Compensability

The Industrial Claim Appeals Office (“the Panel”) affirmed the ALJ’s order regarding two different workers’ compensation claims brought by the same claimant: (1) denying compensability and (2) determining that the respondents overcame the Division Independent Medical Examiner (“DIME”) physician’s opinion in a second claim.

Claimant alleged an injury in August 2014 during work hours as a greenhouse laborer; when she allegedly fell off of a later after missing the final rung and hurt her knee. Although she notified her supervisor of the incident, she did not report an injury and declined medical treatment. She worked full duty for another month, and was eventually laid off, and sought care for her knee 4 months after the injury.  When she returned to work, she told her co-workers she was injured at home.

The ALJ dismissed the claim and the Panel affirmed, finding substantial evidence supported the order.

In the second, admitted knee claim, the Claimant was placed at MMI with no impairment and challenged through a Division IME (DIME). The DIME opined the claimant was not at MMI and needed surgery related to the injury.  Respondents countered with two IME’s, both of whom opined that the tears in the knee requiring surgery were not work related.  The ALJ agreed, specifically noting that the DIME neglected to perform a proper causality analysis under the Medical Treatment Guidelines.  The Panel affirmed the ALJ’s order based on substantial evidence.

 

Claims Representation Practice Tip:

Encourage employers to take contemporaneous notes/incident reports when a claimant reports  even a “minor” event.  The claimant’s version of events, description of symptoms, and declining care could all factor into the compensability analysis.

De La Luz Saenz v. Tagawa Greenhouse, W.C. Nos. 4-972-238-02 & 5-112-306-01.

Would you like to know more? Contact Ilene Feldmeier at ifeldmeier@pollartmiller.com or 720.488.9586

 

From the March 2018 Pollart Miller Newsletter

2019-01-29T09:12:37-07:00