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Penny Wise and Pound Foolish: Employers who leave open future medical rights on small work comp claims risk big headaches

Employers and insurance claims handlers often confront minor workplace injuries which, on the surface, appear to be straightforward and simple. The parties enter an agreed award for lifetime open medical care for a minor bump, scratch, sprain or strain. The employee treats their minor injury with conservative, inexpensive medical care—possibly without even missing a day of work—and everyone moves on and forgets the whole thing ever happened. 

Fast forward forty years, now that employee who has an open medical award comes back knocking on your door for some major medical care they believe is causally related to that minor bump they suffered while working for you. Suddenly, what was a small and simple claim has turned into a big, expensive problem. 

Although you might be able to prevail in court against this employee or former employee, you’ll be spending a pretty penny to fight it. Worse yet, you might lose. And losing might be very, very expensive—as in the recent case of Pittsylvania County Board of Supervisors v. Janna Hall, Court of Appeals of VA, Record No. 1869-17-3, June 12, 2018.

In 1978, Jann Hall fell down several stairs at work, injuring her right knee. She was twenty years old at the time. Hall and employer endorsed a “Memorandum of Agreement as to Payment of Compensation” in 1979, describing the injury as a “[c]ontusion and hemarthrosis of [the] right knee.[1]” Later that year, the Commission approved the parties’ agreement and entered an award. The final sentence of that 1979 award, like all awards, stated: “Medical benefits are awarded for as long as necessary.”

In 1980, rheumatologist Vincent Giuliano examined Hall, and reviewed her medical records. He wrote that Hall had “a 2 year history of a chronic inflammatory arthritis of both knees.” He concluded: “she was well prior to the fall and since that time she has had arthritis in 2 knees and 1 elbow, all of which appear to have been traumatized at that time. If her story is accurate, and I have no reason to think otherwise, then clearly her arthritis is temporally related to her fall.”

Between 1979 and approximately 2010, rheumatologist Jeffrey Wilson treated Hall. In 1998, Dr. Wilson wrote of Hall: “The patient certainly remains completely disabled from her chronic long standing inflammatory spondyloarthropathy.”

 In 2008, Dr. Wilson opined that Hall “continued to have active inflammatory arthritis resulting from her fall as before.” In a 2010 letter to the employer, Dr. Wilson wrote that “Hall has been followed in our office for over 30 years with problems of inflammatory polyarthritis which has been grossly deforming, requiring multiple joint replacements, and followed a traumatic injury and fall.” During the time Dr. Wilson treated Hall, she underwent several surgeries in connection with her joints, including knee and hip replacements and was prescribed numerous medications. At his deposition, her treater stated that Hall had “been termed to have post-traumatic arthritis in multiple joints since” her work injury occurred.

The employer obtained the written opinions of three experts in an attempt to overcome the opinion of Claimant’s primary treater.

The first expert for the employer, Dr. Blank, opined that “the claimant did not have ‘traumatic polyarthritis’ but rather had an inflammatory autoimmune polyarthritis unrelated to the work comp injury from the beginning.” 

The second expert for the employer, Dr. Bello, concluded that “the claimant has rheumatoid arthritis. . . . This is not related to the 9/5/78 injury.” Thus, he wrote, “[n]one of the claimant’s medications are causally related to the original workers’ compensation injury.”

Finally, the third expert for the employer, Dr. Patel, stated: “In my opinion, the bilateral knee surgeries and continued knee issues are not related to the work compensation injury that was sustained in September of 1978. I do not believe that there is any direct permanent or long-term damage from the worker’s compensation injury. The Rheumatoid Arthritis or Spondyloarthropathy are unrelated to the patient’s fall in 1978.”

After hearing the evidence, the deputy commissioner entered a medical award in Hall’s favor, and ruled that “medical benefits are continued for as long as necessary for reasonable, necessary and authorized treatment causally related to the claimant’s September 05, 1978 injury and in particular, for payment of Celebrex, OxyContin, Pepcid and Vitamin D prescriptions.” 

On the employer’s appeal, the full Commission affirmed the Deputy Commissioner. The employer again appealed to the Court of Appeals of Virginia, who affirmed the Commission, citing the longstanding status quo in the Workers’ Compensation Commission that, “[t]hough not necessarily conclusive, ‘the opinion of the treating physician is entitled to great weight.” 

The lesson here for employers and claims handlers is that: 1) minor injuries, like the knee contusion suffered by Hall, can result in expensive future medical treatment; and 2) with very few exceptions, you should close down future medical rights.

No matter how minor an injury, there are very few circumstances in which the employer should leave future medical rights open, cross their fingers, and pray for the best. While many employers and claims examiners hate the thought of spending one more cent on a claim once it appears the employee’s injury has fully resolved, leaving medical rights open in lieu of a full and final settlement is, as the old saying goes, penny wise and pound foolish. In most cases, the employer would be wise to spend an extra penny now to obtain a settlement with closure of future medical rights to avoid spending many pounds of cash down the road in litigation expenses and for expensive treatment and medications and for the remainder of the employee’s life. 

With that said, you should consult an experienced workers’ compensation attorney to help you determine if it makes sense to leave medical open, perhaps to avoid funding a costly Medicare set-aside, or if you should enter into a full and final settlement of all issues. 

If you would like to contact Setliff Law to find out whether a full and final settlement makes sense for a worker’s compensation claim, or to find out the appropriate settlement value, please contact us at any time at 804-377-1261.

 

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