Compensability – No Accident Found When Need for Treatment Stemmed From Prior Injury

ALJ denied and dismissed claim for a total knee replacement when the initial incident that ultimately led to the need for treatment occurred in 1997.

The claimant worked as a police officer who initially injured his right knee in 1997. He sustained a tibial plateau fracture, which set in motion and accelerated the onset of progressive degenerative and arthritic process in claimant’s knee. Claimant sustained several additional aggravations to his knee while he continued to work as a police officer. Claimant alleged he sustained another specific injury to his knee on June 13, 2016 when he attempted to lift a car off a person. He heard a pop and experienced pain in his right knee. Claimant sought medical treatment and claimant’s authorized treating physician (ATP) recommended claimant required a total knee replacement. The ATP initially recommended that claimant attempt to re-open his 1997 case. When the ATP learned that was not possible, he changed his opinion and opined that claimant’s need for a knee replacement was due to both an acute event in 1997 and an occupational disease due to claimant’s ongoing work as a policy officer.

Respondents’ expert, Dr. O’Brien, evaluated claimant for an independent medical examination. Dr. O’Brien opined that once claimant sustained the 1997 injury, it caused accelerated or premature severe degenerative arthritis and claimant would have required a total knee replacement regardless of whether he suffered any additional injuries after the 1997 tibial plateau fracture. The ALJ credited Dr. O’Brien’s causation opinions in finding that claimant failed to prove he sustained a compensable work injury. The ALJ denied and dismissed claimant’s request for medical treatment.

Steven Kunst v. City of Englewood, WC 5-062-310-01

Would you like to know more? Contact Brad J. Miller or Kendra Garstka at, or 877-259-5693.

From the November 2018 Pollart Miller Newsletter