Anthony Davis v Negri Plumbing
Release Date: Jan 14, 2020 (Accident Date Sept 1, 2010)
Venue: Howell County
Plot Summary: The Commission in a 2-1 decision reverses a denial of SIF benefits. Claimant alleges he was unable to return to work as a plumber after a knee injury. A majority of the commission finds claimant's brittle bone condition was a qualifying fund condition equivalent to 20% BAW.
https://labor.mo.gov/sites/labor/files/decisions_wc/DavisAnthony10-06980801-14-20.pdf
Cast:
Alberhasky
Elmer, ALJ
Swaim
Putnam -10% (report not in evidence)
Eldred - PTD
England - PPD
Comments:
The ALJ noted prior to the accident claimant's demonstrated a sustained capacity to perform heavy-duty work and failed to establish his brittle bone condition was an obstacle or hindrance, even though his osteogenesis imperfecta had caused 22 prior fractures.
What's it worth?
45% knee with open medical
Tuesday, January 28, 2020
Monday, January 27, 2020
Fund total denied based on lack of clear expert opinon
Sterling Bennett v Coatings Unlimited
Phoenix/Travelers Ins.
Date of Release: Jan 10, 2020 (Accident Date Aug 14, 2013)
Venue: Clay County
Plot Summary: Commission affirms a denial of benefits against the SIF for a claimant who fell backwards in a bucket lift and injured his knee. Claimant failed in his burden of proof to establish convincing Fund claim which alleged PTD benefits.
https://labor.mo.gov/sites/labor/files/decisions_wc/BennettSterling13-07793301-10-20.pdf
Memorable Quotes:
"She noted that he would not present well in a job interview because he appears drowsy and confused, had impaired attention and memory, had problems holding a pencil with his right hand and took his blood sugar twice during the interview."
Comments:
Berkin "includes boilerplate Second Injury Fund combination language that says, "I feel the combination of his disabilities is significantly greater than their simple sum, and a loading factor should be applied." At first glance, it is clear that this combination language Dr. Berkin provides in this report, includes the combination of the March 24, 2014 disabilities with everything else listed. I find nothing in the report, and no opinions from Dr. Berkin, that narrowly tailors the combination language to the combination of the August 14, 2013 injury and any pre-existing disabilities creating a synergistic effect and invoking Second Injury Fund liability for permanent partial disability."
"Dr. Berkin's failure to, specifically, opine the nature and extent of the permanent partial disabilities that may have pre-existed the August 14, 2013 injury, his failure to, specifically, opine that any disabilities were a hindrance or obstacle to employment or re-employment prior to August 14, 2013 (as opposed to March 24, 2014), and his failure to provide clear and persuasive opinions (along with explanations) for how the August 14, 2013 injury combined with any pre-existing disabilities to result in a greater overall amount of disability than the simple sum. This finding is also based on Claimant's failure to provide clear and convincing evidence on how these disabilities may have combined to make him worse on account of the combination."
What's it worth?
22.5% meniscectomy
Phoenix/Travelers Ins.
Date of Release: Jan 10, 2020 (Accident Date Aug 14, 2013)
Venue: Clay County
Plot Summary: Commission affirms a denial of benefits against the SIF for a claimant who fell backwards in a bucket lift and injured his knee. Claimant failed in his burden of proof to establish convincing Fund claim which alleged PTD benefits.
https://labor.mo.gov/sites/labor/files/decisions_wc/BennettSterling13-07793301-10-20.pdf
Cast
Ottenad, ALJ
Berkin
Gonzalez
Mass, atty
Sandberg
Memorable Quotes:
"She noted that he would not present well in a job interview because he appears drowsy and confused, had impaired attention and memory, had problems holding a pencil with his right hand and took his blood sugar twice during the interview."
Comments:
Berkin "includes boilerplate Second Injury Fund combination language that says, "I feel the combination of his disabilities is significantly greater than their simple sum, and a loading factor should be applied." At first glance, it is clear that this combination language Dr. Berkin provides in this report, includes the combination of the March 24, 2014 disabilities with everything else listed. I find nothing in the report, and no opinions from Dr. Berkin, that narrowly tailors the combination language to the combination of the August 14, 2013 injury and any pre-existing disabilities creating a synergistic effect and invoking Second Injury Fund liability for permanent partial disability."
