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Was employee’s hernia work-related if it happened at home?

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An employee suffered a hernia at home but claimed it was work-related. Did he get workers’ comp benefits?

James Ball slipped and fell at work in 1993, injuring his shoulder, neck, back and right leg. He was awarded permanent total disability benefits.

Part of his treatment for pain included implantation of a spinal cord stimulator in 2000.

By 2006, the original stimulator wasn’t working and a new one was implanted.

The new stimulator occasionally delivered “good jolts” to Ball, as he described them. These jolts occurred without warning.

In July 2007, Ball was at home lying in bed when he experienced one of these jolts that caused him to attempt to stand up quickly. As he tried to stand, Ball fell. Afterward, he noticed a new pain in his left groin.

Ball was diagnosed with a hernia and had surgery. Based on his description of how he fell after receiving a jolt from the stimulator, a doctor concluded that the hernia developed as a result of Ball’s work-related injury — the stimulator was necessary because of Ball’s 1993 injury, and its malfunction caused Ball to fall which in turn caused the hernia.

The Wyoming Workers’ Safety and Compensation Division appealed, saying that the hernia wasn’t work-related.

As the case was appealed, Ball won some rounds and the Division won some. The case eventually worked its way up to the Wyoming Supreme Court.

The state’s highest court noted that Wyoming law says an injury is covered under workers’ comp if there exists a connection “between the injury and some condition, activity, environment or requirement of the employment,” and that “a hernia, like any other injury, is compensable whether it occurs on of off the premises of the employer, as long as the required nexus exists between the employee’s work and the hernia.”

The court’s conclusion: The stimulator, part of treatment for Ball’s original work injury, caused his subsequent hernia — a link between a work injury and the injury at home had been made. The court ordered for Ball to receive workers’ comp benefits.

(Ball v. WY Workers’ Safety and Compensation Division, Supreme Court of WY, No. S-09-0165, 9/22/10)

What do you think about the court’s decision? Let us know in the Comments Box below.

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Comments

  1. What about the manufacturer of the stuimulator that malfunctioned? No accountability for a defective product that led to an injury?

  2. For face value, it’s obvious to me that it was work-related due to the root-cause of the hernia. Case closed…next! LOL.

    Happy Thanksgiving to all!

  3. I agree with the decision as he would not have had the stimulator if it wasn’t for the original injury. I also am curious though, as Jason asked, was the manufacturer of the stimulator at all liable?

  4. This was a very weak call by the court.

  5. What court Chuck?

  6. CHUCK:

    Disregard my question sir; only one court involved. Why is it a weak call? Just curious as to where you’re coming from.

  7. Without knowing the details of the case, I think a “reasonable person” would have a challenge attempting to deduce the proximal cause based upon a 14 year gap from initial injury to secondary injury.

    I think that Jason raises an good question.

    Since the suit was filed as the Wyoming Workers’ Safety and Compensation Division being the respondent, was the former employer required to pay the additional costs?

    I’m not familiar with WY W/C law, however, isn’t W/C usually based upon a % of earned wages?

  8. I agree with Jason, I think they should have looked at whether this was truly a malfunction of the stimulator and if so then why wasn’t the manufacturer of the stimulator responsible? If it was not a malfunction and just the patient’s response to the stimulator then why should the insurance company be responsible if he had not reported this for at least a year? I just don’t feel that the requirement of the original stimulator 7 years after the injury and then a replacement stimulator 6 years later that occasionally fired a jolt that he referred to as “good jolts” for a year without having the stimulator evaluated for malfunctioning should be the responsiblity of the worker’s compensation insurance company. If he had not had the unfortunate fall would he still be enjoying these “good jolts” today?

  9. Heidi Brightly says:

    I am a safety professional, I have seen WC as a good thing and as a catch all for every ache and pain and I have seen people plan an injury–case in point, one employee said to several members of management, “I am tired of all of this BS I am going to have an injury and collect compensation until I can retire.” And he did. The “injury” was not disputable, it was a losing proposition to even fight it. WC has become the alternative to the lotto. Another employee spent his life living on WC and had moved from state to state to keep claims going. Some employers may be at fault, but I believe the bulk of the scam is on the claimant.

