Safety and OSHA News

She didn’t complain of pain until a month later: Did work fall cause injury?

Sometimes an injury might not be completely apparent immediately after an incident at work, like a fall. This is particularly true about a secondary injury, and that can have a complicating effect on workers’ comp claims.

Phylis Stevens slipped and fell down a flight of stairs outside of her workplace, the Pinedale Aquatic Center (PAC). Her immediate complaints about pain centered around her hand.

Her hospital intake form said Stevens’ chief complaint was pain in her left hand. Doctors found fractures in the hand.

Two days after the fall, she filled out an injury report for work. The report only contained information about her hand.

Stevens had several follow-up visits with her treating doctor. It wasn’t until more than a month after her fall that she first mentioned soreness in her right hip.

Not quite three months after her fall, her doctor ordered x-rays be taken of both of Stevens’ hips. There were no abnormal findings. Days later she had an MRI. After viewing the MRI results, her doctor diagnosed Stevens with avascular necrosis (AVN) in the femoral head of her right hip. (AVN is the death of a bone due to lack of blood supply.) Her doctor noted:

“This is probably a posttraumatic event related to the slip-and-fall accident.”

Eventually, the femoral head on her right hip collapsed due to the AVN progression. Almost 14 months after her fall, Stevens received a total right hip replacement.

Stevens applied for workers’ comp benefits for her hip injury, claiming it was caused in the course of her work.

The Wyoming Workers’ Safety and Compensation Division denied all payments for Stevens hip-related treatment because “the right hip is not related to the original work injury to the left hand.” Stevens requested a hearing.

Three co-workers testified in support of Stevens’ claim that the hip injury was work related.

Although the hearing examiner found all three women credible, she stated in her findings that “any statements or implications that Stevens had significant pain in the hip immediately after the fall are not supported.”

Stevens’ treating doctor also testified that, in his opinion, the hip injury was caused by her workplace fall.

But there was other medical evidence.

One MRI showed the possibility that Stevens had AVN in both her hips, even though only one worsened to the point that replacement surgery was necessary.

Her doctor’s reaction to that? “You know, it does throw a wrench into the works and raises a question,” the doctor testified. AVN in both hips would be inconsistent with a case caused by trauma such as a fall.

Another doctor reviewed Stevens’ case at the Comp Division’s request. The second doctor believed it was “very unlikely” that the AVN in the right hip was due to her fall at work. The doctor explained the onset of her AVN was too early for it to be connected to Stevens’ fall at work. On top of that, there was evidence the AVN was also present in her left hip. Having it on both sides would also rule out that it was caused by her fall.

The hearing officer gave more weight to the opinion of the second doctor, not Stevens’ own physician and denied the request for workers’ comp benefits for the hip injury. A state appeals court agreed with the hearing officer’s decision.

Next, Stevens’ case went to the Wyoming Supreme Court.

Deference to wrong doctor?

In her argument to the Supreme Court, Stevens said the hearing officer sided with the wrong medical professional.

The Comp Division noted that the testimony given about Stevens’ injuries from her fall were inconsistent with the medical documentation. There’s no mention of hip pain in the records until more than a month after her fall.

The high court held that Stevens failed to show the hearing officer’s deference to the second doctor’s opinion was wrong.

Stevens was ultimately denied workers’ comp benefits for her hip injury. This case shows that good documentation by company safety and/or benefits personnel can play a key part when it’s disputed whether an injury is work-related. Besides the documentation by her doctor, Stevens was required to fill out an injury report by her employer in which she didn’t mention any pain in her hip.

What do you think about this case? Have you ever had a similar experience in which a worker claimed an injury was work-related some time after an incident occurred at work? You can tell us about it in the comments.

(In the matter of the workers’ compensation claim of Phylis Stevens, Supreme Court of Wyoming, No. S-14-0076, 12/2/14)

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  1. Barry Lauger says:

    I have had a case like this one and it extremely hard to determine the origin of injury when the pain felt is weeks or months away. I went ahead and filed on our insurance, for coverage, but the employee has yet to follow-up and claim further or increased pain. I have held a safety meeting with all employees and explained the gravity of not reporting incidents, or late reporting, in relation to insurance coverage. Our employees understood how the insurance companies work and how this “late” reporting could be rigged or suspected. Our employees saw things from the side of the insurance company or any reviewer of the case and came away with a more complete understanding and the necessity for timely reporting.

  2. I started reading this article and thought it was about Delayed Onset Muscle Soreness (DOMS) but I see this is completely different. I have a very good friend who recently had to have a double hip replacement due to AVN. He hadn’t had any incidents involving trauma in his situation and his doctor told him the cause was most likely due to his alcohol consumption.

    I’ve had employees who were struck by objects claim to be okay, then the following day come in and tell me they went to the ER overnight because of the pain later. Nowadays, when an employee refuses medical evaluation I have them return to my office a couple of times so I can make sure they’re okay. I then give them my business card and tell them to call me if the pain gets unbearable overnight and they need to go to a doctor. That way I can still manage the injury for my company. It’s also a lot easier for the employee that they don’t start receiving medical bills in their name and try to get them reimbursed by the company. I’ve seen those go to collection before finally getting paid, and that ultimately hurts the employee. As a 50 year old man who still runs, cycles, and lifts weights, I know that DOMS is real. Don’t ever assume that an employee is lying or faking an injury. You could be making the problem worse for your company.

  3. Mickie Burns says:

    Ok, well, after a car accident, the doctor you see, will even tell you that a lot of symptoms will not show up until months after an accident, and after my car accident (which was the other persons fault), even the other persons insurance company said that they will leave the medical part open because it can take months before symptoms can show, (but luckily for me and the person who hit me), I didn’t end up with any injuries, and neither did they, so I never had to use it, so all they had to pay for was to replace my car. But anyway my point is that falling down a flight of stairs, could easily be compared to an auto accident. And that our bodies all react differently, and even if she might have had the start of damage before the fall, that the fall itself could have caused it to rapidly deteriorate, and spread a lot faster, or it could have been something that runs in her family, that she may or may not get, but because of the fall, her body responded to the fall by causing it to rapidly deteriorate. Just like the doctors ask you about your family history, so they can try to stop it from happening to you. Or she could have been one of those people who try to make money by sueing others. But there is not really enough information in this article to make that decision. But it is a very interesting article, and gets you thinking.


  1. […] If there was a witness that saw the accident, collect their testimony as well. Collected updates periodically after the injury and keep them filed. These updates might be useful if your worker later notes delayed onset injuries. […]

  2. […] If there was a witness that saw the accident, collect their testimony as well. Collected updates periodically after the injury and keep them filed. These updates might be useful if your worker later notes delayed onset injuries. […]

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