Tracie L. Flug v. Labor and Industry Review Commission
Tracie L. Flug v. Labor and Industry Review Commission
Opinion of the Court
¶ 1.
Trade L. Flug suffered from two medical conditions — a soft-tissue strain, and a degenerative disc disease. The first was work-related (and has since resolved), the second is not. She underwent surgery in the belief it was necessary to treat her work-related soft-tissue strain. In actuality, it was treating the unrelated degenerative disc disease. The procedure left her with a permanent partial disability. Ms. Flug tells us Wal-Mart (her employer) must compensate her for this permanent partial disability because she believed, in good-faith, that the disability-causing surgery was necessary to treat her work-related condition. We review the decision of the Labor and Industry Review Commission (the "Commission") denying Ms. Flug's claim for permanent partial disability benefits.
I. BACKGROUND
A. Ms. Flug's Injury and Surgery
f 2. Ms. Flug worked as a store supervisor at the Chippewa Falls Wal-Mart. In February of 2013 she was using a 25-ounce price scanner in the store's shoe department. After scanning an item above her head, she felt pain in her neck and right arm as she lowered the scanner. Ms. Flug sought medical treatment from
¶ 3. Ms. Flug was referred to Dr. Andrew Floren, an occupational medicine specialist, with whom she met the following month. Dr. Floren's notes state that on the date of her injury Ms. Flug "developed a severe sudden pain in her right upper back area. This pain went down the posterior shoulder and arm to the wrists." At the time of the visit, Ms. Flug stated that her symptoms were "slowly resolving," but that she had an "aching burning pain in her upper back" that "radiat[ed] into the posterior right shoulder and down the arm just a bit." Dr. Floren also noted that a cervical spine x-ray showed "mild degenerative changes," but he drew no connection between that condition and her work injury. He concluded that Ms. Flug had right upper back and shoulder pain with no sign of cervical involvement.
¶ 4. Ms. Flug's condition improved in some ways over the next few months, but not in others, so Dr. Floren referred her to Dr. Eduardo Perez, a neurosurgeon. Dr. Perez recommended an anterior cervical discectomy with fusion/fixation at the C5-C6 and C6-C7 levels. Ms. Flug had the surgery on June 4, 2013. A month later, she met with Dr. Perez and reported that she was "doing excellent" and was feeling "almost 100 [percent]." Dr. Floren released Ms. Flug back to work on July 17, 2013, with a lifting restriction that was eventually eliminated. Dr. Floren declared that Ms. Flug reached a healing plateau by November of 2013, and assessed her (at that time) as having a limited permanent partial disability.
¶ 5. Wal-Mart agreed that Ms. Flug had suffered a work-related injury, and its worker's compensation insurance carrier paid medical expenses up to May 9, 2013, and disability benefits up to June 22, 2013. But because the insurance carrier did not agree the degenerative disc disease was attributable to Ms. Flug's work injury, it refused further compensation for medical expenses or disability benefits.
f 6. Ms. Flug filed her worker's compensation claim with the Wisconsin Department of Workforce Development on August 16, 2013. She sought compensation from Wal-Mart for continuing medical expenses, additional temporary disability benefits through August 8, 2013, as well as benefits for a 20 percent permanent partial disability consequent to her back surgery.
¶ 7. Wal-Mart asked Dr. Morris Soriano to perform an Independent Medical Examination (IME) of Ms. Flug's injury. In a report submitted in February of 2014, Dr. Soriano said that Ms. Flug's records contained evidence of two unrelated medical issues. He diagnosed Ms. Flug's condition as a "post cervical strain" (the work-related injury), and "preexisting mild degenerative disc disease C6-7 and C5-6."
¶ 8. Dr. Soriano opined that the only injury Ms. Flug suffered from the February 14, 2013, work-related incident was a "soft tissue cervical and shoulder strain." He said this condition "reached an end of healing within a four to six-week period," long before Ms. Flug underwent her back surgery. Because that was a reasonable amount of time within which to recover from such a strain, Dr. Soriano said it would be
¶ 9. The disc degeneration, however, was an entirely different matter. Dr. Soriano said this was a pre-existing condition and there was never any anatomical or medical relationship between it and Ms. Flug's soft-tissue strain. In fact, he said "[i]t is not probable or even possible that the accident of February 14, 2013, [caused Ms. Flug's] disc degeneration." Considering the nature of the work Ms. Flug was performing at the time of her injury, Dr. Soriano also said "[i]t is not probable or even possible that reaching up with a 25-ounce scanner over a period of time" could have "cause[d] any disability by precipitating, aggravating or accelerating the preexisting condition." He also noted that Dr. Floren had offered no objective evidence of any cervical disability related to the accident. He concluded, therefore, that the surgery was not "reasonable, necessary or related" to Ms. Flug's work injury.
C. Review of Ms. Flug's Claim
¶ 10. On April 1, 2014, an Administrative Law Judge held a hearing on Ms. Flug's claims. Dr. Floren submitted a report and addendum stating that although Ms. Flug's work activities had not caused her degenerative condition, it was "medically probable" that they precipitated, aggravated, or accelerated that preexisting condition beyond its normal progression. Dr. Floren found the surgery and all medical treatment received since February 14, 2013, reasonable and necessary to treat the consequences of Ms. Flug's work-related injury.
¶ 11. Dr. Soriano also submitted a report. He said Ms. Flug suffered from "multilevel moderate degenerative disc disease," though the condition wasn't
f 12. The ALJ
¶ 13. Ms. Flug sought review of the Commission's decision in the Chippewa County circuit court. There, the Commission recognized and admitted it had mistakenly concluded the ALJ had found no work injury at all. It argued the court should nonetheless affirm the Commission's decision because Ms. Flug's surgery was unrelated to her compensable injury. The
¶ 14. In an unpublished opinion, the court of appeals reversed the circuit court.
¶ 15. The Commission's timely petition for review presented this single issue: "Does Wis. Stat. § 102.42(lm) make an employer liable for disability resulting from invasive treatment, when the claimant has not established that the treatment in fact treated a compensable work injury?" We granted the petition, and now affirm the Commission's order dismissing Ms. Flug's claim for disability benefits.
II. STANDARD OF REVIEW
¶ 16. In cases involving administrative agencies we review the decision of the agency. Estate of Szleszinski v. LIRC, 2007 WI 106, ¶ 22, 304 Wis. 2d
1 17. The Commission's findings of fact, however, are normally beyond question: "The findings of fact made by the commission acting within its powers shall, in the absence of fraud, be conclusive." Wis. Stat. § 102.23(l)(a)l. Ms. Flug does not challenge the Commission's findings of fact here, so we accept them as presented by the Commission.
III. ANALYSIS
¶ 18. Whether Ms. Flug is entitled to compensation depends on how Wis. Stat. § 102.42(lm) applies to her pre-existing medical condition, her compensable injury, her treatment, and her resulting disability. The statute provides the following:
Liability for unnecessary treatment. If an employee who has sustained a compensable injury undertakes in good faith invasive treatment that is generally medically acceptable, but that is unnecessary, the employer shall pay disability indemnity for all disability incurred as a result of that treatment.
Wis. Stat. § 102.42(lm). The parties agree Ms. Flug sustained a compensable injury while working for
A. The Terms of the Argument
¶ 19. The disagreement centers on the necessary relationship, or lack thereof, between the treatment and the employee's compensable injury. The Commission says an invasive treatment is "unnecessary" within the meaning of this statute if its purpose is to treat the compensable injury, but it fails to cure the injury, or relieve its effects. If an employee undergoes such a treatment in good faith, the Commission says, this statute makes the employer liable for benefits when the treatment causes a disability. The court of appeals, on the other hand, concluded it does not matter whether the invasive procedure was actually directed at a compensable injury, so long as the employee had a good faith belief that it was. Flug, No. 2015AP1989, ¶ 32 ("[W]e conclude that, to establish good faith under Wis. Stat. § 102.42(lm), an employee must show that he or she reasonably believed the proposed treatment was both necessary and the result of a compensable injury."). Thus, the court of appeals held that this statute can make an employer liable for benefits even when the injury and its treatment had nothing to do with the workplace.
f 20. Contrary to what one might expect, Ms. Flug's argument neither directly refutes the Commission's position, nor champions the court of appeals'
¶ 21. Out of the several cases Ms. Flug addressed in her argument, there are two that provide particularly helpful insight on the nature of her argument. The first is Spencer v. DILHR, 55 Wis. 2d 525, 200 N.W.2d 611 (1972). Indeed, Ms. Flug dedicated the
f 22. The second case providing insight on Ms. Flug's argument is City of Wauwatosa v. LIRC, 110 Wis. 2d 298, 328 N.W.2d 882 (Ct. App. 1982). Her treatment of this case confirms that she believes her dispute with the Commission is about the extent of available benefits consequent upon treatment of a compensable injury, not about whether benefits are
f 23. Thus, Ms. Flug's argument assumes her surgery was, in fact, "for" the compensable injury, and that the real controversy is over how much treatment was necessary to relieve her of the symptoms caused by that injury.
