Pittsburgh & Conneaut Dock Co. v. Director, Office of Workers' Compensation Programs, United StatesPittsburgh & Conneaut Dock Co. v. Director, Office of Workers' Compensation Programs, United States
Lead Opinion
MCKEAGUE, J., delivered the opinion of the court, in which POLSTER, D.J., joined. MOORE, J. (pp. 267-273), delivered a separate opinion concurring in part and dissenting in part.
AMENDED OPINION
This case arises out of a claim for worker’s compensation benefits under the Longshore and Harbor Workers’ Compensation Act (“Longshore Act”).
I. BACKGROUND
Thomas Bordeaux began working at P & C Dock in 1997. He worked as a structural welder initially and then as a pipe fitter. Bordeaux was injured on September 12, 2000. While he was working in a catch basin, a fifty-pound sandbag fell into the pit and struck him on the base of his head and neck, missing his hard hat. Bordeaux estimated that the sandbag fell approximately twelve to fourteen feet before hitting him. Following treatment at the emergency room, Bordeaux was released. He returned to the hospital the following day because he was having difficulty formulating any kind of sentence and was suffering extreme headaches. After his visit to the emergency room, Bordeaux was treated for a right wrist fracture and underwent extensive therapy for his neck and wrist. Bordeaux testified that two to three months following his accident he continued to have episodes of numbness and tingling in his head, occasionally leading him to become dizzy and pass out. Bordeaux also indicated he was having difficulty with focusing and his attention span.
Bordeaux underwent extensive medical treatment for both his neck and wrist injuries and his cognitive problems. Throughout 2000, 2001, and into 2002 he attended numerous physical therapy sessions before being discharged when his progress reached a plateau. At the time of the
Bordeaux also attended numerous speech therapy sessions. The speech therapy was in the form of cognitive therapy which was designed to aid him in his day-to-day activities such as remembering people’s names, numbers and appointments. Therapy was also designed to help him read due to complaints that he had been unable to concentrate for more than ten minutes. Bordeaux indicated that the speech sessions were beneficial and that he was able to increase his concentration time from ten to twenty minutes.
Bordeaux’s wife stated that prior to his accident in September of 2000, Bordeaux was in good shape and had no problems with his memory. The day following his accident she noticed that he was a little slow with his speech, and he indicated that he was having trouble getting his thoughts together. Mrs. Bordeaux also noted that Bordeaux seemed somewhat confused following his accident and was not able to focus on what was going on around him. Bordeaux’s speech and focus steadily improved for six to eight months. After that, she believed that his progress plateaued. She believed that he continued to have memory problems and problems focusing.
In May of 2001, Bordeaux began taking Zoloft, an antidepressant medication, at the suggestion of psychologist Dr. Schwa-benbauer. The prescription for Zoloft was discontinued approximately a month later when Bordeaux presented to his family physician, Dr. Choi, with unusual symptoms including cold sweats and elevated blood pressure. Bordeaux’s medical records show that he subsequently was prescribed, and demonstrated an intolerance for, several other antidepressant medications including Nortriptoline, Depakote, Elavil, and Doxepin.
At the formal hearing, deposition testimony from three doctors was submitted that addressed the state of Bordeaux’s cognitive limitations. Dr. Schwabenbauer pointed out that Bordeaux was well beyond the six to twelve month primary recovery period for head injuries and opined that his cognitive limitations had reached maximum medical improvement. The doctor also indicated that further individual psychotherapy and antidepressant therapy could assist Bordeaux in dealing with the “emotional residuals” of his head injury although they would not enable any further recovery in the area of cognitive function. Dr. Schwabenbauer acknowledged that the further therapy he was suggesting should help Bordeaux with his anxiety and depression which could, in turn, have an impact on whether he could return to work. The doctor stated that he had no way to estimate the likelihood that Bordeaux would see beneficial results from the suggested therapy. When asked whether the chance was better than a coin flip, he responded that it was “[pjrobably better than a coin flip, but it could be very difficult to predict someone’s response to treatment in advance.”
