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Salinas v. Bridgeview Estates

Supreme Court of Idaho

May 9, 2017

LETICIA M. SALINAS, Claimant-Respondent,
v.
BRIDGEVIEW ESTATES, Employer, and OLD REPUBLIC INSURANCE COMPANY, Surety, Defendants-Appellants.

         2017 Opinion No. 42

         Appeal from the Idaho Industrial Commission.

         The award of attorney fees by the Commission is vacated.

          Alan Gardner and Margurit R. Cleverdon, Boise, attorneys for appellant. Margurit R. Cleverdon argued.

          Patrick Brown, Twin Falls, attorney for respondent.

          JONES, JUSTICE.

         I. Nature of the Case

         Leticia Salinas ("Salinas") injured her back while working for Bridgeview Estates (the "Employer"). After receiving medical treatment for roughly six weeks, her workers' compensation benefits were temporarily denied by Old Republic Insurance Company (the "Surety"). Nearly two years later, Salinas filed a claim for reimbursement for medical costs and all future medical care. The Idaho Industrial Commission (the "Commission") concluded that Salinas failed to prove that she was entitled to payment of compensation. Notwithstanding that conclusion, the Commission awarded Salinas attorney's fees pursuant to Idaho Code section 72-804. The Employer and Surety appeal that award.

         II. Factual and Procedural Background

         On or about May 5, 2011, Salinas injured her back (the "Injury") while in the course and scope of her employment as a registered nurse. At the direction of the Employer, Salinas visited Dr. Stagg seven times between June 1, 2011, and July 13, 2011. However, sometime between late July and early August 2011, Salinas was temporarily cut off from workers' compensation medical benefits while the Surety investigated her medical background. The temporary denial became, in effect, permanent when the Surety stopped communicating with Salinas. Because Salinas did not have the funds to continue her treatment at the time, she was not treated again until April 2013. It was then that Salinas hired an attorney and pursued this claim for previously denied benefits. Salinas argued that she was entitled to reimbursement of all medical costs that she incurred after the Surety refused to provide further medical treatment, and additionally, all future palliative care related to the Injury. The Employer and Surety argued as follows: (1) Salinas had been paid all benefits to which she was entitled; (2) her current condition is not the result of the Injury; (3) she has no permanent impairment or disability from the Injury; and (4) she has failed to prove an entitlement to attorney's fees.

         On August 6, 2015, the Commission assigned the matter to Brian Harper (the "Referee"). The Referee made five conclusions. First, he concluded that Salinas had failed to prove that her current low back condition was caused in whole or in part by the Injury. This conclusion was supported by the finding that Salinas had periodic low back issues pre-dating the Injury. Second, he concluded that Salinas had failed to prove a right to past unpaid medical care or future medical care, palliative or curative, related to the Injury. Specifically, he noted that Salinas had failed to show that she obtained any medical care for her low back during the time immediately after the Surety discontinued her claim. It was not until April 2013 that Salinas sought low back-related treatment, and she did not prove that this treatment or any subsequent treatment was causally related to the Injury. Third, he concluded that Salinas had failed to prove that she suffered a permanent impairment as a result of the Injury. Fourth, he concluded, that since Salinas did not suffer a permanent impairment, she could not have suffered a permanent disability. Fifth, and most important to this appeal, the Referee concluded that Salinas was entitled to attorney's fees pursuant to Idaho Code section 72-804 for the "Surety's prolonged discontinuation of medical benefits without a reasonable ground." Specifically, the Referee concluded as follows:

In effect, Surety discontinued compensation justly due and owing to [Salinas] without a reasonable ground, not per se by temporarily suspending her medical coverage, but by unreasonably delaying its decision on continuing coverage on an accepted claim and/or refusing to communicate with [Salinas] on her coverage status despite her repeated attempts to speak with the adjuster.

         On March 4, 2016, the Commission issued an order consistent with the Referee's recommendation.

         On March 24, 2016, the Employer and Surety moved for reconsideration of the award of attorney's fees. On April 28, 2016, the motion for reconsideration was ...


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