Safety and OSHA News

Workers’ comp: Just a broken toe or Complex Regional Pain Syndrome?

Some doctors thought this employee could go back to work, while others said that wasn’t possible because she was still in pain. How did a court resolve this impasse? 

On April 12, 2014, Maxine Hall was working as a housekeeper for Global Solutions Services LLC in Louisiana. A closet door automatically shut on her left foot. An x-ray showed a broken toe.

Hall was treated by an orthopedic surgeon, a neurologist, a vascular surgeon and a pain management doctor. Hall said despite the medical treatment, she didn’t get relief from her pain. She received workers’ comp, but her benefits were terminated on Aug. 7, 2016, more than two years after breaking her toe. She sought to have benefits reinstated, but a workers’ comp court judge dismissed her claim. A state appeals court recently heard her case.

Doctors had differing opinions about Hall’s condition:

  • A vascular surgeon said Hall suffered from Complex Regional Pain Syndrome (CRPS), but she had “significant improvement” after receiving a nerve block.
  • A neurologist put Hall on medication and recommended physical therapy for her continuing pain.
  • An orthopedist diagnosed Hall with acute foot pain and CRPS.
  • A neurologist she was referred to by her employer’s workers’ comp insurer said her complaints were “all out of proportion to the nature of the injury and is not supported by the clinical examination or diagnostic studies.” The neurologist said Hall could return to work.
  • A doctor appointed by the Office of Workers’ Compensation to conduct an independent medical exam (IME) on Hall said her “pain perception was over exaggerated.” He said her symptoms were malingering, and from a neurological perspective, there was no reason she couldn’t go back to work. Hall didn’t have CRPS, according to the IME report.

The appeals court gave more weight to the IME that found Hall didn’t have CRPS and could return to work. Louisiana courts have interpreted state law to mean that “an IME’s medical conclusions should be given significant weight because the IME is an objective witness.”

For that reason, the appeals court upheld the previous ruling: Hall’s workers’ comp benefits would not be reinstated.

(Maxine Hall v. Global Solutions Services LLC, Court of Appeal Fourth Circuit of Louisiana, No. 2018-CA-0060, 6/20/18)

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