Detailed claim investigation results in denial of claim for multiple fusion surgeries and PTD benefits at trial
Inman and Fitzgibbons obtained a very favorable decision for a client in a recent case concerning the claim of a police officer for two cervical fusion surgeries and significant disability benefits. The arbitrator denied all benefits and agreed with our position that the petitioner did not sustain a compensable accident arising out of and in the course of his employment.
Petitioner was a correctional officer who alleged that two lengthy round-trip federal prisoner transports to Kentucky aggravated a pre-existing cervical condition. He testified that the squad car forced him into an uncomfortable position due to the prisoner cage in the back restricting his ability to adjust the seating. He further alleged that the roads they traveled were under construction and generally rough and bumpy. His treating surgeon had opined that the trips were an aggravation which set in motion the need for the surgery.
We subpoenaed all of the medical records and uncovered chiropractic and other treating records containing a history of neck pain from moving concrete blocks the weekend prior, in addition to the history of the prisoner transport trips. We cross-examined the surgeon extensively over this inconsistent history of which he was not aware, and gained significant concessions during his deposition. An early IME had been arranged by the claims handler with an occupational specialist who essentially opined that there was no accident within the meaning of the Act. The claims handler also obtained a valuable statement from the officer who accompanied the claimant on the trips. The statement revealed that the claimant told him during the drive that his neck was hurting from a recent fishing trip in which their trailer got a flat and they ended up having to lift tires and a boat battery. The co-worker also stated that the claimant made no complaints that the driving or positioning during the trip was causing his pain.
We enlisted the additional support of a neurosurgeon who authored a records review report and opined that the lengthy trips were not casually related to his need for surgery. The insured was able to provide detailed photographs of the interior of the vehicle traveled in, and these were provided to both of our doctors. Both doctors were deposed and were able to testify with authority to the lack of causation based on their review of all of the medical records, the photographs of the vehicle’s interior, as well as the statement from the co-worker.
At trial we subpoenaed in the co-worker officer, who no longer worked for the insured, and he provided credible testimony consistent with his statement, and also was able to provide testimony regarding the interior of the vehicle. Petitioner testified that the history in the records referring moving concrete blocks was simply wrong, and that although there was a fishing trip, that he never lifted a tire or a car battery. He testified that all he did was walk to a nearby farm and locate a cement block, which his son then came and carried back to the trailer in order to raise it up further while changing the tire. The claimant’s son then testified consistent with that version as well. We cross-examined them extensively regarding this version of events and how it simply did not square with the actual medical notes or common sense.
The Arbitrator completely agreed with our position and denied all claims for benefits. This is a final decision as the petitioner elected not to file a Review. Petitioner had undergone 2 cervical fusion surgeries and was claiming over $175,000.00 in medical bills, TTD benefits of $28,843.20, as well as permanent and total disability. Had petitioner prevailed at trial, the exposure would have totaled over $500.000.00. The case was tried by Terry Donohue of our office.