7 Workers’ Compensation Legal Decisions and Their Impact on the Industry

The quest to deny opioid treatment to a documented drug abuser, a telecommuter's fall over a dog, a slip on a hand-sanitizer puddle and more.
By: | June 10, 2019

Employer Allowed to Reject Opioid Treatment for Severely Injured Worker

Minthorn v. ET 10 Inc., 33 MIWCLR 20 (Mich. W.C.B.M. 2018)

Ruling: The Michigan workers’ compensation magistrate found that the evidence supported the conclusion that the worker’s medical treatment consisting of narcotic opioid medication was not reasonable and necessary. Accordingly, the employer was not required to pay for such medication.

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What it means: In Michigan, where the worker never fully disclosed prior alcohol and chemical dependency to the treating doctor, the worker’s complaints are primarily subjective in nature, and the worker previously ran out of medication because he was likely taking it more frequently than prescribed, the evidence suggests that the worker’s medical treatment with opioid medication is not reasonable and necessary.

Summary: A worker sustained severe injuries to his lower extremities, hip, and low back resulting in multiple surgeries. At issue was the employer’s refusal to authorize or reimburse any medical treatment. The worker had a history of narcotic use and misuse. The treating doctor prescribed various narcotic medications for the worker’s work injury. Most of these drugs continued to be prescribed years later. The employer’s independent medical examiners opined that the continued use of the opioid medications was not appropriate.

Upon review of the evidence, the magistrate relied on the opinions of the employer’s examining doctors. The magistrate noted that the worker never fully disclosed his prior alcohol and chemical dependency to the treating doctor, which may have had some effect upon the doctor’s choice of medication.

Also, the treating doctor conceded that the worker’s complaints since the onset of treatment were primarily subjective in nature. Furthermore, the doctor conceded the possibility that the worker previously ran out of medication because he was taking it more frequently than prescribed. Based on the evidence, the magistrate concluded that the worker’s medical treatment, consisting of narcotic/opioid medication, was not reasonable and necessary medical treatment.

Pre-Employment Testing Injury Fails to Win Benefits

Gadalean v. SAIF Corp., No. SC S065203 (Or. 04/18/19)

Ruling: The Oregon Supreme Court held that a job applicant injured during a preemployment test was not entitled to benefits.

What it means: In Oregon, to qualify as a “worker,” a claimant must engage to furnish services reasonably expecting remuneration.

Summary: An applicant responded to a job advertisement for a truck driver position with Imperial Trucking. He submitted his resume and a copy of his driver’s license, medical card, Social Security card, DMV records, and drug screen results. Imperial’s owner had him go to his office for an interview.

The applicant was scheduled to take a preemployment driving test. The applicant met with one of Imperial’s truck drivers for the test in which the applicant drove a truck with the driver as a passenger to a designated delivery location. While disconnecting hoses from the trailer at that location, the applicant fell four or five feet from the truck to the ground. He injured his hip and filed a workers’ compensation claim. The Oregon Supreme Court held that he was not entitled to benefits because he was not a “worker.”

The court rejected the applicant’s argument that the minimum wage law was relevant in determining whether he was a “worker.” The court noted that the legislature defined “worker” under the workers’ compensation law and the minimum wage law would not be helpful in determining the definition. The court said that the “most plausible reading of the statute” was that a worker undertook an obligation to furnish services and that he did so with the expected result of remuneration.

The court found that as the record demonstrated that Imperial agreed that the applicant would provide services but also told the applicant that there would be no remuneration, the applicant could not have reasonably expected remuneration and did not quality as a worker.

Teleworking Worker’s Trip Over Dog in Home Doesn’t Fall Within Comp

Sedgwick CMS, et al. v. Valcourt-Williams, No. 1D17-96 (Fla. Dist. Ct. App. 04/05/19)

Ruling: The Florida District Court of Appeal held that a teleworking worker’s injuries did not arise out of her employment and were not compensable.

What it means: In Florida, a worker is not entitled to workers’ compensation benefits unless there was occupational causation — a risk not existent in the worker’s nonemployment life.