Dr. McCue, a neuropsychologist, examined Bordeaux in January and February of 2003. While he initially stated that Bordeaux had not yet reached maximum psychological improvement, later in his deposition he stated that the cognitive limitations Bordeaux was suffering were permanent and that Bordeaux had reached maximum medical improvement. Dr. McCue testified that a course of psychotherapy (including antidepressant medi
Bordeaux’s treating neurologist, Dr. Lyons, treated Bordeaux for his head injury, not for any underlying psychological condition. When asked whether she agreed with the recommendations for additional psychotherapy made by Drs. Schwa-benbauer and McCue, Dr. Lyons replied that she “was in no position to disagree.” She went on to opine that the proposed treatment would not treat the underlying cognitive condition or significantly improve Bordeaux’s degree of cognitive limitation. As to Bordeaux’s ability to return to work after undergoing the proposed treatment, Dr. Lyons opined that there was a twenty percent chance that it would help him return to work and an eighty percent chance that it would help him feel better. Dr. Lyons further testified that returning Bordeaux to work by relieving his symptoms of anxiety and depression was “worth trying,” but she commented that “I don’t think it is going to happen.”
On January 21, 2004, the ALJ entered an order awarding benefits under the Longshore Act. Following an extensive review of the evidence, the ALJ awarded permanent and total disability benefits. He found August 20, 2002 to be the date Bordeaux became permanently and totally disabled. Temporary total disability was awarded for the preceding period. Medical benefits were also awarded. While the matter had been pending before the ALJ, P & C Dock had requested the ALJ to compel Bordeaux to participate in the psychotherapy that had been recommended. The ALJ refused this request in the order awarding benefits. In a supplemental proceeding, the ALJ ordered P & C Dock to pay Bordeaux’s attorney’s fees pursuant to
P & C Dock appealed the decision awarding compensation and denying the motion to compel and the award of attorney’s fees to the Benefits Review Board (“BRB”). The BRB affirmed the decision of the ALJ that Bordeaux was permanently and totally disabled. The BRB also upheld the refusal of the ALJ to direct Bordeaux to pursue the prescribed psychotherapy. Next, the BRB upheld the award of attorney’s fees. However, it found that the fees should not have been awarded under
II. ANALYSIS
A. Standard of Review
This court reviews ALJ and BRB decisions on a limited basis. Morehead Marine Services, Inc. v. Washnock,
B. Permanent Disability
After the formal hearing, the ALJ found that Bordeaux was permanently and totally disabled. P & C Dock appealed this determination to the BRB which affirmed the ALJ’s determination. P & C Dock acknowledges that the ALJ correctly determined that Bordeaux’s physical injuries had reached maximum medical improvement, but argues that his cognitive impairment was temporary because several experts opined that Bordeaux would benefit from additional psychotherapy. The ALJ’s determination that Bordeaux’s disability was permanent is based on substantial evidence and consistent with applicable law.