"Dr. Berkin's failure to, specifically, opine the nature and extent of the permanent partial disabilities that may have pre-existed the August 14, 2013 injury, his failure to, specifically, opine that any disabilities were a hindrance or obstacle to employment or re-employment prior to August 14, 2013 (as opposed to March 24, 2014), and his failure to provide clear and persuasive opinions (along with explanations) for how the August 14, 2013 injury combined with any pre-existing disabilities to result in a greater overall amount of disability than the simple sum. This finding is also based on Claimant's failure to provide clear and convincing evidence on how these disabilities may have combined to make him worse on account of the combination."
What's it worth?
22.5% meniscectomy
Friday, January 24, 2020
Benefits denied for fall involving arthritic shoulder
Valerie Williams v Senior Lutheran Services
Safety National Casualty
Release Date: Jan 10, 2020
Venue: St. Louis
Plot Summary: A 66 year old social worker fell on her employer's icy parking lot and landed on her arm. The Commission affirmed the denial of benefits that claimant failed to establish the fall was the prevailing factor in the cause of the medical condition.
https://labor.mo.gov/sites/labor/files/decisions_wc/WilliamsValerie18-00182601-10-20.pdf
Cast
Teer, ALJ
Peterson, atty
Reynolds, atty
Wright
Aleem
Young
Comments
The employer paid about $3700 in medical bills but disputed the relationship of ongoing care to the accident and that the employer owed for a total shoulder when claimant denied her pre-existing severe arthritis caused prior symptoms.
Dr. Young indicated the accident caused a "flare up" but no new evidence of internal derangement and the symptoms flow from her severe arthrosis. Claimant scheduled a total joint replacement. Two of claimant's orthopedic surgeons reached conflicting conclusions whether she had an unusual combination of severe arthritis and a full thickness tear. The ALJ indicated the evidence did not support a finding that claimant had a 'unspecified' shoulder strain. Claimant denied prior symptoms.
The ALJ found claimant established an accident, and that the accident was only a triggering condition and failed to meet the prevailing factor standard to show injury by accident. The ALJ indicate that "it is not sufficient that the event simply aggravates a preexisting condition. See Johnson v. Indiana Western Express, Inc., 281 S.W.3d 885 (Mo.App. 2009).
Safety National Casualty
Release Date: Jan 10, 2020
Venue: St. Louis
Plot Summary: A 66 year old social worker fell on her employer's icy parking lot and landed on her arm. The Commission affirmed the denial of benefits that claimant failed to establish the fall was the prevailing factor in the cause of the medical condition.
https://labor.mo.gov/sites/labor/files/decisions_wc/WilliamsValerie18-00182601-10-20.pdf
Cast
Teer, ALJ
Peterson, atty
Reynolds, atty
Wright
Aleem
Young
Comments
The employer paid about $3700 in medical bills but disputed the relationship of ongoing care to the accident and that the employer owed for a total shoulder when claimant denied her pre-existing severe arthritis caused prior symptoms.
Dr. Young indicated the accident caused a "flare up" but no new evidence of internal derangement and the symptoms flow from her severe arthrosis. Claimant scheduled a total joint replacement. Two of claimant's orthopedic surgeons reached conflicting conclusions whether she had an unusual combination of severe arthritis and a full thickness tear. The ALJ indicated the evidence did not support a finding that claimant had a 'unspecified' shoulder strain. Claimant denied prior symptoms.
The ALJ found claimant established an accident, and that the accident was only a triggering condition and failed to meet the prevailing factor standard to show injury by accident. The ALJ indicate that "it is not sufficient that the event simply aggravates a preexisting condition. See Johnson v. Indiana Western Express, Inc., 281 S.W.3d 885 (Mo.App. 2009).
ALJ awards carpal tunnel treatment and finds claimant's testimony more reliable than ergonomic study
Genise Richards v Becton-Dickinson
Ace American Ins.
