Just Because an Injury is Compensable Does Not Mean Medical Care is Causally Related

Posted July 12, 2017

The Industrial Claims Appeals Office (ICAO) affirmed the Administrative Law Judge’s (ALJ) decision that there was an insufficient causal link between claimant’s surgery and her compensable industrial injury.

Here, claimant injured her knee while pushing a washing machine at work.  An MRI revealed that claimant had pre-existing issues with her knee; thereafter, she received surgery. However, the ALJ did not find that the surgery and work injury were related because an MRI revealed that claimant’s need for knee surgery was the result of a longstanding and preexisting instability condition that was not triggered by the industrial accident.

On appeal, claimant argued the ALJ abused his discretion in holding that the surgery was not causally related to the injury.  However, the ICAO affirmed the ALJ’s decision, holding that the ALJ did not err in concluding that the surgery and injury were not causally related.  The ICAO held ALJ’s findings were supported by several medical reports which indicated that claimant’s need for surgery was not a result of the industrial injury, but the result of a longstanding issue.

Gilbert v. Sears Outlet, W.C. No. 5-002-271-02 (ICAO May 1, 2017).

Would you like to know more?  Contact Eric J. Pollart at epollart@pollartmiller.com or 303.414.0782. [Eric J. Pollart]