 70 6/7 weeks and (2) finding that claimant was entitled to$824.15 additional compensation under section 19(k) of the Act,$2500 under section 19(l) of the Act (820 ILCS 305/19(l) (West2000)), and $329.65 section 16 attorney fees. The circuit courtmodified the decision to add additional compensation of $580.93under section 19(k) of the Workers' Compensation Act (Act) (820ILCS 305/19(k) (West 2000)) and $232.37 additional attorney feesunder section 16 of the Act (820 ILCS 305/16 (West 2000)) based onunpaid medical bills and confirmed the Commission decision in allother respects.

The issues raised by respondent on appeal are whether (1)the Commission's calculation of claimant's average weekly wage wasagainst the manifest weight of the evidence, (2) the Commission'sfinding of the duration of TTD was against the manifest weight ofthe evidence, (3) the Commission's determination that claimant wasentitled to additional compensation and attorney fees was againstthe manifest weight of the evidence, (4) the Commission's findingof the amount of section 19(l) additional compensation was againstthe manifest weight of the evidence, and (5) the circuit court'sfinding that claimant was entitled to additional compensation andattorney fees for unpaid medical expenses was against the manifestweight of the evidence. The only issue raised by claimant iswhether the circuit court's refusal to award additional compensation and attorney fees for the $21,246.11 medical expenses incurredat Blessing Hospital was against the manifest weight of theevidence or contrary to law. We reverse the circuit court'smodification of the Commission decision directing respondent to paysection 19(k) additional compensation and section 16 attorney feesfor failing to pay $1,161.87 in medical expenses and affirm thecircuit court's order in all other respects, thereby reinstatingthe Commission decision in its entirety.

Claimant (born January 30, 1964) testified that he beganworking for respondent in August 1997. Respondent's exhibit 10 wasclaimant's payroll records from September 8, 1997, through December31, 1997, and from January 2, 1998, through February 20, 1998. During this 23-week period, claimant worked 835 regular hours and44.75 hours of overtime. He earned $8 per hour in straight timeand $12 per hour for overtime. In addition to claimant's testimony, evidence was presented from Drs. Phillip Wilson, MichaelFeely, Curtis Burton, Arden Reynolds, Leo Ludwig and Marshall Matz.

The Commission found that claimant was temporarilytotally disabled commencing February 25, 1998, through July 6,1999, for a period of 70 6/7 weeks and that claimant was authorizedoff work by Drs. Wilson, Feely, Burton, and Reynolds during thistime commencing with Wilson's note of February 25, 1998, takingclaimant off work "unless very light duty then call me." AlthoughBurton released claimant to restricted duty commencing November 9,1998, the Commission found that respondent continued to pay TTDbecause it could not accommodate claimant's restrictions. TheCommission found that claimant had not reached maximum medicalimprovement and was not released from medical treatment. TheCommission observed that Pierron examined claimant's right hip onNovember 4, 1998, and recommended arthroscopic surgery. FromNovember 9, 1998, through March 24, 1999, claimant attendedappointments with respondent's examining physicians and continuedto actively seek medical treatment from his treating physicians forcontinued complaints of back and right hip pain. Claimant wastaken off work again on March 24, 1999, after a visit to theemergency room at Blessing Hospital. Wilson continued claimant offwork as of April 5, 1999. Reynolds also continued claimant offwork pending his second back surgery in May 1999, and claimant hadnot been released to work at the time of the arbitration hearing. Based on the foregoing findings, the Commission found that claimantwas temporarily totally disabled commencing February 25, 1998,through the date of the arbitration hearing on July 6, 1999.

The Commission further found that claimant's averageweekly wage was $315.29, exclusive of overtime. The Commissionreferred to respondent's exhibit 10 indicating that claimant worked22 full pay periods for respondent and that the accident ofFebruary 18, 1998, occurred during the 23rd pay period ending onFebruary 20, 1998. Claimant's preaccident earnings, beginning withhis employment with respondent in August 1997, were determined asof the last day of the employee's last full pay period immediatelypreceding the date of injury. Claimant's total straight timeearnings in the 22 weeks preceding the accident were $6,432. Therecord indicated that claimant lost eight days of work during the22-week period prior to the accident. These eight days werededucted from the 22-week period leaving a total of 20.4 weeksworked and resulting in an average weekly wage of $315.29. TheCommission found that claimant did not regularly work overtimeduring the 22-week period and did not include overtime in thecalculation of his average weekly wage.