  10. Jason, you assume the “good jolts” were a malfunction. Nothing in the story presented here indicates that it was. That said, that would be an angle for someone to pursue. I wonder if the employee ever asked any medical personnel if the jolts he was receiving were normal.

    I think the final decision is right, based on the information we are given in the story. The doctor made the expert diagnosis and we are not presented with any disputing evidence.

    It’s a shame there was no witness to corroborate the story. The injury could have been from lifting a sack of potatoes at home. We’ll never know, and the system is designed to err on the side of the injured.

  11. tracy burdette says:

    I feel that it is w/c responcibility to go after the manufacturer of the device and not hte injured worker..The manufacturer should hold some kind of liability as they said it was a malfunction.

  12. I also have 2 workers compensation claims for employees who told me that they want to retire early, buy a truck, and have spending money. I report them and nothing happens. I think that doctors and medical equipment manufacturers should be held accountable, and the employer stop holding of all burden. I think too much protection is granted by the medical profession. I think that in this case the doctor and the manufacturer should have been held liable for the solution that further injured the employee. Otherwise the burden to pay is on the employer, who has no control over the care.

  13. I’ve been reading the postings with great interest. While one issue remains clear, none of us have all the facts disclosed through process of discover.

    There are several issues that come up for me.
    a) the respondent is the WY Workers’ Safety & Compensation Division, not the (former) employer.
    b) there is a 14 year gap from the time of compensable injury to the secondary, exacerbated injury.
    c) the proximal cause is NOT the initial injury, but rather the treatment
    yes, I understand that had it not been for the initial injury, the worker would not have received treatment in the form of a stimulation device.
    d) is there a subrogation issue?
    e) not being familiar with WY W/C law, does the award give a % of avg. earned wages over a reasonable period of time.
    f) good point Jody, an unwitnessed occurrence on the plaintiff’s private property, unsupervised.
    g) would a “reasonable and prudent person” arrive at this conclusion?
    h) what about liability of the stimulation device maker?
    i) what about liability of the treatment provider?
    j) what about MMI (max. medical improvement) exam records or was the original case settled out of court?

    Without investing the time to obtain factual answers to these and other questions, I think it points out the potential flaws in our systems and begs the question, what are safety professionals going to do to preclude it?

  14. @Jody

    “By 2006, the original stimulator wasn’t working and a new one was implanted.”

    “the stimulator was necessary because of Ball’s 1993 injury, and its malfunction caused Ball to fall which in turn caused the hernia.”

    The article stated it was malfunctioning, I did not make that assumption.

  15. CW:

    Of course we don’t have all the facts here, never had and never will with these strories. Therefore, we do our best and post our .02 on the information given. Then with our posted opinons, like yours, it drums-up debates and other thoughts of consideration as well as rabbit trails…

    And I have to ask, “preclude” what? The lawsuit, the injury, or ?

    Thanks

  16. CW, why are you trying to outguess the results of this case or contribute new facts? The point is that the court answered to the facts provided. Are you thinking we have a say in a new verdict?

    If we agree or do not agree with the resulting case, corrections need to be made to the WC system. I personally think that the WC system is broken. Though I hope that the courts will always try to provide an award based on the laws and facts, I think that the laws for workers compensation place too much burden on the employer – and very little responsibility on the medical profession, employee, equipment manufacturers. Workers Compensation gets paid premiums, doctors are paid, employees are paid – all by an employer who may OR MAY NOT be intentionally causing injury to occur.

    WHY IS THE SYSTEM PUTTING ALL BURDEN ON AN EMPLOYER?

    The point, to me, is whether the system is offering a fair review by all parties. I don’t think so. I hope that employers are given a little more leeway in protecting themselves from faulty claims (fraudulent that are not allowed to be proved fraud).

    I’m not saying that this claim is fraud – but the period of time that has gone by since the injury should have been given a limit.

    What do you think, is the worker’s compensation system fair and written with all parties in mind?

  17. After reading the whole case, it’s pretty clear to us that the decision is proper. Interesting that much of the decision turned on the phrase “in the course of employment”, and what meaning the Wyoming Legislature intended by such a general phrase. We think this is a cautionary tale for those who haven’t read their State’s statutes that closely.

