Great Decisions Around The Office
Michael Rusin scored a zero award for Illinois Public Risk Fund and CCMSI in the case of Timothy Capua v. Lisle-Woodridge Fire Protection District, 10 WC 10042.
Petitioner claimed that he suffered an injury on November 15, 2009 resulting in a hernia. Petitioner claimed that he was working at a fire scene pulling hoses and carrying gear. He specifically claimed that he felt pain in his groin when he was required to lift a 35 pound ladder.
We disputed the claim because petitioner did not report any accident or injury on November 15, 2009. Petitioner admitted that he never reported any work injury at the time of the alleged accident. We proved that petitioner went for an annual department physical December 2, 2009 and while at the physical the doctor noted a hernia. Petitioner told the company doctor that he first noticed something in his abdomen over the summer.
Petitioner then visited his family doctor. We proved that his records show no history of a work accident. Petitioner first reported the case as a work injury December 8, 2009. Petitioner had hernia surgery done by Dr. Ward, but we showed that his records documented the hernia as gradual an onset and occurring over a course of several months. We arranged for an IME with Dr. Scott Kale, an internist. He concluded there was insufficient evidence to associate petitioner’s hernia with a work injury.
The arbitrator ruled in our favor and found that petitioner failed to prove accident and failed to prove causal connection. The claim was denied in its entirety.
I obtained a favorable decision for AIG Insurance in the case of Dana Djokic v. National Union Fire Insurance Co., 11 WC 16704, 13 IWCC 902. The petitioner was a workers’ compensation attorney for AIG Insurance. She suffered a slip and fall injury on her way to work. She testified that her job as a workers’ compensation defense attorney was a busy one and she was required to bring files back and forth to work so that she could work on them at home. She claimed that she was carrying files to work on January 18, 2011. While walking from her train station to her office, she slipped and fell on an icy public sidewalk. She tried to claim she was a traveling employee.
We disputed and denied liability in this case on the basis that the act of coming and going to work was not compensable. We presented testimony that petitioner was not required to bring files back and forth to the office. We proved that petitioner was simply coming to the office and not on any special errand. The arbitrator ruled the case not compensable and denied liability in its entirety. Petitioner appealed to the Commission and the Commission affirmed the denial of liability. The case was denied in its entirety. Petitioner did not appeal to the Circuit Court and the decision is final.
Michael Rusin obtained an excellent decision for CCMSI and their insured, Dayton Freight Lines, Inc., in the case of Maurice Adams v. Dayton Freight Lines, 12 WC 37184, 13 IWCC 1116.
Petitioner was employed by respondent as a dock worker on October 17, 2012. Petitioner was working inside a trailer. While walking in the trailer, petitioner’s right knee popped and fell to the ground. He suffered a patellar tendon tear and required surgery.
Petitioner testified that his injury occurred while he was squatting and twisting between some dock bars in the trailer. We disputed petitioner’s testimony. We presented the testimony of the terminal manager who testified that petitioner could not have been squatting between deck bars at the time of his injury. Further, the terminal manager testified that petitioner admitted at the time of his accident he was simply walking in the trailer. The terminal manager’s testimony was also supported by an excellent recorded statement taken by the claims adjuster shortly after the accident.
The arbitrator found that petitioner failed to prove that he sustained an accident which arose out of his employment. Petitioner appealed to the Commission and the Commission issued a unanimous decision affirming the decision of the arbitrator. Compensation was denied in all respects.
Petitioner contended that simply by the fact that he was working inside a trailer increased his risk of injury. This decision confirms that simply walking in a trailer is insufficient to justify a conclusion that petitioner’s injury arose out of his employment.
Jeffrey Rusin scored an excellent decision from the Illinois Workers’ Compensation Commission on behalf of AmTrust Insurance in the case of Omar Enriquez v. D&K Group, Inc., 11 WC 41953, 13 IWCC 404.
Petitioner alleged an injury to his lumbar, thoracic and cervical spine as a result of an October 5, 2011 accident at work. We accepted liability for a mild sprain/strain to the thoracolumbar region, but we disputed liability for petitioner’s alleged cervical spine injury.
Following the accident, we proved petitioner sought medical treatment with a primary care physician and was diagnosed with back pain, but not neck pain. We proved that petitioner treated with the company doctor at Alexian Brothers Corporate Health Service with a diagnosis of a thoracolumbar sprain/strain.
However, petitioner discontinued treatment at Alexian Brothers and started treating with Marque Medicos and Medicos Pain & Surgical Specialists. Petitioner received extensive and excessive medical treatment including multiple diagnostic tests (scans, MRIs and EMG/NCV studies). Petitioner incurred in excess of $35,000.00 in disputed medical bills.
We arranged for an evaluation with Dr. Julie Wehner, an orthopedic surgeon. She opined that petitioner’s cervical complaints were not causally related to petitioner’s accident. She opined that six to 12 physical therapy visits were reasonable, but the excessive treatment from Marque Medicos was not. She found petitioner at MMI and able to do full duty work.