The Commission awarded additional compensation undersections 19(k) and 19(l) and attorney fees under section 16 of theAct based on the respondent's unreasonable and vexatious termination of temporary total disability benefits as of May 25, 1999. The Commission noted that claimant testified he never received atrain ticket from respondent and that the proffered travel expensesof $50 was insufficient to cover claimant's costs. The Commissionfound that claimant's failing to travel 600 miles round trip fromQuincy to Chicago for an examination by Matz did not justifyrespondent's termination of benefits. According to the Commission,while respondent had a right to schedule an examination, the $50advanced could not cover the cost of his travel, and it wasunreasonable for respondent to schedule an exam so far fromclaimant's home. The Commission took notice of the fact that itfrequently reviewed expert medical reports from physicians closerto claimant's home. In addition, the Commission found that theopinion of Matz regarding the necessity of claimant's fusionsurgery rendered after his review of claimant's medical recordsfailed to provide a sufficient good faith basis for the terminationof benefits so as to avoid the imposition of penalties and feesunder the Act. The Commission determined that claimant was entitledto section 19(k) additional compensation in the amount of $824.15,section 19(l) additional compensation in the amount of $2,500, andsection 16 attorney fees in the amount of $329.65. The awardedadditional compensations and attorney fees were not calculatedbased on any unpaid medical expenses because the Commission foundthat the record reflected that respondent received the outstandingmedical bills on the day of the arbitration hearing, eliminatingany delay in payment warranting the imposition of penalties. Inaddition, the amount of unpaid medical expenses was not included inthe penalties petition filed by petitioner which was based entirelyon the termination of TTD benefits.

Computation of average weekly wage is governed by section10 of the Act (820 ILCS 305/10 (West 2000)). Section 10 sets forthfour methods for determining average weekly wage. Sylvester v.Industrial Comm'n, 197 Ill. 2d 225, 230-31, 756 N.E.2d 822, 826(2001). On the undisputed facts of this case, respondent arguesthat the Commission utilized the wrong method for calculatingaverage weekly wage and that the correct calculation should resultin an average weekly wage of $293.36 instead of $315.29. Since theanalysis amounts to a determination of which statutory methodapplies to the undisputed facts of this case, this is a question ofstatutory construction that we consider de novo. Sylvester, 197Ill. 2d at 232, 756 N.E.2d at 827.

The Commission applied the third method of section 10 inthis case. Under the third method, if the claimant's employmentbegan in the 52-week period preceding the date of injury, claimant's earnings are to be divided by the number of weeks and partsthereof during which claimant "actually" earned wages. Sylvester,197 Ill. 2d at 230-31, 756 N.E.2d at 826; 820 ILCS 305/10 (West2000).

Respondent inappropriately relies on Ricketts v.Industrial Comm'n, 251 Ill. App. 3d 809, 623 N.E.2d 847 (1993). InRicketts, the court found that the Commission's use of the thirdmethod was improper. In Ricketts, the employee had worked fourdays over a three-week period so that the appropriate method forcalculating average weekly wage was the fourth method instead ofthe third method. Ricketts, 251 Ill. App. 3d at 812, 623 N.E.2d at849. The Ricketts court determined that, under the facts of thatcase, the proper method to be utilized was that referring tocircumstances in which the employment was noncontinuous or lessthan full time. Ricketts, however, is distinguishable from thiscase for the same reasons that it was distinguished in Sylvester,i.e., the decision was based, not on statutory construction, but onthe insufficiency of evidence. Sylvester, 197 Ill. 2d at 234, 756N.E.2d at 828. Ricketts does not require a different result in thecase at bar where there is no dispute that claimant worked fulltime and was employed continuously from the date of hire to thedate of injury. The fact that claimant lost eight days prior tothe injury, for whatever reason, did not render his employment withrespondent noncontinuous since he remained in respondent's employ. There was no evidence of extended layoffs or intermittent employment. The Commission's finding of average weekly wage was notagainst the manifest weight of the evidence.

The time during which a claimant is temporarily totallydisabled is a question of fact for the Commission; claimant mustprove not only that he did not work, but that he was unable towork; and the dispositive test is whether the claimant's conditionhas stabilized. Freeman United Coal v. Industrial Comm'n, 318 Ill.App. 3d 170, 175, 741 N.E.2d 1144, 1148-49 (2000). In determiningwhether the Commission's finding of fact is against the manifestweight of the evidence, this court considers the sufficiency of thefactual evidence in the record to support the Commission'sdetermination. Freeman United Coal, 318 Ill. App. 3d at 173, 741N.E.2d at 1147, quoting Beattie v. Industrial Comm'n, 276 Ill. App.3d 446, 450, 657 N.E.2d 1196, 1199 (1995).

