When it comes to deciding whether an injured employee should get temporary total disability payments from workers’ comp, just how much do doctors’ opinions matter?
Jean O’Connor was a duty nurse for Med-Center Home Health Care in Connecticut. While in the course of her employment, she slipped on ice in a patient’s driveway and injured her hand, wrist, knee and shoulder. Med-Center accepted and covered these injuries.
Several years later, O’Connor requested coverage for a partial knee replacement. In the course of seeking compensation for her surgery, O’Connor was evaluated by two orthopedic doctors, who both said she was capable of sedentary work. That led Med-Center to request reduction or discontinuation of O’Connor’s workers’ comp temporary total disability benefits. A workers’ comp commissioner heard the case.
O’Connor submitted a report from her treating physician, stating that she was “functionally disabled.” More specifically, the doctor said, “There is little in terms of work capacities that she could tolerate other than sedentary capacities, but her ability to get to and from her house to place of employment is now severely limited.”
Another doctor testified that O’Connor was also at risk of “potentially fatal blood clots.”
O’Connor also testified before the commissioner that she couldn’t perform everyday activities, such as cleaning, doing laundry or driving.
The commissioner ruled that O’Connor was totally disabled and that Med-Center should pay per workers’ comp benefits. On appeal, the workers’ comp board agreed with the commissioner.
Next stop for Med-Center: a Connecticut appeals court.
Doctor’s word or commissioner’s opinion?
The employer argued that the finding that O’Connor should be awarded total disability was made without receiving direct medical evidence that she was totally disabled.
The appeals court noted that no doctor or occupational specialist determined that O’Connor was totally disabled.
But the court disagreed with Med-Center’s assertion that O’Connor couldn’t be found totally disabled without direct medical evidence indicating that.
“The evaluation of whether a claimant is totally disabled is a holistic determination of work capacity, rather than a medical determination,” the court wrote.
Given the medical testimony and O’Connor’s own credible description of what she was capable of doing, the court ruled the commissioner could have found as he did, that she was totally disabled.
“The commissioner reasonably and logically could have concluded that the plaintiff’s inability to sit for long periods, stand for long periods, repeatedly get up from a chair, twist, lift or drive, combined with the pain associated with her condition, rendered her temporarily totally incapacitated from work,” the court said.
For that reason, the commissioner’s decision was affirmed.
What do you think about the court’s decision? Let us know in the comments below.
(O’Connor v. Med-Center Home Health Care, Appellate Court of CT, No. AC30200, 3/5/13)
Duration of temporary total disability increasing
Having workers on temporary total disability (TTD) is costly.
The National Council on Compensation Insurance (NCCI) has found the average duration of TTD benefits has been increasing since the start of the recession in 2008. The rate of increase slowed somewhat in 2010 and 2011, the period for which the most recent statistics are available. The study includes data from 45 states plus Washington, DC.
The mean duration of TTD benefits rose from 130 days in 2005, to 147 days in 2009 and 149 days in 2011.
Some other statistics about TTD from NCCI:
- Contracting (plumbing, construction) consistently has the highest duration of all the industry groups (the other four groups are Manufacturing, Goods & Services, Office & Clerical, and Miscellaneous which includes trucking and public safety workers). Contracting claims tend to be for more severe injuries than claims in other industries because of the relatively high exposure to hazardous work conditions (ex. working at heights).
- The type of injury with the longest duration is fractures. The duration of hernia claims has declined significantly since 2000 because of improved surgical treatments.
- The body part with the longest duration is the wrist. Ankle injury duration has increase more than any other body part from 1998 to present.