¶ 24. Justice Ann Walsh Bradley experienced some difficulty with this. She says there is a "procedural morass" in this case that stymies her ability to assess the ALJ and Commission's factual findings. Justice Ann Walsh Bradley's dissent, f ¶ 107-10. The relevant facts, however, are just not that complicated. For purposes of this analysis, we must know whether the ALJ and the Commission believed the surgery addressed Ms. Flug's compensable injury, or instead her pre-existing condition. The ALJ found no injury beyond that for which Wal-Mart had already compensated Ms. Flug. He said there was "a legitimate doubt as to the compensability of the claim as a traumatic injury beyond that already conceded and paid by the
B. What it Means to be "Unnecessary"
¶ 25. Still, we must determine what it means for a treatment to be "unnecessary" within the meaning of
¶ 26. The statute we are considering is part of Wisconsin's comprehensive Worker's Compensation program. This is "a legislatively enacted compromise designed to bring employers and employees together in a mutually beneficial scheme of guaranteeing benefits in the event of work-related injury [or] disease." Nelson v. Rothering, 174 Wis. 2d 296, 302, 496 N.W.2d 87 (1993). It "provides a broadly applicable method for compensating persons who suffer work-related physical and mental injuries." Byers v. LIRC, 208 Wis. 2d 388, 395, 561 N.W.2d 678 (1997). By relieving employers from tort liability, the Worker's Compensation program "mak[es] employers strictly liable for injuries encompassed within the Act, but limit[s] the liability to compensation established by the statute." Id. These
¶ 27. Compensation under the Worker's Compensation program is available only when the employee satisfies the statutorily-defined eligibility requirements. Broadly speaking, an employee is eligible for compensation under this program if he sustains an injury that arises out of his employment. See Wis. Stat. § 102.03(1). Upon the occurrence of such an injury, the employer is responsible for supplying "such medical, surgical, chiropractic, psychological, podiatric, dental, and hospital treatment... as may be reasonably required to cure and relieve from the effects of the injury . . . ." Wis. Stat. § 102.42(1). An employer must also pay the employee benefits "if the injury causes disability." Wis. Stat. § 102.43. Thus, in the general scheme of the program, medical expenses and disability benefits are payable only when they are attributable to a qualifying injury.
f 28. This context informs our inquiry into the meaning of Wis. Stat. § 102.42(lm), the nucleus of which says that " [i] f an employee who has sustained a compensable injury undertakes in good faith invasive treatment that is generally medically acceptable, but that is unnecessary, the employer shall pay disability
f 29. There are two logical ways of reading a statutory provision like Wis. Stat. § 102.42(lm). One can read it as a sentence (as it was written), paying attention to rules of grammar, syntax, and diction to tease out its meaning. Or one might dice it up into its constituent parts and treat each resulting element as an independent requirement that neither qualifies nor is qualified by the others. The court of appeals favored the second approach. It said Ms. Flug is entitled to disability benefits if she meets five distinct elements, which it defined as follows:
(1) the employee sustained a compensable injury;
(2) he or she undertook invasive medical treatment;
(3) the treatment was undertaken in good faith;
(4) the treatment was generally medically acceptable, but unnecessary; and
(5) the employee incurred a disability as a result of the treatment.
Flug, No. 2015AP1989, ¶ 30. This, of course, is not what the legislature wrote. It is simply how the court of appeals chose to frame its analysis. While this is a legitimate method of approaching statutory language, it does present peculiar risks. When translating a sentence into discrete elements, it is easy to lose critical information by neglecting to propagate the proper relationship between the parts of the sentence into the list. And that is what happened here.
¶ 31. Instead of separating the statute into separate elements, we will analyze the sentence as written, using our standard toolbox to help us derive its meaning. The court of appeals properly recognized the centrality of "treatment" to the meaning of the statute —the term appears in four of the five elements it culled
¶ 32. With that understanding of this central term, we can now let the rules of grammar direct our understanding of Wis. Stat. § 102.42(lm). Our first goal is discovering the objective of the "treatment." We begin with the part of the statute that says "[i]f an employee who has sustained a compensable injury undertakes . . . invasive treatment. . . ." Without considering more of the statute, "treatment" could operate on one of two possible objects — the employee, or the compensable injury. It is plausible, both textually and logically, that the employee could be the object of the term "treatment." The phrase "who has sustained a compensable injury" could be understood as simply identifying the employee who undertook the treatment, leaving "employee" as the only possible object of the "treatment."
¶ 34. Ms. Flug tells us she fits within the statute because the treatment — her surgery — was unnecessary. But unnecessary to what? If the object of the treatment is the employee (as opposed to the compensable injury), then it wasn't unnecessary at all. In fact, it was quite the opposite. Ms. Flug herself reported that the treatment brought her back to nearly 100 percent. Neither Ms. Flug nor the court of appeals has explained how a treatment can be that effective while simultaneously being unnecessary. If, on the other hand, the statute makes the object of the treatment the compensable injury, then one must determine whether the treatment was directed — as a factual matter — at that particular injury. Either way, Ms. Flug's claim must end here. If the object of "treatment" is the employee, Ms. Flug cannot succeed because the treatment was clearly necessary — it cured her condition. If, instead, the object of "treatment" is the compensable
¶ 35. The only way to reach the court of appeals' conclusion would be to allow the object of the treatment to flicker between the employee and the com-pensable injury, depending on whether we are considering (a) what the treatment was treating, or (b) the treatment's necessity. The court of appeals' formulation would make Ms. Flug the object of "treatment" when considering what the surgery was treating, but flit to the compensable injury in assessing its necessity. Only if such grammatical instability is possible may one conclude that the treatment was treating Ms. Flug, but was unnecessary because it was not treating the compensable injury. However, there is no grammatical rule that allows the object of the treatment to flicker like that.
¶ 36. We return now to the requirement that the treatment in question be "generally medically acceptable." Because the phrases "generally medically acceptable" and "but that is unnecessary" both act as delimiters on the term "treatment," the treatment must partake of both qualities. And because we have already concluded that the proper object of "treatment" is the compensable injury, we must also conclude that
f 37. The statute has one further requirement, which we have not yet addressed — "good faith." And although it does not budge "compensable injury" from its place as the object of "treatment," it is important to a complete understanding of how the statute functions. The portion of Wis. Stat. § 102.42(lm) that describes eligibility for benefits says, in full: "If an employee who has sustained a compensable injury undertakes in good faith invasive treatment that is generally medically acceptable, but that is unnecessary. . . ." This provision exists against the backdrop of a Worker's Compensation program that requires payment of medical expenses only to the extent they are "reasonably required" to "cure and relieve from the effects of the [compensable] injury,"
C. Consistency
f 38. Ms. Flug says Wis. Stat. § 102.42(lm) codified Spencer (but for one aspect not relevant here), and all parties urge us to apply that statute consistently with cases decided before its adoption. This opinion fits neatly into our canon.
I 39. Spencer addressed itself to an employee who injured his knee while on the job; everyone agreed he was entitled to compensation. Mr. Spencer had his kneecap removed, but he continued to suffer. He sought the advice of a different doctor, who recommended an arthrodesis.
¶ 40. The court of appeals subsequently considered an injured employee's situation that closely tracks that of Ms. Flug in City of Wauwatosa v. LIRC, 110 Wis. 2d 298, 328 N.W.2d 882 (Ct. App. 1982). There, a police officer had slipped off a curb while on duty, and incurred a compensable hip injury. Id. at 299. The officer's treating doctor diagnosed him as also having a pre-existing hip condition that his work-related accident aggravated, and recommended surgery. The insurance carrier's doctor disagreed, opining that the fall "had not aggravated nor accelerated the preexisting [] condition, but merely brought the condition to the attention of the surgeon." Id. The hearing
¶ 41. Finally, we consider Honthaners Restaurants, Inc. v. LIRC, 2000 WI App 273, 240 Wis. 2d 234, 621 N.W.2d 660. An employee suffered a compensable injury to her arm, and received disability benefits for just under six months as well as accrued medical expenses during that period. Id., ¶ 3. She subsequently sought benefits for an additional year of treatment. The Commission found that she had been "over-diagnosed and over-treated," because she continued to receive treatments long after her compensable injury had resolved. However, because she had sought the extended treatment in "good faith," the Commission said she was entitled to continued benefits. Id., ¶ 7. Agreeing with the Commission, the court of appeals said "Spencer teaches that as long as the claimant engaged in the unnecessary and unreasonable treatment in good faith, the employer is responsible for payment." Id., f 15. It distinguished Spencer and City of Wauwatosa on the basis that "[i]n Spencer, the parties disputed medical treatment, not cause." Id., 1 21. The court of appeals concluded that the Spencer rule applied because the treatment the employee received was directed at her compensable injury, even though it turned out not to have been necessary.
