State ex rel. Honda of Am. v. Indus. Comm.
2021 Ohio 2113
| Ohio Ct. App. | 2021Background:
- Honda is a self-insured employer; Todd Hughes sustained an allowed work-related back injury in 1997 and had multiple related surgeries (most recent 2011).
- Hughes obtained Percocet prescriptions in 2015 from Dr. O'Connor and sought employer (Honda) payment; DHO and SHO authorized payment in 2016.
- BWC adopted Ohio Adm.Code 4123-6-21.7 (opioid-utilization limits) effective Oct. 1, 2016 for new injuries and for all claims on or after Jan. 1, 2017.
- Hughes filed a C-86 reimbursement motion in 2018; the full Industrial Commission (Feb. 9, 2019) upheld authorization, reasoning the prescribed dosage was below the rule's morphine-equivalent threshold and therefore the rule did not apply.
- Honda sought a writ of mandamus in the Tenth District, arguing the commission misapplied the rule (it applies to all claims after Jan. 1, 2017 and to opioids in the chronic phase regardless of dose); the court agreed and remanded for a new hearing to apply 4123-6-21.7.
Issues:
| Issue | Plaintiff's Argument (Honda) | Defendant's Argument (Commission / Hughes) | Held |
|---|---|---|---|
| Does Ohio Adm.Code 4123-6-21.7 apply to Hughes's claim adjudicated Feb. 9, 2019? | The rule applies to all claims on or after Jan. 1, 2017, so it governs Hughes's 2019 adjudication regardless of 1997 injury date. | The commission argued the rule does not apply because the prescription dosage is below the rule's MED threshold. | Court: Rule applies to "all claims" on or after Jan. 1, 2017; commission erred by not applying the full rule. |
| Is the rule limited to high-dose prescriptions only, or does it also govern opioids prescribed in the chronic phase regardless of dose? | The rule governs opioids in the chronic phase (more than 12 weeks after injury/surgery) even if dosage is below the MED threshold. | Commission relied on dosage threshold as dispositive. | Court: Chronic-phase prong applies; commission should have considered whether Hughes was in chronic phase. |
| Did the commission abuse discretion by failing to consider the documentation prerequisites (4123-6-21.7(D) and (E)) before authorizing payment? | Honda: Commission failed to consider whether required documentation was submitted, as mandated before reimbursement. | Commission/Hughes: Focused on MED threshold; other defenses raised on appeal. | Court: Commission abused discretion by refusing to evaluate the full text and documentation requirements; remand for new hearing. |
| Could the "compassionate care" exception (4123-6-21.7(G)) justify reimbursement? | (Implicit) If applicable, exception could support payment but documentation must show it. | Commission argued compassionate care might apply. Hughes raises other procedural/regulatory defenses. | Court: Magistrate properly declined to address compassionate-care exception because commission’s order did not rely on it and record lacks evidence supporting its application. |
Key Cases Cited
- State ex rel. Pressley v. Indus. Comm., 11 Ohio St.2d 141 (1967) (mandamus standard: relator must show clear legal right and commission's clear legal duty)
- State ex rel. Elliott v. Indus. Comm., 26 Ohio St.3d 76 (1986) (mandamus where commission's factual finding has no supporting evidence)
- State ex rel. Ohio Presbyterian Retirement Servs. v. Indus. Comm., 151 Ohio St.3d 92 (2017) (defers to commission on factual questions but mandamus may issue for legal error)
- McFee v. Nursing Care Mgmt. of Am., Inc., 126 Ohio St.3d 183 (2010) (administrative rules are construed using statutory construction principles)
- Brilliant Elec. Sign Co. v. Indus. Comm., 57 Ohio St.2d 51 (1979) (ordinary-meaning rule applies to administrative rules)