A worker who suffered an injured neck when a toilet exploded can’t receive additional workers’ compensation benefits because part of his disability was due to a prior medical condition.
The West Virginia Supreme Court found that the worker’s prior diagnoses of spinal issues and carpal tunnel syndrome warranted an award for 4% permanent partial disability rather than the 11% award requested by the worker.
He was treated for spine issues prior to explosion
Robert Lilly Jr. worked as a bus driver and summer painter for the Raleigh County Board of Education.
On May 10, 2019, Lilly was diagnosed with a spinal condition and carpal tunnel syndrome. At that time, his doctor referred him to a specialist over concerns regarding the possibility of Parkinson’s disease. An MRI of the cervical spine revealed a disc protrusion and Lilly reported having discomfort in his neck and uncontrolled movement in his upper extremities.
Lilly injured his neck on July 24, 2019, when a toilet exploded while he was painting in a bathroom, causing him to get blown into a wall. When Lilly flushed the toilet, there was a build up of pressure that caused it to explode. The force of the explosion pushed him into the wall, with his neck taking the brunt of the impact.
He filed a workers’ compensation claim, which a claims administrator found was compensable for a cervical strain on Sept. 16, 2019. Lilly was granted temporary total disability benefits beginning Sept. 23, 2019.
2 independent exams offer conflicting opinions
An independent examination conducted on Feb. 10, 2020, found that Lilly was at maximum medical improvement with no further treatment needed for the compensable injury. The doctor found that Lilly had an 8% whole person impairment rating for abnormal motion. However, only 4% of that was due to the compensable injury with the other 4% being due to the pre-existing conditions Lilly was being treated for prior to the injury.
A second independent medical evaluation conducted by another doctor on May 19, 2020, found a 4% whole person impairment from the cervical strain and another 7% for abnormal motion. This added up to a rating of 11% which the doctor claimed was all due to the work-related injury.
The doctor who conducted the first independent examination performed a follow-up exam on Aug. 27, 2020. He stood by his recommendation of 4% due to the compensable injury.
There was sufficient medical evidence to justify 4% award
The West Virginia Office of Judges affirmed the 4% permanent partial disability award that had been initially granted by the claims administrator. The Office of Judges based that decision on the doctor’s opinion from the first independent examination and on medical evidence presented regarding Lilly’s pre-existing conditions and the injury. The state’s Board of Review affirmed this decision.
The West Virginia Supreme Court agreed with the Office of Judges and affirmed the 4% award. The pre-injury medical records regarding Lilly’s previous spine issues was sufficient evidence to justify the 4% apportionment, according to the court.