GQ Corner

Q. I have a claimant who had left ankle surgery back in April – she had a torn tendon. This surgery had nothing to do with a work injury. I do not know where she sought treatment for that injury. She told me that has been going through the healing process and is on a knee roller while it heals instead of crutches. For this claim, she was walking/scooting out of a conference room inside the office, lost her balance, and fell on her left foot/ankle. She did not come to work today and just went to clinic today. Our client can accommodate her, as she is primarily a clerical employee so there will be no lost time that I know of. However, do we accept compensability of this claim considering she simply lost her balance? I would likely consider this a compensable claim as I think it took place in the course and scope of her employment in an area she is required to use. I am waiting on the physician notes. She missed work today and went to the clinic. I will wait and see what the notes say.

A. The fact that the claimant lost her balance due to the scooter would not be a basis for denial. The more important question is whether there is additional damage or harm to the body as a result of the fall. That is a highly technical medical question if there is not a new body part she is claiming. For example, if she has bruises on her hip from falling off her scooter, then yes we have a compensable injury, in the form of a contusion to the hip. However, if all that happened is that her ankle is sore again, there is no evidence of an injury. Therefore, it depends on what the claimant is alleging she hurt as a result of the fall. To establish additional injury to a recovering surgical ankle, we need to see an opinion from a doctor that there was additional damage caused by the fall, not just soreness. If you do not have a claim of injury to a different body part and no medical to say she re-injured her ankle, then you can dispute it as no evidence of an injury as a result of the incident.

Q. I have a question regarding the compensability of this claim. Claimant was going on a business trip to New Jersey in April; he felt a pull in his right shoulder/arm when he was putting his bag in the overhead bin of the airplane. He states he told his employer about it a couple of days later, as he felt intermittent pain in his upper arm for the next couple of days and they authorized him to seek medical treatment. He did not seek treatment until 5/28/19. Would this be compensable as he was on a business trip when it occurred?

A. Yes, if there is evidence of an injury that is consistent with the mechanism he reported. The answer to that question will depend on what they diagnose him with. If it is just a strain and they give him exercises to perform, I do not see a problem. If they do an MRI quickly, they will probably find degenerative pathology that they will try to start treating and “fixing”. I would send this for peer pretty quickly if there is a diagnostic study done. A strain is not out of the question. And the fact that it reportedly occurred while traveling out of town on a business trip would make it an activity that would be in the course and scope.