Flake v. Aetna Life & Casualty Co.

No. 13526 IN THE SUPREME COURT OF THE STATE OF P40MTANA 1977 VIRGINIA FLAKE, Claimant and Appellant, -vs- ST. VINCENTS'S HOSPITAL, Employer, and AETNA LIFE & CASUALTY COMPANY, Defendant and Respondent. Appeal from: Workers' Compensation Court Honorable William E. Hunt, Judqe presiding. Counsel of Record: For Appellant: Kelly and Foley, Billings, Montana William T. Kelly argued, Billings, Montana For Respondent: Anderson, Symmes, Forbes, Peete and Brown, Billings, Montana Weymouth D. Symmes argued, Billings, Montana Submitted: September 20, 1977 Decided: QEC 1 3 jm Filed: der 2 s M r . J u s t i c e John Conway Harrison d e l i v e r e d t h e Opinion of t h e Court. This i s an appeal from a decision of t h e workers' compen- s a t i o n c o u r t , B i l l i n g s , t h a t claimant sustained a 12% permanent p a r t i a l d i s a b i l i t y and awarding a lump sum payment i n t h e amount of $2,431.20. V i r g i n i a Flake, claimant and a p p e l l a n t , i s a l i c e n s e d p r a c t i c a l nurse. She s u f f e r e d an i n j u r y t o h e r lower back i n t h e course of h e r employment a t S t . Vincent's H o s p i t a l i n B i l l i n g s on March 3, 1974. P r i o r t o h e r i n j u r y , she was employed part-time, working an average of t h r e e e i g h t hour days per week. The record r e v e a l s claimant worked one f u l l f o r t y hour week j u s t p r i o r t o her i n j u r y . Following the i n j u r y , claimant continued t o work u n t i l March 30, 1974, when the paid of t h e i n j u r y forced h e r t o discontinue h e r work. D r . D . R. Huard performed a laminectomy on claimant i n August 1974. The workers' Compensation Division paid a l l b i l l s and l o s t wages during t h e period of c l a i m a n t ' s nonemployment. O November 18, 1974, claimant resumed work a t S t . Vincent's. n She was unable t o do l i f t i n g because of t h e i n j u r y . However, she was a b l e t o work t h r e e t o four days per week and h a s , i n f a c t , worked s e v e r a l f o r t y hour weeks subsequent t o t h e i n j u r y . Her wages have increased approximately eightycents per hour, p r i m a r i l y due t o across t h e board c o s t of l i v i n g i n c r e a s e s , so she makes somewhat more money now than before the i n j u r y . On August 29, 1974, D r . Huard submitted a r e p o r t s t a t i n g : "* * 9: I b e l i e v e t h e r e i s a p a r t i a l permanent impair- ment. This following r e s u l t of laminectomy would be 20% of h e r s p i n e , which converts t o 12% of t h e man a s a whole. * * *" The insurance c a r r i e r f o r S t . V i n c e n t ' s , defendant and respondent Aetna L i f e & Casualty Company concluded t h e 12% impairment f a c t o r l i m i t e d i t s l i a b i l i t y under t h e ~ o r k e r s ' Compensation Act t o 12% o r 60 of t h e p o s s i b l e 500 weeks of maximum b e n e f i t . Multiplying 60 weeks by t h e weekly compensa- t i o n r a t e of $40.52 y i e l d e d $2,431.20, which sum was o f f e r e d t o claimant. Claimant r e j e c t e d t h e o f f e r and, on September 4 , 1975, sought a de termination b e f o r e t h e workers ' compensation c o u r t . During t h e h e a r i n g of November 5 , 1975, pursuant t o c l a i m a n t ' s p e t i t i o n , claimant submitted evidence of h e r i n a b i l i t y t o perform c e r t a i n types of work, such a s l i f t i n g , a s a d i r e c t r e s u l t of h e r i n j u r y . The c o u r t , by i t s f i n d i n g s of f a c t and conclusions of law dated August 23, 1976, accepted t h e c a r r i e r ' s computation of $2,431.20, upon a f i n d i n g of no s u b s t a n t i a l l o s s of e a r n i n g c a p a c i t y , based upon c l a i m a n t ' s work r e c o r d s and t h e 12% impairment r a t i n g . Claimant a p p e a l s t h e c o u r t ' s conclusions. The i s s u e p r e s e n t e d by t h i s appeal i s