Case name: Lupisan v. Federal-Mogal
Ruling: An arbitrator’s decision that
awards penalties against the employer is affirmed and adopted by the
Commission
What it means: When denying a claim,
an employer cannot rely on an unreasonable physicians opinion that the
work-related injury did not cause the claimant’s current condition when the
employer also has clear and un-rebutted evidence that the injury caused the
current condition.
Summary: The arbitrator awarded
penalties and attorney’s fees against the employer, finding the employer’s
reliance on it’s physicians recommendation unreasonable in light of the
clear facts surrounding the claimant’s injury. The 30-year-old claimant
experienced left shoulder pain while moving a handcart. He reported to the
employer’s medical department and underwent physical therapy for one month.
Several months later the claimant requested medical attention, complaining
of “popping, grinding sounds” in the same shoulder. An employee in the
medical department wrote a note that she did not “like what she felt on this
shoulder.” An MRI revealed that if trauma occurred, a contusion might
exist. A physician, at the employer’s request, examined the claimant’s
records without examining the claimant himself and concluded that the
previous work-related injury did not cause the claimant’s current MRI
findings because the MRI findings showed a degenerative disease. However,
this opinion was dismissed by the claimant’s surgeon, who performed surgery
and corrected his condition. The surgeon stated that the claimant’s injury
was a well-know cause of the type of tear found in his shoulder. Because
the employer relied on the unreasonable opinion of its physician to deny the
claimant benefits when the circumstances of his injury were clear, the
arbitrator awarded statutory penalties and attorney’s fees against the
employer.
The arbitrator awarded the claimant a total
of $18,554.40 in penalties and $3,710.88 in attorney’s fees.
