An employee’s doctor says she suffered a workplace injury. The insurance company’s doctor says she didn’t. Who will the court believe, and will the employee get workers’ comp? There’s a lesson in this one for all employers.
Megan Peterson worked as a certified nursing assistant for The Evangelical Lutheran Good Samaritan Society’s nursing home.
One night, she bent down to help a resident with a wheelchair foot pedal, stood up and felt a sharp pain in her lower back. Peterson told her supervisor she had back pain and asked for medication. She took Tylenol and completed her shift.
The next day, Peterson couldn’t move from the waist down due to pain. An ambulance took her to a hospital ER. A CAT scan revealed a disc protrusion. She was released but told to get bed rest.
Peterson went to a board certified orthopedic surgeon for treatment. Her doctor said she suffered a workplace injury to her back. Because of restrictions he put on her work, Peterson was fired from Good Samaritan, and then she sought workers’ comp benefits.
Good Samaritan’s workers’ comp insurance company retained another doctor who reviewed Peterson’s medical records. That doctor said Peterson’s back injury was caused by a preexisting condition, not from a work injury.
The state Department of Labor adopted the insurance company doctor’s opinion and denied Peterson benefits. An appeals court upheld that opinion. Peterson appealed to the South Dakota Supreme Court.
The state’s highest court reversed the opinion. The judges noted Peterson’s doctor was the only one to actually see her. The insurance company’s doctor only reviewed her medical records — he never saw her. The court also said her doctor’s credentials were superior to those of the insurance company’s physician.
“The opinion of an examining physician should be given substantial weight when compared to the opinion of a doctor who only conducts a review of medical records,” the court wrote.
There’s the lesson: If your workers’ comp insurance carrier wants to deny a claim, it better make sure its doctor actually examines the employee to make it more likely the denial will stand up to a challenge.
(Peterson v. Good Samaritan, Supreme Court of SD, No. 26214-rev, 6/27/12)