Summary: A workers’ compensation claims adjustor for Sedgwick worked from her home. On the day of the accident, she had been working for three hours when she went to her kitchen for a cappuccino. As she reached to get a cup, she tripped over her dog and fell. The fall resulted in knee, hip, and shoulder injuries. The adjustor filed a workers’ compensation claim. Sedgwick denied the claim, asserting that the adjustor’s injuries did not arise out of her employment. The Florida District Court of Appeal held that the adjustor’s injuries were not compensable.

The court explained that compensability turned on whether the employment led to the risk — whether there was “occupational causation.” Here, the court found that there was no risk that didn’t exist in the adjustor’s nonemployment life. Features of the adjustor’s nonemployment life, such as her dog, her kitchen, her reaching for a coffee cup, caused the accident.

The court said that under the adjustor’s view, it would have to hold that a worker’s tripping over her own dog at home on a Friday was attributable to risks of employment while the same worker’s tripping over the same dog at the same home on a Saturday was not. The court said that it would not set aside the legislature’s “arising out of” limitation.

The court pointed out that work-at-home arrangements don’t immunize employers from workers’ compensation claim, explaining that work-at-home accidents can have occupational causation.

A dissenting judge opined that the majority’s opinion changed the “arising out of” element to mean that only injuries that are directly caused by working rather than incidental to employment.

Employer’s Surveillance Did Not Establish Laborer Was Disqualified From Comp

Persons v. Halmar International LLC, No. 526722 (N.Y. App. Div. 04/11/19)

Ruling: The New York Supreme Court, Appellate Division reversed the Workers’ Compensation Board’s ruling that a laborer was disqualified from receiving benefits by exaggerating his condition and failing to disclose his volunteer firefighter activities.

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What it means: In New York, the board’s decision that a worker was disqualified from receiving benefits by exaggerating his condition and failing to disclose activities will not stand where the decision was based on speculation, surmise, and mischaracterizations.

Summary: The New York Supreme Court, the Appellate Division reversed the Workers’ Compensation Board’s ruling that a construction laborer was disqualified from receiving benefits by exaggerating his condition and failing to disclose his volunteer firefighter activities. The court noted that when questioned at a hearing, the laborer readily acknowledged his volunteer activity with the local fire department and disclosed that he had responded to six fire department calls.

At a prior hearing, the laborer was also forthcoming about his volunteer firefighter activities. There was no indication that the carrier or any physician, either directly or on any questionnaire form, asked the laborer about his involvement in any volunteer activity.

The court also found that the board’s conclusion that the laborer’s movements of his neck, arms, and back on video surveillance were inconsistent with his alleged loss of range of motion was not supported by any medical testimony at the hearing and amounted to speculation. The court found the board mischaracterized video surveillance depicting the laborer at a grocery store. The video did not clearly reflect any heavy lifting or repetitive motion inconsistent with his complaints of pain.

Slip on Wet Grass During Storm Doesn’t Create Compensable Claim

Conner v. City of Danville, No. 1486-18-4 (Va. Ct. App. 04/23/19)

Ruling: The Virginia Court of Appeals held that a corporal’s injuries due to slipping on wet grass were not compensable.

What it means: In Virginia, under the actual risk test, proof of an injury while at work from lightning or some other natural force, standing alone, is considered “an act of God” and does not establish that the worker is entitled to coverage under the workers’ compensation law.

Summary: A corporal and other police officers for the City of Danville police department were conducting surveillance at a duplex. During the surveillance, the officers located a homicide suspect. The corporal and another officer began interviewing the suspect outside the duplex. During the interview, the weather began changing. It started to rain heavily, became windy, and hail began to fall. The officers decided to move the suspect to the other side of the duplex. The corporal started running when she slipped on the grass and injured her knee. She sought workers’ compensation benefits. The Virginia Court of Appeals held that the corporal’s injuries were not compensable.

The court concluded that the corporal’s injuries did not arise out of her employment. She argued that the risk of her slipping on wet grass was an employment-related risk because her employment duties brought her to the duplex and that it was logical that she would seek cover from the storm. The court said the fact that the corporal’s job happened to bring her to the location where she was injured was insufficient to show that her injury arose out of her employment. The corporal’s reason for running was for the purpose of removing herself from the rain and not any employment-related purpose.