The arbitrator ruled in our favor and denied TTD and medical bills after Dr. Wehner’s evaluation. Petitioner appealed to the Commission and the Commission affirmed all TTD, TPD and medical bills after our IME on January 9, 2012 were denied.
Jeffrey Rusin also scored an excellent decision on behalf of Continental Insurance/Applied Underwriters in the case of Maria Manriquez v. Unique Thrift Store, 11 WC 26401.
Petitioner claimed that she suffered an injury to her midback and low back April 27, 2011. She treated with the company clinic at Physicians Immediate Care through June 14, 2011 at which time she was placed at MMI and released to full duty work. TTD and medical benefits were discontinued.
Nevertheless, petitioner sought treatment with a chiropractor and pain management physician. We disputed this treatment. We arranged for an IME with Dr. Jay Levin on September 19, 2011. He also concluded that petitioner was at MMI and could do full duty work. He opined that petitioner’s additional medical care after June 14, 2011, which included epidural steroid injections and radiofrequency rhizotomies were not reasonable and necessary. Despite Dr. Levin’s report, petitioner continued to treat with yet another chiropractor for several more months before eventually returning to work February 22, 2012.
After considering all of the evidence, the arbitrator relied on the company doctor records and the IME report of Dr. Levin. She found petitioner suffered a mild lumbar strain. She awarded TTD and medical through June 14, 2011 only. She denied the disputed medical bills which exceeded $50,000.00. She awarded petitioner 5% loss of use of the man as a whole. This was an excellent resolution for our client.
Daniel Arkin scored a zero decision on behalf of the Intergovernmental Risk Management Agency (IRMA) in the case of Scott Moran v. Village of Homewood, 10 WC 20287.
Petitioner claimed an accident on March 30, 2010 while working as a firefighter/paramedic for respondent. On the date of the incident, petitioner was working as a lieutenant. He was assigned to supervise a house fire on March 30, 2010. Petitioner appeared at the scene and took charge of the fire directing firefighters where to go and what to do. Petitioner testified that all of his activities occurred outside of the house. Petitioner did not go into the house or onto the roof. He was not involved in any rescue activities. During the course of the fire, one of the firemen working inside the house died and a second suffered serious burns. Petitioner admitted that he did not sustain any physical injuries whatsoever as a result of the house fire, but instead claimed psychological injuries. Petitioner had treatment with a psychologist on orders by the Department. Petitioner was off work following the event until June 14, 2010 and treated until December 21, 2010. The psychologist diagnosed him with posttraumatic stress disorder which was improved.
We disputed liability for petitioner’s condition and the arbitrator ruled in our favor. The arbitrator reviewed and noted the case law stating “The arbitrator initially notes that cases involving psychological problems, in the absence of a direct physical injury are generally found not to be compensable.” After reviewing the case law, the arbitrator concluded that petitioner failed to prove that he sustained an accident which arose out of and in the course of his employment. Compensation was denied in its entirety.
Greg Rode also scored an excellent result for IRMA in the case of Jeffrey Barton v. Village of Addison, 11 WC 612.
This case involved an undisputed accident which occurred on March 31, 2010 while petitioner was working as a maintenance worker. Petitioner was exiting a backhoe when he grabbed a handle which broke off and he fell about 20 inches to the ground landing on his right elbow. Petitioner claimed that he immediately had pain in his right shoulder and neck. He initially treated primarily for shoulder problems. He had an MRI which showed a full thickness tear of the supraspinatus tendon.
He underwent a right shoulder surgery July 19, 2010 including a rotator cuff repair along with a subacromial decompression, distal clavicle resection and debridement of the biceps tendon.
Thereafter, he made slow improvement with his shoulder, but complained of neck pain with radiating pain down the arm. He underwent an EMG/NCV which was primarily positive for cubital tunnel syndrome at the elbow and carpal tunnel syndrome at the wrist. We arranged for an IME with Dr. Lawrence Lieber, an orthopedic surgeon. He opined that petitioner’s accident caused a right shoulder injury, but petitioner’s cervical problems, right elbow problems and right wrist problems were not causally related to the accident. We disputed and denied those conditions.
Nevertheless, petitioner continued to receive medical treatment from his treating orthopedic physician Dr. Bartucci. Dr. Bartucci performed a cubital tunnel release at the elbow and a carpal tunnel release at the wrist. Petitioner eventually returned to work May 25, 2011, but he continued to seek medical treatment. He additionally treated with Dr. Koutsky, another orthopedist. Dr. Koutsky prescribed surgery on petitioner’s cervical spine which was to include an anterior cervical discectomy and fusion at the C6-C7 level.
The case was tried pursuant to Section 8(a) for prospective medical treatment. The arbitrator ruled in our favor and found that his cervical, right elbow and right carpal tunnel conditions were not causally related to the accident. Medical bills for those conditions were denied and the request for prospective surgery was denied. TTD was awarded to petitioner only through the date of Dr. Lieber’s IME finding petitioner at MMI with respect to his shoulder. This is an excellent result for the client savings tens of thousands of dollars in TTD and medical bills.
Kisa Sthankiya obtained an excellent decision on behalf of EMC Insurance in the case of Jack Rebholz v. AG View FS, Inc., 10 WC 25801 and 10 WC 25823.
