Rogers v. Jack's Supper Club
304 Neb. 605
| Neb. | 2019Background
- Rogers injured her back at work in 2001 and designated Dr. Beyers as her Form 50 physician.
- A 2010 lump-sum settlement resolved indemnity claims; JSC remained liable for reasonable and necessary medical care.
- Dr. Beyers died; Rogers later moved to Florida and obtained treatment from Dr. Jonathan Daitch (pain management) and chiropractor Dr. Mark Means without employer agreement or a court-ordered change of Form 50 physician.
- JSC refused to reimburse many Florida medical bills; Rogers moved to compel payment.
- The Workers’ Compensation Court ordered JSC to reimburse certain bills and stated Rogers could continue treatment with Drs. Daitch and Frey.
- JSC appealed, arguing (a) statutory rules (Neb. Rev. Stat. § 48-120(2) and W.C. Ct. R. 50) bar reimbursement for providers obtained in disregard of the Form 50 process, and (b) the compensation court’s order failed to supply findings required for meaningful appellate review (W.C. Ct. R. 11).
Issues
| Issue | Rogers' Argument | JSC's Argument | Held |
|---|---|---|---|
| Whether JSC must reimburse medical bills for Florida providers obtained without employer agreement or court order under § 48-120(2) and Rule 50 | Rogers asserted she could select a new physician after moving and that prior reimbursements (e.g., Dr. Stonehocker) or practical necessity justified treatment in Florida | JSC argued § 48-120(2) and Rule 50 limit reimbursement to the Form 50 physician or referrals; services obtained in disregard of the statute are not JSC’s responsibility | Held for JSC: statute’s plain text bars reimbursement where employee unilaterally obtained providers outside Form 50/referral process; compensation court erred ordering payment |
| Whether JSC waived its right to assert § 48-120 by previously reimbursing treatment from a colleague (Dr. Stonehocker) | Rogers argued past reimbursements show JSC acquiesced and permitted her to choose new providers | JSC maintained voluntary payments are not admission of liability and do not alter statutory selection rules | Held for JSC: voluntary payments do not admit liability and do not authorize unilateral physician changes |
| Whether JSC waived the defense by failing to plead failure to obtain referral as an affirmative defense | Rogers contended JSC failed to plead the defense and thus forfeited it | JSC responded disputes may be raised by motion; nonmoving party is not required to file a responsive pleading in W.C. proceedings | Held for JSC: absence of a formal pleading did not waive reliance on § 48-120 in this motion-based proceeding |
| Whether the compensation court’s order allowing continued treatment with Dr. Daitch complied with W.C. Ct. R. 11 (adequate findings) | Rogers treated continuation as approval to continue treatment | JSC argued the order lacked the findings necessary to (a) change the Form 50 physician under § 48-120(6) or (b) explain required review of opioid regimen | Held for JSC on procedural ground: the order was ambiguous about whether Dr. Daitch became the Form 50 physician and insufficiently explained any required review; case reversed and remanded for a Rule 11-compliant order |
Key Cases Cited
- Martinez v. CMR Constr. & Roofing of Texas, 302 Neb. 618 (discusses standards for modifying or reversing Workers’ Compensation Court decisions)
- Clark v. Alegent Health Neb., 285 Neb. 60 (addresses when an employee may unilaterally change treating physician after employer denies compensability)
- McBee v. Goodyear Tire & Rubber Co., 255 Neb. 903 (voluntary payments of workers’ compensation benefits do not constitute admission of liability)
- Anthony, Inc. v. City of Omaha, 283 Neb. 868 (statutory construction: courts may depart from literal text only to avoid manifest absurdity or contradictions)
- Owen v. American Hydraulics, 254 Neb. 685 (remand required where compensation court’s order lacks findings necessary for appellate review)