CLAIM NO. E600098


Before the Arkansas Workers’ Compensation Commission

Upon review before the FULL COMMISSION in Little Rock, Pulaski County, Arkansas.

Claimant represented by the HONORABLE PHILLIP WELLS, Attorney at Law, Jonesboro, Arkansas.

Respondents represented by the HONORABLE CURTIS NEBBEN, Attorney at Law, Fayetteville, Arkansas.

Decision of Administrative Law Judge: Affirmed as modified.

[2] The respondent has appealed a decision of the administrative law judge awarding the claimant certain medical benefits. The respondent is appealing the decision because it believes all the medical care was unreasonable and unnecessary. For the reasons set out below, the administrative law judge’s decision is hereby affirmed as modified.

[3] The claimant suffered an admittedly nonspecific injury to her left wrist. The parties stipulated to an injury date of September 5, 1995. When the claimant reported her wrist injury, the respondent referred her to Dr. Terence Braden, the company physician. Dr. Braden saw the claimant twice in regard to her complaints of left wrist pain. Dr. Braden diagnosed De Quervain’s syndrome. Dr. Braden recommended conservative care including ice massages and anti-inflammatory medication along with rotation of job duties. Dr. Braden saw the claimant again on September 22 and recommended outpatient and occupational therapy at the Arkansas Hand Center. However, the claimant was dissatisfied with the treatment she was receiving from Dr. Braden and subsequently effected a change of physician pursuant to Ark. Code Ann. § 11-9-514 (a)(ii)(b), from Dr. Braden to Dr. Brooks Holifield, a chiropractor. The claimant first saw Dr. Holifield on September 28, 1995. Dr. Holifield proceeded to administer a program of massage therapy and wrist manipulation for the claimant. He continued treating her through February 15, 1996. The claimant was eventually released and returned to work without restrictions. At the hearing in this case, the claimant indicated that her condition had completely resolved. At no time during this case had the claimant ever missed work.

[4] The respondent contends that treatment provided by Dr. Holifield was not reasonable or necessary. In support of that contention, the respondent argued that there is no objective medical evidence to support the reasonableness or necessity of Dr. Holifield’s treatment. The respondent also argued that some of the treatment was performed by Dr. Holifield’s staff who are not properly certified or licensed to administer such care. The respondent also argues that there was a significant amount of double billing and other irregularities in Dr. Holifield’s billing practices.

[5] The claimant contends that the treatment was reasonable and necessary. She supports her contention by pointing to the fact that she noted immediate improvement after she began treatments by Dr. Holifield, and that her condition did completely resolve. She also argues that the treatment provided to the claimant by Dr. Holifield is equivalent to the physical therapy proposed by Dr. Braden.

[6] The first issue to be dealt with is the respondent’s argument that the treatment furnished by Dr. Holifield was not reasonable or necessary. The respondent is apparently basing this contention on Ark. Code Ann. § 11-9-102 (5)(D) that states “A compensable injury must be established by medical evidence supported by objective findings as defined by Ark. Code Ann. § 11-9-102 (16).” However, the respondent’s reliance upon this section is misplaced. That section refers to the question of compensability. In this case, compensability is not an issue. The same argument being made by the respondent was specifically rejected inGraham v. Chamber Door Industries, Inc., Full Commission opinion, January 9, 1997 (E400258). In that case, the Commission held that they did not agree with the respondent’s assertion that objective medical evidence is a necessary prerequisite to a finding of entitlement to temporary total disability benefits. The Commission further held that certain additional disputed medical care was reasonable and necessary. We hold here that the objective medical finding requirement only applies to compensability and not collateral issues.

[7] The respondent also contends that treatment furnished by Dr. Holifield was of excessive duration and was unduly repetitive. In this regard, they relied upon the opinion of Dr. Terrence Braden set out in his report of April 12, 1996. We agree that not all of Dr. Holifield’s treatments were reasonable and necessary. In our opinion, five months of treatments that occurred three to four times per week is excessive for this type of injury. A review of Dr. Holifield’s office notes support this conclusion. Dr. Holifield’s initial office note dated September 29, 1995, states that the claimant was having left forearm, wrist, and thumb pain with a dull ache associated with numbness and tingling in the tips of her fingers. This same note was repeated until December 28, 1995. The office note for that date states that since her last visit, the claimant has not experienced any wrist pain and has no objective complaints. That note is basically repeated for the balance of Dr. Holifield’s treatment of the claimant with only an occasional reference to some soreness to the claimant’s wrist. However, we do not agree with the respondent’s argument that none of Dr. Holifield’s treatment is reasonable or necessary. Dr. Braden had indicated that the claimant needed additional treatment and opined in his report of April 12, 1996, that the claimant’s condition would not resolve for several weeks.

