Monday, June 30, 2014
Any award of second injury fund liability requires different proof for permanent partial and permanent total according to the Court. In the context of a permanent total award, the court concluded claimant must only show that there is a prior condition that is an obstacle or hindrance to employment. There is no requirement that it reaches a statutory threshold or is measurable. Section 287.220.1 provides: "If all of Claimant's disability is from the work injury, then there is no Fund liability. However, if there is any percentage of Claimant's disability that is not attributable to the work injury, then the Fund becomes liable for the difference." The requirement to show actual and measurable disability enunciated in Messex v Sachs Electric Co., 989 S.W.2d 206 (Mo. App. 1999) applies only in the context of permanent partial awards. The claimant does not require proof a specific percentage of disability, but in this case such ratings supported the finding of a measurable disability. Claimant testified that the employer downgraded his position after 31 years demonstrated his ability to maintain the same production requirements. Claimant testified that he was unable to meet the job requirements or find alternate work.
The court describes several decisions which appear to support the Fund's defense but are distinguished as judicial "oversights" which do not appreciate a distinction between calculation of PPD and PTD.
The employer at the time of the hearing settled the primary case which involved an alleged ganglion cyst. The ALJ found the primary injury in the case resulted in 15% disability to the thumb. The treating physician gave him a full duty release.
Experts: Berkin, Poetz, Volarich, England
Panel: Sullivan, Mooney, Dowd
Friday, June 27, 2014
The ALJ award close to 1/4 million dollars in disability and disputed medical expenses related to a fusion surgery. The claimant was picking up storm debris when he fell down. He was treated by a neurosurgeon and released with a finding a strain and disc protrusion. He sought treatment on his own and obtained a fusion for disputed instability. He saw two psychiatrists: one concluded he had disability from an unrelated major depressive disorder, another concluded he had new post-accident pain and mood disorders.
The employer disputed TTD on appeal. The Commission indicated that the employer could not dispute the amount of TTD, based on any alleged miscalculation, if it had already stipulated to the lump sum at the beginning of the hearing. The Commission further found the disputed bills to be reasonable, like the ALJ, but found the ALJ based his opinion in part on a medical report that was not part of the evidence. Wagner v City of Maryland Heights, 2014 Mo WCLR Lexis 84 (June 18, 2014)
Experts: Volarich, Stillings, Jarvis
Treaters: Kitchen, Robson
Friday, June 20, 2014
She asserted as a result of the accident she developed constant neck pain, post-concussive syndrome and PTSD, and required daily rest breaks. Dr. Park had performed a multi-level cervical procedure.
Dr. Koprivica was regarded as credible. Dr. Jackson indicated claimant could not return to driving a truck but was employable in the open labor market. The vocational expert indicated at 61-years old claimant was unemployable, that her prior extensive medical experience in nursing was not a transferrable skill, and no one would hire her if she needed to lie down.
Experts: Koprivica, Jackson; Drieling, Sprecke
Treater: Dr. Park
Thursday, June 5, 2014
Medicare regulations provide some interpretative guidance as to what might be reasonably related.
“After an injury or disability”
Medicare prohibits transportation benefits unless the need for transportation relates to Medicare-covered services. It’s one thing to have an air ambulance take a worker to a trauma one center. It is quite another thing to ask a helicopter to drop a worker off at his house. There is an actual federal regulation on this point. Ground transportation may be a reasonable alternative if the distance to the appropriate medical facility is close.
Medicare prohibits transportation benefits beyond the nearest “appropriate” facility. This is clearly defined in Chapter 10.3 of the Medicare Benefit Policy Manual that “transport is covered to the nearest appropriate facility to obtain necessary diagnostic and or therapeutic services.” Transportation to a more remote facility does not flow from medical necessity.
Can fee resolution resolve a $30,000 helicopter bill?
Section 4531 (b) (2) of the Balanced Budget Act (BBA) of 1997 added a new section 1834 (l) to the Social Security Act which mandated the implementation of a national fee schedule for ambulance services.
Fee schedule under Medicare for fixed and rotary wing ambulance