Worker's brain hemorrhage isn't related to surgery for work injury
Case name: Welcher v. Central Mutual Insurance Co., No. M2012-00248-WC-R3-WC (Tenn. 03/21/13, unpublished).
Ruling: In an unpublished decision, the Tennessee Supreme Court held that a worker was not entitled to benefits for the brain hemorrhage he suffered after surgery for his work-related neck injury.
What it means: In Tennessee, an independent medical examiner's opinion that a worker's condition was not related to his work injury can support the denial of medical benefits.
Summary: A worker sustained a work-related injury to his neck, and he received workers' compensation benefits and future medical benefits. A dispute arose regarding his medical treatment. His treating physician recommended that he undergo surgery. The employer's workers' compensation insurer declined to pay for the recommended surgery until the worker underwent a second opinion examination. After having problems obtaining a second opinion examination, the worker underwent surgery and sought coverage through his wife's health insurer. Four days after surgery, he suffered a brain hemorrhage. The insurer refused to pay for the medical expenses for the hemorrhage, although the neck surgery was ultimately found work-related. The Tennessee Supreme Court held that the insurer was not liable for the costs of treatment for the hemorrhage.
The court noted that expert opinions as to causation of the hemorrhage differed. The treating physician believed that the onset of symptoms of the hemorrhage occurred when the worker was straining to defecate due to constipation caused by pain medication. However, the worker said that he was not straining when the symptoms began. An independent medical examiner said that hemorrhage was "spontaneous" and the treating physician's opinion was "a stretch." Both doctors agreed that many brain hemorrhages had no known cause. The court concluded that the hemorrhage was not related to the neck surgery necessitated by the worker's work injury.
The court rejected the worker's argument that he was entitled to attorney's fees for the recovery of medical expenses for treatment of his hemorrhage. The court found that an attorney's fee award should not be limited to 20 percent of the amount the insurer paid for the surgery. The court remanded the case to determine a reasonable award of attorney's fees.
Read more at the WorkersComp Forum homepage.
July 8, 2013
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