The Commission recently reversed an unfavorable decision by the Arbitrator as to our client’s liability for renewed treatment and lost time five months after the prior treating physician deemed the claimant at MMI. Our client had paid benefits on a repetitive trauma claim for a couple of years through surgery and follow up care necessitated by the petitioner’s persistent ongoing complaints. In July of 2009, the treating surgeon determined that no further care was necessary and that petitioner was capable of continuing in her regular job.
Petitioner continued to have complaints in her hand and arm, and sought treatment with a new physician in November of 2009. This doctor took petitioner off of work, and ultimately performed new surgery after an MRI showed findings “vastly different” from a prior MRI done by the previous physician. The new doctor testified via report that he had a “passive understanding” of petitioner’s job duties and their relation to her symptoms, but noted he would need more information concerning her job and her prior medical condition to opine on causation.
Despite this obvious hole in petitioner’s case, the Arbitrator found causal connection between the treatment and lost time commencing in November 2009 and the work accident alleged in our case. Following briefing and oral argument on Review, the Commission agreed with us that petitioner failed to carry her burden of proof of causation between the renewed treatment in November 2009 and the work accident. In so doing, the Commission reversed nearly two years of TTD exposure and tens of thousands of dollars in medical bills. The decision also lowers the potential PPD value of the injury, and cuts off our client’s liability for ongoing medical care. We are now looking at a PPD award or settlement based solely on the first surgery the petitioner underwent following our work accident.
BOTTOM LINE: A basic principle of Illinois Worker’s Compensation is that the petitioner maintains the burden of proving all of the elements of his or her claim. Even though repetitive trauma claims have historically been notoriously difficult to defend in Illinois, this case illustrates how experienced counsel can assist in determining when benefits are proper.
Congratulations to Jack Shanahan for the outstanding result.