Employer Liable for Unauthorized Back Surgery

Marion County Health Department v. Hill, No. 93A02-1402-EX-69 (Ind. Ct. App. 07/09/14, unpublished)

Ruling: In an unpublished decision, the Indiana Court of Appeals held that an employer was liable for the costs of an assistant’s back surgery.

What it means: In Indiana, a worker is allowed to select medical treatment in an emergency if the employer fails to provide needed medical care or for other good reason.

Summary: An administrative assistant for the Marion County Health Department felt a muscle pull in his lower back while he was lifting and carrying tables. The department authorized medical treatment for the injury through an occupational health clinic. An MRI revealed a disk extrusion in contact with a nerve root. Physical therapy did not help with the assistant’s pain, and a steroid injection only helped temporarily. Later, the department’s physician released the assistant from his care without any restrictions. The assistant sought further medical treatment on his own with an orthopedic spine surgeon. The surgeon performed surgery. The Indiana Court of Appeals held that the department was liable for the costs of the assistant’s surgery.

The department asserted that it was not required to pay for the assistant’s back surgery because he did not seek prior approval for the surgery. The court concluded that the assistant was not required to seek prior approval because his decision to obtain unauthorized care fell under the “other good reason” exception.

The court found that the assistant acted in good faith when he sought treatment from the surgeon without obtaining the department’s approval. The record also showed that the course of treatment offered by the department was inadequate. Despite the efforts of two physicians and other health care professionals, the assistant still suffered pain which was getting progressively worse. At one visit to the clinic, the assistant used a cane even though the department’s physician concluded less than two months earlier that he was at maximum medical improvement and did not sustain a ratable impairment. The court also found that the surgeon’s treatment was “reasonable and necessary” and improved the assistant’s medical condition.

Officer Secures Total Disability for PTSD 12 Years After Incident

Duncan v. State of Michigan, 28 MIWCLR 47 (Mich. C.A.C. 2014)

Ruling: The Michigan Compensation Appellate Commission granted an open award of benefits to an officer for mental disability injuries due to being held hostage by inmates in 1990.

What it means: In Michigan, a worker’s delayed response to a traumatic event that led to her disability and need to leave work will support an award for benefits.

Summary: The commission affirmed the magistrate’s decision granting an open award of benefits to a corrections officer for mental disability injuries due to being held hostage by inmates in 1990. She returned to work in 1991 but never felt safe in any of the job positions she was assigned. She left work in 2002 and eventually received a duty-related retirement. She alleged mental injury as well as an orthopedic condition. The magistrate found no evidence of a work-related physical injury in 2002. However, the magistrate found that a delayed response to the traumatic work event in 1990 led to the officer’s total disability and necessity to leave work in 2002 and was the cause of her post-traumatic stress syndrome. In affirming, the commission refused to disturb the magistrate’s reasonable choices of medical evidence.

The commission determined that the magistrate’s finding of total disability due to the 1990 work incident was fully supported by the medical witnesses, treating practitioners, and other examining expert witnesses. The majority of the medical expert witnesses fully supported a finding that the officer was totally disabled and not employable in any occupation suitable to her experience, training, and education.

Firefighter Files Claim for Injury Sustained When Rising from Chair

Chambers v. Monroe County Board of Commissioners, No. A14A0265 (Ga. Ct. App. 07/16/14)

Ruling: The Georgia Court of Appeals held that a firefighter’s knee injury was not compensable because it did not arise out of her employment.

What it means: In Georgia, an injury arises out of a worker’s employment when there is a causal connection between the employment and the injury.

Summary: A firefighter for Monroe County was sitting at a desk watching television. Her supervisor asked her to get up from the desk so he could use it. When she rose from the chair, the firefighter felt and heard a “pop” in her left knee. She underwent knee surgery. The firefighter sought benefits. The Georgia Court of Appeals held that she was not entitled to benefits.

The firefighter testified that she did not get up from the chair in an unusual manner. She offered no testimony to establish a causal connection between her employment and her injury. For example, she did not assert that the chair or desk configuration caused her to lose her balance or strain to reach a standing position, that a work-related emergency such as a fire alarm caused her to jump out of the chair in a hurried manner, or that she came into contact with any object or hazard such as the desk, stairs, or a piece of equipment. The court concluded that the firefighter’s injury did not arise out of her employment.

A dissenting judge opined that where the undisputed evidence shows that the worker was injured while undertaking a physical activity at the express direction of her supervisor, the injury arose out of and in the course of the employment. The judge opined that in this case, there was a sufficient causal connection between the conditions of employment and the resulting injury to warrant compensation.