Petitioner was employed by respondent as a technician. His job duties required maintenance on trucks including oil changes, alignments, ball joint and brake pad replacement and tire rotation and repair. He testified that he used airguns, hand tools, hammers and wrenches. He testified he worked ten hours a day, five days a week. He never worked on Sundays, as the shop was closed. He claimed an injury to his right shoulder. He alleged both a specific accident and repetitive trauma. He testified his accident occurred June 1, 2008 when he was using a bar to loosen a semi tire. He claimed he reported the injury to his supervisor, Mr. Dunn. However, we presented Mr. Dunn and he denied any report of an accident on or about June 1, 2008.
After that alleged accident, we proved that petitioner continued to work and he did not seek any medical treatment. We proved medical records showed the first visit to a doctor was May 18, 2010 with complaints of right shoulder pain going back ten years. Petitioner subsequently had an MRI which showed significant degeneration along with a rotator cuff tear and deformity of the distal clavicle. Petitioner eventually had shoulder surgery. Petitioner claimed repetitive trauma with an accident date of June 1, 2010.
We had an IME done with Dr. Troy Karlsson, an orthopedic surgeon. He concluded that petitioner did not suffer a work injury and that his condition was insidious in onset. He opined that petitioner’s work duties would not be expected to cause a rotator cuff tear and that petitioner suffered from a personal degenerative condition.
We cross-examined petitioner’s treating surgeon and even he admitted that the distal clavicle deformity was not acute. He found arthritic and degenerative changes during surgery.
After considering all of the evidence, the arbitrator ruled in our favor. The arbitrator ruled that petitioner failed to prove a specific accident or a repetitive trauma. The arbitrator found our witness, Mr. Dunn, more credible than petitioner and she relied on the testimony of our IME doctor. She found the IME doctor’s testimony more persuasive than petitioner’s treating physician. The case was denied in its entirety.
Kisa Sthankiya also obtained a very favorable decision on behalf of AmTrust Insurance in the case of Lisa Cazeau v. Goldberg & Perl, 09 WC 28630.
Petitioner was employed by respondent as an office manager. Her job duties included showing apartments to potential clients and inspecting apartments. She suffered an accident January 12, 2009 when shoveling snow in order to be able to enter a garage and park her car. She claimed an injury to the middle of her back and started chiropractic care. We showed that her medical history documented significant past chiropractic care for neck and back pain.
She sought chiropractic treatment for a few weeks. She also saw her family doctor and underwent an MRI of her lumbar spine. Several months later, in December, 2009, she sought additional chiropractic care. She also sought treatment from Dr. Michel Malek, a neurosurgeon who tends to overtreat claimants. He generated almost $34,000.00 in medical bills.
We disputed liability for those bills. We arranged a medical record review with Dr. Avi Bernstein, an orthopedic surgeon. He opined that petitioner suffered only a lumbar strain and was at MMI for that condition as of February 9, 2009.
The arbitrator found that petitioner sustained an accident, but he adopted the findings of our IME doctor, Dr. Bernstein. He found that petitioner was at MMI as of February 9, 2009 and that her medical bills after that date were denied. He found petitioner exceeded her choice of doctors. Further, she denied the claim for permanent partial disability.
This was an excellent result for the client. We had tried to settle the case for $10,000.00 prior to trial, but petitioner rejected the offer and instead was awarded $425.00.
John Maciorowski scored a zero award for CCMSI in the case of Ronald Davidson v. Keystone Steel & Wire, 11 WC 20011.
Petitioner was employed by respondent as a wire drawer. The job was not a heavy one. Based on the job description, petitioner would rarely stoop or twist and never kneel, crouch or crawl. On March 24, 2011, he started work at 6:15 a.m. He received his work orders from his supervisor, Joe Maher, and went to his work station. He was not sure if he had enough tags and he turned to obtain tags that were situated in a barrel. When he turned, he experienced shooting pain in his right leg. We had Mr. Maher testify and he stated that petitioner reported “You’re not going to believe this, but after you walked away I turned and felt a pop in my right leg.”
We proved that petitioner was not doing anything heavy at the time of his incident. He simply turned and felt pain in his right knee. We proved that he had a history of knee problems. He had a prior diagnosis of osteoarthritis and a prior right knee surgery. He had previously undergone Synvisc injections.
He came under the care of Dr. Below, an orthopedic surgeon. He had arthroscopic surgery which included a partial medial and lateral meniscectomy along with a chondroplasty. Dr. Below testified that petitioner’s condition was caused or aggravated by the incident of March 24, 2011. However, during cross-examination, he admitted that if the onset of the pain occurred while petitioner was not holding or carrying anything and merely turned to go or move away that the condition would not be work-related.
We retained Dr. Player to perform a record review. He opined that petitioner’s condition was a degenerative one and not caused by any work injury.
The arbitrator ruled in our favor. After considering the evidence, she found that petitioner failed to prove that he sustained an accidental injury and failed to prove a causal relationship between a work injury and his condition of ill-being. The claim for compensation was denied in its entirety.