1) Zlata Uzicanin (Claimant) sustained an accidental injury arising out of and in the course of employment on or about the date of injury of April 9, 2003.
2) Claimant was an employee of Bethesda Town House (Employer).
3) Venue is proper in the City of St Louis.
| 4) | Employer received proper notice. |
| 5) | The Claim was filed within the time prescribed by the law. |
| 6) | At the relevant time, Claimant earned an average weekly wage of 314.22, resulting in applicable rates of compensation of 209.49 for total disability benefits and $209.49 for permanentpartial disability (PPD) benefits. |
| 7) | Employer has not paid any temporary total disability benefits to date. |
| 8) | Employer paid medical benefits totaling $114.00. |
| ISSUES: |
| 1) | Are Claimant’s injuries and continuing complaints, as well as any resultant disability, medically causally connected to her accident at work on or about April 9,2003? |
| 2) | Is Employer liable for past medical expenses of an undetermined amount? |
| 3) | Is Claimant entitled to receive future medical care related to this injury? |
| 4) | What is the nature and extent of Claimant’s permanent partial disability attributable to this injury? |
| EXHIBITS: |
| The following exhibits were admitted into evidence: |
| *Employee Exhibits:* |
| A. | Deposition of Dr. David T. Volarich, with attachments, dated March 21, 2007 |
| B. | Deposition of Dr. Edwin Wolfgram, with attachments, dated March 20, 2007 |
| C. | Certified medical treatment records of Dr. Alexander Rudoi |
| D. | Certified medical treatment records of Dr. Alexander Rudoi |
| E. | Medical treatment records of Dr. Richard A. Head |
| F. | Certified medical treatment records of St. Anthony’s Medical Center |
| G. | Certified medical treatment records of St. Anthony’s Medical Center |
| H. | Medical treatment records of Unity Corporate Health |
| I. | Certified medical treatment records of Forest Park Hospital |
| J. | Medical bill from Internal Medicine, LLC (Dr. Rudoi) in the amount of $74.00 |
| K. | Medical bill from St. Anthony’s Medical Center in the amount of $1,127.00 |
| L. | Medical bill from South County Radiologists, Inc. in the amount of $165.00 |
| M. | Medical bill from Metropolitan Neurology, LTD. (Dr. Head) in the amount of $210.00 |
| N. | Claim for Compensation date-stamped July 15, 2003 |
| O. | Letter from Claimant’s attorney to Employer’s attorney dated November 19, 2004 |
| P. | Letter from Claimant’s attorney to Employer’s attorney dated March 10, 2005 |
| *Employer/Insurer Exhibits:* |
| 1. | Deposition of Dr. Patrick A. Hogan, with attachments, dated March 13, 2007 |
| 2. | Certified medical treatment records of St. Anthony’s Medical Center |
| 3. | Medical treatment records of Dr. Edward A. Hengel (Chiropractor) |
| *Notes:* | *1) Unless otherwise specifically noted below, any objections contained in these Exhibits are overruled and the testimony fully admitted into evidence.* |
| *2) Some of the records submitted at hearing contain handwritten remarks or other marks on the Exhibits. All of these marks were on these records at the time they were admitted into evidence and no other marks have beenadded since their admission on April 3, 2007.* |
Based on a comprehensive review of the evidence, including Claimant's testimony, the expert medical opinions and depositions, the medical records and bills, and the testimony of the other witness, as well as based on my personal observations of Claimant and the other witness at hearing, I find:
1) Claimant is a 47-year old female who was born in Novi Sad, Yugoslavia (Serbia). She has been married to Mujo Uzicanin for 27 years. They have one son who is 26 , and who still lives with them. Claimant had 14 years of schooling in Yugoslavia, and worked for 2 years as a Kindergarten teacher. She left Yugoslavia (Serbia) just before the war, so she was not involved in it. After stays in Austria and Germany, she eventually landed in the United States, and has lived in St. Louis since 1998.
2) Claimant testified she has had three jobs here, all with Employer. She has worked in housekeeping, in the restaurant, and in laundry. She last worked for Employer in January 2007. Her employment ended for Employer when she was discharged (fired) by them. She testified that she lost the job because she would forget things and she was not good with communicating with her supervisors and co-workers. Before April 9, 2003, Claimant denied any problems with headaches, depression, anxiety or anything else.
