Applicant allegedly sustained a low back injury on March 22, 2019 that was both unwitnessed and unreported timely to his employer. Applicant filed a Workers’ Report of Injury and the Industrial Commission of Arizona (“ICA”) issued a Notification of Worker’s Compensation Claim. Defendants did not receive these pleadings due to an internal filing error and argued that, regardless, they had properly denied the claim once it was received due to significant medical history pre-dating the alleged injury that was not disclosed by Applicant to his treating doctors.
The Administrative Law Judge (“ALJ”) agreed with Defendants on both counts. The ALJ found there was no bad faith for proceeding with a defense not well-grounded in fact or law or for unreasonably failing to respond/acknowledge communications from the ICA or Applicant. Rather, the ALJ found persuasive that Defendants promptly issued a denial once the misfiled documents were brought to the adjuster’s attention. Further, on compensability, the ALJ agreed with Defendants that Applicant failed to disclose to his treating doctors a significant and identical pre-existing history that was last treated just days prior to the alleged injury. The ALJ resolved the conflicts in the medical record in Defendants’ favor, finding that Applicant failed to prove medical causation necessary for a compensable claim.
Practice tip: A procedural mistake should not deter a proper and thorough investigation into initial compensability.
Karl Welch v. Life Care Center of Amer., ALJ0003042 (Indus. Comm’n of Arizona).