Sometimes an injury might not be completely apparent immediately after an incident at work, like a fall. This is particularly true about a secondary injury, and that can have a complicating effect on workers’ comp claims.
Phylis Stevens slipped and fell down a flight of stairs outside of her workplace, the Pinedale Aquatic Center (PAC). Her immediate complaints about pain centered around her hand.
Her hospital intake form said Stevens’ chief complaint was pain in her left hand. Doctors found fractures in the hand.
Two days after the fall, she filled out an injury report for work. The report only contained information about her hand.
Stevens had several follow-up visits with her treating doctor. It wasn’t until more than a month after her fall that she first mentioned soreness in her right hip.
Not quite three months after her fall, her doctor ordered x-rays be taken of both of Stevens’ hips. There were no abnormal findings. Days later she had an MRI. After viewing the MRI results, her doctor diagnosed Stevens with avascular necrosis (AVN) in the femoral head of her right hip. (AVN is the death of a bone due to lack of blood supply.) Her doctor noted:
“This is probably a posttraumatic event related to the slip-and-fall accident.”
Eventually, the femoral head on her right hip collapsed due to the AVN progression. Almost 14 months after her fall, Stevens received a total right hip replacement.
Stevens applied for workers’ comp benefits for her hip injury, claiming it was caused in the course of her work.
The Wyoming Workers’ Safety and Compensation Division denied all payments for Stevens hip-related treatment because “the right hip is not related to the original work injury to the left hand.” Stevens requested a hearing.
Three co-workers testified in support of Stevens’ claim that the hip injury was work related.
Although the hearing examiner found all three women credible, she stated in her findings that “any statements or implications that Stevens had significant pain in the hip immediately after the fall are not supported.”
Stevens’ treating doctor also testified that, in his opinion, the hip injury was caused by her workplace fall.
But there was other medical evidence.
One MRI showed the possibility that Stevens had AVN in both her hips, even though only one worsened to the point that replacement surgery was necessary.
Her doctor’s reaction to that? “You know, it does throw a wrench into the works and raises a question,” the doctor testified. AVN in both hips would be inconsistent with a case caused by trauma such as a fall.
Another doctor reviewed Stevens’ case at the Comp Division’s request. The second doctor believed it was “very unlikely” that the AVN in the right hip was due to her fall at work. The doctor explained the onset of her AVN was too early for it to be connected to Stevens’ fall at work. On top of that, there was evidence the AVN was also present in her left hip. Having it on both sides would also rule out that it was caused by her fall.
The hearing officer gave more weight to the opinion of the second doctor, not Stevens’ own physician and denied the request for workers’ comp benefits for the hip injury. A state appeals court agreed with the hearing officer’s decision.
Next, Stevens’ case went to the Wyoming Supreme Court.
Deference to wrong doctor?
In her argument to the Supreme Court, Stevens said the hearing officer sided with the wrong medical professional.
The Comp Division noted that the testimony given about Stevens’ injuries from her fall were inconsistent with the medical documentation. There’s no mention of hip pain in the records until more than a month after her fall.
The high court held that Stevens failed to show the hearing officer’s deference to the second doctor’s opinion was wrong.
Stevens was ultimately denied workers’ comp benefits for her hip injury. This case shows that good documentation by company safety and/or benefits personnel can play a key part when it’s disputed whether an injury is work-related. Besides the documentation by her doctor, Stevens was required to fill out an injury report by her employer in which she didn’t mention any pain in her hip.
What do you think about this case? Have you ever had a similar experience in which a worker claimed an injury was work-related some time after an incident occurred at work? You can tell us about it in the comments.
(In the matter of the workers’ compensation claim of Phylis Stevens, Supreme Court of Wyoming, No. S-14-0076, 12/2/14)
