State ex rel. Daily Servs., L.L.C. v. Indus. Comm.
2017 Ohio 2771
| Ohio Ct. App. | 2017Background
- Claimant Darion Stanford suffered a work-related right shoulder injury on October 16, 2013 (allowed for supraspinatus and subscapularis tears) and underwent arthroscopic rotator cuff repair on July 15, 2015.
- After initial postoperative improvement and return to light duty, claimant reported worsening pain and clicking after lifting a 20 lb bag at work (Nov 2015) and after mopping at work (Jan 2016).
- MRI on February 3, 2016 showed a near full-thickness re-tear at the prior repair site; treating surgeon Dr. Knapic requested revision rotator cuff surgery (C-9 dated Feb 11, 2016).
- Independent peer reviewer Dr. Rutherford concluded the repeat surgery was related to the allowed industrial injury and medically necessary; BWC, the DHO, the SHO, and the Commission approved authorization and claimant underwent revision surgery on March 11, 2016.
- Relator (Daily Services, LLC / Iforce) argued two subsequent workplace incidents (lifting dog food; mopping) were intervening injuries breaking causation and obtained a file review opinion from Dr. Erickson supporting that view.
- Relator sought a writ of mandamus to compel the Commission to find intervening injury and vacate authorization; the court denied mandamus, finding some evidence supported the Commission's decision.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether subsequent work acts constituted intervening injuries breaking causation and vitiating authorization for revision surgery | Relator: lifting (Nov 2015) and mopping (Jan 2016) were new injuries that broke causal link to 2013 injury | Commission/claimant: those ordinary work activities did not amount to distinct intervening injuries; retear related to original allowed condition | Denied relief — Court: Commission did not abuse discretion; record contains some evidence supporting relation to original injury |
| Whether Miller criteria for medical authorization were met (relatedness, necessity, cost reasonableness) | Relator: because causation broken, Miller prongs fail | Respondents: peer review and treating records show services related and necessary and cost reasonable | Held: Evidence (MRI, treating notes, peer review) satisfies Miller; authorization proper |
| Standard for mandamus relief to overturn Commission | Relator: Commission abused discretion by ignoring Dr. Erickson | Respondents: Commission may weigh evidence and credibility; need only some evidence to support decision | Held: Mandamus denied — no abuse where some evidence supports Commission |
| Whether Commission must treat ordinary activity-related exacerbations as intervening injuries | Relator: incidents were new injuries | Respondents: ordinary tasks post-repair commonly exacerbate compromised repair and do not necessarily break causation | Held: Commission reasonably concluded ordinary activities were not discrete intervening injuries in this record |
Key Cases Cited
- State ex rel. Miller v. Indus. Comm., 71 Ohio St.3d 229 (1994) (three-prong test for authorizing medical services: relatedness, necessity, cost reasonableness)
- State ex rel. Berger v. McMonagle, 6 Ohio St.3d 28 (1983) (mandamus requirements: clear right, clear duty, no adequate remedy)
- State ex rel. Pressley v. Indus. Comm., 11 Ohio St.2d 141 (1967) (mandamus review of Commission orders standard)
- State ex rel. Elliott v. Indus. Comm., 26 Ohio St.3d 76 (1986) (mandamus lies only if Commission order unsupported by any evidence)
- State ex rel. Lewis v. Diamond Foundry Co., 29 Ohio St.3d 56 (1987) (some evidence supports Commission precludes mandamus)
- State ex rel. Teece v. Indus. Comm., 68 Ohio St.2d 165 (1981) (credibility and weight of evidence lie with Commission)