Respondent argues that claimant has failed to prove thathe was disabled from November 8, 1998, to March 29, 1999, because,on November 8, 1998, Burton released him to return to light-dutywork. Respondent conceded that claimant sought to return to workfor respondent, but respondent had no work available withinclaimant's restrictions. According to respondent, it was claimant's "responsibility to prove that he was unable to find workwithin his restrictions after reaching maximum medical improvement." "[A]n argument focusing on whether the claimant isavailable for work in some other capacity and could and should havesought alternative employment misses the mark in TTD cases." Freeman United Coal, 318 Ill. App. 3d at 177-78, 741 N.E.2d at1150.

Respondent points to nothing in the record that supportsits contention that claimant reached maximum medical improvement onNovember 8, 1988, and indeed the entire record suggests otherwise. The Commission found that claimant did not reach maximum medicalimprovement on November 8, 1998, and further found that claimanthad significantly improved following subsequent medical treatment. Respondent does not argue that the medical treatment provided toclaimant subsequent to November 8, 1998, was for a condition thatwas not causally related to the accident of February 18, 1998. Asa result, the Commission could reasonably find, on the evidence inthe record, that claimant had not reached maximum medical improvement on November 8, 1998.

We next consider whether the Commission's determinationthat claimant was entitled to additional compensation and attorneyfees was against the manifest weight of the evidence. Respondentargues that it reasonably relied on claimant's failure to appearfor two scheduled functional capacity evaluations, his failure toappear for the independent medical examination by Matz, and Matz'opinions regarding discrepancies between the claimant's complaintsand behavior.

"The additional compensation authorized bysection 19(l) is in the nature of a late fee. The statute applies whenever the employer orits carrier simply fails, neglects, or refusesto make payment or unreasonably delays payment'without good and just cause.' If the paymentis late, for whatever reason, and the employeror its carrier cannot show an adequate justification for the delay, an award of the statutorily specified additional compensation ismandatory.

In contrast to section 19(l), section19(k) provides for substantial penalties,imposition of which are discretionary ratherthan mandatory. See Smith v. IndustrialComm'n, 170 Ill. App. 3d 626, 632 (1988). Thestatute is intended to address situationswhere there is not only delay, but the delayis deliberate or the result of bad faith orimproper purpose. This is apparent in thestatute's use of the terms 'vexatious,' 'intentional' and 'merely frivolous.' Section16, which uses identical language, was intended to apply in the same circumstances." McMahan v. Industrial Comm'n, 183 Ill. 2d 499,515, 702 N.E.2d 545, 552-53 (1998).

Awards for additional compensation will not ordinarily be imposed,for example, when the employer acts in reliance on responsiblemedical opinions or when there are conflicting medical opinions. Matlock v. Industrial Comm'n, 321 Ill. App. 3d 167, 173, 746 N.E.2d751, 756 (2001). Whether the employer's conduct justifies imposingadditional compensation is a question of fact for the Commissionthat will not be disturbed on review unless it is against themanifest weight of the evidence. Matlock, 321 Ill. App. 3d at 173,746 N.E.2d at 756.

Respondent argues on appeal that its termination of TTDbenefits on May 26, 1999, was justified based on (1) Ludwigrecommending a functional capacity evaluation, Burton schedulingthe functional capacity evaluation for April 13, 1999, claimanttestifying he did not appear because he did not feel well and hischiropractor, Dr. T.J. Vance, told him to stay off his feet; (2)claimant not attending the rescheduled functional capacityevaluation; (3) respondent scheduling an independent medicalexamination by Matz for May 25, 1999, claimant knowing of theappointment and receiving and cashing a $50 check for expenses, atrain ticket having been mailed to claimant, although claimanttestified he did not receive the train ticket, and claimant notattending the scheduled examination by Matz; and (4) the opinionsreported by Matz in his report dated June 4, 1999, following reviewof the medical records.

After claimant filed his statement of exceptions to thearbitrator's decision and supporting brief, respondent filed abrief in support of the arbitrator's decision. In the section ofthe argument relating to the refusal of the arbitrator to awardclaimant additional compensation and attorney fees, respondent didnot mention claimant's failure to attend the original and rescheduled functional capacity evaluations. Respondent cannot now relyon an argument not made to the Commission. Insulated Panel Co. v.Industrial Comm'n, 318 Ill. App. 3d 100, 105, 743 N.E.2d 1038, 1042(2001) (argument not made before the Commission is waived onappeal).

