A substitute teacher, 33 years old, fell on some ice and snow and alleged injuries to her back and knee.
The Commission affirmed a denial of benefits, based on a finding of lack of credibility, but awarded some limited medical bills from a provider not authorized by the employer. The ALJ found the claimant lacked credibility about testimony playing basketball several times a week and failing to acknowledge a radical change in weight of 65 pounds in a short time based on her medical records.
The ALJ found claimant's expert not credible.
"It is not credible that Dr. Droege determine a twenty-five percent permanent partial disability to the left knee when the three other physicians that treated found zero permanent partial disability. Neither of Dr. Droege's PPD ratings are credible. The record does not support an award of permanent partial disability "
The Commission modified the award to include $783 in bills from Dr. Droege in care over 10 days right after the claim was filed and medical was requested in the claim. The Commission found the employer was put on notice was an unambiguous request for medical care that was included as part of the claim for compensation. The claim was acknowledged on Jan 14. Claimant incurred charges starting on Jan 17. The employer tendered an appointment on Jan 30 (16 days after the claim) . The employer failed to attend the appointment in a timely fashion but later provided additional care.
The Commission finds the care (therapy) reasonable and consistent with the type of care later tendered by the employer, and ordered the care. It notes the general rule to acknowledge some reasonable delay to set up appointments.
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" Furthermore, brief delays in scheduling appointments
other than in emergency situations
do not render employer/insurer liable for unauthorized care."
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It does not appear claimant's treatment was an "emergency". The treatment in dispute was more than a month after the accident. It is not clear where the commission draws the line between reasonable and unreasonable delay in the tender of care but suggests the employer must exercise its absolute duty to tender care quicker than 16 days.
The commission does not disturb the finding that Dr. Droege lacks credibility. In the end, the Commission orders the employer to pay for treatment it did not authorize from a doctor the ALJ found was not credible.
Take away: This case shows the importance to check claims for additional comments that are often added outside the information requested in the form. It highlights there is no safe harbor for employers before an answer is filed. The Commission seems to reward the growing practice of extraneous comments added to the claim for compensation.
Boykins Walls v Normandy School District
2017 MOWCLR Lexis 51
Nov. 13, 2017
ALJ Keaveny
Atty: Johnson, Shockley
Experts: Droege, Doll
