Court awards medical bills when claimant demanded care

 Erwin v Midway Arms

2025 Mo. App. Lexis 131

release date:  March 4, 2025

The Court of appeals reverses the Commmission based on a misapplication of law and awards medical bills for a surgery which the employer's expert eventually concluded was reasonable including the need for future medical for psych and orthopedic conditions. 

Employee declined employer's request to provide records and furnished them only after claimant underwent surgery.  The court found claimant had made requests for medical care, and had no duty in its aburden of production of medical records or reports to refute an earlier finding of MMI to trigger a further duty to provide care. The case is distinguishable in which claimant did not provide any notice.   

The Commission reversed an award of nearly $60,000 in sanctions against the employer noting employer relied upon a medical, even if it was not adopted by the Commission.  The Court refused to award sanctions based on the finding of  the Commission that both sides acted unreasonably by the employer not seeking further medical opinion and the claimant withholding medical records.

 

Commission affirms denial that surgery flowed from injury

 Robert Byers v New Prime Inc.

Inj. No. 10-103528 

Release Date;  Feb. 20, 2025.

Employer disputed surgery 10 years post accident flowed from the accident  and sought to recover  benefits of 19 weeks of overpaid TTD benefits after claimant reached MMI.  The Commisson affirms an award of 20% BAW  without separate opinion. 

Claimant alleged 35% PPD from a neck fusion and PPD from psychiatric injury and concluded claimant was PTD. Dr. Lennard rates 15% disability and noted inconsistent behavior on video.  Dr. Halfaker felt claimant ha a somatic disorder and no psychiatric injury from the accident.  The ALJ found claimant lacked credibility.

Claimant was on his third atorney at the time of hearing.

 

Commission finds new accident aggravated prior shoulder condition.

 Marc Moore v TForce Freight Inc.

Inj. No.  23-026970

Release Date:  2-4-2025

Venue:  St. Charles (Kohner, ALJ)

The Commission affirmed in a 2-1 award a temporary award with nearly $125,000 in back benefits for unpaid medical and TTD  related to a shoulder injury in an auto collision with some limited damage to the vehicles.    

Dr. Duerr performed shoulder surgery and related to need for surgery to the accident due to acute inflamation on more chronic findings.    Dr. Farley concluded the mechanism of the accident would not cause findings resulting in the need for surgery.  The ALJ noted the history of no prior symtoms supported Dr. Duerr's causation opinion, and described Dr. Farley's analysis on the mechanism of the collision but noted he could not give an opinion with a reasonable degree of biomechanical certainty.   

Claimant stated at the time of the April 2024 hearing he had one remaining appointment within two weeks but did not anticpate further care.  No future medical was awarded.   The issue of PPD was left open for later determination.  

Vietnam vet awarded PTD with 'flare up' of PTSD

 Peter Lococo v  Lou Fusz (settled)

Inj. No.  08-116135 

venue:  St. Louis (Keaveny)

Release Date:  Feb. 4, 2025

The Commission affirms an award of PTD against the second injury fund, based on a combination of back and neck strain injuries from falling on black ice, de minimus PTSD  "aggravation" and prior psych conditions, primarily PTSD.

The employer settled the claim for 1% psych based on Dr. Stillings' rating.   His expert asserted 50% BAW disability that the accident triggered Vietnam-era PTSD and mental anguish from his youth as a helicopter door gunner  and developed into unexplained and unimaginable limitations.  The ALJ found no support for the expert's diagnosis of traumatic brain injury as that was a neurologic diagnosis and no neurologic exam was performed.    

The SIF award was based on ratings for prior psych conditions ranged 47.5 to 50%, despite claimant's history that he worked 60 hours a week but still had issues.  

The employer settled the soft tissue claims for the neck and back for a total of 35% BAW. 

Commission modifies scope of a 230 week TTD award in disputed back case

 Claimant in 2008 reports he fell backwards about 4 feet while handling a crowbar, resulting in back and psych injuries in a claim for PTD benefits. 

The ALJ awarded more than $300,000 in benefits and relied upon opinions of Dr. Fonn that claimant's back surgery was necesary and gave less credit the neurosurgeons who reached a different conclusion becuase they had incomplete medical reocrds.  In addition, claimant alleged both prior and new psych injuries.  the ALJ awarded 25% of the back, 10% for psych and PTD against the second injury fund. The attorney fee was 15%.

The Commission reduced some of the TTD noting a failure to proof that claimant was engaged in a rehabilitative process and  that another doctor had taken claimant off work for pre-existing conditions. Claimant asserted he was entitled to benefits becuse the employer disputed causation..

The dissent would have denied benefits on failure to prove injury by accident or that the surgery, 4 years post-njury,  flowed from the accident based on objective findings.  

In 2008 claimant was off work due to a prior accident. In 2009 claimant was off work by Dr. Fonn due to back fusion for a prior motorcycle accident.   There was a gap in treatment for two years, and then Dr. Fonn performed additional back surgery in August 2012 which he related to the accident and kept him off work until June 2014.  Dr. Sky performed in expert exam in 2018, 10 years after the accident, and conceded his plan of care was the same type of care claimant had recieved prior to the accident.   

William Wilson v Noranda  Inj. No. 08-120003

Release Date:  Jan 27, 2025   2-1 affirm   

ALJ Young

Attorneys:  Butler, Brueggman, Lindsey

Experts: Fonn, Woitschek, Kavers, Sky; Bernardi, Kitchens 

Claimant fails to prove risk source from fall in her own home

 LaDonna Johnson v OATs

Inj. No.  23-047500  

Release Date:  Jan 7, 2025

The Commission in a 2-1 decision reverses an award of approximately $70,000 in benefits, and finds the claimant van driver failed to prove injury by accident in course and scope of her employment based on an equal exposure defense when claimant sustained injuries in her own home to retrieve work-related supplies and slipped in her own kitchen and claims walking outside in water to inspect the van made her shoes wet and slippery.


ALJ Elmer awarded benefits and found a work related risk caused claimant to be outside in the rain, standing in wet grass, that lead her to fall. She argued, among other factors, that driving her private car does not require her to step in grass, and that in private life she does not have to be exposed to the rain and that cleaning the van was a benefit to the employer.

Diabetic worker fails to convince judge that work was the prevailing factor in CTS

Larry Santhuff v Doe Run

Inj. No. 20-055584

Decision:  Dec. 13, 2024

The Commission affirms a denial of a claim of injury by occupational disease and finds a diabetic claimant failed in the burden of persuasion  that hand-intensive work that was a mild-moderate risk of trauma was the prevailing casue of carpal tunnel syndrome.

The ALJ found Dr. Brown more persausive in his explanation of the role of diabetes as the more severe risk factor noting EMG evidence likely from diabetes both to the ulnar, median and sensory nerves.  Dr. Brown dismissed the finding of synovium thickening or improvement after surgery as convincing factors why the conditon should be regarded as occupational.  The parties disputed the reliability of information about jub duties.  The ALJ felt claimant's surgeon and expert, Dr. Schlalfy, had not fully addressed the risk associated with diabetes.  

Atty:  Medcalf, Reynolds

Experts:  Schlafly,  Brown

ALJ:   Young