3) On April 9, 2003, the date of the injury, Claimant was washing windows as a part of her normal job duties for Employer as a housekeeper. She was washing the bottom half of the window, and another employee was washing the upper half. Claimant was bent down, and when a resident opened the door to come into the room, the upper half of the window fell on her head. It struck her on the right side of the head, higher up near the top. She did not lose consciousness. She described immediate complaints of shaking, and lost concentration. She said she felt bad, and she had to sit down on the ground. She said she just could not stand anymore. She reported the injury to her supervisor. She said the older lady and the other worker explained what had happened. She received some ice on her head, but no other first aid.
4) Claimant testified that her manager, Betty Altman, drove her to the company doctor. Claimant said there was no translator, so her manager was explaining things for her to the doctor. She was only able to show where things were hurting by pointing with her hand. No X-rays were taken. Claimant said her manager then drove her home.
5) The medical records from Unity Corporate Health (Exhibit H) document a visit on April 9, 2003. The record contains a consistent history of the window falling and striking her on the right side of the head. According to the record, Claimant denied loss of consciousness, visual disturbances, nausea, or headaches. Physical examination revealed no swelling, discoloration, and no break in the skin. Her vision and neuromuscular testing was all normal. She was diagnosed with a contusion to the right side of the head. The record characterized the injury as "very minor." She was released from care without restrictions. The report notes that permanency is not anticipated.
6) Regarding her continuing complaints in the days and weeks following the accident, Claimant testified that she had a bruise on her head for awhile. Later, her nose started bleeding. She said she was taking Tylenol every day for the pain on the top of her head. She said her head was hurting all the time.
7) On cross-examination, Claimant confirmed that she worked the next day after this accident, and in fact, worked from April 9, 2003 until she saw Dr. Rudoi for the first time in July 2003. During this time though, she indicated that she did have the bleeding nose and she was waiting to be sent to the doctor.
8) Claimant testified that she eventually went to the secretary and asked her about going back to the doctor. Claimant testified that they never sent her back. She said her problems with headaches were getting worse and she could not work as quickly as before. She testified that she eventually went to see her own doctor, Dr. Rudoi, after they did not respond to her requests for medical treatment. Dr. Rudoi sent her for a head scan and gave her some pills. She said she was also sent to a neurologist, Dr. Head, who gave her some medications for her headaches. Claimant testified that it helped ease the pain, but the pain was still there.
9) Following her initial visit to Unity Corporate Health on the day of the accident, the next medical treatment record is from Dr. Alexander Rudoi (Exhibit C), and is dated July 7, 2003. Her chief complaint at that time was a headache. She gave a history of the window falling on her. She also complained that she now had blurry vision in the right eye. Dr. Rudoi referred her to Dr. Richard Head (Exhibit E), a neurologist, for further evaluation. Dr. Head first saw her on July 24, 2003. Because of the language barrier, he was not able to get a good history from her. She complained of headaches for the last 2 to 3 months that were continuous, 24 hours a day. He was unable to definitively conclude if there was a visual disturbance on the right side. He did find an elevated blood pressure, which she apparently attributed to the headache. Dr. Head gave her pain medication and recommended a CAT scan of the head. The CAT scan taken on July 18, 2003 was read as normal. In a letter from Dr. Head to Claimant dated August 6, 2003, he confirmed that "there are no signs of anything serious going on" in her head. He again notes her elevated blood pressure and recommends that she follow-up with Dr. Rudoi for that condition. She next saw Dr. Rudoi on September 26, 2003 and was still complaining of a headache.