Both cases involve no dispute that the claimants suffered a compensable injury. Both deal with differing medical opinions on diagnosis and treatment. Both cases have a claimant who continued the unnecessary treatment in good faith. Thus, we conclude the Commission properly relied on Spencer and [the employee] is entitled to additional benefits.
Id., ¶ 22. That conclusion is consistent with our holding today, which requires that the treatment in question was directed at the compensable injury.
* * *
¶ 42. Our opinion today tracks the language of Wis. Stat. § 102.42(lm) and is consistent with prior opinions delivered by the courts of this state. It is also consistent with the nature of Wisconsin's Worker's Compensation system. Indeed, any other conclusion would represent a sharp break with the "legislatively enacted compromise" between employers and employees for the payment of expenses and benefits consequent upon "work-related injury [or] disease." Nelson, 174 Wis. 2d at 302. And it would represent a significant step towards making the Worker's Compensation system "a blanket insurance policy to provide benefits for disabilities which may become manifest while on the job but are in no way caused by or related to the employment." Lewellyn, 38 Wis. 2d at 61. There is nothing in the text of Wis. Stat. § 102.42(lm) to suggest such a momentous change, and even if that change is warranted, we are not the proper branch of government to prescribe it. Thus, we will not adopt an understanding of this statute that would extend em
IV. CONCLUSION
¶ 43. We hold today that an employee is not eligible for benefits under Wis. Stat. § 102.42(lm) if the disability-causing treatment was directed at treating something other than the employee's compensable injury. Because Ms. Flug's surgery treated her preexisting condition, not her compensable injury, her claim must be disallowed. We reverse the court of appeals because it should have affirmed the Commission's decision.
By the Court. — The decision of the court of appeals is reversed and the case is dismissed.
Roy L. Sass, presiding.
The Honorable James M. Isaacson, presiding.
Flug v. LIRC, No. 2015AP1989, unpublished slip. op. (Wis. Ct. App. June 21, 2016).
All subsequent references to the Wisconsin Statutes are to the 2013-14 version unless otherwise indicated.
Because we affirm the Commission's decision, the question of deference is immaterial to the outcome of the case.
The extent of Ms. Flug's assessment of the court of appeals' reasoning was to misinterpret it as rejecting a requirement that the invasive procedure "was actually necessary to treat her work injury." That is not what the court of appeals said. What it said was that there need be no relationship between the disability-causing treatment and a compensable injury: "By arguing that an employee must show his or her treatment was the result of a compensable injury, the Commission reads an additional causation requirement into the statute." Flug, No. 2015AP1989, ¶ 30.
To the extent this sentence refers to the Commission, it is a characterization of its argument here — Justice Ann Walsh Bradley misunderstands it as referring to the Commission's decision under review. See Justice Ann Walsh Bradley's dissent, ¶ 129.
Ms. Flug introduced her argument with the assertion that "[t]he holding in Spencer is the central focus of this case." She said Wis. Stat. § 102.42(lm) is significant only in that it limited Spencer to circumstances in which the disability-causing treatment is invasive (whereas Spencer required payment of benefits even when the procedure was non-invasive).
There was an obvious, and direct, line of causation that started with the workplace injury and ended with the stiff knee. The "treatment" to which we referred in the Spencer v. DILHR, 55 Wis. 2d 525, 200 N.W.2d 611 (1972), quote was not just any treatment, it was treatment of the compensable injury. And it was the treatment of the compensable injury that ended in a stiff knee. This relationship is as important to our analysis of Wis. Stat. § 102.42(lm) as it was in Spencer.
This is a continuation of the argument Ms. Flug made in the court of appeals, where she unequivocally stated she "sustained a compensable injury and. . . underwent surgery for a compensable injury." Ms. Flug maintained this position even through oral argument here. Her counsel was asked to acknowledge the surgery was not necessary to treat her compensable injury, but he elected not to concede the point.
Although Ms. Flug's "good faith" belief about the necessity of the back surgery is important, as we discuss below, it cannot change the objective fact that the treatment had nothing to do with her compensable injury.
Justice Ann Walsh Bradley says Ms. Flug did challenge the findings of fact here. Although Ms. Flug may have done so before the circuit court and court of appeals, she did no such thing here. Justice Bradley finds a factual challenge in Ms. Flug's argument that she acted in good faith in obtaining the surgery. See Justice Ann Walsh Bradley's dissent, ¶ 123. But that was Ms. Flug's argument about the law; it was not a challenge to the Commission's findings of fact. Ms. Flug based her argument on the assumption that the surgery treated her compensable injury. An assumption, however, is neither an argument nor a challenge. A challenge to the Commission's factual findings would involve marshalling the facts supporting her argument, juxtaposing them against the facts supporting the Commission/ALJ's findings, and then demonstrating the credible and substantial evidence does not support the Commission's decision. That effort is wholly absent from Ms. Flug's argument here.
So Justice Bradley bobbles twice. First, she confounds legal and factual challenges. And second, she promotes assumptions to arguments. We will neither distort nor re-write Ms. Flug's brief to make it say something it clearly does not.
Justice Ann Walsh Bradley also accuses us of getting the facts wrong. See Justice Ann Walsh Bradley's dissent, ¶¶ 125-30. She disagrees, in particular, with our statement that Ms. Flug believed the surgery was treating her soft-tissue strain. She bases this assertion, apparently, on an argument she created for Ms. Flug ex nihilo — that the work injury exacerbated her pre-existing condition beyond its normal progression, and that the surgery was necessary to treat that exacerbated condition. Maybe Ms. Flug's counsel should have adopted Justice Bradley's litigation strategy. But he didn't — perhaps because the ALJ and Commission had already determined there was insufficient evidence to conclude this had occurred, and he had chosen not to challenge the factual findings before this court.
Although we are reviewing the Commission's decision, not that of the court of appeals, we refer to the court of appeal's reasoning to assist us in determining the proper interpretation of this statute.
As is Chief Justice Roggensack's dissent. Chief Justice Roggensack's dissent, ¶ 87.
Treatment, The American Heritage Dictionary of The English Language (3d ed. 1992) (emphases added).
If a treatment treats the "employee," then the object of the treatment comprises any malady from which the employee
Chief Justice Roggensack faults us for eliding "good faith" from this part of our analysis. Chief Justice Roggen-sack's dissent, ¶ 85. We do so because our task at this stage is to discover what the "treatment" is supposed to be treating. The employee's "good faith" in accepting the treatment provides no information useful to that inquiry. Ms. Flug's subjective beliefs cannot affect the statute's grammar, regardless of the sincerity with which they are held.
Wis. Stat. § 102.42(1).
Wis. Stat. § 102.43.
In light of our holding that this statute extends liability only to treatments that are directed at a compensable injury, Chief Justice Roggensack asks this eminently reasonable question: "What then of the context in which an employee who in good faith believed that the invasive treatment she undertook would treat her compensable injury?" Perhaps employees in such circumstances ought to receive benefits, but they must direct their petition for relief to the legislature — not the court. We can only apply the law as the legislature created it. The statute, as it currently exists, extends liability based on the reality of what the treatment addresses, not the employee's belief about what it addresses.
Arthrodesis is "[t]he stiffening of a joint by operative means." Arthrodesis, Stedman's Medical Dictionary (28th ed. 2006).
The court of appeals, Ms. Flug, and the Chief Justice discuss whether the compensable injury must "cause" a treatment to qualify for benefits — a proposition they all reject. See, e.g., Chief Justice Roggensack's dissent, ¶¶ 85-87, 90. It is difficult to know what to do with this construct (which finds no place in the statutory language) because injuries, of course, do not "cause" treatments. They certainly need them. And they frequently won't cure without them. But if treatments are caused by anything, they are caused by those skilled in the healing arts. In any event, nothing in this opinion should be construed as requiring that a compensable injury "cause" a treatment. Our opinion is simply that a qualifying treatment is one that treats a compensable injury.
Dissenting Opinion
¶ 44.
{dissenting). This review arises from an unpublished decision of the court of appeals
¶ 45. I condude that Flug, who has sustained a compensable (work-related) injury from which began a continuing course of pain and who underwent surgery upon the advice of her medical doctor to alleviate that pain, is entitled to compensation pursuant to Wis. Stat. § 102.42(lm) if she accepted the physician's advice and undertook surgery with the good faith belief that surgery would treat her work-related injury, even though surgery was unnecessary treatment for that injury. Neither LIRC nor the Administrative Law Judge (ALJ) made factual findings in regard to Flug's good faith belief, or the lack thereof, in undertaking surgery. Therefore, I would remand the matter to LIRC to make the requisite finding and complete its obligations under § 102.42(lm).
¶ 46. Accordingly, I would affirm the court of appeals' decision reversing LIRC and remanding the matter for additional fact-finding on the issue of good faith, and if necessary for a determination of the damages to which Flug is entitled. Because the majority opinion fails to recognize the factual nature of good faith, its importance to the plain meaning of Wis. Stat. § 102.42(lm) and avoids addressing good faith in the context in which it arises, I respectfully dissent from the majority opinion.
