Incarceration Doesn’t Block TTD Benefits

Damme v. Pike Enterprises, Inc., No. S-14-304 (Neb. 12/05/14)

Ruling: The Nebraska Supreme Court held that a worker was not barred from receiving temporary total disability benefits while she was incarcerated.

What it means: In Nebraska, if a worker can prove a loss of earning capacity, her incarceration after sustaining a compensable injury will not bar her receipt of benefits.

Summary: A worker with a history of degenerative disk disease felt a pop in her back while carrying bags when she was working in a McDonald’s restaurant. She was prescribed narcotic medications. Later, the worker was arrested and incarcerated. After she was released, she underwent surgery, which was a success. The surgeon released her to work without restrictions. The worker sought temporary total disability benefits. The Nebraska Supreme Court held that she was entitled to benefits during the time she was incarcerated.

The court rejected the employer’s arguments that the incident was a “temporary symptom aggravation” of the worker’s preexisting back problems and that she underwent surgery in an effort to obtain more narcotic prescriptions. The court found that two physicians’ opinions were sufficient to show that she sustained a work-related injury to her back. The physicians opined that she sustained an exacerbation of her preexisting degenerative disk disease. One physician’s notes showed that surgery was necessary to treat her condition. The court noted that nonsurgical treatment had been unsuccessful.

The court also rejected the employer’s argument that temporary disability benefits are intended to replace a worker’s wages while they are healing from an injury. Disability benefits are awarded for diminished employability or impaired earning capacity and do not depend on a finding that the worker cannot be placed with the same employer or a different one. The court explained that the workers’ compensation law does not disqualify incarcerated workers from receiving those benefits. Unless the legislature amends the statute, the court cannot deny workers’ compensation benefits to prisoners.

Here, the court found that the worker proved her diminished working capacity from the date of her injury until the date her surgeon released her to return to work.

Comp Denied for Pain Not Related to Work Accident

Bowman v. Terrebonne Parish Consolidated Government, No. 2014 CA 0978 (La. Ct. App. 12/23/14)

Ruling: The Louisiana Court of Appeal held that an associate was not entitled to benefits for his leg pain.

What it means: In Louisiana, a worker with a preexisting condition is entitled to benefits if he can prove that the work-related accident contributed to, aggravated, or accelerated his injury.

Summary: A juvenile care associate for the Terrebonne Parish Juvenile Detention Center fell backwards while attempting to break up a fight between two juvenile detainees. He reported experiencing “some tightening” on his right side and “some discomfort” in his neck immediately after the incident. He was cleared by a paramedic and completed working his shift for the night. He continued to work without missing any days until three months later when he complained of leg pain. An MRI revealed degenerative disk disease. The associate sought workers’ compensation benefits. The Louisiana Court of Appeal held that he was not entitled to benefits.

The court pointed out that the associate did not complain to his supervisors and coworkers of any problems after the date of the accident. The Office of Workers’ Compensation judge found that the employer rebutted the presumption that the associate’s disability was caused by the workplace accident. The judge pointed out that the disabling condition had to appear and continually manifest itself after the accident, and the associate had to provide sufficient medical evidence that there was a connection with the disabling condition.

The judge found no evidence of a disabling condition. The associate was able to work after the accident without consequence. The judge found that any subsequent issues that arose were not related to the accident but could have been related to his age and his preexisting condition.

Impartial Panel Rejects Finding of Causal Connection

Estate of Reitz v. Labor Commission, No. 20130373-CA (Utah Ct. App. 12/11/14)

Ruling: The Utah Court of Appeals held that a worker’s estate was not entitled to benefits.

What it means: In Utah, a worker must establish a medical causal connection between his work accident and his medical problems.

Summary: A worker for Hilti injured his back after falling from a ladder. He sought workers’ compensation benefits but died while his claim was pending. His estate also sought dependent and burial benefits. The Utah Court of Appeals held that the worker’s estate was not entitled to benefits because it failed to establish a medical causal connection between the work accident and the worker’s medical problems.

The worker had preexisting physical and emotional problems, including pain in his back, neck, and extremities, headaches, abdominal pain and vomiting, episodes of explosive anger, and periods of drug and alcohol abuse. He also had been involved in multiple accidents and had continued to receive medical treatment for his various ongoing problems, including injuries from a motor vehicle accident, sleep apnea, respiratory infections, depression, and vomiting.

An impartial medical panel concluded that the worker’s accident “may have aggravated chronic recurring low back pain,” but his condition became medically stable. The panel also concluded that medical care was not necessary to treat his condition as a result of the industrial accident but was necessary because his “underlying medical problems persisted, progressed, and were compounded.” The panel concluded that the worker’s death was likely the result of a cardiac arrhythmia due to an acute electrolyte imbalance from an episode of persistent vomiting. Headaches with vomiting may have accompanied back pain, but they were not caused by the abrasions and contusions to the back caused by the work-related ladder fall. The court found a reasonable mind could accept as adequate the medical panel report.

Worker’s Intoxication During Accident Bars Claim for Benefits

Giles v. Eagle Farms, Inc., No. 41469 (Idaho 11/28/14)

Ruling: The Idaho Supreme Court held that a worker was barred from receiving income benefits.

