The Commission recently modified an Arbitrator’s decision in part in a case – Antonio Rice v. Chicago Construction Specialists, Inc., in denying prospective medical treatment, modifying an award of TTD benefits and determining a date in which the petitioner reached maximum medical improvement. The Commission found the opinion of the IME physician to be more persuasive and better supported by the facts than the opinion of the treating physician/surgeon.

In this case, the petitioner had been a construction laborer since 1986 and began working for the Respondent on November 7, 2011. On the first date of employment, the petitioner was assigned to push a full wheelbarrow to a dumpster and to empty it in the dumpster. The empty wheelbarrow weighed approximately 15 pounds and a full wheelbarrow weighed approximately 90 pounds. The petitioner testified that he pushed the wheelbarrow to the dumpster between 20 and 30 times during his first day on the job before he felt his left knee pop. He notified his supervisor and went to the emergency room on November 8, 2011 due to his pain. He subsequently underwent a partial medical meniscectomy on January 27, 2012 and the treating physician opined that the tear was small and frayed, but with no sharp edge, and could have occurred acutely or over time. The treating physician related the tear to the work accident based on the Petitioner’s history. The petitioner’s condition improved and eventually plateaued and he was released from physical therapy on June 30, 2012. On July 13, 2012, the Petitioner was seen by the treating physician and noted continued intermittent pain and swelling; lack of full extension of his left knee and medial joint line tenderness. The treating physician recommended a left total knee replacement.

On January 10, 2012, the petitioner underwent an IME, who noted no loose bodies and associated the Petitioner’s popping event on November 7, 2011 to no more than a patellofemoral event related to Grade IV arthritis. The IME physician opined that the work accident did not cause an aggravation or acceleration of the left knee problem and that his symptoms and problems were the same that he was having in 2011. The IME physician opined that the petitioner’s symptoms were related to degenerative arthritis, that knee replacement was in no way related to the accident and that he was at MMI. The IME physician later testified that given the Petitioner’s advanced arthritis, it was expected that his symptoms would wax and wane. He also testified that the Petitioner was going to need a total knee replacement regardless of the injury.

At Trial, there was witness testimony that the Petitioner walked with a limp prior to his work accident. There was also evidence of the Petitioner’s well-documented pre-existing left knee condition, including prior arthroscopic procedures in November 2006 and December 2009. The petitioner also underwent a left knee arthroscopy and partial medical meniscectomy on December 28, 2010 following left knee popping episodes in December 2010 while getting out of a chair and getting out of a car, respectively. The petitioner twisted his left knee again and underwent a left knee arthroscopy and lateral chondroplasty on May 10, 2011. Prior to his work accident in November 2011, the petitioner had an antalgic gain; diffused tenderness of the knee; mild degenerative changes and he lacked full extension of his left knee. It was also noted that the Petitioner sought treatment for his left knee one month prior to his work accident.

At Trial, the Arbitrator awarded TTD benefits through the hearing date and a prospective award for the total knee replacement. On review, the Commission found that the (meniscal) fraying and the need for the arthroscopic surgery to be causally related to the Petitioner’s work accident. However, the Commission determined that the petitioner returned to his pre-injury condition and reached MMI as of June 30, 2012 and was not entitled to TTD benefits beyond that date and that the left total knee replacement recommendation was not related to the Petitioner’s November 7, 2011 work accident.

It its decision, the Commission noted that the treating physician indicated that the Petitioner’s need for the total knee replacement was based on his degenerative condition and prior surgeries, along with the accident. However, the Commission found the opinion of the IME physician that the petitioner was going to need a total knee replacement regardless of his November 7, 2011 work injury to be more persuasive. The Commission noted that the IME physician’s opinion was supported by the fact that the Petitioner had Grade 4 degenerative left knee arthritis and had two prior surgeries. The Commission also noted that the Petitioner’s pre-accident medical examination findings from May 10, 20111 through October 10, 2011 were virtually identical to the post-accident findings beginning on March 5, 2012.

The Commission modified the Arbitrator’s decision and found that the petitioner was only entitled to TTD benefits from November 7, 2011 through June 30, 2012 and that he the Petitioner was not entitled to the total left knee replacement.

Thanks to Senior Attorney Mark Carter for this important summary of a recent decision illustrating effective reliance on an IME and perseverance through the Commission review level.