I. BACKGROUND
f 47. The majority opinion ably sets forth the underlying facts. Therefore, I shall relate only those facts necessary to attune the reader to the discussion that follows.
¶ 49. Because the pain continued, on February 25, 2013, Flug sought physical therapy from Debra Stow. Stow's records show:
[Flug] presents with the diagnosis of right shoulder pain. Patient stated that on Thursday, February 14 she started work without any pain.... When she woke up Friday morning she had a lot of really intense pain and had to leave work early. . . . [T]he pain starts in her neck and goes down the back portion of her shoulder down into her arm.
¶ 50. On March 6, 2013, Flug saw Dr. Andrew Floren. Dr. Floren noted that Flug "was doing a good deal of overhead work scanning some boxes in the Shoes Department. She developed a severe sudden pain in her right upper back area. This pain went down the posterior shoulder and arm to the wrists." On March 22, 2013, Floren's notes indicate that Flug's neck and back were slowly getting better, but the pain in her shoulder was not improving. In addition, she had begun to have numbness in her right hand and fingers.
¶ 51. On April 2, 2013, Flug had a follow-up appointment with Dr. Floren and said that her pain was not improving. Floren recommended a steroid injection, which Flug had. However, it did not alleviate her pain.
f 53. On June 4, 2013, Dr. Perez performed a discectomy. At a follow-up approximately one month after the surgery, Flug told Dr. Perez that she was "doing excellent" and almost back to full health. Dr. Floren allowed Flug to return to work on July 17, 2013, but gave her a twenty-pound lifting restriction. Eventually, that restriction was increased to thirty-pounds before being eliminated entirely in November 2013.
| 54. Initially, Wal-Mart paid Flug worker's compensation disability benefits. However, subsequent to Flug's surgery, Wal-Mart retained its own physician, Dr. Morris Soriano, to conduct an independent review of Flug's medical records. Dr. Soriano concluded that the surgery was not necessary to treat Flug's work-related injury. Based on these findings, Wal-Mart notified Flug that it was terminating her disability benefits as of June 22, 2013.
¶ 55. On August 16, 2013, Flug filed a worker's compensation claim against Wal-Mart with the Department of Workforce Development. Flug sought disability benefits through August 8, 2013, including benefits related to the surgery, as well as 22% permanent partial disability benefits and medical expenses.
¶ 56. Flug submitted a "Practitioner's Report on Accident or Industrial Disease in Lieu of Testimony" signed by Dr. Floren. Dr. Floren opined that given the
¶ 57. Flug was the only witness to testify in-person at the hearing. She testified that she felt a "[plain, instant pain, just shooting down from my neck down into my shoulder and into my arm" while scanning a box above her head. She further testified that she believed all of the medical treatment she subsequently received was necessary to relieve the continuing pain she sustained due to the work-related injury.
f 58. The ALJ reasoned that the medical history provided by Flug to Dr. Floren was inconsistent, and therefore, the ALJ discounted his testimony. As a result, the ALJ denied Flug's application for disability benefits.
f 59. LIRC adopted the factual findings of the ALJ. However, contrary to what the ALJ had found, LIRC then concluded that Wis. Stat. § 102.42(lm) did not apply to Flug's claims because she had not suffered a compensable work-related injury. The circuit court affirmed LIRC.
¶ 60. Before the court of appeals, LIRC argued that Wis. Stat. § 102.42(lm) requires a causal link between an employee's compensable injury and his or her invasive treatment. The court of appeals reasoned that LIRC, by requiring "that an employee must show his or her treatment was the result of a compensable injury, the Commission reads an additional causation
II. DISCUSSION
A. Standard of Review
¶ 61. "When reviewing a worker's compensation claim, we review LIRC's decision, not the decisions of the circuit court or court of appeals." DeBoer Transp., Inc. v. Swenson, 2011 WI 64, ¶ 29, 335 Wis. 2d 599, 804 N.W.2d 658 (citing Cty. of Dane v. LIRC, 2009 WI 9, ¶ 14, 315 Wis. 2d 293, 759 N.W.2d 571).
¶ 62. This appeal turns on the interpretation of Wis. Stat. § 102.42(lm). The interpretation of a statute presents a question of law that we generally review independently. Cty. of Dane, 315 Wis. 2d 293, ¶ 14 (citing Watton v. Hegerty, 2008 WI 74, ¶ 6, 311 Wis. 2d 52, 751 N.W.2d 369).
¶ 63. There are times when an agency's interpretation of a statute is entitled to deference. Id. (citing Clean Wis., Inc. v. Pub. Serv. Comm 'n of Wis., 2005 WI 93, ¶ 37, 282 Wis. 2d 250, 700 N.W.2d 768). However, in the present case, LIRC did not interpret Wis. Stat. § 102.42(lm). Instead of construing the statute, LIRC said that Flug "failed to present credible medical evidence to establish that she suffered a work-related injury because the history upon which Dr. Floren relied when making his determination as to whether the incident on February 14, 2013, resulted in a work
f 64. Except in very limited circumstances not present in the case now before us, we accept LIRC's factual findings as conclusive. Wis. Stat. § 102.23(l)(a)l. However, neither LIRC nor the ALJ made a factual finding in regard to whether Flug had a good faith belief that surgery would treat her work-related injury.
¶ 65. Accordingly, I interpret and apply Wis. Stat. § 102.42(lm) under well-established principles of statutory interpretation. And, as did the court of appeals, I make no factual findings, but refer the lack of a finding in regard to whether Flug had a good faith belief that undertaking surgery would treat her work-related injury to LIRC so that it can complete its obligations under § 102.42(lm).
B. Statutory Interpretation, General Principles
¶ 66. "It is, of course, a solemn obligation of the judiciary to faithfully give effect to the laws enacted by the legislature, and to do so requires a determination of statutory meaning." State ex rel. Kalal v. Circuit Court for Dane Cty., 2004 WI 58, ¶ 44, 271 Wis. 2d 633, 681 N.W.2d 110. For this reason, "statutory interpretation 'begins with the language of the statute. If the meaning of the statute is plain, we ordinarily stop the inquiry.' " Id., ¶ 45 (quoting Seider v. O'Connell, 2000 WI 76, ¶ 43, 236 Wis. 2d 211, 612 N.W.2d 659). "Statutory language is given its common, ordinary, and accepted meaning, except that technical or specially-
¶ 67. Additionally, "[c]ontext is important to meaning." Id., ¶ 46. As a result, "statutory language is interpreted in the context in which it is used; not in isolation but as part of a whole; in relation to the language of surrounding or closely-related statutes; and reasonably, to avoid absurd or unreasonable results." Id. And, if "statutory language is unambiguous, there is no need to consult extrinsic sources of interpretation, such as legislative history." Id. (citing Bruno, 260 Wis. 2d 633, ¶ 7).
¶ 68. It is under these principles that I interpret Wis. Stat. § 102.42(lm).
C. Interpretation of Wis. Stat. § 102.42(lm)
¶ 69. "A purpose of the worker's compensation statute is to 'provide prompt justice for injured workers and to prevent, as far as possible, the delays that might arise from protracted litigation.' " Cty. of Dane, 315 Wis. 2d 293, ¶ 34 (quoting Bosco v. LIRC, 2004 WI 77, ¶ 48, 272 Wis. 2d 586, 681 N.W.2d 157). And, "an injured employee is guaranteed 'recovery irrespective of his own fault and irrespective of the employer's absence of fault.'" Id. (quoting Mulder v. Acme-Cleveland Corp., 95 Wis. 2d 173, 180, 290 N.W.2d 276 (1980)). "However, in exchange for this guarantee, the employee is obliged to accept a limited and scheduled compensation award." Id. (internal quotations omitted). "As a result, the statute must be broadly construed in order to best promote its statutory purposes." Id. (citation omitted); see also Johnson v. Wis. Lumber
I 70. As part of Wisconsin's worker's compensation scheme, employers
¶ 71. In addition to the obligation to pay certain medical expenses, an employer also may be liable for disability indemnity if an employee becomes disabled as a result of an injury or treatment for the effects of an injury. Under certain circumstances, the employer's obligation includes payment for unnecessary, invasive medical treatment that causes an employee to become disabled. See, e.g., Wis. Stat. § 102.42(lm).
f 72. Wisconsin Stat. § 102.42(lm) renders an employer liable for disability indemnity when an employee undergoes invasive treatment that is later dis
Liability for unnecessary treatment. If an employee who has sustained a compensable injury undertakes in good faith invasive treatment that is generally medically acceptable, but that is unnecessary, the employer shall pay disability indemnity for all disability incurred as a result of that treatment. An employer is not liable for disability indemnity for any disability incurred as a result of any unnecessary treatment undertaken in good faith that is noninvasive or not medically acceptable.
