Medical Benefits and Causation

Here, the Industrial Claim Appeals Office (“Panel”) affirmed the ALJ’s order requiring the respondents to pay for claimant’s hip surgery because the order was based on the resolution of competing medical opinions, which is well within the ALJ’s authority.

The claimant sustained an admitted industrial injury on December 27, 2013, when she slipped and fell onto her left side. The claimant was not immediately referred to an authorized provider and sought treatment with her chiropractor, Dr. Pool. In January of 2014, the respondents referred the claimant to the emergency room because there was no provider associated with her workers’ compensation claim. The claimant went to the St. Mary Corwin Hospital emergency room on January 9, 2014, and stated that she injured her left shoulder, arm, elbow and side. The claimant also described pain in her left buttock that radiated to her left lateral thigh. The examination of the claimant’s left hip was reported as normal except for “mild tenderness about the lateral aspect.” Claimant treated with Dr. Pool for almost three years.

Dr. Raschbacher performed an independent medical exam (“IME”) on November 15, 2015. Dr. Raschbacher opined that the claimant’s greater trochanteric bursitis was the most likely primary diagnosis to explain the claimant’s hip complaints. Dr. Raschbacher recommended discontinuing chiropractic treatment and referral for an orthopedic evaluation with consideration of injection and, if not successful, an MRI.

The claimant saw orthopedic surgeon, Dr. Danylchuk on February 16, 2016, and noted that the claimant’s most significant complaint at that time was her low back, but that she also reported left hip pain. X-rays of the hip were normal. An MRI revealed a mildly displaced anterior superior labral tear. Dr. Danylchuk later administered a left greater trochanteric bursa injection. At her next appointment, the claimant reported that she received no benefit from the injection. Although Dr. Danylchuk recommended an intra-articular injection, the claimant declined and was referred to Dr. White.

Dr. White recommended surgery for the labral tear he opined was due to the injury.  Dr. Claimant obtained a IME who and concurred with Dr. White.  Respondents obtained an IME from a hip specialist, who disagreed and noted that the radiologic evidence supported only that the changes were chronic, degenerative and longstanding, and not caused by the work incident.

The ALJ credited the opinions of Dr. White and Claimant’s IME over that of Respondents’ IME, despite the superior qualifications of Respondents’ IME as a hip specialist.

On appeal, the Panel rejected Respondents’ contention that Dr. White did not perform a competent causation analysis.  The ALJ determined that the claimant proved by a preponderance of the evidence that her need for the hip surgery was proximately caused by her work injury. Indeed, because the question of the need for medical treatment is one of fact, the Panel must defer to the ALJ.

Olguin v. Texas Roadhouse, Inc., W.C. No. 4-965-734-03 (ICAO Mar. 6, 2018).

Would you like to know more? Contact Christin Bechmann at or 720.488.9586.


From the March 2018 Pollart Miller Newsletter