Release Date: Jan 15, 2020
Venue: St. Louis County
Plot Summary: Commission affirms in 2-1 decision award of temporary benefits for carpal tunnel syndrome based on testimony that claimant's job as inventory administrator involved repeated grasping, pinching and keyboard work.
https://labor.mo.gov/sites/labor/files/decisions_wc/RichardsGenise15-05419501-15-20.pdf
Cast:
Denigan, ALJ
Gault, atty
Schlafly
Rotman
Comments:
Employer expert appeared to relate claimant's condition to her work and then reviewed a job description and concluded her weight, age, and gender were more likely the cause. ALJ Denigan notes: "Dr. Rotman, for reasons that are not clear in the record, elaborates on the likelihood of Claimant's job tasks causing work related carpal tunnel syndrome (CTS) and suggests he would gladly review any additional information on the job exposure." Claimant testified the job involving gripping or pinching, contrary to information provided by the employer.
A dissent argued claimant's expert relied on factually incorrect information about the frequency or intensity of claimant's activities and notes conflicting testimony: "Jeanette Tucker, employee's direct supervisor at the time of her alleged injury, testified that employer received about forty tubes per week, not 700 per day" and that claimant had identifiable risk factors of " female gender, post-menopausal age, and obesity."
Ace American Ins.
Release Date: Jan 15, 2020
Venue: St. Louis County
Plot Summary: Commission affirms in 2-1 decision award of temporary benefits for carpal tunnel syndrome based on testimony that claimant's job as inventory administrator involved repeated grasping, pinching and keyboard work.
https://labor.mo.gov/sites/labor/files/decisions_wc/RichardsGenise15-05419501-15-20.pdf
Cast:
Denigan, ALJ
Gault, atty
Schlafly
Rotman
Comments:
Employer expert appeared to relate claimant's condition to her work and then reviewed a job description and concluded her weight, age, and gender were more likely the cause. ALJ Denigan notes: "Dr. Rotman, for reasons that are not clear in the record, elaborates on the likelihood of Claimant's job tasks causing work related carpal tunnel syndrome (CTS) and suggests he would gladly review any additional information on the job exposure." Claimant testified the job involving gripping or pinching, contrary to information provided by the employer.
A dissent argued claimant's expert relied on factually incorrect information about the frequency or intensity of claimant's activities and notes conflicting testimony: "Jeanette Tucker, employee's direct supervisor at the time of her alleged injury, testified that employer received about forty tubes per week, not 700 per day" and that claimant had identifiable risk factors of " female gender, post-menopausal age, and obesity."
Commission reverses perm total when prior conditions do not each satisfy fund criteria
Christopher Klecka v Johnny Jones Inc.
Accident Fund
Release Date: Jan 14, 2020 (Accident date April 18, 2014)
Venue: St. Louis
Plot Summary: The ALJ awards PTD benefits based on evidence "Claimant and his medical experts credibly testified his compensable and noncompensable pre-existing injuries significantly aggravated or accelerated his primary injury."
The Second Injury Fund filed a timely application for review with the Commission alleging the administrative law judge misapplied§ 287.220.3 RSMo by including conditions within her analysis that do not satisfy the criteria for permanent total disability claims against the Second Injury Fund.
"Dr. Volarich made clear, however, that his opinion that employee is permanently and totally disabled includes consideration of the effects of the 1981 head injury, 2005 thumb injury, and 2006 hernia, as well as the effects of the 2007 right shoulder injury."
The commission notes a failure to proof to meet the criteria of 287.220.3 that each of the enumerated prior conditions either established PPD or met the 50 week threshold and further noted that evidence from Dr. Volarich that there was a synergistic effect was not "persuasive" to establish the element of 27.220.3 to establish causation.
Cast:
Hart, ALJ
Sievers, atty
Enzmann
Volarich
Sky
England
Gonzalez
Memorable quotes
"The question presently before us, then, is whether employee is entitled to permanent total disability benefits where his claimed permanent total disability does not result from a combination of the primary injury and preexisting disability that satisfies the enumerated criteria under§ 287.220.3(a)a, but rather from the combination of his primary injury and a// of his claimed preexisting disabling conditions, including those conditions that do not satisfy§ 287.220.3(a)"
Comments:
Claimant settled the primary injury to his shoulder that was "yanked" and involved multiple surgical repairs and became depressed.