¶ 73. To receive disability indemnity from his or her employer under Wis. Stat. § 102.42(lm), an employee must meet a number of statutory criteria: (1) a compensable (work-related) injury; (2) good faith in undertaking invasive medical treatment; (3) medically acceptable treatment that is unnecessary for the work-related injury; (4) disability incurred because of the treatment. § 102.42(lm).
f 74. Here, LIRC does not dispute that Flug suffered a compensable injury, even though it did so in the opinion we review. "Injury" is defined by Wis. Stat. § 102.01(c), in relevant part, as any "mental or physical harm to an employee caused by accident or disease." And the types of injuries for which an employer is liable are enumerated in Wis. Stat. § 102.03.
f 75. Good faith is the touchstone of a plain meaning interpretation of Wis. Stat. § 102.42(lm). Stated more completely, whether the employee undertakes invasive treatment with the good faith belief that it would treat her work-related injury is a central focus of § 102.42(lm).
¶ 77. Good faith is not defined in Wis. Stat. § 102.42. Therefore, we apply its ordinary meaning such as may be found in a dictionary. Kalal, 271 Wis. 2d 633, ¶ 53. The current version of Black's Law Dictionary defines good faith, in part, as "[a] state of mind consisting in . . . honesty in belief or purpose." Good Faith, Black's Law Dictionary 808 (10th ed. 2014). Accordingly, an employee must act with an honest "belief or purpose" in order to act with good faith.
¶ 78. The legislature has tied the employee's good faith obligation to the employee's undertaking invasive treatment because good faith modifies the verb "undertakes" pursuant to the plain meaning of the terms employed in Wis. Stat. § 102.42(lm). ("If an employee . . . undertakes in good faith invasive treatment.")
¶ 79. Moreover, the employee's treatment must be generally medically acceptable, but unnecessary to treat a compensable work-related injury. Wisconsin Stat. § 102.42(lm) does not mandate that the treat
¶ 80. Finally, the employee must show that the invasive treatment resulted in the employee's disability. This is the only aspect of Wis. Stat. § 102.42(lm) that requires an employee to show causation.
f 81. The terms of Wis. Stat. § 102.42(lm) must be read in context. The obligation for the employee to act with a good faith belief that the invasive treatment is treatment for her work-related injury limits the employee's treatment choices and in so doing, protects the employer. However, as long as an employee acts with a good faith belief that undertaking medically invasive treatment will treat her work-related injury, the employer is liable for disability even when the treatment was medically unnecessary to treat a work-related injury. This good faith obligation protects employers from an employee seeking medical treatment that the employee knows is unnecessary to treat a compensable injury.
¶ 82. Importantly, all Wis. Stat. § 102.42(lm) requires is that an employee act with a good faith belief that undertaking invasive treatment is treatment for her work-related injury. Nothing in the plain language of the statute can reasonably be construed as requiring the employee to know that medical advice for invasive treatment should not be taken.
¶ 83. Nevertheless, LIRC and the majority opinion
¶ 84. The majority opinion's statutory interpretation reads good faith out of the statute in the context of the employee who undertakes invasive, unnecessary treatment with a good faith belief that the compensatory injury is being treated. For example, the majority opinion repeatedly substitutes an ellipsis for the words "good faith" when it quotes portions of the statute, as it makes what it believes are winning statutory constructs.
¶ 85. While the majority opinion's grammatical arguments are interesting, they do not explain why the legislature did not include a provision requiring the employee to show that the work-related injury caused the treatment, if the legislature had wanted to include that requirement. See Kalal, 271 Wis. 2d 633, ¶ 44 ("We assume that the legislature's intent is expressed in the statutory language."); cf. Ott v. Peppertree Resort Villas, Inc., 2006 WI App 77, ¶ 25 n.11, 292 Wis. 2d 173, 716 N.W.2d 127 ("We are not permitted to re-write the statute, however, and we conclude the difference in language the legislature chose to use in the two subsections supports our conclusion that it did not intend to impose the causation-of-pecuniary-loss requirement on private plaintiffs who bring a claim under [Wis. Stat.] § 707.57(1)."). It chose not to do so.
¶ 86. In addition, requiring an employee show the work-related injury caused the invasive treatment would lead to unreasonable results. See Kalal, 2004 WI 58, ¶ 46 (we interpret statutes in such a way as "to avoid absurd or unreasonable results"). It would force an employee to know, at the time of an invasive treatment whether the invasive treatment she is undertaking is to alleviate pain from a compensable injury or, whether it would alleviate pain from a pre-existing injury or both. But see Brown v. Dibbell, 227 Wis. 2d 28, 51, 595 N.W.2d 358 (1999) (reasoning, "a patient is not in a position to know treatment options and risks and, if unaided, is unable to make an informed decision").
¶ 87. We do not expect lay people to have knowledge of when medical practices or procedures should be employed. See generally Martin v. Richards, 192
¶ 88. Our decision in Spencer v. DILHR, 55 Wis. 2d 525, 200 N.W.2d 611 (1972), illustrates this principle.
f 89. Accordingly, all that Wis. Stat. § 102.42(lm) requires the employee to prove in order to come within the statutory provisions is that at the time when the employee undertakes an invasive procedure he or she had a good faith belief that the procedure would treat a compensable injury and that the invasive treatment resulted in a disability. The employee need not show that the compensable work injury caused the employee to undergo invasive treatment.
D. Application
¶ 90. In the present case, Flug provided proof to the ALJ in the form of Dr. Floren's written report and she testified. Dr. Floren was one of her treating physicians. Wal-Mart provided the report of Dr. Soriano, who did not review Flug's medical records until after she had surgery.
¶ 91. It is undisputed that Flug suffered a com-pensable injury and underwent an invasive treatment, a discectomy. It is also undisputed that she did not
¶ 92. Dr. Soriano's report opines that surgery was unnecessary to treat her work-related injury. However, Flug did not have the benefit of his opinion at the time she undertook invasive treatment. Finally, it is undisputed that Flug's unnecessary treatment caused the disability for which she now seeks benefits.
f 93. Moreover, Dr. Soriano's opinion that the work-related injury did not necessitate invasive treatment is of no relevance. Dr. Soriano's opinion speaks to whether the need for invasive treatment was caused by her work-related injury. However, Dr. Soriano gave his opinion after Flug's surgery.
f 94. Post-hoc examinations like Dr. Soriano's are not relevant when determining whether Flug acted with a good faith belief at the time she undertook surgery that it would alleviate the pain she had suffered since her work-related injury on February 14, 2013. Flug's good faith belief is her state of mind at the moment when she undertook the invasive treatment. And, it is her state of mind at the time she undertook surgery that the majority opinion avoids discussing.
¶ 95. In sum, Flug satisfied most of Wis. Stat. § 102.42(lm)'s criteria. She sustained a compensable (work-related) injury. Based on medical advice to treat pain, she underwent a discectomy, an invasive and medically acceptable treatment that was unnecessary to treat her work-related injury. And, she sustained a disability as a result of the surgery. If she undertook the discectomy with the good faith belief that it would
III. CONCLUSION
¶ 96. I conclude that Flug, who has sustained a compensable (work-related) injury from which began a continuing course of pain and who underwent surgery upon the advice of medical doctors to alleviate that pain, is entitled to compensation pursuant to Wis. Stat. § 102.42(lm) if she accepted the physician's advice and undertook surgery with the good faith belief that surgery would treat her work-related injury, even though surgery was unnecessary treatment for that injury. Neither LIRC nor the ALJ made factual findings in regard to Flug's good faith belief, or the lack thereof, in undertaking surgery. Therefore, I would remand the matter to LIRC to make the requisite finding and complete its obligations under § 102.42(lm).
¶ 97. Accordingly, I would affirm the court of appeals' decision reversing LIRC and remanding the matter for additional fact-finding on the issue of good faith, and if necessary for a determination of the damages to which Flug is entitled. Because the majority opinion fails to recognize the factual nature of good faith, its importance to the plain meaning of Wis. Stat. § 102.42(lm) and avoids addressing good faith in the context in which it arises, I respectfully dissent from the majority opinion.
Flug v. LIRC, No. 2015AP1989, unpublished slip op. (Wis. Ct. App. June 21, 2016).
Flug v. LIRC, No. 2015AP1989, unpublished slip op. (Wis. Ct. App. June 21, 2016).
Trade Flug v. Wal-Mart Assoc., Inc., ERD No. 2013-006010 (LIRC, Feb. 23, 2015).
Employer is defined by Wis. Stat. § 102.04 and includes, in relevant part, any "person who usually employs 3 or more employees for services performed in this state, whether in one or more trades, businesses, professions, or occupations, and whether in one or more locations." Wis. Stat. § 102.04(1)(b)1f.
Majority op. f ¶ 32-33. The statute requires causation only insofar as the invasive treatment must have caused the disability.
See majority op., ¶¶ 31, 32.
Majority op., ¶ 37.