Section 12 of the Act states in relevant part:

"An employee entitled to receive disability payments shall be required, if requestedby the employer, to submit himself, at theexpense of the employer, for examination to aduly qualified medical practitioner or surgeonselected by the employer, at any time andplace reasonably convenient for the employee,either within or without the State of Illinois, for the purpose of determining thenature, extent and probable duration of theinjury received by the employee, and for thepurpose of ascertaining the amount of compensation which may be due the employee from timeto time for disability according to the provisions of this Act. ***

An employer requesting such an examination, of an employee residing within the Stateof Illinois, shall pay in advance of the timefixed for the examination sufficient money todefray the necessary expense of travel by themost convenient means to and from the place ofexamination, and the cost of meals necessaryduring the trip, and if the examination ortravel to and from the place of examinationcauses any loss of working time on the part ofthe employee, the employer shall reimburse himfor such loss of wages upon the basis of hisaverage daily wage. ***

***

If the employee refuses so to submithimself to examination or unnecessarily obstructs the same, his right to compensationpayments shall be temporarily suspended untilsuch examination shall have taken place, andno compensation shall be payable under thisAct for such period." 820 ILCS 305/12 (West2000).

The Commission found (1) claimant never received thetrain ticket, (2) the $50 tendered by respondent was insufficientto cover claimant's travel expenses and (3) it was unreasonable toschedule an examination so far from claimant's home when physicianswho had previously provided expert opinions before the Commissionwere available closer to claimant's home. For those reasons, theCommission found that termination of TTD benefits by respondent wasunreasonable and vexatious.

Section 12 requires that the time and place for examination must be "reasonably convenient for the employee." 820 ILCS305/12 (West 2000). Section 12 further requires that the employerpay "in advance of the time fixed for the examination sufficientmoney to defray the necessary expenses of travel by the mostconvenient means to and from the place of examination, and the costof meals necessary during the trip." 820 ILCS 305/12 (West 2000). The Commission reasonably found that respondent had not compliedwith section 12 and, therefore, could not rely on section 12 as abasis for terminating TTD benefits. Those findings were notagainst the manifest weight of the evidence.

Respondent also relies on Matz' report. The Commissionfound that Matz' opinion regarding the necessity of fusion surgeryfailed to provide sufficient good-faith basis for terminating TTDbenefits.

Initially, it is observed that TTD benefits wereterminated prior to the June 4, 1999, report from Matz. Matz wasof the opinion that the original surgery was not necessary in lightof claimant's complaints and symptoms. He had no information aboutany intervening occurrence, but believed that the continuingcomplaints were not organically based. Based on the recordsprovided, Matz was unable to state whether the original spinalfusion had healed fully, but he did not believe that claimant hadrecurrent disc herniation and continuing bulging at L4. In Matz'opinion, further surgery would not be of any value. Becauseclaimant had no focal findings or signs to go with his complaints,Matz felt claimant "may have reached maximum medical improvement"but "it can be extremely difficult to tell whether or not he hasany residual impairment as a result of the February 18, 1998,occurrence." According to Matz, claimant may have a long-standinglevel of chronic back complaints, and Matz anticipated claimant wasreluctant to resume gainful employment activity.

In light of Matz' equivocation about whether claimant hadreached maximum medical improvement and the nature and extent ofclaimant's injury, the Commission could reasonably find that Matz'report was not sufficient to support respondent's unilateraltermination of TTD benefits.

Respondent further argues that the amount of section19(l) additional compensation was not properly calculated by theCommission. Section 19(l) provides that additional compensationunder that provision is to be calculated at "$10 per day for eachday a weekly compensation payment has been so withheld or refused,provided that such additional compensation shall not exceed the sumof $2,500." 820 ILCS 305/19(l) (West 2000).

Respondent argues that from May 26, 1999, the date TTDbenefits were terminated, to July 6, 1999, the date of thearbitration hearing, was only 42 days and, therefore, the section19(l) penalty should be $420. However, the arbitrator did notaward section 19(l) additional compensation. Instead, theCommission did that, and the date of the Commission decision wasAugust 3, 2000, more than 250 days after May 26, 1999. TheCommission correctly calculated the section 19(l) additionalcompensation. The Commission is the finder of fact and is notreviewing the arbitrator's award as would a reviewing court. SeeMessamore v. Industrial Comm'n, 302 Ill. App. 3d 351, 356, 706N.E.2d 44, 47 (1999) (the Commission exercises original rather thanappellate jurisdiction).