  18. No where in the story above, does it mention that the 2nd stimulator “malfunctioned” causing Ball to rise quickly & then fall. Did the jolt just wake him up & that was simply his reaction to the jolt? Ball had this 2nd implantation for a year, was he not used to these jolts? If it jolted him more than normal, then why? Maybe it did malfunction, but then it should be the responsibility of the manufacturer or the ones involved in the implantation–are there “settings” in these stimulators? His original injury happened in 1993–14 yrs prior to this fall!! There’s got to be a limitation where the employer’s WC is no longer responsible! The employer always seems to bare the burden–as Susan says, who has no control over the care!

  19. There is virtually no personal accountability in the WC systems of our country. They are a mode of social engineering that says “Employers are bad”, “Employees are victims”. In most cases all a worker has to do is say it happened and IT IS SO, no questions asked. I am a safty professional dealing with WC claims and have seen things happen to our company that makes my blood boil. The absolute disfunctional logic used by the states is appaling. The system is broken and needs to be re-designed to deter workers from making false claims. One poster stated that the doctor gave an “EXPERT” opinion as to work relatedness. In my experience, workers merely have to tell their doctor what to say and 9 times out of 10 that is exactly what happens. Expensive IME’s are often the only way to expose the sham. But even then WC will likely keep a claim open.

  20. I agree with Jason and Jackie on this. The latest injury, the hernia, was the result of defective equipment. It shouldn’t matter how or why the stimulator was being used. That company should have been responsible for their malfunctioning equipment.

  21. Jason, you’re right. I missed that in my first reading.

    Susan, your story is the one that makes me cringe. To have an employee basically tell you they are scamming the system is what makes W/C (and FMLA for that matter) so frustrating. It’s bad enough to suspect it to a high degree of certainty, but to have the employee thumb their nose makes you want to scream.

    CW, the subrogation idea is compelling. That takes it right back to Jason’s original statement.

  22. Yes, all the above. The accident, the injury, the lawsuit. Isn’t that what we do as safety professionals?

  23. Susan:

    I’m not trying to introduce fact not in evidence. Hence the question marks.

    I don’t presume to second guess the court system. I may not agree, but we’re all entitled to an opinion.

    In this case, the WY Workers’ Safety & Compensation Division was named, not the (former) employer.

  24. I really have a problem with this. Legally, I may be wrong, but the decision basically says that if I be injured at work, then go home for years, and there is a chance that I can blame my employer, and that includes anything that happens to me medically for life. It may be a legal decision, but in my book it is plain wrong…I don’t care what the law says – on its face, that whole philosophy is wrong.

  25. I don’t want to make it sound like all employers are good and employees bad. But why aren’t employees able to be punished for taking advantage of the system? I can’t get a fraud case to stick. I even had a photo of a guy holding his hunting trophy (the head of an elk) from the newspaper! It didn’t help.

    I had an employee who learned the WC system, his wife worked for the state and knew the system. He used to teach other employees how to “work the system”. He bragged about being able to finally buy a truck! I tried to stop the activity, but WC was unable to get the employee to step forward (self incriminating himself – image- they couldn’t get him to tell them that he had put in a fraudulent claim) and other employees would not step forward for fear or retribution by this employee. I was stuck. The man got his truck, but at least now no one will hire him (word spread quickly).

    Then, the 2nd employee hit the system. This is in Montana. Guess what, Montana has the HIGHEST WC claim “poor safety” record in the USA. Employers get hit with being bad employers and unsafe. Really? It couldn’t be that employees know how to work the system? Could it be that the system is corrupt? What can be done with the fraud? I’ve tried to find an attorney to help me, but so far those I’ve asked will not jeopardize their position of representing the employee!

    So, I just got the 3rd employees claim notice with an increased WC claim reserve. He tripped at a bank (no witness) and his story just didn’t add up. He is now out on permanent disability even though he worked for a month after. He also signed an “Early Return to Work”. We had sedentary work available. He got an attorney and doctor to say he “cannot work at all”. I hired a private eye, found he was working for himself, but his own hire employees took back their testimony. His reserve was just increased $100K by WC. My premium will go up again!

    It’s a spiral when employee see that using a WC system for general income and health insurance and this then is generally accepted.

  26. Captain Safety says:

    Liability of the manufacturer would fall under a different case than the Worker’s Comp. filing. If he decided to sue them, he’d probably win that one, too.

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