What it means: In Idaho, a worker is not entitled to income benefits if intoxication was a reasonable and substantial cause of the injury.

Summary: A worker for Eagle Farms was involved in a one-vehicle accident while returning from repairing a sprinkler pivot. He was ejected from his vehicle and suffered severe injuries. At the time of the accident, he was driving 123 miles per hour in a 50 mile per hour zone, he was legally intoxicated with a blood alcohol level of 0.11, he was familiar with the road, and he was not wearing a seat belt. The worker also claimed that he was texting at the time leading up to the accident. The worker sought benefits. The Idaho Supreme Court held that he was not entitled to income benefits.

The court found that the worker’s intoxication was a reasonable and substantial cause of the injury, stating that the case was “close to a no-brainer.” The court explained that just because a worker with a blood alcohol level of more than the legal limit is involved in an accident does not mean that intoxication was a reasonable and substantial cause of the accident. Here, a trooper who investigated the accident testified that the circumstances of the accident suggested that intoxication was a cause of the accident. The trooper opined that the judgment of a person behaving in such a way would have been affected by his consumption of alcohol. A pharmacologist also opined that the worker would have been impaired in his ability to safely operate a vehicle and that intoxication was a reasonable and substantial cause of the crash and injury.

The court found that the Industrial Commission’s consideration of the worker’s use of prescription pain medication was at most harmless error. The court also explained that even assuming that the worker had been texting at the time of the accident, there was still substantial and competent evidence to find that intoxication remained a substantial cause of the accident and resulting injuries. The court pointed out that the worker’s failure to wear a seat belt may have caused his injuries to be greater than they might otherwise have been, but it did not change the fact that there would have been no injuries if the worker had not had the accident.

Failure to Request Kidney Cancer Treatment Sinks Claim

Sears Outlet v. Brown, No. 1D14-2289 (Fla. Dist. Ct. App. 12/09/14)

Ruling: The Florida District Court of Appeal held that an employer was not required to pay the medical costs for the treatment of a worker’s renal cancer.

What it means: In Florida, a worker must make a specific request for the initial treatment, and the employer or carrier must be given a reasonable time period within which to provide the treatment before the worker can recover any amount expended for the initial treatment.

Summary: A worker experienced a recurrence of back pain after he underwent low back surgery to treat his compensable injury. An MRI of the lumbar spine revealed a right kidney mass suspicious for renal cancer. An authorized urologist referred the worker to a hospital for further diagnostic testing regarding the kidney. Physicians opined that the kidney mass needed to be removed before the worker could undergo further evaluation of the low back, have back surgery, or take additional anti-inflammatories. Instead of requesting the recommended kidney diagnostics and surgery from the employer, the worker had surgery to remove his kidney on an unauthorized, nonemergency basis. He asked the employer to pay for the surgery after it was complete. The Florida District Court of Appeal held that the worker was not entitled to medical costs related to the treatment of his renal cancer.

The court explained that a worker must make a specific request for the initial treatment, and the employer or carrier must be given a reasonable time period within which to provide the treatment before the worker can recover any amount expended for the initial treatment. Here, it was undisputed that the worker did not specifically request that the employer provide the treatment recommended by the urologist and provided by the hospital. Although the urologist recommended follow-up for the kidney mass, he indicated that it was unlikely that the kidney condition was related to the workers’ compensation injury. The court found that the urologist’s report could not be reasonably construed as a specific request for treatment from the employer.

Manager Within Scope of Employment When Shot

Modern Property Management v. Estate of Wilburn, et al., No. 2013-CA-001425-WC (Ky. Ct. App. 12/12/14, unpublished)

Ruling: In an unpublished decision, the Kentucky Court of Appeals held that a manager’s estate was entitled to death benefits.

What it means: In Kentucky, a death can be considered work-related when the worker’s exposure to the risk is related to his employment and except for his presence there, he would not have been killed.

Summary: A maintenance manager for Modern Property Management leased an apartment in a building managed by Modern. Tenants in the building sometimes approached him directly for repairs. The manager left work from another of Modern’s buildings and went home to eat lunch and visit with guests who were staying in his apartment. He planned to drive his guests to the airport after lunch. While eating lunch, a tenant in the building knocked on his door. The tenant, who had a history of mental illness, had previously complained about water and plumbing issues. The tenant shot the manager multiple times, and he died from his injuries. The manager’s estate and dependents sought workers’ compensation death benefits. The Kentucky Court of Appeals held that the estate was entitled to death benefits.

Modern argued that the manager was not acting within the scope of his employment at the time he was killed. The court found that he was on a personal errand when he returned to his apartment for lunch. However, he returned to his work duties when he began to interact with the tenant. Evidence showed that tenants in the building directly approached the manager with maintenance issues. Also, during criminal proceedings, the tenant told a psychologist that she believed dirty water was coming out of her faucets, and she wanted the manager to observe the situation. No evidence showed that the tenant randomly approached the manager that day or that she went to him for another reason.

The court found that the manager was exposed to the danger as a result of his employment. Therefore, his death was work-related.

The court also found that the estate was entitled to interest on the death benefits award.