The dissent argues once some pre-existing conditions qualify under the fund test, then others can be considered without each meeting the qualification standards as there was no clear legislative intent for the employer to assume liability for the impact on non-qualifying prior conditions.
"This result is so antithetical to the well-established purposes underlying the Second Injury Fund, and constitutes such a drastic departure from the state of the law at the time the legislature enacted the 2013 amendments, that I will not presume the legislature intended such a result absent express language so declaring. (For example, if such a result were intended, one would expect our legislature to simultaneously and expressly abrogate the long line of Missouri cases declaring the purpose of the Second Injury Fund.)"
Accident Fund
Release Date: Jan 14, 2020 (Accident date April 18, 2014)
Venue: St. Louis
Plot Summary: The ALJ awards PTD benefits based on evidence "Claimant and his medical experts credibly testified his compensable and noncompensable pre-existing injuries significantly aggravated or accelerated his primary injury."
The Second Injury Fund filed a timely application for review with the Commission alleging the administrative law judge misapplied§ 287.220.3 RSMo by including conditions within her analysis that do not satisfy the criteria for permanent total disability claims against the Second Injury Fund.
"Dr. Volarich made clear, however, that his opinion that employee is permanently and totally disabled includes consideration of the effects of the 1981 head injury, 2005 thumb injury, and 2006 hernia, as well as the effects of the 2007 right shoulder injury."
The commission notes a failure to proof to meet the criteria of 287.220.3 that each of the enumerated prior conditions either established PPD or met the 50 week threshold and further noted that evidence from Dr. Volarich that there was a synergistic effect was not "persuasive" to establish the element of 27.220.3 to establish causation.
Cast:
Hart, ALJ
Sievers, atty
Enzmann
Volarich
Sky
England
Gonzalez
Memorable quotes
"The question presently before us, then, is whether employee is entitled to permanent total disability benefits where his claimed permanent total disability does not result from a combination of the primary injury and preexisting disability that satisfies the enumerated criteria under§ 287.220.3(a)a, but rather from the combination of his primary injury and a// of his claimed preexisting disabling conditions, including those conditions that do not satisfy§ 287.220.3(a)"
Comments:
Claimant settled the primary injury to his shoulder that was "yanked" and involved multiple surgical repairs and became depressed.
The dissent argues once some pre-existing conditions qualify under the fund test, then others can be considered without each meeting the qualification standards as there was no clear legislative intent for the employer to assume liability for the impact on non-qualifying prior conditions.
"This result is so antithetical to the well-established purposes underlying the Second Injury Fund, and constitutes such a drastic departure from the state of the law at the time the legislature enacted the 2013 amendments, that I will not presume the legislature intended such a result absent express language so declaring. (For example, if such a result were intended, one would expect our legislature to simultaneously and expressly abrogate the long line of Missouri cases declaring the purpose of the Second Injury Fund.)"
Commission guts PTD award for worker with credibility issues
Justin Kent v NHC Healthcare
Premier Group Ins. Co.
Release date: Jan. 10, 2020 (Accident date Jan 4, 2008)
Venue: St. Louis
Length: 22 pages
Plot Summary: Commission reverses a PTD award for back injury of a 33-year old producing "post-traumatic spondylosis" with radicular symptoms. the Commission notes "credibility" is "suspect" and "diminished , doubts whether the expert had knowledge of multiple other accidents, and the "largely subjective" symptoms. There was no evidence the employer was aware of the need for further care directly or constructively from court settings. The claimant failed in a burden of proof to show the nature of the communication that the employee claims should have put the employer on notice.
Cast:
Boresi, ALJ
Fagan
Leahy
Kitchens
Chen
Musich
England (report not admitted)
Randolph
Comments: The ALJ found injuries sustained in the last accident alone to be "catastrophic" impacting pain, sleep and the ability to work and self-medication by drinking after his accident and concludes claimant was in "perfect" health previously.
