Safety and OSHA News

Does previous coverage guarantee future comp for unexplained blackouts?

This case started relatively simply: After being struck, a worker required neck surgery. But then unexplained blackouts entered into the picture, leading ultimately to a workers’ comp decision by this state’s supreme court. 

In December 2008, Tommy Hood was injured while working on a drilling rig in Wyoming. A chunk of ice fell off the rig, hitting Hood on the head and injuring his neck. The Wyoming Workers’ Safety and Compensation Division awarded him benefits.

His doctor recommended fusion surgery on vertebrae which Hood had in March 2010. The surgery went fine. Two to three months later, something in Hood’s neck popped during physical therapy and he experienced pain in his neck.

Throughout 2010, Hood suffered from neck, shoulder and left arm pain.

In April 2011, Hood experienced a syncope episode: an unexplained blackout. Hood says he turned his head, heard a pop in his neck and woke up on the floor.

Medical records show Hood had at least three more syncope episodes, and he says he suffered from even more of them.

The Division and Hood’s doctors attempted to learn why he was passing out, but no one was able to determine a cause. During this time, the Division paid for all of the treatment Hood received for injuries he suffered when he blacked out and for all the diagnostic tests conducted to determine a cause.

Hood sought treatment for lower back pain in March 2013 which was associated with a fall due to a syncope episode the month before. Doctors found disc tears in Hood’s lower back and recommended surgery. Hood sought authorization for the lower back surgery from the Division.

Two doctors independently reviewed Hood’s case. Both concluded there was nothing which suggested the syncope episodes were a consequence of Hood’s neck injury or surgery. As a result, the Division denied his request for surgery, finding that medical evidence didn’t show the surgery was necessary.

Hood appealed to the Wyoming Medical Commission which upheld the decision. A district court also agreed. Hood took his case to the Wyoming Supreme Court.

Did they ignore worker’s testimony?

Hood made two arguments on appeal.

First, he argued the Commission ignored his own testimony about what was causing his syncope episodes. Hood says he never passed out before his neck surgery, that he heard a pop in his neck the first time he passed out, and that he’s suffered from the blackouts ever since.

But the Wyoming Supreme Court found the Commission clearly considered Hood’s testimony.

It also noted the medical experts in the case (a physical medical specialist, two neurologists, a neurosurgeon, an orthopedist, a cardiologist and Hood’s treating physician) were all unable to find a connection between Hood’s neck injury or surgery and his syncope.

“There clearly was substantial evidence supporting the Commission’s determination that Hood had not proven a causal connection,” the court wrote.

Hood’s second argument was that he shouldn’t be required to prove a connection between his syncope and the work injury because the Division previously paid for his medical expenses related to the syncope.

The court noted there is a common-law principle that “a right, question or fact put in issue, and directly determined by a court of competent jurisdiction, cannot be disputed in a subsequent suit by the same parties.”

But when it comes to workers’ comp benefits, Wyoming has held that the Division’s award of uncontested benefits doesn’t mean future benefits can’t be challenged.

“The fact that the Division previously paid uncontested medical claims related to Mr. Hood’s syncope does not preclude the Division from contesting the causation of the syncope for purposes of future benefits,” the court wrote.

The Wyoming Supreme Court affirmed the previous rulings and denied Hood coverage for additional surgery.

(Tommy Hood v. State of Wyoming, Supreme Court of Wyoming, No. S-16-0058, 10/28/16)

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