The claimant sustained an admitted injury to her right knee while working for the employer just two weeks after her hire. As a result of this injury, the claimant was placed on off work status and ultimately had the knee surgically repaired. After her surgery, she began reporting low back and SI joint pains, which the treating doctors linked to an allegedly compensable limp mechanism. Ultimately the claim proceeded to a Division IME, who opined the claimant had 13% whole person impairment for her lumbar spine and SI joint for a work-related right SI joint dysfunction arising out of the limping. Significantly, the claimant denied prior low back and SI joint issues, injuries and treatment to all medical providers and the Division IME; she further did not disclose any prior back injuries to Respondents in discovery.
Shortly after the Division IME was completed, it became evident that the claimant had an industrial injury prior to this event in another state. As part of this out-of-state injury to her low back and SI joints, the claimant obtained an IME who had opined that she had a 25% whole person impairment due to lumbar degenerative disc disease. Significant maintenance care was recommended, and this IME occurred just 10 months prior to her industrial injury with the Respondent-employer.
Respondents requested a hearing to overcome the Division IME as to impairment and causation and the ALJ fully agreed. The ALJ found persuasive the lack of disclosure by the claimant of a “relevant and pre-existing right-sided low back injury that was substantially similar in character and nature” to the condition linked to the work injury by the Division IME. The ALJ opined that the Division IME’s causation opinion was incomplete, essentially through no fault of his own, and credited the records and Respondents’ IME summarizing same. As a result, the ALJ found the low back and SI joint issue was not related to the work injury, significantly reducing the impairment exposure on the claim.
Williams v. Amazon.com, Inc., W.C. No. 5-196-505-002 (April 29, 2024).
Want to know more? Contact Jessica Grimes at [email protected] or 877-259-5693.