There are two separate tests for determining whether and when a disability has become permanent under the Long-shore Act. E.g., Eckley v. Fibrex & Shipping Co., 21 BRBS 120, 122-23 (1988). Under the first test a residual disability is considered permanent when an employee’s condition reaches the point of maximum medical improvement. James v. Pate Ste-vedoring Co., 22 BRBS 271, 274 (1989); Phillips v. Marine Concrete Structures, 21 BRBS 233, 235 (1988). Under the second test, even if a person has not reached maximum medical improvement, his or her disability is still considered permanent if it “has continued for a lengthy period, and it appears to be of lasting or indefinite duration, as distinguished from one in which recovery merely awaits a normal healing period.” Watson v. Gulf Stevedore Corp.,
P & C Dock argues that it was error for the ALJ to find that Bordeaux’s cognitive impairment was permanent because Drs. Schwabenbauer, McCue, and Lyons opined that there was a possibility that Bordeaux’s cognitive impairment would improve in the future with additional psychotherapy and antidepressant medication. Specifically, P & C Dock points out that Dr. Schwabenbauer testified that the chances Bordeaux would benefit from additional psychotherapy were “probably better than a coin flip, but it could be very difficult to predict someone’s response to treatment in advance.” Dr. Lyons opined that there was a twenty percent chance psychotherapy would help Bordeaux return to work and an eighty percent chance it would help him feel better. According to P & C Dock, this medical evidence that there was a possibility of improvement precludes a finding that Bordeaux’s cogni
P & C Dock’s argument addresses the first test for disability, but ignores the second. The entirety of its argument is based on the premise that the possibility of improvement in the future necessarily precludes a finding of permanency. The case law is replete with statements to the contrary. Watson,
There is substantial evidence in the record to support the ALJ’s conclusion that Bordeaux’s cognitive disability was permanent under the Watson test. Dr. Schwa-benbauer testified that six to twelve months was the primary recovery period for a head injury such as the one Bordeaux suffered. The ALJ pointed out that Bordeaux’s cognitive limitations had lasted for more than a year and a half beyond the primary recovery period. There was no testimony that Bordeaux’s cognitive limitations were actually improving at the time of the formal hearing. Drs. Schwa-benbauer and Lyons, the two doctors who were familiar with the treatment Bordeaux had undergone, both pointed out that any additional improvement brought on by additional therapy would only be in the manner Bordeaux deals with his cognitive limitation. Neither doctor anticipated a decrease in the underlying limitation itself. Looking at the record as a whole, there is substantial evidence for the conclusion that Bordeaux’s cognitive limitation had “continued for a lengthy period, and it appearfed] to be of lasting or indefinite duration, as distinguished from one in which recovery merely awaits a normal healing period.” Watson,
C. Motion to Compel
After the formal hearing, but before the ALJ issued his decision, P & C Dock filed a motion to compel requesting the ALJ to issue an order directing Bordeaux to participate in the recommended course of psychotherapy or have his worker’s compensation payments suspended. The ALJ first observed that this motion was not timely, but proceeded to declare that it also failed on the merits because Bordeaux’s refusal to participate in the suggested psychotherapy was not unreasonable. P & C Dock challenges both determinations. We do not need to reach the timeliness issue because the ALJ’s de-
The Longshore Act provides that:
If at any time the employee unreasonably refuses to submit to medical or surgical treatment, or to an examination by a physician selected by the employer, the Secretary or administrative law judge may, by order, suspend the payment of further compensation during such time as such refusal continues, and no compensation shall be paid at any time during the period of such suspension, unless the circumstances justified the refusal.
The determination of whether the refusal of medical treatment is unreasonable is an issue of fact which must be upheld if it is supported by substantial evidence in light of the whole record. See Profitt v. Deatley-Overman, Inc.,
The ALJ determined that Bordeaux’s refusal to undergo the suggested psychotherapy was not unreasonable. The essential reasons the ALJ reached this conclusion were that the suggested treatment would require Bordeaux to take antidepressants and that Bordeaux testified at the hearing that he was not depressed. The ALJ pointed out that between the time of the injury and the formal hearing Bordeaux had been prescribed various antidepressant medications which had all been discontinued by his doctor due to his inability to tolerate them. A reasonable mind could conclude that an ordinary person who did not feel depressed would decide not to pursue a course of treatment directed at resolving depression when such treatment would involve taking antidepressant medications towards which he had previously demonstrated considerable intolerance.
