NEWS / Legal News - August 2017
Supreme Court Reverses WCCA stating employer and insurer's IME had foundation
Supreme Court Reverses WCCA
An employee had pre-existing ankle arthritis. She then sustained a work injury to the ankle, which led to an ankle fusion surgery a year later.
The employer and insurer argued that the ankle fusion was substantially caused by the work injury and an Independent Medical Evaluation (IME) supported their argument. Conversely, the employee's treating doctor failed to give definitive statements on causation, so the employee then sought her own IME, in which the doctor stated the fusion WAS related to the work injury.
The compensation judge reviewed all the medical opinions and adopted the employer and insurer's IME opinions and denied the claim.
The employee appealed the decision and the WCCA reversed the judge's decision, stating that the employer and insurer's IME opinion lacked foundation because the doctor relied on an expected natural history of an arthritis condition, as opposed to the employee's actual history, and the doctor failed to note a ten year gap in symptoms between the original arthritis diagnosis and the work injury.
SUPREME COURT DECISION
The Supreme Court reversed the WCCA's decision, stating that the employer and insurer's IME had foundation, and like the Giannotti case, the WCCA took statements out of context. While the IME did talk about the expected natural history of arthritis, the doctor also clearly recounted and analyzed the specifics of the employee's injury.
The court found that compensation judge's decision was supported by substantial evidence. The IME opinion supported the decision, as well as the employee's testimony that she had ongoing symptoms for ten years before her work injury. Similarly, the X-rays showed degenerative changes and the employee's ultimate diagnosis was degenerative arthritis, indicating that her ankle had deteriorated over time. Additionally, the employee did not have work restrictions after the work injury and had gradual improvement in her condition. It was not until a few months before her surgery, a year and a half after the work injury, that her symptoms became excruciating.
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