Partial Settlement Protects Against Future Causation Disputes

The claimant injured his left foot/ankle and low back in 2017, resulting in left ankle surgery and a CRPS diagnosis. After significant treatment, the claimant was placed at maximum medical improvement (MMI) and underwent a Division Independent Medical Examination (Division IME). The Division IME was unequivocal that the work injuries included left ankle/foot, low back, and CRPS. The claimant was assigned impairment consistent with those body parts and maintenance was limited to those body parts. Specifically, at the time of 2019 Division IME, no right knee condition was assessed or found work-related, and no impairment was found for that condition.

Respondents admitted to the Division IME opinions and filed a Final Admission, after which the claimant requested a hearing on permanent total disability benefits only. The parties ultimately entered into a partial settlement of indemnity in December 2019. Maintenance care was left open.

During the pending application for hearing, the claimant began complaining of right knee pain and seeking out care for that condition. The claimant’s treating physicians, despite not documenting any right knee symptoms from the date of injury in 2017 until after the Division IME in 2019, felt that the right knee condition was related to the original injury. The claimant requested a hearing on maintenance benefits.

At the hearing, the partial settlement was introduced as evidence. The ALJ found persuasive that the claim was only open to medical treatment that was reasonable, necessary, and causally related to the initial injury, of which the right knee was not included. Therefore, the ALJ found that she lacked jurisdiction to award maintenance care for the right knee. The claimant appealed to the Industrial Claims Appeal Office (the Panel), which affirmed the ALJ’s determination. Specifically, the Panel noted that the partial settlement was unambiguous that the claimant waived treatment related to the right knee. In so finding, the Panel noted that the settlement documents delineated the admitted body parts and contained a clause regarding waiver of “unknown” body parts and conditions at the time of the settlement.

 

Joe Jones v. HSS, Inc. and Hartford Ins. Co., W.C. No. 5-040-522-002 (I.C.A.O. Feb. 12, 2021).

 

Want to know more? Contact Jessica Grimes at jgrimes@pollartmiller.com or 877-259-5693.

March 2021 Newsletter

2021-04-21T07:40:07+00:00