| 10) | Claimant submitted medical bills for this treatment into evidence in this case. A bill from **Internal Medicine, LLC (Dr. Rudoi)** showed a charge for the July 7, 2003visit of 74.00, which was reduced by his insurance contract by 16.78, leaving a balance due of $57.22. (Exhibit J) A bill from **St. Anthony’s Medical Center** for the July 18, 2003 CAT scantotaled 1,127.00. (Exhibit K) It was reduced by insurance payments and adjustments of 876.53, leaving a balance due of $250.47. A bill from **South County Radiologists, Inc.** for the reading of theCAT scan totaled 165.00. (Exhibit L) It was reduced by an insurance adjustment of 83.09 and an insurance payment of 65.53, leaving a balance due of 16.38. Finally, a bill from **Metropolitan Neurology, LTD. (Dr. Head)** totaled 210.00. (Exhibit M) It was reduced by an insurance adjustment of 54.91, leaving a balance due of 155.09. The initial total for all of thesebills is 1,576.00. However, after taking into account the insurance payments and adjustments, the amount still outstanding is $479.16. |
| 11) | Claimant filed her **Claim for Compensation** for this accident on July 15, 2003. (Exhibit N) On the Claim in the additional statements section, Claimant wrote, “Claimant is in need of medicalcare. Her supervisors have told her to ‘see your own doctor’, which she is doing, but it sounds as though the insurer will still claim this is ‘unauthorized’, as this is the usual M.O.” Claimant’s attorney also sent Employer’s attorney correspondence on November 19, 2004 and March 10, 2005 demanding medical treatment per Dr. Volarich’s and Dr. Wolfgram’s reports.(Exhibits O and P) |
| 12) | Claimant described that she also began to notice some emotional changes after a few months. She said she was crying a lot. She avoided friends and did not want to communicate with them. She testified it was hard to work. She was always taking pills. She said she started to forget things, like turning off the stove. She would close the door, but forget the keys, or she would leave her wallet. At work, she said she would forget what her supervisors told her to do. She also described problems at home. Claimant said that her husband makes her nervous, and her son also makes her nervous by asking questions. She said she has been more aggressive with her husband by yelling at him. |
| 13) | Claimant testified that she went on a trip to Bosnia for 27 or 28 days, from July 31, 2003 until September 2, 2003. She described the trip as a vacation. She testified that her husband has a child there, and he went to visit his child. She said she went along because she is more comfortable with him there, than without him. |
| 14) | In December 2003 she said that she had chest pain for which she went to St. Anthony’s. She testified that she had the chest pains because of her headaches and nervousness. She said that her head hurt so badly that she believed it caused the pain in her chest. |
| 15) | Medical records from **St. Anthony’s Medical Center** (Exhibit G) document an admission on December 10, 2003 for a complaint of chest pain, and increased blood pressure. The notes indicate that she has a history of hypertension and migraine headaches. Physical examination revealed that she was severely hypertensive. Claimant was given a full cardiac work-up, but all the tests were negative for a heart attack. She was discharged with diagnoses of atypical chest pain, hypertension, and migraines. |
| 16) | Claimant testified that her attorney sent her to Dr. Volarich, and then she was referred to Dr. Wolfgram. She testified that Dr. Wolfgram gave her medications to ease her nervousness. She said he talked to her quietly and slowly. She felt he was trying to help her. She said that she had a translator 2 or 3 times, and the rest of the time with Dr. Wolfgram, they communicated with gestures or speaking slowly. She also sometimes called her son to translate questions. |
| 17) | The deposition of **Dr. David T. Volarich** was taken by Claimant on March 21, 2007 to make his opinions in this case admissible at trial. (Exhibit A) Dr. Volarich is an osteopathic physician who examined Claimant at the request of Claimant’s attorney, but who provided no treatment. |
| 18) | Dr. Volarich first examined Claimant on October 12, 2004. She provided a consistent history of being struck in the head with the window. She described a wide array of complaints from this injury, including constant daily headaches increased by changes in the barometric pressure, lack of energy, nervousness, occasional left arm numbness, diminished vision, sensitivity to noise, an inability to distinguish between multiple people talking at the same time, and poor sleep. She reported no difficulty driving. Dr. Volarich was unable to perform a physical examination on that date because she was anxious and under a great deal of emotional stress. He nonetheless diagnosed a closed head trauma with posttraumatic headaches, and significant anxiety with possible depression as a result of the injury on April 9, 2003. He did not believe she was at maximum medical improvement, did not provide ratings of disability, and instead recommended psychiatric care. |
| 19) | Medical records from **St. Anthony’s Medical Center** (Exhibit F) document an admission to the emergency room on November 12, 2004 with complaints of chest pain from the evening before and numbness in the left face, arm and leg as well. A CAT scan of the head from that date was read as normal. Although the doctor wanted to admit her to do further testing, she refused admission and instead wanted to go home. |
| 20) | Claimant was next examined by Dr. Volarich on May 12, 2005 at the request of her attorney. She continued to |
complain of headaches. Dr. Volarich noted her additional visit to the hospital for chest pain and headaches. His physical examination of her head revealed no significant osseous deformity of the bony calvarium, a normal size and symmetry to the skull, and a scalp examination characteristic for her age without significant abnormality. The eyes, ears, nose and neck examinations were all normal. In fact, there were no objective abnormalities at all documented from the physical examination. Dr. Volarich also found that she was less anxious than at his first examination. He diagnosed an enclosed head trauma with posttraumatic headaches, and anxiety and posttraumatic stress related to the April 9, 2003 accident at work. He rated her as having 10\% permanent partial disability of the body as a whole for her headaches, and deferred any rating of her anxiety (psychiatric disorder) to a psychiatrist. He recommended continued care for her anxiety, headaches, and hypertension. Dr. Volarich admitted that he based the diagnosis and rating solely on her subjective complaints, and he further admitted that his examination did not indicate any evidence of injury at the time he examined her in 2005.
