Monday, March 1, 2021

No award for disputed medical bills without notice of need for care

 Justin Kent v NHC Healthcare

Release Date:  2-2-2021  (Accident date Dec. 2008)

Venue:  ED   108667

Plot summary:  Claimant sought a claim of PTD benefits, past medical bills and TTD and he was awarded PPD only.  He appealed.  The court affirms and found sufficient evidence to support a PPD award and no foundation of notice of a need for medical care to award the medical bills before he proceeded to have a microdiscectomy and later a fusion.   The ALJ had excluded various expert reports used in conjunction with a disability claim. 

The ALJ awarded 35% to the spine.  It note: 

"Only after his termination by NHC Healthcare did Kent embark on a long, expensive, and at times questionable path seeking medical treatment for back pain Kent associates with his workplace injuries. Kent’s journey involved multiple physicians and medical professionals offering varied diagnoses and treatments. The record unambiguously shows that at no time while Kent sought medical care and treatment from Dr. Parks or anyone else, did Kent make any demand on NHC Healthcare or notify NHC Healthcare of his desire to continue medical treatment with these professionals. To the contrary, the record clearly shows that Kent intentionally declined to notify NHC Healthcare of his intent to seek continuing medical care for his reported back pain following his termination of employment. The record supports the Commission’s finding that Kent knowingly incurred medical care and treatment after his March 2009 termination at his own expense. See Section 287.140.1. The record reveals that Kent did not request any additional medical treatment from NHC Healthcare because he did not think 24 NHC Healthcare would assist him. Whether Kent was correct in his assessment of how NHC Healthcare might react to a post-termination request for medical care is strictly a matter of speculation and inconsequential to our review as the record before us clearly shows Kent never asked for medical treatment from NHC Healthcare after March 2009. Nevertheless, Kent argues the Commission is obligated to order NHC Healthcare to pay the medical expenses Kent incurred while directing his own course of treatment because NHC Healthcare had notice of his need for additional treatment. We are not persuaded."



No SIF benefits when failure to prove aggravation by prior non-compensable condition

 Tamara Polston v State of Mo. 

Release Date:  2-11-2021 (Accident date 3-10-2015, injury #2)

Venue:  Callaway County

Plot Summary:  Claimant was assaulted and hurt her knee, settled the case with the employer, and sought benefits against the Fund.  The ALJ found claimant sustained a compensable knee injury but failed to show she was PTD due a combination of prior conditions and noted she was not credible regarding her limitations, symptoms and physical and psychiatric conditions and did not  introduce credible evidence that her non-work prior psychiatric condition significantly aggravates or accelerates her primary knee condition to satisfy the statutory burden of proof.  

A dissent felt claimant was PTD and found credible that claimant had bipolar disorder and PTSD. 

15-013956

PolstonTamara15-013956-02-11-21.pdf (mo.gov)


Cast:

Farmer, ALJ

Dr. Daniel

Dr Cohen

Dr. Oliveri  

Dr. Pribor

Concussive injury supports partial disability despite memory lapse who it occurred

Terry Humphrey v Ruan Logistics Co. 

Release Date:  2 5 2021  (Accident 9/6/2012)

Venue:  Newton County

Plot summary:  medical fee dispute

The ALJ awards 12.5% PPD for a concussive injury with memory problems when claimant struck his head on a truck safety mirror while walking around  a truck. The ALJ rejected an expert who concluded the accident could not happen the way it was alleged, even though claimant could not fully describe it due to memory loss.  


HumphreyTerry12-07815302-05-21.pdf (mo.gov)


Cast:

Fisher

Webster

Koprivica

Appelbaum


No combo, no total in SIF claim

 Robert March v Millbank Mfg.

Release Date:  Feb. 23, 2021  (D/A  May 1, 2015)

Venue:  Lafayette County

Plot Summary:  Claimant denied SIF PTD claim based on a failure to prove a prior lower leg condition did not aggravate or accelerate work related carpal tunnel or that  disability wasn't caused by post-accident worsening. The Commission affirmed a denial on the failure of the burden of persuasion that claimant's inability to work was not because of the prior leg condition alone, and describes how the employer provided accommodations.

Cast:

Siedlik

Kenter

Wilson

Note:  A majority criticizes the original opinion for grammatical errors and confusing language.