The Commission held the claimant could
receive temporary total disability benefits for back injuries she
sustained when she fell down a staircase. The Commission ruled the
claimant was also entitled to reasonable medical and surgical expenses
for her back injuries. (Mary Loomes . Harrisburg Manufacturing and R.
Anthony Marrese M.D., [Ill. Ind. Com.], 93 WC 3406, 02 IIC 0417,
05/29/02)
The claimant fell down series of steps in
her workplace, hitting her head, neck, back and hip as she fell. She
alleged the accident caused her to suffer unbearable pain in her back.
Her surgeon operated on her lumbar and cervical spine, and imposed
permanent physical restrictions on her movement. The surgeon testified
the prolonged physical problems, coupled with her strict limitations on
movement, cause her to suffer severe depression.
The defendant contended the claimant had a
pre-existing lumbar injury unrelated to her workplace fall. The
arbitrator disagreed. Although the claimant previously complained of
minor back problems, the arbitrator noted she did not seek medical
treatment for them until they became unbearable after her fall.
Moreover, the claimant's surgeon testified her neurological damage
resulted from the fall, even though it did no manifest until some time
later. Based on the surgeon's explanation, the arbitrator found the
claimant's fall caused her back injuries and her depression.
The defendant also challenged the
reasonableness of the claimant's medical bills, arguing the resubmitted
bills more than tripled the amount due under the original bills. The
claimant's surgeon testified he based the original charges on improper
surgical codes. The resubmitted bills, the surgeon explained, reflected
the proper coding.
Because the defendant failed to address the
usual customary charges of lumbar and cervical surgery if properly
billed and coded, the arbitrator awarded the claimant the amount charged
for her medical and surgical expenses. The arbitrator also awarded her
total temporary total disability benefits for the time she was unable to
work due to her physical limitations, as well as permanent partial
disability for her physical injuries and depression.
The Commission affirmed and adopted the
arbitrator's decision, finding the claimant's physical restrictions,
major depression and limited education left her unable to meet the
standards of regular employment.
