Employees can expect that costs for medical expenses for work-related injuries will be covered by workers’ compensation benefits. These include subsequent injuries that occur as a direct result of the original injury. In these cases, however, one can expect the employer/insurer to require proof of causation. That means showing that the secondary injury was proximately caused by the work-related injury or illness.
This was the case in the matter of Hood v. State, ex rel. Department of Workforce Services, recently before the Wyoming Supreme Court.
The plaintiff was injured in December 2008 while working on an oil rig. Another worker knocked off a chunk of ice, and it fell, striking him on the head and injuring his neck. His doctor put him on light duty and recommended fusion surgery on his vertebrae.
The surgery reportedly went fine, although he did suffer a subsequent infection in his elbow at the site where an intravenous needle was used. Three months later, he experienced a “pop” in his neck during physical therapy. His neck pain thereafter did not subside and in fact worsened. He also continued to suffer pain in his left arm.
Doctors disagreed about whether additional surgery was necessary.
In 2011, more than a year after his initial surgery, he started to experience episodes of “syncope,” which is when he would suddenly pass out due to a marked drop in blood pressure.
After one incident, he explained he’d heard a “pop” in his neck and then awoke on the floor with a compound fracture of his thumb, as well as a cracked wrist and damaged ear drum. His workers’ compensation insurer paid for treatments for these injuries.
He continued to suffer these episodes, although he couldn’t say exactly how often. His doctors ran a number of tests but couldn’t definitively pinpoint the cause. It was clear, however, that the plaintiff hadn’t suffered these episodes prior to his neck injury.
The insurer paid for numerous diagnostics to try to determine the cause of the plaintiff’s syncope episodes, but there was never a definitive diagnosis.
In 2013, the plaintiff sought treatment for serious back injuries stemming from a fall reportedly caused by a syncope episode. Doctors tried to treat the injury conservatively but failed. Surgery was recommended. The insurer sought a review of medical records to determine the cause of the plaintiff’s syncope. However, they could not find evidence that the necessity of surgery stemmed from his original injury or surgery.
As a result, the workers’ compensation insurer denied a pre-authorization request for the new surgery.
A hearing was held, and contested evidence was presented by both sides. However, none of the experts – including five testifying on behalf of the plaintiff – were able to causally relate the work injury or fusion surgery to the syncope episodes.
Based on this, the workers’ compensation commission reasoned that a mere temporal relationship between the episodes and the work injury and surgery didn’t necessarily establish a causal connection. The commission also held that the uncontested payments by the employer for the initial syncope-related injuries didn’t necessarily preclude the employer from challenging future benefits.
The plaintiff appealed, but the Wyoming Supreme Court affirmed. The court held the commission’s conclusion was not unsupported by substantial evidence. This means the outcome did not run contrary to the overwhelming weight of the evidence.
Contact the Carolina workers’ compensation lawyers at the Lee Law Offices by calling 800-887-1965.
Hood v. State, ex rel. Department of Workforce Services, Oct. 28, 2016, Wyoming Supreme Court
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