P & C Dock is unable to point to a sufficient basis for overturning the ALJ’s determination that Bordeaux’s refusal of the psychotherapy was not unreasonable. P & C Dock argues that Bordeaux’s refusal must be unreasonable because there was testimony that the psychotherapy might have helped him feel better or return to work or both. Although this is the case, it is not a basis for overturning the ALJ’s determination. The reasonableness determination must be made by considering how an ordinary reasonable person in the claimant’s condition would weigh the risks as well as the potential benefits. The mere fact that the record contains some evidence of a potential benefit from a pro
P & C Dock points to two purportedly similar cases in which refusal of medical treatment was held unreasonable. The first case upheld an ALJ’s determination that refusal to undergo conservative, noninvasive treatment for a back injury was unreasonable. Profitt v. Deatley-Over-man, Inc.,
The remainder of P & C Dock’s arguments that the ALJ should have granted its motion to compel are based on the premise that Bordeaux’s refusal of treatment was unreasonable. The ALJ’s determination that Bordeaux’s refusal was not unreasonable is supported by substantial evidence and consistent with applicable law. P & C Dock has not cited any authority granting an ALJ the power to suspend payment of compensation based on a refusal of medical treatment that was not unreasonable. Consequently, there is no basis to overturn the ALJ’s denial of P & C Dock’s motion to compel or the BRB’s affirmance of that decision.
D. Attorney’s Fees
After the ALJ determined that Bordeaux was permanently and totally disabled, Bordeaux filed a motion for attorney’s fees. The ALJ granted the motion finding that Bordeaux was entitled to fees pursuant to
When a claimant employs an attorney to pursue his or her claim under the Long-shore Act,
P & C Dock began voluntarily paying Bordeaux temporary total disability benefits within thirty days of receiving notice of his claim, but later disputed that his disability was permanent in nature. P & C Dock refused to pay permanent disability benefits until Bordeaux prevailed on this issue in the formal hearing. Before the formal hearing an informal conference was held on September 19, 2002.
1. S
The ALJ held that P & C Dock was liable for attorney’s fees pursuant to subsection (a). The ALJ recognized that subsection (a) does not give rise to liability for fees if an employer voluntarily pays at least some compensation. Nevertheless, the ALJ went on to assert that subsection (a) does apply whenever an employer “has controverted some aspect of the claim and claimant successfully obtains an award which employer contested.” Mobley v. Bethlehem Steel Corp., 20 BRBS 239, 245 (1988). Even though P & C Dock paid some compensation in the form of temporary total disability payments, the ALJ concluded that subsection (a) applied be
The BRB pointed out that Bordeaux filed his claim on November 6, 2000 and that P & C Dock promptly began paying temporary total disability payments. Bordeaux claims that the requirements of subsection (a) are met because his request for an informal conference to determine the issue of permanency was a “claim for compensation” for purposes of subsection (a) and P & C Dock refused to pay the permanent disability benefits he sought in that claim. The only case Bordeaux cites in support of this argument is a Ninth Circuit case which observed in dicta that under such circumstances subsection (a) might be applicable. Natl Steel & Shipbuilding Co. v. OWCP,
The Fourth Circuit has thoroughly examined the same argument Bordeaux presents here, and it rejected that argument for two reasons. Edwards,
The reasoning in the Edwards case provides a sound basis for the principle other cases have consistently applied. Attorney’s fees cannot be assessed under subsection (a) when an employer voluntarily pays compensation within thirty days of when the claimant files his or her initial claim for compensation. P & C Dock paid temporary total disability compensation to Bordeaux within thirty days of when he filed his claim for compensation on November 6, 2000. Therefore, the BRB’s conclusion that Bordeaux was not entitled to attorney’s fees under subsection (a) was proper.