Memorable Quotes:
"Although Employer can argue with the benefit of hindsight that not every treatment decision was sound, that does not relieve Employer for assuming responsibility for the treatment…."
"It is implausible for an employer to assert it did not have notice of the need for treatment after over 20 court settings dealing with a claimant's injury."
The ALJ barred a custodian records deposition due to irregularities that involved two staff members and the doctor himself.
Claimant reported temporary relief from a L4-5 discectomy (Kitchens) followed by a fusion (Dr. Chen) and subsequent diagnosis of non-union (Crane). The ALJ had awarded more than $200,000 in TTD and unpaid medical expenses. The Commission decision was for $44,123.80 in PPD.
What's it worth?
35% PPD (L4-5 microdiscectomy)
Premier Group Ins. Co.
Release date: Jan. 10, 2020 (Accident date Jan 4, 2008)
Venue: St. Louis
Length: 22 pages
Plot Summary: Commission reverses a PTD award for back injury of a 33-year old producing "post-traumatic spondylosis" with radicular symptoms. the Commission notes "credibility" is "suspect" and "diminished , doubts whether the expert had knowledge of multiple other accidents, and the "largely subjective" symptoms. There was no evidence the employer was aware of the need for further care directly or constructively from court settings. The claimant failed in a burden of proof to show the nature of the communication that the employee claims should have put the employer on notice.
Cast:
Boresi, ALJ
Fagan
Leahy
Kitchens
Chen
Musich
England (report not admitted)
Randolph
Comments: The ALJ found injuries sustained in the last accident alone to be "catastrophic" impacting pain, sleep and the ability to work and self-medication by drinking after his accident and concludes claimant was in "perfect" health previously.
Memorable Quotes:
"Although Employer can argue with the benefit of hindsight that not every treatment decision was sound, that does not relieve Employer for assuming responsibility for the treatment…."
"It is implausible for an employer to assert it did not have notice of the need for treatment after over 20 court settings dealing with a claimant's injury."
The ALJ barred a custodian records deposition due to irregularities that involved two staff members and the doctor himself.
Claimant reported temporary relief from a L4-5 discectomy (Kitchens) followed by a fusion (Dr. Chen) and subsequent diagnosis of non-union (Crane). The ALJ had awarded more than $200,000 in TTD and unpaid medical expenses. The Commission decision was for $44,123.80 in PPD.
What's it worth?
35% PPD (L4-5 microdiscectomy)
Commission affirms award to treat arthritic knee after meniscectomies
Jackie Hooper v Mo Dept. of Corrections
self-insured
Release Date: 1/14/2020 (Accident date 1/27/2015)
Venue: Pike County
Plot Summary: Commission 2-1 affirms a temporary award for future medical, including total knee replacement following an accident while moving a ventilation unit. Claimant reports an earlier injury to the knee when he "pivots" on a stairwell to talk to a supervisor.
Cast
Kohner, ALJ
Wood, atty
Thomas
Volarich
King
Comments:
The ALJ found the need for future medical flowed from a accident, despite an assertion by Dr. King that accident to medical compartment would not case arthritis and there were no characteristics of an acute tear. A dissent felt the duty to provide care ended after claimant was placed at MMI following surgeries to repair meniscus tears.
self-insured
Release Date: 1/14/2020 (Accident date 1/27/2015)
Venue: Pike County
Plot Summary: Commission 2-1 affirms a temporary award for future medical, including total knee replacement following an accident while moving a ventilation unit. Claimant reports an earlier injury to the knee when he "pivots" on a stairwell to talk to a supervisor.
Cast
Kohner, ALJ
Wood, atty
Thomas
Volarich
King
Comments:
The ALJ found the need for future medical flowed from a accident, despite an assertion by Dr. King that accident to medical compartment would not case arthritis and there were no characteristics of an acute tear. A dissent felt the duty to provide care ended after claimant was placed at MMI following surgeries to repair meniscus tears.
