July 31, 2013
Reliable Doctor's Report

by Justice Paul E. Pfeifer

Benjamin Coleman was employed as a window washer when he was injured in a motor-vehicle accident while driving a company truck on July 9, 1984. His worker’s compensation claim was originally allowed for a variety of injuries, including cervical, thoracic, and lumbar strain; herniated cervical disc; cervical degenerative disc disease; and related conditions.

Almost 25 years later, on January 30, 2009, following an appeal to the Hamilton County Court of Common Pleas, his claim was amended to include the additional allowed condition of degenerative disc disease of the lumbar spine. As a result, Coleman filed a motion for temporary total disability compensation, to be effective beginning October12, 2006, based on the report of his treating physician – Dr. Luis Pagani.

A district hearing officer from the Industrial Commission – which handles these claims – concluded that Coleman was unable to return to work as a result of the newly allowed low-back condition and granted temporary total disability compensation to be effective beginning March 10, 2007.

On the last day of 2009 – December 31 – an independent medical examination was performed, by a Dr. Mannava, on behalf of the Bureau of Workers’ Compensation. Dr. Mannava stated in his report that he accepted Coleman’s allowed conditions and the objective findings in Coleman’s medical records.

Dr. Mannava reported that during the examination, Coleman complained of pain when his ankle reflex was checked and Coleman said that further examination of his body would cause him more pain.

At that point, according to the report, Dr. Mannava stopped the examination and advised Coleman that if further examination was going to result in pain, there was no point in continuing the evaluation and causing him more problems or symptoms.

In his report, Dr. Mannava stated in bold print: “NOTE: There is absolutely nothing I did that should have caused any pain or discomfort, especially in the knee.” He reported that Coleman “did not show any difficulties leaving our office and actually climbed up one-half flight of stairs at a rapid pace without any difficulty.”

Dr. Mannava concluded: “Based on the available medical and limited evaluation today, there is no evidence of any specific change or indication for any new treatment plan. There is no objective evidence to support any further fundamental, functional or physiological changes within reasonable medical probability in his condition despite ongoing current treatment including any pain management by Dr. Pagani, rehabilitation or other procedures.

“Despite today’s limited evaluation in my opinion based on the above discussion and evidence he has reached maximum medical improvement.”

Based on Dr. Mannava’s report, the Bureau of Workers’ Compensation filed a motion to terminate Coleman’s disability payments. A district hearing officer determined that Coleman had reached maximum medical improvement and terminated temporary total disability compensation as of February 19, 2010.

Coleman filed a complaint with the court of appeals alleging that the Commission acted contrary to law when it relied on Dr. Mannava’s report. According to Coleman, Dr. Mannava did not examine his low back for purposes of evaluating his lumbar degenerative disc disease and thus, the doctor’s opinion was based on an incomplete medical evaluation and his report could not constitute “some evidence” upon which the Commission could base its decision to terminate disability compensation. “Some evidence” is a threshold standard the Commission must meet in order to make such a decision.

The court of appeals, however, concluded that Dr. Mannava’s report constituted some evidence upon which the Commission could rely. The court noted that Dr. Mannava had examined Coleman – although the exam was limited; he had reviewed Coleman’s medical records; he had observed his ability to walk, sit, and move around the office; and he had specified that there was no indication of any new treatment plan.

The court of appeals determined that Coleman had not demonstrated that the Commission had abused its discretion when it terminated his temporary total disability compensation in reliance on Dr. Mannava’s report. Accordingly, the court denied his claim.

When Coleman’s case came before us – the Supreme Court of Ohio – we had to determine whether Dr. Mannava’s limited examination prevented him from rendering an opinion that was sufficiently reliable to constitute some evidence to support the Commission’s decision.

When the Commission makes a determination regarding the extent of disability, it must consider every allowed condition – that is, all of the injuries that have been allowed for compensation – in the claim. If a physician does not provide a complete evaluation of all the medical conditions, then that physician’s report does not constitute some evidence upon which the Commission may rely.

In this case, the court of appeals correctly concluded that Coleman failed to demonstrate that Dr. Mannava’s limited examination rendered his opinion unreliable. First, Dr. Mannava’s report lists the allowed conditions, including the newly allowed lumbar condition that Coleman described to him. Second, the report lists the medical records that Dr. Mannava reviewed, including multiple MRIs of Coleman’s lumbar spine, and the report indicates that he accepted the objective findings in those records.

Dr. Mannava conceded that his examination had been limited due to Colemans’s complaints of pain, but he nevertheless described his observations of Coleman moving around the office – walking, sitting, and getting on and off the exam table.

Finally, the report identifies facts that support Dr. Mannava’s conclusion, including the lack of a new or changed treatment plan and the lack of objective evidence of any “fundamental, functional or physiological changes within reasonable medical probability in his conditions despite ongoing current treatment, including any pain management by Dr. Pagani, rehabilitation or other procedures.”

Consequently, our court determined that Dr. Mannava’s report was sufficiently reliable to constitute some evidence to support the Commission’s decision. Once the injured employee’s allowed condition has reached maximum medical improvement, compensation for temporary total disability must be terminated, in accordance with the workers’ compensation laws.

We thus concluded that the Industrial Commission of Ohio did not abuse its discretion in reaching its decision. By a six-to-zero vote, we affirmed the judgment of the court of appeals.

EDITOR'S NOTE: The case referred to is State ex rel. Coleman v. Schwartz, 135 Ohio St.3d 423, 2013-Ohio-1702. Case No. 2011-1572. Decided April 30, 2013. Opinion Per Curiam.