£
Subsection (b) sets forth the requirements for fee liability when an employer voluntarily pays some compensation but a dispute arises concerning additional compensation. That provision states that the following circumstances must occur in order for an employer to be liable for
The BRB acknowledged that in this case there was no written recommendation regarding the disposition of the controversy as required by the plain language of subsection (b). Nevertheless, the BRB went on to claim that “the absence of a written recommendation by the district director following the informal conference ... does not preclude liability.” The BRB went on to note that since P & C Dock voluntarily paid compensation and Bordeaux was awarded additional compensation by the ALJ, that was sufficient to make P & C Dock liable for attorney’s fees under subsection (b). The Ninth Circuit precedent relied upon by the BRB does support its ruling. See, e.g., Nat’l Steel,
The Ninth Circuit has routinely held employers liable for attorney’s fees under subsection (b) even when the literal terms of the statute have not been met. This approach is based on the assessment that “[t]he purpose of the statute is to authorize the assessment of legal fees against employers in cases where the existence or extent of liability is controverted and the employee-claimant succeeds in establishing liability or obtaining increased compensation in formal proceedings in which he or she is represented by counsel.” Nat’l Steel,
The Fourth and Fifth Circuits have rejected the approach taken by the Ninth Circuit and have strictly enforced the specific terms of subsection (b). They have emphasized that the requirements set forth in the plain language of the statute must be met. Therefore, the lack of an informal conference and the lack of a written recommendation have been held to preclude the assessment of attorney’s fees under subsection (b). Edwards,
We adopt the approach taken by the Fourth and Fifth Circuits. “In all cases of statutory construction, the starting point is the language employed by Congress.” Appleton v. First Nat’l Bank of Ohio,
III. CONCLUSION
The ALJ’s determination that Bordeaux’s cognitive disability was permanent was based on substantial evidence and consistent with applicable law. Therefore, it is beyond the purview of this court to overturn that decision. The ALJ’s denial of the motion to compel based on his conclusion that Bordeaux’s refusal to undergo the recommended additional therapy was not unreasonable is similarly well-grounded. However, the conclusion that subsection (a) applies in this case is contrary to applicable law as pointed out by the BRB. Finally, the BRB’s determination that subsection (b) applies was error. Accordingly, the fee award is vacated, and the case is remanded for further proceedings to fix the fee payable by Bordeaux, pursuant to
Notes
. If an employee's condition does improve after he or she has been determined to be permanently disabled, the employer may have the employee’s condition reviewed and reevaluated under the modification procedure set forth in
. P & C Dock does allege that Bordeaux refused psychotherapy for the purpose of staying fully disabled and ensuring that he would not recover enough to return to work. This allegation is mere speculation which the ALJ properly rejected based on the extensive medical treatment Bordeaux willingly underwent in the years following his accident.
. At oral argument, counsel for P & C Dock stated that a total of three informal conferences were held. However, the record does not provide any reference to or information regarding any informal conferences other than the one held on September 19, 2002.
. Since the Benefits Review Board is not a policymaking agency, its interpretation of the Longshore Act is not entitled to any special deference from the court. Potomac Elec. Power Co. v. OWCP,
. The complete text of subsection (b) reads as follows:
If the employer or carrier pays or tenders payment of compensation without an award pursuant to section 914(a) and (b) of this title, and thereafter a controversy develops over the amount of additional compensation, if any, to which the employee may be entitled, the deputy commissioner or Board shall set the matter for an informal conference and following such conference the deputy commissioner or Board shall recommend in writing a disposition of the controversy. If the employer or carrier refuse to accept such written recommendation, within fourteen days after its receipt by them, they shall pay or tender to the employee in writing the additional compensation, if any, to which they believe the employee is entitled. If the employee refuses to accept such payment or tender of compensation, and thereafter utilizes the services of an attorney at law, and if the compensation thereafter awarded is greater than the amount paid or tendered by the employer or carrier, a reasonable attorney's fee based solely upon the difference between the amount awarded and the amount tendered or paid shall be awarded in addition to the amount of compensation. The foregoing sentence shall not apply if the controversy relates to degree or length of disability, and if the employer or carrier offers to submit the case for evaluation by physicians employed or selected by the Secretary, as authorized insection 907(e) of this title and offers to tender an amount of compensation based upon the degree or length of disability found by the independent medical report at such time as an evaluation of disability can be made. If the claimant is successful in review proceedings before the Board or court in any such case an award may be made in favor of the claimant and against the employer or carrier for a reasonable attorney’s fee for claimant’s counsel in accord with the above provisions. In all other cases any claim for legal services shall not be assessed against the employer or carrier.
Concurrence Opinion
concurring in part and dissenting in part.