Id
Spencer v. DILHR, 55 Wis. 2d 525, 200 N.W.2d 611 (1972) predated the passage of Wis. Stat. § 102.42(lm). In Spencer, the employee suffered an injury at work and underwent surgery. Id. at 526-27. After the surgery, the employee suffered a 15% partial permanent disability. Id. The doctor that performed the surgery determined that further treatment was unnecessary. Id. However, the employee saw another physician, who concluded that the employee should undergo another surgery. Id. The subsequent surgery left the employee with partial permanent disability of 40%. Id.
Dissenting Opinion
¶ 98.
(dissenting). There is a reason that the court of appeals issued an
¶ 99. There is one, and only one, LIRC decision that was ever issued in this case. It is dated February 23, 2015, and it is the decision we review today. DeBoer Transp., Inc. v. Swenson, 2011 WI 64, ¶ 29, 335 Wis. 2d 599, 804 N.W.2d 658 ("When reviewing a worker's compensation claim, we review LIRC's decision, not the decisions of the circuit court or court of appeals."); see also Stoughton Trailers, Inc. v. Labor and Indus. Review Comm'n, 2007 WI 105, ¶ 26, 303 Wis. 2d 514, 735 N.W2d 477.
¶ 100. The majority has forthrightly acknowledged that we owe no deference to LIRC's conclusion of law set forth in that decision because, as even LIRC has now confessed, its conclusion is clearly erroneous. Majority op., ¶ 16. Likewise, the majority has acknowledged that the issue it decides today was never addressed by the Commission because of "its mistaken belief that Ms. Flug had suffered no compensable injury at all." Id.
f 101. So what is this case doing here?
f 102. The problem, of course, arises from LIRC's February 23, 2015, decision where it misstated or misunderstood the essential conclusion of law it was supposed to be reviewing. Rather than issuing an order modifying the Feb 23, 2015, decision or issuing a new decision from which appeal rights attend,
f 104. However, in its February 23, 2015, decision, LIRC expressed one important caveat concerning findings of fact that excludes any potential for reliance on Dr. Soriano's report — a report relied upon in the majority opinion — the ALJ "did not adopt the findings of Dr. Soriano." Flug v. Wal Mart Assocs., Inc., WCD No. 201300610 (LIRC, Feb. 23, 2015). Consequently, LIRC also did not adopt those findings.
¶ 105. Additionally, appellate counsel's argument flies in the face of well-established precedent on administrative agency review. Counsel is trying to do now what LIRC did not do. However, appellate counsel is stuck with the facts of the case, which consist of a clearly erroneous February 23, 2015, LIRC decision. "[T]his court cannot accept appellate counsel's post hoc rationalization for agency action. If an agency's order is upheld, it must be on the same basis articulated in the order by the agency itself." Illinois v. United States, 666 F.2d 1066, 1077 (7th Cir. 1981) (citing Fed. Power Comm'n v. Texaco, Inc., 417 U.S. 380, 397, 94 S. Ct. 2315 (1974); Burlington Truck Lines v. United States, 371 U.S. 156, 168-69, 83 S. Ct. 239 (1962)). See also Bagdonas v. Dep't of Treasury, 93 F.3d 422, 426 (7th
¶ 106. Rather than acknowledge and address the procedural morass into which this court has waded, the majority skirts the issue, contending that it must accept LIRC's findings of facts: "the Commission has already found and we must accept [the findings]." Majority op., ¶ 34.
f 107. What factual finding is there that the majority feels so enslaved to uphold?
¶ 108. It cannot be any factual finding based on Dr. Soriano's report because as stated above, the LIRC decision specifically observed that it did not adopt those findings.
¶ 109. It cannot be any of the asserted factual findings relied upon by the majority because they do not exist. For example, the majority asserts that the ALJ and the Commission specifically found that "the surgery didn't treat Ms. Flug's compensable injury." Majority op., ¶ 23. Likewise, the majority contends that LIRC made a factual finding about the object of the surgery: "we must accept" the Commission's factual finding that the "object of Ms. Flug's surgery was not her compensable injury, but her pre-existing condition." Majority op., f 34.
¶ 110. Attached to this writing are the findings of fact of the ALJ as well as the February 23, 2015, decision of LIRC. As the reader will be able to observe, neither the ALJ nor LIRC made such findings.
¶ 111. The majority uses the clearly erroneous LIRC decision and nonexistent findings of fact as a springboard to avoid the real issue in this case: whether the event of February 14, 2013, aggra
¶ 112. Contrary to the majority, I would remand this case to LIRC for a new hearing so that it can weigh the competing medical opinions and then, based on those opinions, issue findings of fact and a conclusion of law that is not clearly erroneous.
Accordingly, I respectfully dissent.
⅜ — I
¶ 113. This case started out as a somewhat routine worker's compensation case. Ms. Flug has a conceded work injury of February 14, 2013, which she sustained while repeatedly raising her right arm to scan boxes at Walmart. She initially treated with her primary care physician, who referred her to an occupational specialist, Dr. Andrew Floren.
¶ 114. After a two month period of treatment, Dr. Floren referred Ms. Flug for an evaluation by a neurosurgeon, Dr. Eduardo Perez. He found that she had a degenerative disc disease and that a discectomy and fusion was needed at two levels in the cervical spine.
¶ 115. The surgery that Ms. Flug underwent on June 4, 2013, was apparently successful. Under worker's compensation law, this particular procedure is a scheduled injury, which means a pre-determined minimum amount of disability attributable to the limitations that arise from the nature of the surgery itself.
¶ 116. In a follow up exam, Ms. Flug reported that she "was doing excellent" and felt almost 100 percent better. That's the good news for Ms. Flug. Now the bad news.
¶ 117. After Ms. Flug underwent surgery, the worker's compensation carrier hired Dr. Morris So-riano to do an independent medical exam. He never met with Ms. Flug, but upon a review of her records, filed a report one year after the injury and 9 months after the surgery, opining that the February 14, 2013, event did not aggravate beyond normal progression her pre-existing spinal condition.
¶ 118. On the other hand, Dr. Floren opined that it did. He stated that he "strongly disagree [d]" with Dr. Soriano's statement, observing that "[t]he patient's history, clinical examination, and radiologic studies all support her need of surgery; which decision was also shown appropriate by her response to that surgery."
f 119. Competing medical opinions in worker's compensation cases are standard fare. Ms. Flug does not contend that the event of February 14, 2013, caused her degenerative spinal condition. Of course it did not. Nor does she assert that the event simply aggravated her spinal condition, because a mere ag
¶ 120. At the administrative hearing, the case was presented as a battle between written expert medical opinions. One determined that the February 14, 2013, injury aggravated and accelerated beyond normal progression the pre-existing condition and the other concluded that it did not.
¶ 121. The ALJ's decision set forth the information provided in the written reports of both Dr. Floren and Dr. Soriano, however, it relied on neither. As the LIRC decision explains, the ALJ's decision is not based on the findings of Dr. Soriano. And it certainly is not based on Dr. Floren's opinion because it is contrary to it.
f 122. If the ALJ's decision was based on neither the medical opinion of Dr. Floren nor on that of Dr. Soriano, then on what medical expert opinion did the ALJ base its conclusion? Apparently, the ALJ engaged in its own sojourn into the medical records and determined that no additional compensation was due.
1 — { H-l
¶ 123. Having set forth the facts, I turn to address both what the majority opinion has erroneously stated and what of import it has failed to state.
• The majority is incorrect. Ms. Flug did not undergo surgery because she believed it necessary to treat a strain. The record reflects that prior to recommending surgery, Ms. Flug's surgeon, Dr. Perez, diagnosed Ms. Flug with "right-sided C7 radiculopathy associated with C6-7 disk osteophyte complex and degenerative disk disease at the C5-6 level." Dr. Perez "discussed all these findings with Ms. Flug," and "entered into an informed consent discussion regarding anterior cervical discectomy with fusion/fixation at the C5-6, C6-7 levels."
f 125. The majority again errs when it contends that the ALJ and the Commission specifically found that "the surgery didn't treat Ms. Flug's compensable injury."
• No such finding exists.
• No such finding exists.
¶ 127. The majority further asserts that Ms. Flug's argument is beyond its reach, because she "does not assert the findings of fact are the result of fraud, or that the Commission acted outside of its powers." Majority op., f 23.
• Ms. Flug has consistently argued that the Commission acted outside of its powers. In her appeal to the circuit court she argued that "LIRC acted without and in excess of its powers as described in Wis. Stat. § 102.23." She continued this argument in the court of appeals, which explained that "Flug argues the Commission acted in excess of its powers in three respects." Flug v. Labor & Indus. Review Comm'n, No. 2015AP1989, ¶ 24, unpublished slip op. (Wis. Ct. App. June 21, 2016).