Finally, we consider whether the circuit court's findingthat claimant was entitled to additional compensation and attorneyfees for unpaid medical expenses was against the manifest weight ofthe evidence. The Commission found claimant entitled to $22,433.98in medical expenses, but also found that the section 19(k)additional compensation and section 16 attorney fees would not becalculated on the amount of unpaid medical expenses because therecord indicated respondent received the outstanding bills on theday of the arbitration hearing so there was no delay in paymentwarranting imposition of additional compensation and attorneyfees. The circuit court apparently found this finding of theCommission against the manifest weight of the evidence with regardto $1,161.87 of unpaid medical bills and modified the Commissiondecision to include an additional $580.93 in section 19(k)additional compensation and $232.37 in section 16 attorney fees. The only medical bills on which additional compensation andattorney fees was not calculated were the bills of BlessingHospital, amounting to $21,246.11, and a $26 payment already madeto Vance Chiropractic.

At the arbitration hearing, the parties addressedclaimant's motion for additional compensation and attorney fees. Claimant's attorney explained that the specific amounts of medicalbills were not listed in the motion "because I don't think at thattime we knew for sure what it was." Respondent's attorney informedthe arbitrator that she had not received the Blessing Hospital billuntil the day of the hearing.

In his appeal, claimant contends that section 19(k)additional compensation and section 16 attorney fees should beimposed for the $21,246.11 Blessing Hospital bill. At the hearingbefore the circuit court, claimant's attorney admitted that thisbill was presented to opposing counsel on the day of the hearingbecause he had received it only a short time before. This isconsistent with respondent's counsel's statement to the arbitratorthat she had received the Blessing Hospital bill the day of thehearing.

For calculating section 19(k) additional compensation andsection 16 attorney fees, each type of benefit (TTD, PPD, PTD,medical) constitutes "an award" within the meaning of the Act. Moore v. Industrial Comm'n, 188 Ill. App. 3d 31, 36, 543 N.E.2d1062, 1065 (1989). However, at the Commission's discretion, theamount of additional compensation and attorney fees may becalculated on (1) the "entire" amount of similar types of benefitpayable at the time of the "award" even if there has been no delayin paying part of that benefit or (2) only the unpaid portionthereof. Navistar International Transportation Corp. v. IndustrialComm'n, No. 1-01-3285WC, ___ Ill. App. 3d ___, ___, ___ N.E.2d ___,___, slip op. at 13 (May 16, 2002). The Commission may not imposepenalties and attorney fees on any portion of an award that has notyet accrued. Zitzka v. Industrial Comm'n, 328 Ill. App. 3d 844,852, 767 N.E.2d 405, 411 (2002).

Respondent does not dispute that section 19(k) additionalcompensation and section 16 attorney fees can be imposed on theunreasonable and vexatious delay in paying claimant's medical billsincurred as a result of the accidental injury. See McMahan v.Industrial Comm'n, 183 Ill. 2d at 512, 702 N.E.2d at 551. TheCommission could properly find it had insufficient evidence toestablish that any delay in payment of medical bills occurred. Claimant had the burden of proving that the bills were submitted torespondent, when that occurred, and that respondent had failed orrefused to pay. Thereafter, the burden would shift to respondentto establish a valid reason for failing or refusing to pay thosebills. See Modern Drop Forge Corp. v. Industrial Comm'n, 284 Ill.App. 3d 259, 266, 671 N.E.2d 753, 758 (1996) (if employer delayspaying compensation, then the employer must prove it had areasonable belief that the delay was justified).

On appeal, claimant relies on the dates when the serviceswere rendered and argues that respondent should not be allowed tochallenge the services as being unrelated to the accidental injury. Respondent, however, does not challenge causal relationship.

The argument of claimant's attorney before the circuitcourt also did not point to any specific evidence in the recordabout when the bills were submitted to respondent, but only said"the other bills that were not paid and should have been paid hadbeen forwarded to the respondent a good deal of time prior to thehearing." He was referring to the bills other than the BlessingHospital bill.

The Commission's finding that claimant failed to prove anunreasonable and vexatious delay in payment of any medical bills,including the Blessing Hospital bill, was not against the manifestweight of the evidence. In light of the absence of proof, theCommission's determination that section 19(k) additional compensation and section 16 attorney fees should not be calculated on theunpaid medical bills was not against the manifest weight of theevidence.

We reverse the circuit court's modification of theCommission decision directing respondent to pay section 19(k)additional compensation and section 16 attorney fees for failing topay $1,161.87 in medical expenses; affirm the circuit court's orderin all other respects; and reinstate the Commission decision in itsentirety.

Circuit court affirmed in part, reversed in part;Commission decision reinstated.

HOFFMAN, O'MALLEY, HOLDRIDGE, and RARICK, JJ., concur.