A worker who was injured in a fall from a stool while operating a paper shredder could only get limited workers’ compensation benefits since medical evidence didn’t support all the injuries on his claim.
The Superior Court of Delaware found the worker was entitled to benefits for an injury to his left shoulder and neck that he reported to his supervisor but not for injuries to his right wrist and shoulder.
Emails, injury report only mention left shoulder
Ty Jason was working for the State of Delaware on April 7, 2014, when he fell from a stool while shredding confidential documents.
Jason immediately called his supervisor and reported the incident, stating that he’d caught himself with his left hand when he fell to the ground. Later the same month, Jason emailed his supervisor about the incident and mentioned that he’d hurt his left shoulder when he fell and caught himself with his left hand.
The supervisor told him to report the incident to his manager, leading to a formal injury report submitted in May 2014. In his communication with the manager, Jason again mentioned stopping his fall with his left hand and injuring his left shoulder.
Jason claimed that he completed the injury report and submitted it as instructed. However, the State of Delaware didn’t report the claim to its workers’ compensation insurance carrier and Jason didn’t receive any communication from his employer about the submission.
Surgeon diagnoses neck, left shoulder injuries
Within three weeks of the fall, Jason had seen an orthopedic surgeon for pain in his shoulders and neck. The surgeon ordered two MRIs, one for each shoulder, but since one would’ve been out of pocket, Jason opted to only have the MRI of his left shoulder completed. Based on the MRI, the surgeon diagnosed both cervical and left shoulder injuries from the work-related fall.
In February 2015, Jason saw a spine specialist, but he didn’t mention the work incident. He received physical therapy for both shoulders and his health insurance provider denied coverage because Jason claimed the treatment was for a work-related injury. He stopped physical therapy because he feared the cost of the out-of-pocket expenses.
During a visit to his primary care physician in September 2019, Jason reported that he was continuing to work and took Aleve when he experienced intermittent pain in his neck and shoulders. Later that year, he returned to the spine specialist due to numbness in his arms and hands that affected his ability to perform some of his job duties.
Despite the denial of both health insurance and workers’ compensation benefits, Jason underwent multiple surgeries, including bilateral carpal tunnel releases, bilateral shoulder surgeries and a neck surgery. He continued with physical therapy and made out-of-pocket payments in 2020 and 2021.
Board denies benefits for wrist, right shoulder, spine treatments
On Oct. 22, 2021, Jason filed a petition with the state’s Workers’ Compensation Board to seek a determination of compensability for expenses related to issues with his wrists, shoulders and cervical spine.
Based on the medical evidence, the Board granted benefits for the injuries to Jason’s left shoulder and neck, while denying benefits related to his bilateral carpal tunnel and right shoulder injuries.
Decision based on substantial evidence, worker’s testimony
On appeal, Jason argued that the Board erred in finding that his work-related injury didn’t result in medical problems with his neck, right shoulder and hands. He claimed his lack of immediate medical treatment for those problems was because his employer prevented treatment due to its failure to report the incident to its workers’ compensation insurance provider.
The appeals court disagreed finding that the Board’s denial of benefits was based on substantial medical evidence and Jason’s own admission in the 2014 email that the injuries from the fall were to his left shoulder and neck.
Jason’s own medical expert acknowledged that if the fall injuries were focused only on the left side then his right-side problems wouldn’t be related to the work incident, the court said.