whether t h e workers' compensation c o u r t e r r e d i n a r r i v i n g a t a 12% permanent p a r t i a l d i s a b i l i t y r a t i n g , given t h e f a c t s of r e c o r d . W hold i t d i d e not. Claimant contends t h e c o u r t should n o t have determined d i s a b i l i t y s o l e l y upon t h e b a s i s of t h e d o c t o r ' s medical impairment r a t i n g b u t , r a t h e r , t h a t d i s a b i l i t y should be com- puted upon a c o n s i d e r a t i o n of " l o s s of e a r n i n g capacity". In making such computation, t h e c o u r t should p r o p e r l y e v a l u a t e t h e d i s a b i l i t y i n view of c l a i m a n t ' s a g e , e d u c a t i o n , work e x p e r i e n c e , p a i n and d i s a b i l i t y , a c t u a l wage l o s s , and l o s s of f u t u r e e a r n i n g a b i l i t y . Here, c l a i m a n t ' s i n a b i l i t y t o perform more than t h r e e o r f o u r days of work should be con- s i d e r e d s t r o n g evidence of a l o s s of e a r n i n g c a p a c i t y . In t h i s r e g a r d , c l a i m a n t submits t h e Workers ' Compensation Act should be l i b e r a l l y construed i n favor o f recovery. Respondent, however, s t r e s s e s t h a t c l a i m a n t i s p r e s e n t l y working a t l e a s t a s many hours and, i n f a c t , i s e a r n i n g more a f t e r than b e f o r e t h e i n j u r y , t h e r e f o r e t h e r e being no a c t u a l wage l o s s t h e r e i s no l o s s of earning c a p a c i t y . Claimant s u s - t a i n e d a "bodily f u n c t i o n a l impairment" o n l y , f u l l y compensable by t h e s e t t l e m e n t o f f e r e d by respondent i n s u r a n c e c a r r i e r . The c o u r t p r o p e r l y based i t s award on t h e percentage of such i m - pairment, t h i s being t h e only s u b s t a n t i v e evidence of d i s a b i l i t y . Claimant's p e t i t i o n f o r workers' compensation b e n e f i t s pro- ceeded under and i s governed by t h e workers' Compensation Act, s e c t i o n 92-703.1, R.C.M. 1947. T h i s s e c t i o n provided p r i o r t o amendment i n 1975: "Compensation f o r i n j u r i e s causing p a r t i a l d i s a b i l i t y . Weekly compensation b e n e f i t s f o r i n j u r y producing p a r t i a l d i s a b i l i t y s h a l l be s i x t y - s i x and two-thirds p e r c e n t (66 2/3%) of t h e d i f f e r e n c e between t h e wages r e c e i v e d a t t h e time of t h e i n j u r y and t h e wages t h e i n j u r e d employee i s capable of e a r n i n g t h e r e a f t e r , sub- j e c e . t o a maximum compensation of s i x t y d o l l a r s ($60.00) a week. S e c t i o n 92-703.1 "* * * bases t h e b e n e f i t upon a c t u a l l o s s of e a r n i n g c a p a c i t y r e s u l t i n g from t h e i n j u r y ** *.I' McAlear v. Arthur G . McKee & Co., - . Mont - 9 558 P.2d 1134, 33 St. R e p . 1.337, 1341 (1976). I t i s m a n i f e s t from a r e a d i n g of s e c t i o n 92-703.1 t h a t t h e t e s t f o r such l o s s of e a r n i n g c a p a c i t y under t h e Workers' Compensation Act i s " t h e d i f f e r e n c e between t h e wages r e c e i v e d a t t h e time of t h e i n j u r y and t h e wages t h e i n j u r e d employee i s c a p a b l e of e a r n i n g t h e r e a f t e r yc + ; *.'I Also s e e : Olson v . Manion's, I n c . , 162 Mont. 197, 202, 510 P.2d 6 (1973). Claimant r e l i e s on d e c i s i o n s of t h i s Court a d o p t i n g t h e " l o s s of e a r n i n g c a p a c i t y " t e s t . S h a f f e r v . Midland Empire Packing Co., 127 Mont. 211, 259 P.2d 340 (1953); Lind v. Lind, 142 Mont. 211, 383 P.2d 808 (1963); Graham v . Tree Farmers, Inc., 142 Mont. 483, 385 P.2d 83 (1963). Claimant draws s u p p o r t p r i m a r i l y from t h e r e l a t e d r u l e emerging from such c a s e s , t h a t l o s s of e a r n i n g power a s a r e s u l t of an i n j u r y i s n o t n e c e s s a r i l y p r o p o r t i