• The majority contradicts itself when it asserts that Flug does not argue here that LIRC acted in excess of its powers. What does "acted in excess of its powers" means in the context of worker's compensation? It is well-settled that "when a decision by LIRC is not supported by credible and substantial evidence, the decision is in excess of LIRC's authority." Xcel Energy Serv. Inc., v. Labor and Indus. Review Comn'n, 2013 WI 64, ¶ 55, 349 Wis. 2d 234, 833 N.W.2d 665.
• And yet, that is precisely what the majority acknowledges is advanced here. The majority describes Ms. Flug's arguments as "a continua*624 tion of the argument Ms. Flug made in the court of appeals, where she unequivocally stated she " 'sustained a compensable injury and .. . underwent surgery for a compensable injury.1 Ms. Flug maintained this position even through oral argument here." The basis of Ms. Flug's argument is that LIRC's decision was not supported by the relevant evidence of record: "She says the relevant medical testimony establishes that the surgery for the injury was reasonable and necessary" and that "her surgery was, in fact, for a compensable injury." Majority op., ¶¶[ 20, 23.
¶ 128. Attempting to explain the reasoning of LIRC and the court of appeals, the majority offers that "both the Commission and the court of appeals base their competing analyses on the shared understanding that Ms. Flug's surgery had nothing to do with her compensable injury." Majority op., ¶ 20.
• The Commission could not have based its analysis on the understanding that her surgery had nothing to do with her compensable injury because it concluded that she had no compensable injury.
• The court of appeals never determined whether Ms. Flug's surgery was related to her compensable injury. Instead, as the majority earlier acknowledged the court of appeals didn't need to decide "whether the invasive procedure was actually directed at a compensable injury, so long as the employee had a good faith belief that it was." Majority op., ¶ 19.
¶ 129. Having set forth some of the majority's errors in what it says, I address next what it fails to say. It is only by relying on some of these errors that
f 130. Although the majority acknowledges that Ms. Flug's true argument is that her surgery was necessitated by the February 14, 2013, event because it aggravated and accelerated beyond normal progression a progressively deteriorating condition, it insists that it cannot discuss it. The majority contends that it is precluded from addressing Ms. Flug's argument regarding the nature of her injury because of nonexistent findings of fact. Majority op., ¶ 23 ("Thus, because the Commission eliminated the factual predicate for Ms. Flug's argument, we would not be able to engage it unless we first rejected the Commission's finding on this point."). It declares that "Ms. Flug's argument [is] beyond our reach." Id.
¶ 131. The majority is likewise silent about the extent of Ms. Flug's disability. It emphasizes in its recitation of facts that at a one month post surgery appointment Ms. Flug stated that "she was doing 'excellent' and feeling 'almost 100 [percent]'". Majority op., ¶ 4. The picture that the majority paints makes the reader wonder whether Ms. Flug has any disability whatsoever. Nowhere in the majority opinion is the reader advised that the surgery causes permanent limitations. The worker's compensation administrative rules recognize that a minimum disability for each level of a discectomy/fusion is 10 percent permanent partial disability.
¶ 133. In sum, because the February 23, 2015, decision of LIRC is clearly erroneous and not supported by any findings of fact, I would remand this case to LIRC for a new hearing, providing an opportunity to weigh the competing medical opinions and then, based on those opinions, issue new findings of fact and a conclusion of law that is not clearly erroneous.
¶ 134. Accordingly, I respectfully dissent.
2013-008010
TRACIE L PLUG
528 W CEDAR ST
CHIPPEWA FALLS Wl 54720
. Applicant,
vs. ‘ PLEASE SEE ENCLOSURE
WAL-MART-ASSOCIATES INC
2786 COMMERCIAL BLVD
CHIPPEWA FALLS Wi 54729-6031
• Respondent,
NEW HAMPSHIRE INSURANCE CO
C/O CLAIMS MANAGEMENT INC
PO BOX 1288
SENTONVILLS AR 72712-1283
Insurance Carrier.
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A hearing was held In Rice Lake, Wisconsin on March 10,2014.
APPEARANCES: The Applicant, In Person and by Attorney Jeffrey • J. Ktemp; the Respondents by Attorney Richard 0, . Dupiessie.
Conceded ware jurisdictional facts and an average weekly wage of §67.4.00. At issue was whether the applicant sustained an injury on February 14,2013, arising out of and occurring whilo performing services growing out of and Incidental to her employment with the employer, respondent. If causation is found the further issues presented are the naturo and extent of disability residing from the injury and the respondents' liability for certain medical exponses.
A.App. 1ÍSS
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Upon the Issues the Administrative Law Judge makes the following:
D 1 N G£ OF F&CT
The applicant, date of birth October 21,1970, worked as a department store retail supervisor for the employer. On February 14, 2013, she was assigned to do price changes utilising a handheld scanning device. She testified that tills required her scan Hems on racks above her head and as she was lowering the scanner she felt the sudden onset of pain in her neck radiating down her right arm. She sought treatment on Fabruaiy20,2013 from Dr. Sabina Monssctfo, complaining of neck and shoulder pain. An x-ray examination revealed a loss of disk space at C5 ánb C6 with some anterior spurring but no evidence of fracture. Dr. Morissetie diagnosed right arm and shoulder pain with a possible relation to the cervical spine. Conservative care was proscribed inefudíng a course of physical therapy. She was referred to an occupational health specialist, Dr. Andrew Floren; Dr. Floren examined the applicant on March 6,2013, noted the condition was resolving with conservative care and reported he saw no sign of cervical involvement. On fo'Ilow-up on March 22,2013 Dr. Floren diagnosed neck and upper back pain, siowiy resolving as well as right shoulder pain, minimally resolving. However, after examination on April 2,2013, Dr. Floren noted the right shoulder pain was not resolving and the, applicant had . persisitenf right hand tingling which worsened with neck exterision. He ordered an MR.I examinaron.
The applicant underwent the MR! examination on April 4, 2013. It revealed moderate spondyioiic change in the cervical spine with no severe foramina! or spina) cana! narrowing and degenerativo change in the right shoulder with no rotator cuff tear or labra! tear identified. The applicant continued to experience symptoms including neck pain and tingling in her right hand. On April 15,2013 Dr. Floren concluded there was potential nerve irritation in the'neck likely at C6-7 on the right. A steroid injection was prescribed and administered on April 19, 2013, However, no relief of symptoms resulted, On May 2,2013 Dr. Floren noted the applicant's condition was siowiy worsening arid referred her for a neurosurgical consultation with Dr, Eduardo Perez..
A.App. 136
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Or. Perez examinee the applicant and diagnosed a C6-7 osteophyte complex and degenerative disfcdisease at C5-6. Dr. Perez recommended surgical Intervention in the form of an anterior cervical discectomy C5 through C7, which was performed on June 4,2013. Recovery was uneventful and Dr. Floren declared herto be at a healing plateau on November 6,2013, rating permanent partial disability at 12 percent as compared ⅛ permanent and total disability
By certified medical report dated August 13, 2013, Dr, Floren concluded that the work activity directly caused the applicant's disability, in answers lo questions attached to that report he agreed the applicant's degenerative condition was not directly caused by any single work incident, that the symptoms began while she was performing overhead work scanning boxes and that the work duties on or about February 15,2013, were at least a material contributory causative factor in the progression of her cervical disability. !n an addendum dated. December 13,2013 he revised his estimate of permanency from 12 percent to 22 percent. In a'third addendum dated February 26, 2013, he revised his opinion to deny the work activity directly caused the disability. Rather he reported that activity caused the disability by precipitation, aggravation and acceleration of her preexisting progressively degenerating condition beyond normal progression. He further reported that an appreciable period of Workplace exposure at the employer-respondent either caused or was a material contributory causative factor in the onset or progression of the applicant's condition.
At the request of the respondents the applicants records were reviewed.by Dr. Morris Soriano. By certified medical report dated February 5,2014, Dr. Soriano found that the alleged incident of February 14,2013 caused* a cervical strain, with a healing period of four to six weeks. He further reported the work incident did not cause or aggravate her pre-existing condition. He noted the only finding during surgery was osteophytes at C6-7 with no evidence of disc herniation. He noted that reaching up with a 25 ounce scanner would not aggravate that condition.
To be compensable a claim for compensation must be established beyond a legitimate doubt. There is significant doubt as to the accuracy of the history upon which Dr. Floren rendered his opinions. The history as testified to was that of a sudden pain on the dato of injury with pain going down the posterior shoulder and arm to the wrists and that Dr. Morrisette's history of
A.Appv 137
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February 20; 2013 colours. However, Dr. Morriseite’s history on that date was only that "she had some neck pain and shoulder pain after doing some repetitive work above shoulder height" causing her to leave work the following day. The applicant Informed her physical therapist on February 25,2013 that "she started work without any pain buttowards the end ofthe day started getting really sore through her shoulder, neck ahd back." The applicant testified she Immediately _ felt pain like needle pricks. That was not mentioned in the contemporaneous records. On the’ contrary in the initial reports she denied any numbness or tingling. There was no mention of tlng!ing in the extremity until April 15,2013. The applicant provided no explanation for this slgriflcant difference in histories. Dr. Floren predicated his opinion upon the sudden onset of symptoms and that "...since that time she has been having unrelenting bumlng/shooting/pain when she puts her head in certain ways..." Again the mecilcal records contradict this. The applicant. roported significant improvement in her condition through March 28, 2013.
