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)
Friday, January 24, 2020
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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