21) The deposition of Dr. Edwin Wolfgram was taken by Claimant on March 20, 2007 to make his opinions in this case admissible at trial. (Exhibit B) Dr. Wolfgram is a board-certified psychiatrist, who first examined Claimant at her attorney's request on December 1, 2004. He met with her twice before issuing his first report dated December 30, 2004. In that report he documents (for the first time in the medical records) crying spells and poor memory, in addition to her headaches. He recommended studies to rule out brain damage, and commenced psychiatric treatment. He began psychotherapy and placed her on medications. He also recorded for the first time that she was fearful, frightened and had trouble being around co-workers. He continued to see her until December 7, 2005. He did issue a second report dated July 11, 2005 in which he diagnosed a pain disorder associated with both psychological factors and a general medical condition, chronic; anxiety disorder due to posttraumatic headaches; and medical diagnoses deferred to medical-neurological evaluations. He opined that the psychiatric diagnoses were the direct result of the accident on April 9, 2003. He indicated she was at maximum medical improvement. He opined that she would need monthly psychotherapy visits for the next five years with quarterly visits thereafter, and she would also need at least two psychoactive medications. Finally, he also rated Claimant as having 20\% permanent partial disability of the body as a whole for her psychiatric conditions. Dr. Wolfgram testified that he believed her to be reliable in terms of her complaints and presentation. He also testified that his charges for her care were $\ 1,567.85.
22) On cross-examination, Dr. Wolfgram noted that he only had an interpreter present for the first visit, and thereafter they communicated in "feelings and tone" which he felt was adequate. He admitted that there were a lot of words he could not understand, and they gestured a lot. Employer's counsel also put into evidence the letters sent by Claimant's attorney to Dr. Wolfgram, including the first letter dated October 28, 2004, indicating that Claimant's attorney wanted to "discuss treatment options" with Dr. Wolfgram before he had even seen Claimant for the first time. Additionally, there was another different billing statement put into evidence which showed total charges of $\ 2,585.35, and further showed that Claimant's attorney had paid for some of the initial visits in the amount of $\ 1,117.85, leaving a balance of $\ 1,357.50.
23) Regarding her current complaints, Claimant testified that she has headaches every day. She said they get worse as the weather changes. She also testified that her emotional problems are just getting worse. She said she continues to forget things, and she is nervous around other people. She is not happy anymore. She does not feel like talking to family, and she avoids friends. She testified she does not drive on the highway anymore, and actually, only drives if it is necessary. She is afraid to wash windows at home. Claimant said her husband helps her with everything. Claimant also noted that she has an uneven spot on her head that hurts when she hits it as she is combing or doing her hair.
24) Claimant said that she was involved in a rear-end car collision with her husband in 2005. She was the passenger in the vehicle. She testified that her neck, back and head hurt a lot. She was initially seen at the St. Anthony's Emergency Room, and she followed up with a chiropractor. On cross-examination, she said she did not remember saying in the records that her headaches were from this car accident, but she said her son was filling out the paperwork for her. She admitted that it was her signature on the form in Exhibit 3, and she further admitted that she wrote in the date of August 16, 2005, but she insisted that her son and husband actually filled it out. Claimant testified that for about 3 weeks after the accident her headaches were very bad. She was unable to get up during this time. She said that she did not work for 3 weeks after this car accident. Then after that 3 weeks, her headaches returned to their normal baseline of complaints for her. Claimant acknowledged that her husband is pursuing a lawsuit for them to recover for the car accident. She said she thought it was settled, but her husband would have the details.