[8] We therefore find that the treatment furnished by Dr. Holifield was reasonable and necessary through December 28, 1995. We find that any treatment rendered after that date by Dr. Holifield was not reasonable and necessary. We are persuaded by the fact that the treatment furnished by Dr. Holifield was similar to the treatment Dr. Braden recommended the claimant receive at the Arkansas Hand Center. Also, the claimant clearly benefitted from this treatment and it appears from Dr. Holifield’s office notes that her condition had completely resolved by December 28, 1995. However, since almost all of Dr. Holifield’s office notes after December 28, 1995, indicate that the claimant was not having any wrist pain, it is our opinion that treatments after that date were not reasonably necessary.

[9] Two other issues raised by the respondent should be addressed. The respondent contends that since some of the treatment received by the claimant was furnished by persons other than Dr. Holifield, these treatments should not be held to be reasonable and necessary. However, this argument is without merit. Doctors frequently refer some aspect of treatment to their staff members. Sometimes this includes nurses, physical therapists, or other persons operating at the direction and control of the physician. In this case, the claimant testified that while some of the massages were performed by the doctor’s staff, they were performed at Dr. Holifield’s direction and usually in his presence.

[10] The respondent also argues in its brief that Dr. Holifield had double billed the treatments he provided to the claimant, both to the claimant’s health insurance carrier and to the respondent. In this regard, the respondent points to the testimony of the claimant stating that while she was being treated by Dr. Holifield he did from time to time manipulate her spine and neck in an attempt to resolve certain non-job related conditions. They argue that they should not pay for any treatments already paid by a health insurance carrier. While this contention would be meritorious, if supported by the evidence, the record does not contain any documents or testimony indicating that Dr. Holifield did double bill the claimant’s health insurance carrier and the respondent or, if he did, to what extent this double billing occurred. While the respondent would clearly be entitled to a credit for any services that had been paid by the claimant’s health insurance carrier, in our opinion, there must be some evidence that this did occur and the extent of the occurrence. In this case, there simply is no evidence offered to reflect how much double billing, if any, occurred. To find that the respondent is relieved of liability for medical costs based solely on the respondent’s assertion, would require us to decide this case based on speculation and conjecture. However, we find that the respondent is entitled to a credit for any of the claimant’s medical care paid by her health insurance provider.

[11] We find that the treatment rendered to the claimant by Dr. Holifield was reasonable and necessary through December 28, 1995. We specifically find that, as of that date, the claimant’s condition had become medically stable and that further treatment rendered to her by Dr. Holifield was not reasonable or necessary for treatment of her compensable injury.

[12] All accrued benefits shall be paid in a lump sum without discount and with interest thereon at the lawful rate from the date of the administrative law judge’s decision in accordance with Ark. Code Ann. § 11-9-809 (Repl. 1996). For prevailing on this appeal before the Full Commission, claimant’s attorney is hereby awarded an additional attorney’s fee in the amount of $250.00 in accordance with Ark. Code Ann. § 11-9-715 (Repl. 1996).



[14] Commissioner Wilson concurs.

[16] Although I concur with the majority opinion modifying the award with regard to Dr. Holifield’s treatment, I write this concurring opinion to express my thoughts with regard to the excessive amount of treatments rendered by Dr. Holifield. There is an indication in the record that Dr. Holifield has been double-billing the workers’ compensation carrier and the group health plan for his treatment of claimant. While there is insufficient evidence in this record to prove that Dr. Holifield did, in fact, double-bill for his treatment, this is not the first time that Dr. Holifield’s billing practices and excessive treatment has been brought before the Commission. In my opinion, we cannot condone the practice of Dr. Holifield to double-bill both carriers, nor can we condone his practice of excessive treatment using unauthorized personnel to perform the treatment.

[17] MIKE WILSON, Commissioner