In a workers’ compensation claim, an employer “shall furnish such medical, surgical, dental, nursing, and hospital treatment…as may be reasonably needed at the time of injury or occupational disease and thereafter during the disability to cure and relieve the employee from the effects of the injury.” The issue addressed by the Industrial Claims Appeals Office (“the Panel”) in Marcella v. Teltech was whether the employer was responsible for injuries that arose out of the reasonable treatment received for the initial workplace injury.
Claimant sustained a workplace injury to his right hand in April, 2015. Claimant’s physician opined he required surgery on his wrist due to his injury. Claimant underwent two surgeries on his wrist in April and June of 2016. Prior to this treatment, in 2014, Claimant sustained a work injury to his back, from which he had since reached MMI with no permanent impairment. It was also found in September, 2016 that Claimant was suffering from cervical spine degeneration. In December, 2016, Claimant was diagnosed with an issue in his right shoulder and received a permanent impairment rating of his upper extremity of 30%. The employer claimed that neither the spinal nor shoulder injuries were due to Claimant’s work injury involving his right wrist.
Claimant sought review of his injuries by a requesting a Division Independent Medical Examination (“DIME”). The DIME physician found that Claimant’s prior conditions were aggravated by the way he was positioned when he underwent his reasonable, necessary wrist surgery related to his workplace injury. The DIME physician found that because of the faulty positioning during Claimant’s wrist surgery, Claimant suffered additional impairment and had not reached MMI. Respondents stated the shoulder issues cited by the DIME physician were independent and predated the workplace injury. However, the Panel found that ALJ properly decided that Respondents failed to overcome the DIME’s findings by clear and convincing evidence. The ALJ had determined there was a causal connection between the workplace injury and the injury’s reasonable treatments, which caused Claimant further injury.
The Panel explained that injuries sustained as a consequence of obtaining reasonably authorized medical treatment are compensable under the quasi-course of employment doctrine. The Panel explained that the employer’s provision of treatment and Claimant’s duty to cooperate with that treatment renders treatment an implied part of an employment contract. Claimant’s compliance with reasonable treatment is indicative of Claimant adhering to the requirements set forth by his employer. The Panel explained that if a claimant is injured in the course of following such requirements for treatment, the employer may be held liable.
The Panel also concluded that whether an injury arises from the reasonable treatment for a workplace injury is a factual finding that is subject to the discretion of the ALJ. The Panel may not substitute its judgment by reweighing the evidence in order to reach a conclusion different than the ALJ. The ALJ was found to have properly weighed the evidence in its finding that the DIME physician’s conclusion was not overcome by Respondents through clear and convincing evidence. The court held that the Claimant was entitled to reasonable treatment to cure and relieve subsequent injuries as they arose from the work place wrist injury.
Marcella v. Teltech Communications, LLC, W.C. No. 4-989-945 (ICAO, May 22, 2020)