Employer Appeals Change in Condition Claim

Employer Appeals Change in Condition Claim
Original Doctor’s Findings Ruled Admissible

The injured: Mary Beth was employed by an Indiana newspaper and injured her neck while lifting newspapers. She later experienced a change in condition and sought to modify the original agreement.

The Facts of the Case

Mary Beth filed a workers compensation claim when she was originally injured. The claim was settled by a mediated agreement that was accepted by the Indiana Workers Compensation Board. The settlement provided lump-sum payments to Mary Beth for her permanent partial impairment, temporary total disability, and attorneys fees. In exchange for the settlement, Mary Beth dismissed her claim and waved further physician review. However, the settlement agreement did allow for a claim change within the statute of limitations. If Mary Beth wished to claim a change in condition that “proximately resulted” from her original workplace injury, she would  submit to an examination and opinion from a mutually agreeable medical doctor, or, if unable to select a medical doctor, then one appointed by the board.

Seven years after the original claim, Mary Beth filed a claim for change of condition, alleging that her condition had worsened. The parties agreed to seek an opinion of an independent neurosurgeon. This doctor diagnosed a synovial cyst and degenerative subluxation that he believed developed over time as a result of the natural history of progressive degenerative disease, and not as a result of any work-related injury occurring 7 years prior.

Mary Beth also had an exam done by her original doctor who disagreed with the independent examiner, saying that the surgery done as a result of the original injury likely contributed to the development of the cyst.

The Board held a hearing to determine whether or not there was a compensable change of condition, and how to deal with the differing medical opinions.

The Resolution

The Appellant (the newspaper company) argued that Mary Beth should be bound by the intent of the compromise agreement: to set a procedure for expeditiously deciding this issue through one physician. Klezmer Maudlin attorneys (representing Mary Beth) maintained that she was not bound by the agreement to accept the independent examiner’s opinion as “dispositive of her claim” and that her own original doctor’s opinion was a better one.

The hearing member (and later full board, the Appeals court judge, and the Indiana Supreme Court) ruled in Mary Beth’s favor finding that, indeed, her original doctor’s opinion was more persuasive, and that she had sustained a change in condition attributable to her prior work injury. The court maintained that the original stipulation provided “a” procedure for determining a change in condition, not “the only” procedure. As such, the court upheld the Board’s decision to modify the conditions of the claim due to a change in condition.

The attorneys from Klezmer Maudlin were vital in helping Mary Beth successfully file her change in condition status and defend the Board’s decision through the Appeals Court.

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