Defense expert found more credible in meso case
Marc Hayden, dec. v Cut Zaven
Hartford, Travelers, Argonaut
Release Date Jan 7 2020 (Accident date June 27, 2014)
Venue: St. Louis
Plot summary: Claimant worked as a hairdresser for 47 years and alleged mesothelioma developed as a result of exposure to hair dryers prior to 1979. The commission affirms the denial based on insufficient proof of the burden of persuasion.
https://labor.mo.gov/sites/labor/files/decisions_wc/HaydenMarc14-10307701-07-20.pdf
Cast:
Landolt, ALJ
Reynolds
Godsey
Taylor
Hyers
Barkman
Memorable Quotes
The ALJ denied benefits: "I find Employee failed to meet his burden of proof regarding medical causation and, therefore, the Claim must be denied. I find Employee was not employed in an occupation or process in which the hazards of an occupational disease due to toxic exposure existed. ..." Dr. Hyers' opinion fails because it is based upon the assumption that Employee was exposed to asbestos throughout his career as a hairdresser, and those assertions were not proved."
The Commission noted: " Pursuant to Vickers and Smith, an employee need not provide evidence of a specific or actual exposure to an injurious agent at work to meet his or her burden of production. By extension, a fact-finder who misapprehends the employee's burden of production (e.g., by suggesting that an employee must identify a particular, specific exposure to the claimed source of injury) may render his or her own fact findings subject to reversible legal error, as demonstrated in both Vickers and Smith."
The commission noted a lack of authority to the requisite proof of exposure in a post-reform case and appears to disavow reliance on a pre-reform "recognizable link" standard. It concluded claimant met his burden of production but not the burden of persuasion.
Hartford, Travelers, Argonaut
Release Date Jan 7 2020 (Accident date June 27, 2014)
Venue: St. Louis
Plot summary: Claimant worked as a hairdresser for 47 years and alleged mesothelioma developed as a result of exposure to hair dryers prior to 1979. The commission affirms the denial based on insufficient proof of the burden of persuasion.
https://labor.mo.gov/sites/labor/files/decisions_wc/HaydenMarc14-10307701-07-20.pdf
Cast:
Landolt, ALJ
Reynolds
Godsey
Taylor
Hyers
Barkman
Memorable Quotes
The ALJ denied benefits: "I find Employee failed to meet his burden of proof regarding medical causation and, therefore, the Claim must be denied. I find Employee was not employed in an occupation or process in which the hazards of an occupational disease due to toxic exposure existed. ..." Dr. Hyers' opinion fails because it is based upon the assumption that Employee was exposed to asbestos throughout his career as a hairdresser, and those assertions were not proved."
The Commission noted: " Pursuant to Vickers and Smith, an employee need not provide evidence of a specific or actual exposure to an injurious agent at work to meet his or her burden of production. By extension, a fact-finder who misapprehends the employee's burden of production (e.g., by suggesting that an employee must identify a particular, specific exposure to the claimed source of injury) may render his or her own fact findings subject to reversible legal error, as demonstrated in both Vickers and Smith."
The commission noted a lack of authority to the requisite proof of exposure in a post-reform case and appears to disavow reliance on a pre-reform "recognizable link" standard. It concluded claimant met his burden of production but not the burden of persuasion.
Open medical denied for clot after diagnostic arthroscopy
Ramadan Hajdini v Hyatt Regency St. Louis at the Arch
New Hampshire Ins. Co.
Release Date: Jan 10, 2020 (Accident date July 19, 2015)
Venue: St. Louis
Plot Summary: Claimant sustained an undisputed knee contusion when he was struck by a table and underwent a diagnostic arthroscopy to rule out a suspected meniscus tear. No tear was identified but the surgeon debrided "degenerative" chondromalacia. Within about 2 weeks claimant sustained a DVT/PE The Commission affirms 2-1 a denial of future medical related to the clot.
Inj. No. 15-052459
Cast:
Keaveny, ALJ
Kolker
McBrearty
Lehman
Krause
Shen
Hammond
Memorable Quotes:
"There is no persuasive evidence that the work injury caused the idiopathic condition of thrombophilia, which resulted in the singular incident of DVT and PE. …. We are not persuaded of the need for continuing or future medical treatment of these conditions resulting from he work injury."
