LETICIA M. SALINAS, Claimant-Respondent,
BRIDGEVIEW ESTATES, Employer, and OLD REPUBLIC INSURANCE COMPANY, Surety, Defendants-Appellants.
Opinion No. 42
from the Idaho Industrial Commission.
award of attorney fees by the Commission is vacated.
Gardner and Margurit R. Cleverdon, Boise, attorneys for
appellant. Margurit R. Cleverdon argued.
Patrick Brown, Twin Falls, attorney for respondent.
Nature of the Case
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
Factual and Procedural Background
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
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.
March 4, 2016, the Commission issued an order consistent with
the Referee's recommendation.
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 ...