Claimant Prevails with the Commission, Despite Having a Preexisting Condition

Claimant Prevails with the Commission, Despite Having a Preexisting Condition

| Oct 2, 2020 | Firm News

In a case involving a beleaguered petitioner in a worker’s compensation case seeking coverage for necessary medical treatment, the claimant was able to obtain relief from the Commission, after having been denied benefits at arbitration. See Preexisting arthritis doesn’t block award for total knee replacement. Illinois Workers’ Compensation Law Bulletin, Volume 28, Issue 6, May 15, 2020, p. 5.[1] The case discussed in the article, Wyse v. Lakeshore Recycling Systems, 28 ILWCLB 61 (Ill. W.C. Comm. 2019), involved a claimant that was employed as a truck driver, and who also performed a variety of other tasks for his employer as well, like handling and hauling heavy equipment such as dumpsters and trash compactors. In June 2016, while adjusting a tarpaulin, the claimant fell off of a box containing metal studs that he had been requested to later haul away.[2] The claimant landed on uneven ground, made up of grass and concrete, and severely injured his right knee. The claimant was diagnosed by his treating physician as having suffered a meniscal tear, which the doctor asserted was primarily caused by the aforementioned accident, but also made worse by the claimant’s preexisting arthritis.[3] The claimant’s treating physician then performed a right-knee arthroscopy with a partial medial meniscectomy, together with a chondroplasty of the claimant’s medial femoral condyle. The claimant’s doctor also recommended an eventual total knee replacement for the claimant as well.[4] Thereafter, the claimant filed a petition for benefits, including coverage for his aforesaid surgical operation, as well as the future knee replacement, but the arbitrator denied his claim, mainly because the respondent employer’s retained physician-expert and/or independent medical examiner (or IME), erroneously postulated that the claimant’s injuries were allegedly and solely due to a degenerative knee condition with which the IME doctor had diagnosed the claimant, and not the workplace accident.[5] However, the Commission reversed the arbitrator’s decision, based on the fact that the claimant’s treating physician had extensively examined and treated the claimant at length for his injuries, and also knew a great deal regarding the claimant’s accident and medical history, while the employer’s IME physician had only examined the claimant once, and knew very little about the accident or the claimant. The Commission further reasoned that the claimant’s activities outside of work did not contribute to his workplace accident, or his knee condition.[6] The Commission then awarded the claimant’s requested compensatory relief, including the cost of the future knee surgery, together with any treatment related to said surgical operation. The main takeaway here seems to be that the opinions of employers’ IME physicians are sometimes only perfunctorily and cursorily offered, and are therefore not always a complete and accurate assessment of causation for a claimant’s injuries, or of the necessary treatment for same.[7] It is thus satisfying that in this case, the Commission came to this conclusion as well.[8]
[1]See. Preexisting arthritis doesn’t block award for total knee replacement. Illinois Worker’s Compensation Law Bulletin (also cited as ILWCLB), Volume 28, Issue 6, May 15, 2020, p. 5.
[1]See Id.
[1]See Id.
[1]See Id.
[1]See Id.
[1]See Id.
[1]See Id.
[1]See Id.

Attorney Matthew Ludwinski