Although I agree with the majority’s conclusion upholding the award of permanent total disability benefits to Thomas Bordeaux (“Bordeaux”) and the denial of the motion to compel, I write to express my disagreement with the majority’s reversal of the attorney-fee award. Both the Administrative Law Judge (“ALJ”) and the Benefits Review Board (“BRB”) concluded that Bordeaux was entitled to recover attorney fees, albeit on different grounds. Although the statutory scheme’s complexity may hinder identification of the proper statutory basis for a fee award, one thing is conclusive: Bordeaux is entitled to attorney fees. Denying fees to Bordeaux based on rigid formalities that are not expressly mandated by the statute is contrary to two of the primary concerns underlying the Longshore and Harbor Workers’ Compensation Act (“the Act”),
I.
A. Basic Contours
Title
B. Employer’s Refusal to Pay One Type of Benefit as “Declin[ing] to [P]ay [A]ny [Compensation”
Two theories support Bordeaux’s claim for attorney fees under
The result in FMC is not dictated here. Bordeaux was awarded $425.47 per month for permanent total disability benefits, and his employer, Pittsburgh & Conneaut Dock (“P & C Dock”), had been paying him $425.01 per month for temporary disability benefits. This difference in payment is not a mere matter of forty-six cents; rather, it points to a qualitative difference in the benefits actually paid to Bordeaux and the benefits to which he was legally entitled and that he was ultimately awarded. Unlike temporary disability benefits, permanent disability benefits are increased each year on October 1 by an annual adjustment under
C. A Request for an Informal Conference as a Claim for Compensation
The second theory supporting Bordeaux’s claim under
The Fourth Circuit in Virginia International Terminals also reasoned that
On these grounds, I find the Fourth Circuit’s decision to be unpersuasive, and instead would consider Bordeaux’s request for an informal conference to have been the “filing [of] a claim” under
II.
A. Statutory Text
and thereafter a controversy develops over the amount of additional compensation, if any, to which the employee may be entitled, the deputy commissioner or Board shall set the matter for an informal conference and following such conference the deputy commissioner or Board shall recommend in writing a disposition of the controversy. If the employer or carrier refuse to accept such written recommendation, within fourteen days after its receipt by them, they shall pay or tender to the employee in writing the additional compensation, if any, to which they believe the employee is entitled.
B.
The majority concludes that to secure an award pursuant to
The statute mentions these formalities, but it does not state that they are preconditions to an award under
When the language of a statute leads to an “unreasonable” result “plainly at variance with the policy of the legislation as a whole,” we are to “follow[] that purpose rather than the literal words.” United States v. Am. Trucking Ass’ns, Inc.,
III. BLOCK BILLING
P & C Dock’s objection to the format of Bordeaux’s applications for attorney fees to the ALJ and the BRB is without merit.
IV. CONCLUSION
Because the text of
. The legislative history leaves the question open. It should be noted, however, that the House Report regarding
. The majority wrongly cites Savannah Machine & Shipyard Company,
. This one-year time limit does not bar Bordeaux’s claim because he requested the informal conference within one year of realizing that his injury was permanent. See
. Given that, as I conclude below, the formalities mentioned in
. In noting that our sister circuits are split on this issue, the majority erroneously asserts that the Fifth Circuit has rejected the Ninth Circuit's position. The Fifth Circuit has issued a number of decisions that do not consider these formalities to be prerequisites to a fee award. See James Flanagan Stevedores, Inc. v. Gallagher,
. The regulations further require that ”[w]hen it becomes apparent during the course of the informal conference that agreement on all issues cannot be reached, the district director shall bring the conference to a close, shall evaluate all evidence available to him or her, and after such evaluation shall prepare a memorandum of conference setting forth all outstanding issues, such facts or allegations as appear material and his or her recommendations and rationale for resolution of such issues.”
. This case is distinguishable thus from those cases cited by the majority that denied an award for lack of an informal conference, see Va. Int'l Terminals, Inc.,
. The regulations require that fee applications submitted to the ALJ “shall be supported by a complete statement of the extent and character of the necessary work done ... and the hours devoted by each such person to each category of work.”
. The ALJ considered a number of P & C Dock's objections to individual entries and discarded those entries that lacked the requisite specificity.