The opinions of a practitioner can be no better than the history upon which the opinion is rendered. Here the significant variance in the history as given from hat reflected in the contemporaneous records raise a legitimate doubt as to file compensability of tbs claim asa traumatic injury beyond that already conceded ana paid by the respondents. .While Dr. Floremaiso reported the appreciable workplace exposure was causative, this was not developed st hearing particularly given the inconsistency in history of injury on February 14, 2013.
NOW, THEREFORE, this:
oSP„§B
The application is ‘dismissed. *
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FlugTracieRLSjasRDO
A.App, 138
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cc;
ATTORNEY JEFFREY J KLEMP
C/O KLEMP LAW OFFICES
LAW OFFICES OF JEFFREY KLEMP
4252 SOUTHTOWN DR STE B
EAU CLAIRE Wl 54701
ATTORNEY RICHARD D DUPLESSIE
C/O WELD RILEY PRENN & RICCI
3624 OAKWOOD HILLS PKWY
PO BOX 1030
EAU CLAIRE WI 54702-1030
A. App.
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TRAQIE L FLUG, Applicant 528 W CEDAR ST CHIPPEWA FALLS WT 5.4729 . ’WORKERS COMPENSATION ' DECISION
Claim No. 2013-006010
Dated and mailed?
WAL MART ASSOCIATES INC, Employer 2786’ COMMERCIAL ELVD CHIPPEWA FALLS W3 54729-5031 FEB 2 3 2015 ÍUKtr^wsd doc:HS:
NEW HAMPSHIRE INSURANCE CO, Insurer C/.0 CLAIMS MANAGEMENT INC PO BOX 1288 BENTONV3LLEAR 72712-1288
SEE ENCLOSURE AS TO TIME LIMIT AND PROCEDURES ON FURTHER APPEAL
An administrative law judge (AU) for the Worker's Compensation. Division of the •Department of Workforce Development issued a decision in. this matter. A timely petition for review was tiled.
The commission has considered the petition and the positions of the parties, and it .has .reviewed the evidence submitted to the AU. Based on its review, the commission, agrees with the decision of the AU, and it adopts the findings and order in that decision aa its own.
ORDER
'Hie findings and order of the administrative law judge are affhpied.
A.App. 140
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MEMORANDUM OPINION
The applicant has petitioned for commission review of the AU’s decision. The applicant asserts, that there is no dispute that she injured herself at work. Rather, the applicant argues that the medical dispute is over the nature and extent of the applicant’s disability. The. issue before the ALT whether the applicant sustained an injuiy pn February 14, 2013, arising out of and occurring while performing services growing out of and incidental to her employment with the employer. The 'applicant has the burden to establish that she suffered k work injury. The applicant failed to present credible medical evidence to establish that she suffered a work-related injury because the history upon which Dr. Floren relied', when making his determination as to whether the incident on February 14, 2013, resulted in awork injury was incorrect.
The applicant asserts that Dr, Soriano, the Respondent’s expert, is incorrect about the nature of the injury. The applicant asserts that Dr. Soriano indicated, that ' scanning a product on a shelf could not have aggravated or worsened two levels of a previously arthritic condition at C5-5 and C5-7 to the point they became symptomatic.- * However, die applicant asserts that there is no burden on the applicant to show that the exertion, was anything beyond unusual. -The AU did not adopt the findings of Dr. Soriano. Rather, the ALJ.was left with legitimate doubt as to whether the applicant suffered any work injury, and so he dismissed the application. See Leist v. LIRC, 183 Wis. 2d 450, 457 (1994).
The applicant also asserts that the respondent is liable for benefits under Wis. Stat. § 102.42(lm) because she in good faith’underwent invasive treatment that is generally medically acceptable but is unnecessary. The applicant asserts that Dr. Soriano determined that the applicant suffered a cervical strain as a result of the work incident and that the surgery was not reasonable and necessary to treat that work injury,- • * . . • ■
2
A.&pp. 141
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(1m) Liability tor vknbce$s/&y treatment. If an employee who has sustained a compensable injury undertakes in good faith invasive treatment that ia generally medically acceptable, 'out that is unnecessary, the employer shall pay disability indemnity ior all disability incurred as a result of that treatment An^cmployer is not liable far disability indemnity for any disability incurred as a result of any unnecessary treatment undertaken in good’ faith that is noainvasive or not medically acceptable.- This subsection applies to all findings that an employee has sustained a compensable injury, whether the finding results Hum a heating, the default .of a party, or a compromise or stipulation confirmed by the department.
In order for Wis. Stat. § I02,42(lmJ lo apply the applicant must first establish that she sustained a compensable injury. The applicant loas failed to do this.
The applicant further asserts that .the ALJ erred when he concluded that the applicant gave a different history to Dr, Morisscttc than the one she gave to Dr, Floren. ‘ Since they both work in the same clinic and since .Dr. Floren wrote that Dr. Morissette’s "history concurs” the applicant asserts that the only reasonable* inference is that Dr. Floren reviewed the notes of Dr. Moriesette. The commission agrees v/ifh the AU’s • conclusions. In February, when the applicant sought treatment with Dr, Morissctte she stated that she had some pabi.after doing some work. _ The applicant told Dr. Floren that she had sudden and significant symptoms.
The applicant asserts that the AU conflated terminology and this led to additional misunderstanding. The applicant asserts that she did not provide an explanation for the significant difference in. histories because she was not asked to as she does nor believe them was a significant difference in. histories. She states she had pain butnot numbness or tingling at the onset of her symptoms. The applicant asserts that she did not experience, tingling until around March 22, 2013. The commission notes that the applicant experienced problems at work on February 14, 2013, but did not seek treatment untñ February 20, 2013, The commission notes that the applicant, was performing a relatively minor task on February 14, and using a scanner which was not heavy. The applicant gave very specific testimony at the hearing regarding radiating, needles going through the shoulder blade and radiating down into her aim. She also indicated that she felt something shift in her neck and it just pinched it off. This shifting was followed by a sudden onset of pain. Thus, the commission agrees with AU's conclusion that the variance in history raises a legitimate doubt as to the compensability of the claim, ' * * v
cc: Attorney Jeffrey J. Klemp Attorney Richard D. Duplessie
3
A-App. 142 TRACTS L FLUG
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cc:
ATTORNEY JEFFREY J KLEMP
b/O KLEMP LAW OFFICES
LAW OFFICES Or JEFFREY KLEMP
4262 SOUTHTOWN DR STE B
EAU CLAIRE Wl 54701
ATTORNEY RICHARD D DUPLESSIE
C/O WELD.RILEY PRENN & RICCI
3824 OAKWOOD HILLS PKWY
PO BOX 1030
EAU CLAIRE Wl 54702-1030
A.App. 143
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Wisconsin Stat. § 102.23(l)(a)2., provides in relevant part that "[w]ithin 30 days after the date of an order or award made by the commission, any party aggrieved by the order or award may commence an action in circuit court for review of
I would reverse and remand LIRC's decision for a determination of the threshold issue of whether Ms. Flug's work injury aggravated and accelerated her preexisting condition beyond its normal progression. With one exception, I also join Chief Justice Roggensack's dissent addressing Flug's alternative argument on the issue of good faith. As set forth herein, the majority opinion contains a number of factual missteps and therefore I cannot join the sentence in Chief Justice Roggen-sack's dissent that states "[t]he majority opinion ably sets forth the underlying facts." Chief Justice Roggensack's dissent, ¶ 47.
Additionally, the majority states that the parties agree that Flug "suffered a permanent partial disability as a direct result of the treatment." Majority op., ¶ 18. Walmart concedes that Ms. Flug suffered a temporary disability due to her cervical strain. However, it does not agree that Ms. Flug suffered a permanent partial disability because it contests that Ms. Flug is entitled to worker's compensation benefits as a result of her surgery.
The ALJ found as a factual matter that there was a variance in the history Ms. Flug gave her treating physicians. Based on this factual finding, the ALJ made the conclusion of law that "there is a legitimate doubt as to the compensability of the claim as a traumatic injury beyond that already conceded and paid by the respondents."
Ms. Flug had surgery on both the C-5/C-6 level and the C-6/C-7 level. The Department of Workforce Development rule governing a scheduled worker's compensation injury provides in relevant part that "[t]he disabilities set forth in this section are the mínimums for the described conditions." DWD 80.32(1)
Reference
- Full Case Name
- Trade L. Flug, Plaintiff-Appellant, v. Labor and Industry Review Commission, Wal-Mart Associates, Inc. and New Hampshire Insurance Company C/O Claims Management, Inc., Defendants-Respondents-Petitioners
- Cited By
- 7 cases
- Status
- Published