Worker’s DVT Is Compensable ‘Spill-Over’ Injury

Architectural Wall Systems v. Towers, No. 13-1653 (Iowa Ct. App. 07/16/14)

Ruling: The Iowa Court of Appeals held that a worker’s deep vein thrombosis was a compensable industrial disability.

What it means: In Iowa, if a worker’s injury is not confined to one of the scheduled areas, the injury is compensated industrially by consideration of the worker’s lost earning capacity.

Summary: An industrial worker/glazier was injured when he twisted and fractured his right ankle while working for Architectural Wall Systems. He underwent surgery to repair the broken ankle. Six weeks after surgery, the worker experienced pain and swelling in his right leg, and he was diagnosed with deep vein thrombosis. A surgeon removed a blood clot and inserted a filter to prevent clots from moving to the worker’s heart or lungs. The worker sought benefits for his DVT. The Iowa Court of Appeals held that the worker’s DVT was a compensable industrial disability.

The court found that AWS was correct that all the medical evidence supported that the injury was confined to the worker’s lower extremity. Each doctor concluded that the DVT was confined to the worker’s right lower extremity. The clots did not travel elsewhere to the body, and the cause of the DVT — trauma to the ankle — restricted the condition to the lower extremity. The court pointed out that the permanent placement of the filter outside of the worker’s leg was evidence of an ongoing disability outside of the leg but still within the lower extremity. The court found that the worker’s DVT represented a “spill-over” injury, which was compensable as an injury to the body as a whole.

The court awarded the worker 60 percent industrial disability. Substantial evidence showed that the worker was on the path to becoming a glazier and was hired in that capacity. The injury substantially impacted his earning capacity. He was unable to reenter the apprenticeship program and become a glazier. Also, his permanent restrictions limited his capacity to perform manual labor, the only work for which he was reasonably suited.

Worker’s Horseplay Nixes Petition for Benefits

Barrett v. Service Management Systems, Inc., 29 PAWCLR 118 (Pa. W.C.A.B. 2014)

Ruling: The Workers’ Compensation Appeals Board affirmed the workers’ compensation judge’s decision denying benefits to a worker, who was injured when the utility vehicle he was driving rolled over. Evidence indicated the worker was not in the course and scope of his employment at the time of the accident.

What it means: In Pennsylvania, a claimant’s injury that is caused by his horseplay, rather than a condition of the employer’s premises, is not compensable.

Summary: A worker testified he was returning to the work area with a lunch he purchased at a nearby gas station when the utility vehicle he was driving started “cutting out.” He hit the gas, and the vehicle started sliding on snow and ice. He hit a dry patch, and the vehicle flipped over. However, two witnesses testified that before the accident they observed the worker performing “fish-tails” and skidding. The WCJ denied benefits. Relying on the testimony of the two witnesses, the WCJ found the worker’s injury occurred while he was attempting to fish-tail the vehicle he was driving. In affirming, the board determined the worker was not acting in furtherance of the employer’s business as he was attempting to fish-tail the vehicle in an overflow parking lot, allegedly on his way back from picking up lunch.

Also, the worker’s injury was not caused by a condition of the premises. Rather, the injury was due to the worker’s horseplay. Therefore, the worker failed to establish an injury occurred in the course and scope of his employment.

Harassment by Co-worker’s Spouse Triggers Compensable Stress Disorder

Mosley v. Hannaford Brothers Co., No. 517175 (N.Y. App. Div. 07/03/14)

Ruling: The New York Supreme Court, Appellate Division held that a manager was entitled to benefits for the exacerbation of his post-traumatic stress disorder.

What it means: In New York, an award of workers’ compensation is appropriate if there is any nexus between the motivation for the assault and the employment.

Summary: An assistant store manager for Hannaford Brothers made a telephone call to a coworker at her home to discuss a work-related matter. The coworker’s husband became convinced that the manager and the coworker were engaged in a romantic relationship. The husband took threatening and harassing conduct against the manager, culminating in an unsuccessful murder-for-hire plot against him. Also, the coworker’s husband contacted the manager’s supervisor regarding the alleged affair, triggering an internal investigation by Hannaford and resulting in the manager requesting a transfer to another store. The manager’s preexisting post-traumatic stress disorder was exacerbated to the point that he was unable to continue to work. He filed a claim for benefits. The New York Supreme Court, Appellate Division held that he was entitled to benefits.

Hannaford argued that the manager’s claimed injury was not causally related to his employment. The court disagreed, finding a nexus between the threatening conduct that exacerbated his condition and his employment. The work-related phone call from the manager to his coworker’s home was the basis for the harassment at the manager’s place of employment, Hannaford’s internal investigation, and the manager’s request for a transfer that exacerbated his preexisting stress disorder.