25) Medical records from St. Anthony's Medical Center (Exhibit 2) document her admission there to the emergency room on July 30, 2005 following her car accident. The notes indicate that she was a front-seat, restrained passenger who was rear-ended. She was complaining of headache and neck pain, but denied chest, abdominal and back pain. A CAT scan of the head was negative.
26) Claimant then sought treatment following the car accident from a chiropractor, Dr. Edward Hengel. (Exhibit 3) The patient information sheet filled out and signed by Claimant on August 16, 2005 indicates her complaints in her head and neck were from an auto accident on July 30, 2005. The next page of the exhibit that contains the
doctor's notes again indicates a date of onset of these complaints on July 30, 2005. There are spaces available on the form to indicate the "dates of same or similar symptoms" and whether or not another type of accident was involved, but those spaces are not filled in on the form. The headaches are described as severe at times and occurring every day. Then on page 3 of the exhibit, there is the specific question, "Have you ever injured this same area before?" The answer to that question clearly marked on the form is "No." She treated with Dr. Hengel through September 8, 2005. There is absolutely no indication in his records that Claimant had any prior problems with her head before the car accident, nor any mention of the prior injury at work at all.
27) Additional medical records from Dr. Alexander Rudoi (Exhibit D) document visits Claimant had with him for various conditions including head congestion, cough, and allergies from playing with stray cats between August 1, 2005 and November 10, 2005.
28) Claimant also described a low back injury at work in 2006. She testified that on September 11, 2006 she hurt her back when she was carrying out and lifting the heavy trash. She said she was out of work for about a month and a half because her back hurt.
29) The deposition of Dr. Patrick A. Hogan was taken by Employer on March 13, 2007 to make his opinions in this case admissible at trial. (Exhibit 1) Dr. Hogan is a board-certified neurologist who examined Claimant one time at the request of Employer.
30) Dr. Hogan examined Claimant on December 15, 2006. She provided a consistent history of injury. She described continued complaints of headaches 2 to 3 times per week, and major symptoms of anxiety and depression, for which she sees a psychiatrist and is on medication. She described occasional numbness in the left arm, but no difficulty with vision. On physical examination, Claimant complained of tenderness at the anterior vertex of the head, but during the eye examination, when Dr. Hogan elevated her eyelid and touched the same spot, she did not complain. There were no objective abnormalities found on the head, and in fact, no abnormalities documented from the examination at all. Dr. Hogan formed an impression of a head injury with a possible contusion, but no neurological disorder. He opined that Claimant had no permanent partial disability as a result of the accident on a neurological basis.
31) Claimant's husband, Mujo Uzicanin, testified on her behalf at the hearing. He said that he does not speak English and he only understands a little English. He testified that he never translated for his wife in speaking to any doctor. He thought he was there with her once, but he thought their son was there as well.
32) Mr. Uzicanin confirmed that his wife had no emotional problems or headaches prior to April 9, 2003. After April 9, 2003, he described "great differences" in her. He testified that within a few months after the injury, he noticed some changes in her. He said that she is very depressed and forgets things. He confirmed that she is in a lot of pain, and must take pills. He said she cannot work around the house, and so he and his son must do much more. He said that he or his son must be with her, since he does not think she should be by herself for a long time. He expressed this concern about leaving her alone because he said if she got a bloody nose that would not stop, then someone would need to take her to the emergency room. He testified that he changed jobs to be able to be with her more. He testified that she has become much more argumentative. He did not believe she could work a full 8 hour work day, because someone needs to be with her. He also testified that she has headaches and some dizziness. He said she spends most of her time laying down or resting. He testified that she is not the person now that she was before the injury. He described Claimant's personality changes including having no friends, being afraid of windows and doors, and being more withdrawn.
33) Regarding their trip to Bosnia, Mr. Uzicanin testified that he did not want to go, but someone had to go with her. He said her status then was the same as it is now. He testified that Claimant wanted to go to Bosnia to visit family because of her illness. He said she also wanted to see if doctors there could take a look at her. He noted that she was not in good emotional standing.