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August 26, 1994


Appeal from Circuit Court of De Witt County. No. 88L17. Honorable Donald R. Parkinson, Judge Presiding.

Petition for Rehearing Denied September 26, 1994. As Corrected September 30, 1994. Petition for Leave to Appeal Allowed February 1, 1995.

Honorable Carl A. Lund, J., Honorable Robert W. Cook, J., Concurring, Honorable Frederick S. Green, J., Specially Concurring

The opinion of the court was delivered by: Lund

JUSTICE LUND delivered the opinion of the court:

The sole issue before our court is whether the circuit court of De Witt County erred in not allowing intervenor, Community Grain Company (Community Grain), and its worker compensation insurer, Farmland Mutual Insurance Company (Farmland), reimbursement from plaintiff David Cole for a specific $12,577.96 expense incurred by Farmland. Other compensation expenditures were awarded from plaintiffs' $1,752,037 common-law action jury award.

The $12,577.96 expense resulted from Farmland's hiring the services of Professional Rehabilitation Management (PRM). The trial court found the PRM services were for "management" of the workers' compensation case, as opposed to "medical treatment" and, therefore, not compensable under section 8(a) of the Illinois Workers' Compensation Act (Act) (820 ILCS 305/8(a) (West 1992)).

Plaintiff was seriously injured in the course of his employment, when the truck he was driving was struck by a school bus. In an offer of proof during trial of the common-law action, PRM employee Nancy Peck, a registered nurse, testified she was hired as a third-party objective consultant to assure that appropriate medical care was given. When asked whose interests she was obligated to protect, the insurance company or the patient, she replied: "The patient, to see that that person gets the best medical care, ends up being as good a person medically as he or she can be." However, when asked whether she considered her work medical treatment or management of the workers' compensation case, she replied "management."

Peck was then asked to give a general overview of the services she provided plaintiff. She replied:

"I started with David Cole in October of '88. Initially I interviewed him, which gives me a whole picture of his case and this follows with the objectivity. How did he feel about his medical care, was he happy with his physicians, how was he doing, visually could see how was he doing.

From there initially I went through the medical records also, and from there I recommended to the insurance company, yes, I think he is receiving appropriate medical care, he is seeing an orthopedic specialist. After the initial interview I kept in contact with him again to see how he was doing. I would go to the office visits with him. Periodically I would go to physical therapy to see how he was doing there, again, all this time to see whether he is making any improvement, what is going on, where could I recommend maybe some more efficient management.

I can think of one particular instance where in the wintertime he was having trouble getting back and forth to Champaign for physical therapy, and I did some research in the immediate area to see if some amount of physical therapy could be obtained in his area. It wasn't possible. But that was one case because if he could have gotten it there it would have saved him trips back and forth to Champaign.

When he had his surgeries I would make contact with him, sometimes in the hospital, to follow up with his home health. This was a big thing and probably the first six months, maybe ninemonths, and this certainly wasn't cost effective. But this was a better management tool, to visit with him to see if he needed home help nursing, to see if there was anything in the home that he needed in the way of equipment. Several times I assessed the home as far as the bathroom, were there any modifications that could have been done to make the bathroom more easily accessible for him. He was there by himself during the daytime quite a bit of the time because his wife worked, and so I made some assessments of the kitchen, [were] there areas there that could be modified for him to make those facilities more accessible.

I offered all along the way quite a bit of moral support to him. Also maybe some support in the way of answering questions. He always had a lot of questions about what was going to happen to him as far as the next surgery goes, what would happen to him in another month or two."

Peck admitted that she was responsible for reporting-plaintiff's progress to Farmland. A small portion of the charges for her services was for time spent consulting with the attorneys involved in the litigation and preparing reports for Farmland. Analyzing cost effectiveness only came into play when ordering equipment or long-term supplies. She never saw any of the bills for her services, and cost effectiveness of medical care was not her concern. She admitted that she followed orders ...

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