Treating Physician’s Opinions Are Key in Court’s Decision to Grant Workers’ Compensation Benefits

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When it comes to work-related injuries, employees should know their rights. Under Louisiana law, employees who suffer from an injury caused by an on-the-job accident are entitled to workers’ compensation benefits. In order to successfully make a claim for those benefits, employees must prove their claimed disability is related to an on-the-job injury. In accordance with their benefits, employees have the right to select one treating physician in a particular field or specialty and the employer is required to pay for all approved necessary expenses. A decision arising out of Calcasieu Parish illustrates just how critical the treating physician’s opinion is in determining whether a claimed disability is work related.

In 2010, Lauryn Ruebush (Ms. Ruebush), a nurse, was injured on the job at The Care Center of Dequincy (the care center) nursing home when she intervened in a scuffle between two patients. During the incident, Ms. Ruebush was struck with an aluminum walker and after the injury, she experienced pain and discoloration in her left hand and wrist. She consulted an orthopedic surgeon who treated the injury with an injection and nerve block; all to no avail.

After her condition failed to improve, Ms. Ruebush’s family physician referred her to anesthesiologist and pain management physician, Dr. Tarun Jolly (Dr. Jolly). Ms. Ruebush received treatment from Dr. Jolly despite her employer’s denial of her request to see him. Dr. Jolly diagnosed Ms. Ruebush with complex regional pain syndrome and treated Ms. Rubuesh with the insertion of a spinal cord inserted stimulator. Ms. Ruebush claimed that she was capable of doing light work, but could not return to her prior job due to its physical demands.

In 2011, Ms. Ruebush sued the care center and Risk Management Services, its workers’ compensation carrier, seeking indemnity benefits, medical benefits, penalties and attorney’s fees for the failure to provide services. The workers’ compensation judge (WCJ) ruled in favor of Ms. Ruebush. The WCJ awarded her temporary disability benefits (TTD) and supplemental earnings benefits (SEB) and ordered reimbursement of out-of-pocket medical expenses, penalties, and attorney’s fees.

TTD benefits are awarded to claimants who suffer total disability and are unable to engage in employment of any kind. La R.S. 23:1221(1)(c). TTD benefits amount to two-thirds of an employee’s average wages during the time he or she suffers from a disabling condition. SEBs are awarded upon a showing that a work-related injury resulted in an employee’s  inability to earn 90 percent of his or her pre-injury wages. Winford v. Conerly Corp., 897 So.2d 560 (La. Ct. App. 2005). SEB benefits pay two-thirds of the difference between the average monthly wages at the time of injury and average monthly wages earned (or capable of being earned) in any month after the injury.

The care center appealed the WCJ’s decision. The crux of the care center’s appeal was the WCJ’s reliance on Dr. Jolly’s testimony. The care center argued that the WCJ should not have relied on Dr. Jolly’s opinion because Dr. Jolly was not Ms. Ruebush’s initial choice of doctor and the center declined her change of physician. The care center explained that had the WCJ disregarded Dr. Jolly’s opinion, Ms. Ruebush would have lost. In other words, she would have failed to meet her burden of proof.

The court of appeals did not buy this argument. The court found no error in the WCJ’s reliance on Dr. Jolly’s opinion, despite his status as an unapproved second choice of physician. The court noted that Ms. Ruebush saw Dr. Jolly upon referral from her family physician after her condition did not improve. It also noted that as an anesthesiologist and pain management physician, he offered treatment from a different perspective. Throughout the court’s analysis of the issues, the court of appeals deferred to Dr. Jolly’s opinion and the findings of the WCJ.

This case demonstrates how critical an employee’s choice of doctor is in successfully making a claim for workers’ compensation benefits. Doctors are our gatekeepers to the healthcare system. They are vital in issuing medical treatment and assisting judges in determining whether the disability is work-related for the purpose of awarding medical and disability benefits. A good lawyer is equally key to this success; they know the ins and outs of workers’ compensation law which helps clients navigate the system and receive an effective recovery.

Additional Sources: LAURYN RUEBUSH VERSUS OFFICE OF RISK MANAGEMENT & THE CARE CENTER OF DEQUINCY

Written by Berniard Law Firm Blog Writer Noah Al-Malt

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