The court also found that the Workers’ Compensation Commission properly found that the corporal’s injury was caused by an act of God and did not arise from her employment. The court found that she had no greater risk than anyone else who happened to be outside that day. There was no evidence that her employment required her to be outside when she interviewed the suspect. The record showed that the officers chose to conduct the interview on the porch of the duplex rather than inside a police vehicle.

Nurse’s Minor Physical Deformity Doesn’t Block Termination Petition

Paolini v. Delaware County Memorial Hospital, 34 PAWCLR 57 (Pa. W.C.A.B. 2019)

Ruling: The Pennsylvania Workers’ Compensation Appeals Board held that the workers’ compensation judge did not err in awarding benefits to a nurse who sustained physical injuries and post-traumatic stress disorder as a result of a dog bite while performing a home visit. However, the board reversed the WCJ’s denial of the employer’s termination petition, as the nurse fully recovered from the physical dog bite.

What it means: In Pennsylvania, where a work injury leaves a minor physical deformity, but no physical impairment, the employer is entitled to termination of benefits.

Summary: The board held that the WCJ did not err in awarding benefits to a nurse who sustained physical injuries and post-traumatic stress disorder as a result of a dog bite while performing a home visit. The nurse was able to meet her burden that the work-related dog bite injury resulted in disability because the WCJ accepted her doctor’s unequivocal medical testimony that she had sustained PTSD as a result of her work injury, which resulted in her inability to perform her job. The WCJ accepted the doctor’s medical opinion that the nurse’s recent Facebook photos — which showed her swimming and parasailing — did not indicate a recovery from PTSD.

However, the board reversed the WCJ’s denial of the termination petition, as the employer’s examining physician found that although the nurse had slight discoloration and subjective, mild numbness, she fully recovered from the physical dog bite. Where a work injury leaves a minor physical deformity, but no physical impairment, the employer is entitled to termination. Accordingly, the nurse fully recovered from the physical dog bite.

Shoulder Injury Compensable Despite Lack of ‘Mechanical or Structural Change’

Alexandria City Public Schools v. Handel, No. 1582-18-4 (Va. Ct. App. 05/14/19, unpublished)

Ruling: In an unpublished decision, the Virginia Court of Appeals held that a teacher’s shoulder injury was compensable.

What it means: In Virginia, when a worker is involved in an obvious accident, a single “sudden mechanical or structural change” is sufficient to demonstrate she suffered an “injury by accident.” All injuries causally connected to the accident are compensable.

Summary: A math teacher for a high school slipped on a puddle of hand sanitizer on her classroom floor and fell on her right side. Among the multiple injuries listed in her hospital records included “pain in joint, shoulder region.” The teacher filed a workers’ compensation claim alleging injuries to her right ankle, knee, hip, shoulder, neck, and back. The school district stipulated to a compensable injury by accident to the teacher’s right hip, neck, back, right ankle, and right knee but disputed claims for the right shoulder and a head injury. The Virginia Court of Appeals held that the teacher’s shoulder injury was compensable.

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The district asserted that the shoulder injury was not compensable because the teacher failed to prove a sudden mechanical or structural change in her right shoulder. The court disagreed with the district’s argument. The court explained that a single “sudden mechanical or structural change” anywhere in the body will suffice to establish that a worker suffered an “injury by accident.” Once an injury by accident is established, any injury connected to the accident is compensable even if it is not connected to the sudden mechanical or structural change.

The court explained that the “sudden mechanical or structural change” requirement is used only to establish that a worker’s injuries are accidental. It is not used to established that injuries are “injuries” under the workers’ compensation law.

In this case, the district conceded that the teacher suffered at least one “sudden mechanical or structural change” to her body. Therefore, as long as her shoulder injury was causally connected to her fall, the injury was compensable. The district did not argue that the shoulder injury was not connected to the fall. Therefore, it was compensable.

Christina Lumbreras is a Legal Editor for Workers' Compensation Report, a publication of our parent company, LRP Publications. She can be reached at [email protected]

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The R&I Editorial Team can be reached at [email protected]