Comments: Employer had provided more than $50,000 in medical and disability benefits. The commission found the DVT/PE may have reasonably flowed from the surgery. The surgeon felt the primary reason was a clotting mutation, Factor V Leiden. The ALJ regarded the synovial chondromatosis did not reasonably flow from the work injury" and denied future medical for DVT/PE following a normal CT scan.
What's it worth?
6% knee
New Hampshire Ins. Co.
Release Date: Jan 10, 2020 (Accident date July 19, 2015)
Venue: St. Louis
Plot Summary: Claimant sustained an undisputed knee contusion when he was struck by a table and underwent a diagnostic arthroscopy to rule out a suspected meniscus tear. No tear was identified but the surgeon debrided "degenerative" chondromalacia. Within about 2 weeks claimant sustained a DVT/PE The Commission affirms 2-1 a denial of future medical related to the clot.
Inj. No. 15-052459
Cast:
Keaveny, ALJ
Kolker
McBrearty
Lehman
Krause
Shen
Hammond
Memorable Quotes:
"There is no persuasive evidence that the work injury caused the idiopathic condition of thrombophilia, which resulted in the singular incident of DVT and PE. …. We are not persuaded of the need for continuing or future medical treatment of these conditions resulting from he work injury."
Comments: Employer had provided more than $50,000 in medical and disability benefits. The commission found the DVT/PE may have reasonably flowed from the surgery. The surgeon felt the primary reason was a clotting mutation, Factor V Leiden. The ALJ regarded the synovial chondromatosis did not reasonably flow from the work injury" and denied future medical for DVT/PE following a normal CT scan.
What's it worth?
6% knee
Lack of hazard defeats claim for fall at work
Lula Gray, dec. v Hy-Vee Food Services
Emcasco Ins. Co.
Release Date: 1/10/2020 (Accident date: Oct 3, 2014)
Venue: Columbia, MO
Plot Summary: An 82-year old part-time restaurant helper fell after walking 15 to 20 steps into the store on a clean, smooth polished floor resulting in injuries to her shoulder and the need for a shoulder replacement. The Commission affirms a denial of benefits, including a denial of more than $82,000 in disputed bills.
https://labor.mo.gov/sites/labor/files/decisions_wc/GrayLula14-0749975-10-20.pdf
Inj. No. 14-074997
Cast:
Fisher, ALJ
Comments:
The ALJ summarizes statements that claimant reported she tripped over her own feet, or the shoes "got her" (again). She further stated she had "no idea" why she fell and could identify no risk associated with the property that caused her to lose her balance.
Emcasco Ins. Co.
Release Date: 1/10/2020 (Accident date: Oct 3, 2014)
Venue: Columbia, MO
Plot Summary: An 82-year old part-time restaurant helper fell after walking 15 to 20 steps into the store on a clean, smooth polished floor resulting in injuries to her shoulder and the need for a shoulder replacement. The Commission affirms a denial of benefits, including a denial of more than $82,000 in disputed bills.
https://labor.mo.gov/sites/labor/files/decisions_wc/GrayLula14-0749975-10-20.pdf
Inj. No. 14-074997
Cast:
Fisher, ALJ
Comments:
The ALJ summarizes statements that claimant reported she tripped over her own feet, or the shoes "got her" (again). She further stated she had "no idea" why she fell and could identify no risk associated with the property that caused her to lose her balance.
Commission bumps up 30 hour rule based on additional wage testimony
Gabrielle Graham v Rosewood Health and Rehabilitation Center
Health Care Facilities of MO
Release Date: 1-7-2020 (Accident date 7-15-2014)
Venue: Jackson County, MO
Plot Summary: 28 year old certified nurse's aide sustained injuries when she was bent down and an obese patient dropped her leg on her causing her to fall and injure her neck, back and shoulders. "Claimant testified that she has significant ongoing complaints as it relates to her body as a whole, referable her neck, shoulders, back, hands and feet. She has chronic pain in her neck down to her buttocks, trouble sleeping and difficulty using her shoulders."
