GQ Corner
Q. I have a claim in which the claimant was just bending over to pick up a piece of aluminum on the floor and had not picked anything up, when his back went out. He was taken to the ER and reported to the ER doctor that he is a power lifter with heavy weights. The doctor advised they felt he has a herniated disc from the power lifting.
The claimant initially did not want to report as workers’ compensation, but after talking with his family he advised he is going to need surgery and wanted to file workers’ comp. We have several different witness statements in which he claimed the injury was due to his power lifting.
Does this evidence support a dispute of the claim?
A. If the claimant has an HNP, he needs expert evidence on causation from the work incident. It does not sound like he has that, so you can dispute the claim.
Q. My claimant works for a pharmaceutical company, in the production area. She says her job entails going into a “clean room” (which means gloving up, putting on the contamination suit, multiple times a day). Once in the isolation room, she unhooks IV bags and reconnects the hoses with empty bags, then carries the bags, one at a time (which she says weigh about 3 lbs), outside of the isolation room, from the uncontaminated area to contaminated, once the bag is sealed. She says this process involves pressing the connector with her thumb with some significant force, and that she repeats this process about 60 times per day.
She began complaining of wrist pain in March, and went to see her primary care doctor, who prescribed Meloxicam. She says tests were performed to rule out arthritis. When the symptoms persisted, she says she tried to adjust her work tasks—she thought maybe the gloves were too tight, and she tried a larger size; she thought she was carrying the IV bags wrong, and tried to hold them from the bottom. Neither of these adjustments resolved her symptoms, so she went back to her PCP on July 10, and she was told that she had a work related wrist injury. She filed the workers’ compensation claim at that time, but the employer is saying she told them it was a personal medical condition for which she was seeking treatment from her personal doctor. I did ask when she knew or should have known that this was work related, and she said not until the doctor visit on July 10 (even though she had just explained all of these work modifications that she had tried over the intervening months that failed to relieve her symptoms).
Given this set of facts, do we accept this claim for carpal tunnel or tendinitis of the bilateral wrists? Our best defense may be timely reporting (not within 30 days of when she knew or should have known that it was work related), but I am not sure that is the strongest defense. Of note, she did say that she sent an email to her HR rep in April stating that she was suffering wrist pain, and that she was trying to get an appointment with her PCP to get it checked out. The employer, of course, denies that this constitutes proper reporting.
A. I think the report in April likely did not inform the employer of a work-related injury because a general report of pain or problems is not a proper report of a work related injury. The employer must also be advised, or have actual knowledge, that the injury is alleged to be work-related. APD 040079. I also think your facts show that she either knew or a reasonable person should have known the problem could be related to work in March, but that depends on what the medical records show. She certainly had an idea it was work-related when she began modifying her activities and trying to prevent it—not sure when that was though.
If you are disputing based on no timely report, I would go ahead and file a dispute of the compensability also. You need to get more information from your insured about the process she goes through and if the information about her job is accurate. I recommend that you send this infoormation along with medical records to a hand specialist or an occupational medicine specialist for a review to see if this is traumatically repetitive enough to have caused the problems. It is plausible that it could be related, but you do not have any way of really knowing that based on just the claimant’s allegations.
FOLIO