o n a l t o b o d i l y f u n c t i o n a l impairment. I t i s argued t h a t t o e q u a t e a percentage b o d i l y f u n c t i o n a l impairment r a t i n g w i t h a percentage d i s a b i l i t y r a t i n g f o r purposes of compensation under s e c t i o n 92-703.1, i s t o make wholly a r b i t r a r y t h e concept of "compensable d i s a b i l i t y " . While we a g r e e a s m a l l p e r c e n t a g e of b o d i l y f u n c t i o n a l impairment can r e s u l t i n a s u b s t a n t i a l l o s s of e a r n i n g c a p a c i t y and a g r e a t e r compensation award i n some c a s e s , t h e evidence adduced a t t h e h e a r i n g i n t h e i n s t a n t c a s e l e a d s t o t h e o p p o s i t e conclusion. Claimant was shown t o be working a t l e a s t a s oisny hours a f t e r t h e i n j u r y a s b e f o r e . The f a c t c l a i m a n t may have worked more h o u r s , earned more pay, o r been promoted i n h e r employment had i t n o t been f o r t h e i n j u r y , i s immaterial t o a d e t e r m i n a t i o n of compensable d i s a b i l i t y e s p e c i a l l y where, ds h e r e , t h e r e c o r d i s devoid of evidence i n s u p p o r t of such ~~onclusion. Olson v . Manion's, I n c . , supra. The s a l i e n t t a c t remains c l a i m a n t was a p a r t - t i m e employee b e f o r e and axter the injury. To base an o r i g i n a l compensation award upon any o t h e r c r i t e r i o n would be t o do v i o l e n c e t o t h e l i t e r a l Language of s e c t i o n 92-703.1. F i n a l l y , we n o t e t h e medical r e p o r t submitted by D r . Huard was t h e s o l e evidence i n t h e r e c o r d s u b s t a n t i a t i n g t h e percentage of c l a i m a n t ' s impairment. W f i n d t h e workers' e zon~pensationc o u r t had no a 1 t e r n a t i v e , based upon t h e f a c t s L t h e r e c o r d , t h a n t o ground t h e award on t h e impairment n r a t i n g i n t h e l i g h t of c l a i m a n t ' s work r e c o r d s and, i n s o doing, a c c e p t i n g t h e s e t t l e m e n t f i g u r e o f f e r e d by respondent insurance carrier. The d e c i s i o n of t h e workers' compensation c o u r t i s a f - tirmed. i4e Concur: - f L - Justices. M r . Chief J u s t i c e Paul G . H a t f i e l d concurs i n the r e s u l t , but n o t i n a l l the discussion. ief Justice. - 6 - M r . J u s t i c e Gene B. Daly d i s s e n t i n g : I respectfully dissent. This claimant was performing part-time employment before h e r i n j u r y i . e . , t h e r e was only t h r e e o r f o u r days a week a v a i l a b l e t o h e r . Since h e r operation - she i s only a b l e t o work t h r e e o r four days a week even though t h e r e i s more work now a v a i l a b l e t o h e r . There i s no doubt claimant may be earning t h e same number of d o l l a r s o r even more b u t t h i s i s n o t m understanding of t h e standard t o be a p p l i e d y when determining h e r r i g h t t o be paid under s e c t i o n 92-703.1 f o r diminished earning c a p a c i t y . The number of d o l l a r s earned and hours spent performing h e r employment c r e a t e a presumption of earning c a p a c i t y compatible with h e r s t a t e d d i s a b i l i t y . This presumption may be r e b u t t e d by evidence t h a t shows h e r p o s t - i n j u r y d o l l a r s earned and time spent t o be an u n r e l i a b l e b a s i s f o r t h e determination of earning capacity. Shaffer v. Midland Empire Packing Co., 127 Mont. 211, 213, 259 P.2d 340,342 (1953). Here, t h e r e seems t o be a l o s s of c a p a c i t y t o perform a s well a s before t h e i n j u r y and a l o s s of a b i l i t y t o compete and earn i n t h e open l a b o r market. This would b r i n g claimant within s e c t i o n 92-703.1, R.C.M. 1947. ......... M r . J u s t i c e Daniel J . Shea d i s s e n t i n g : I concur i n t h e above d i s s e n t of M r . J u s t i c e Daly.