The Commission found reversible error by the ALJ to base PPD rates on a minimum of 30 hours for the part-time employee, given uncontroverted testimony that full-time employees in the same position worked 40 hours.
https://labor.mo.gov/sites/labor/files/decisions_wc/GrahamGabrielle14-07324901-07-20.pdf
Cast:
Hefner
Mirfasihi
Ebbert
Patel
Stuckmeyer 20%
Fevurly 1%
What's it Worth?
10% BAW cervico-thoracic.
Health Care Facilities of MO
Release Date: 1-7-2020 (Accident date 7-15-2014)
Venue: Jackson County, MO
Plot Summary: 28 year old certified nurse's aide sustained injuries when she was bent down and an obese patient dropped her leg on her causing her to fall and injure her neck, back and shoulders. "Claimant testified that she has significant ongoing complaints as it relates to her body as a whole, referable her neck, shoulders, back, hands and feet. She has chronic pain in her neck down to her buttocks, trouble sleeping and difficulty using her shoulders."
The Commission found reversible error by the ALJ to base PPD rates on a minimum of 30 hours for the part-time employee, given uncontroverted testimony that full-time employees in the same position worked 40 hours.
https://labor.mo.gov/sites/labor/files/decisions_wc/GrahamGabrielle14-07324901-07-20.pdf
Cast:
Hefner
Mirfasihi
Ebbert
Patel
Stuckmeyer 20%
Fevurly 1%
What's it Worth?
10% BAW cervico-thoracic.
Commission rejects Fund liability on unpersuasive "boilerplate" expert opinion
Jeffrey Dudley v Chrysler
Old Caro
Release Date: 1/14/2020 (Accident date July 10, 2008)
Venue: St. Louis
Plot Summary: Claimant alleges a back injury from assembly line work. The ALJ awarded 15% disability in a 2018 hearing. Claimant, 47, sought PTD benefits in both cases following a two level fusion. The ALJ found a two level fusion not related to the work injury.
https://labor.mo.gov/sites/labor/files/decisions_wc/DudleyJeffrey08-12470401-14-20.pdf
Cast:
Denigan, ALJ
Mandel
Mirkin
Coyle
Polinsky
Comments:
What's it worth?
15% PPD
Old Caro
Release Date: 1/14/2020 (Accident date July 10, 2008)
Venue: St. Louis
Plot Summary: Claimant alleges a back injury from assembly line work. The ALJ awarded 15% disability in a 2018 hearing. Claimant, 47, sought PTD benefits in both cases following a two level fusion. The ALJ found a two level fusion not related to the work injury.
https://labor.mo.gov/sites/labor/files/decisions_wc/DudleyJeffrey08-12470401-14-20.pdf
Cast:
Denigan, ALJ
Mandel
Mirkin
Coyle
Polinsky
Comments:
"The record of evidence does not permit an award of PPD on the first case (2006) because of the failure of proof on medical causation. The second case (2008) finds substantial probative evidence in the record for an award of PPD reflecting the serious but unoperated, if not abandoned, pathology of 2008 in which the evidence demonstrates Claimant sustained a lifting injury during the period 2006 to 2008 at the truck plant which was diagnosed as a lumbar disc pathology at L4-5. While Dr. Coyle's medical causation was persuasive, his PPD opinions were difficult to understand. Rather, Claimant's medical diagnosis together with clinical presentation warranting Dr. Mirkin's discussion of a surgery form the basis of 15 percent PPD."
The Commission finds a 15% disability associated with a new L4-5 disc herniation injury by occupational disease and a two level fusion reasonably necessary even though one of the levels was not found to be compensable.
The Commission found Dr. Volarich's opinion about synergy was not persuasive, boilerplate, nor was his allocation persuasive "because Dr. Volarich did not explain his equal rating for employee's L4-5 disc herniation, which was treated by a fusion in 2010; employee's 2003 L5-S1 disc herniation, which was treated by surgery; and employee's 2006 recurrent L5-S1 disc herniation, which was treated by injections. Dr. Volarich also appeared to confuse what treatment each injury required by stating that the 2006 recurrent disc herniation required a discectomy, when in fact it only required injections
What's it worth?
15% PPD
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