ALJ Rejects Argument that Claimant’s Low Back Condition is Work-Related (After First Finding That the Division IME Has no Special Weight on the Issue)

Brad Miller and Amanda Branson recently prevailed on a causation defense involving a low back claim.  The claimant admittedly suffered a low back injury but was ultimately placed at MMI.  A Division IME occurred and the doctor found that claimant’s ongoing low back condition was not work-related and released claimant to MMI with a 0% impairment rating.  Respondents filed a Final Admission of Liability and claimant requested a hearing to contest the issues.

Claimant argued at the hearing that this case involved a medical only claim without any wage loss involved so the Division IME was inapplicable and should be given no special weight when considering the causation issue.  Claimant argued that he did not have to overcome the Division IME by clear and convincing evidence and that the Final Admission had no legal effect.  The ALJ agreed with this legal argument based on the recent decisions in the Loofbourrow and Trujillo cases (see prior newsletters about this case law).

Despite the legal determination about the inapplicability of the Division IME process and Final Admission to medical only claims, the ALJ nevertheless found that claimant’s ongoing low back condition was not work-related based in part on the following evidence: (1) claimant had been doing well and had been released from treatment before being incarcerated: (2) after his incarceration, claimant had new symptoms and started using a cane; and (3) there was also evidence that claimant had new structural findings in the low back on a MRI scan after being incarcerated.

As a result, the ALJ found that claimant failed to prove that his medical condition was work-related based on a preponderance of evidence.

WC 5-012-465-04: January 31, 2018 SFFCLO (ALJ Peter Cannici)

If you have any questions regarding this case, please contact Mr. Miller at bmiller@pollartmiller.com or Ms. Branson at abranson@pollartmiller.com.  Both Mr. Miller and Ms. Branson can also be reached at 720.488.9586.

 

From the March 2018 Pollart Miller Newsletter

2019-01-29T09:07:03-07:00