A worker who suffered a back injury is unable to re-open her workers’ compensation claim despite having ongoing back pain, according to the West Virginia Supreme Court.
Because her ongoing pain wasn’t related to her compensable back injury, the claim couldn’t be re-opened, the court said.
Updated list of conditions mentions lumbar sprain
Lisa Gibson was a warehouse worker employed by Cabela’s, Inc. On Feb. 12, 2018, she injured her back as she was packing bricks of ammunition and putting them on a conveyor belt.
Gibson was taken to a MedExpress where she was diagnosed with right shoulder and bilateral thigh strains. A Dec. 3, 2018, independent examination revealed further issues, including a right rotator cuff injury and problems in her lower back.
A workers’ compensation claims administrator issued an order on March 14, 2019, to provide an updated list of compensable conditions in Gibson’s claim, including:
- sprain of the right shoulder joint
- complete rotator cuff tear or rupture
- sprain of the right hip
- sprain of the left hip, and
- sprain of the lumbar spine and pelvis.
This revised list was issued to correct the previous orders on the claim based on the MedExpress examination. Gibson didn’t protest the decision to add these conditions.
Diagnosed with radiculopathy of lumbar region
In April 2019, Gibson sought treatment for continued pain in her lower back. She was diagnosed with radiculopathy of the lumbar region.
Shortly after this treatment, the claims administrator suspended the claim for temporary disability benefits, stating that no evidence was received indicating Gibson was still disabled. Further, medical records revealed that Gibson had been released to modified-duty work on April 15, 2019.
The claim was closed May 23, 2019. Gibson, who continued to suffer from lower back pain, protested this decision.
Claims administrator denies request for authorization
In November 2019, Gibson filed an application to re-open her claim for temporary total disability benefits.
The physician’s part of the form was completed by a MedExpress doctor who diagnosed Gibson with lumbosacral radiculopathy and sprain of the lumber spine and pelvis. The doctor said Gibson had sustained an aggravation of the compensable injury and recommended an EMG and a neurosurgical consultation.
The claims administrator denied the doctor’s request for authorization, stating that the consultation and testing were requested for a diagnosis of lumbar radiculopathy, which was not a compensable diagnosis in the claim. Gibson didn’t protest this decision.
Lumbar radiculopathy never added as condition on claim
Gibson continued to seek treatment for her back pain while continuing to attempt to re-open her claim.
In October 2020, the Office of Judges affirmed the claims administrator’s Dec. 12, 2019 denial to re-open Gibson’s claim, finding her disabling condition was due to lumbar radiculopathy, which was never added as a compensable component of her claim.
The Board of Review affirmed the Office of Judges’ decision.
Supreme Court: ‘No aggravation of compensable condition’
On review by the West Virginia Supreme Court, the court upheld the prior decisions denying the re-opening of the claim.
The court said that while Gibson “may have lumbar spine pain, the reason she was taken off of work was due to lumbar radiculopathy, not the sprain that occurred two years prior. Lumbar radiculopathy is not a compensable component in the claim, and there has been no aggravation or progression of the compensable condition.”
There was no error in the Office of Judges’ decision to deny the claim, so the court affirmed the denial to re-open Gibson’s claim.
