Medical Benefits

Claimant suffered severe chest pain, lightheadness and arm numbness while turning sharply to assist a customer.  His supervisor issued a “code white” and called an ambulance to take him to the hospital. However, subsequent to the initial emergency care it was eventually determined that the claimant’s symptoms originated from  preexisting conditions.   Respondents denied the claim accordingly.

At hearing, the ALJ held that the injury was not compensable, but still ordered employer to pay for the emergency medical care.

Respondents appealed. The Panel reversed the decision of the ALJ, holding that a claimant is not entitled to medical benefits merely because an accident occurs during the course of employment.   Instead, the work related accident must be the proximate cause of the injury suffered, and the medical treatment provided must be reasonable and necessary to cure and relieve the effects of the injury.

The ALJ found that the claimant did not sustain an industrial injury, but rather that the claimant’s conditions pre-existing his arrival at work on the date he suffered the severe symptoms. The Panel held this was akin to finding that the need for emergency medical treatment was not proximately caused by the work incident (turning sharply to assist a customer).   Since the claim was not compensable, Respondents were not responsible for any medical care, including the emergency services.

Madonna v. Wal-Mart, W.C. No. 4-997-641-02 (ICAO Aug. 21, 2017).

Would you like to know more? Contact Eric J. Pollart at or 303.414.0782.


From the September 2017 Pollart Miller Newsletter