Charlotte Rose v. Centene Management

ISSUED BY DIVISION OF WORKERS’ COMPENSATION AWARD

SUMMARY OF FINDINGS

1. Are any benefits awarded herein? Yes
2. Was the injury or occupational disease compensable under Chapter 287? Yes
3. Was there an accident or incident of occupational disease under the Law? Yes
4. Date of accident or onset of occupational disease? April 2, 2004
5. State location where accident occurred or occupational disease contracted: St. Francois County, Missouri
6. Was above employee in employ of above employer at time of alleged accident or occupational disease? Yes
7. Did employer receive proper notice? Yes
8. Did accident/occupational disease arise out of and in the course of the employment? Yes
9. Was claim for compensation filed within time required by law? Yes
10. Was employer insured by above insurer? Yes
11. Describe work employee was doing and how accident happened or occupational disease contracted: Employee was working as a claims analyst and developed pain in her neck, shoulder and arms as a result of repetitive data entry and typing on a computer.
12. Did accident or occupational disease cause death? No
13. Parts of body injured by accident or occupational disease: cervical spine
14. Nature and extent of any permanent disability: Permanent total disability
15. Compensation paid to date for temporary total disability: None
16. Value necessary medical aid paid to date by employer-insurer: 1,514.99
17. Value necessary medical aid not furnished by employer-insurer: 1,249.22.
18. Employee's average weekly wage: 590.08
19. Weekly compensation rate: 393.39 for temporary total disability and permanent total disability, and $347.05 for permanent partial disability.
20. Method wages computation: By agreement
21. Amount of compensation payable:

1. Second Injury Fund liability: Claim denied
2. Future requirements awarded:

Claim for future medical denied (See findings)

Employer-insurer is directed to pay to the employee the sum of $\ 393.39 per week commencing on November 18, 2004, and continuing for the lifetime of the employee pursuant to Section 287.200.1, unless said payments are suspended during a time in which the employee is restored to her regular work or its equivalent as provided in Section 287.200.2 (See findings).

Said payments shall be payable as provided in the findings of fact and rulings of law, and shall be subject to modification and review as provided by law.

The Compensation awarded to the claimant shall be subject to a lien in the amount of 25 % of all payments hereunder in favor of the following attorney for necessary legal services rendered to claimant: Terry A. Bond

On February 22, 2007, the employee, Charlotte Rose, appeared in person and by her attorney, Mr. Terry A. Bond, for a hearing for a final award. The employer-insurer was represented at the hearing by its attorney, Mr. John P. Palombi. The Second Injury Fund was represented at the hearing by Assistant Attorney General, Greg Johnson.

Prior to the hearing, the Second Injury requested that the record be left open to allow the Second Injury Fund to complete the deposition of Dr. Jerome Levy. Neither the employee nor the employer-insurer objected. Based on that request, at the conclusion of the hearing on February 22, 2007, the record was left open and the hearing was continued for the limited purpose of allowing the Second Injury Fund to complete the Deposition of Dr. Jerome Levy. Dr. Levy's deposition was subsequently received on March 21, 2007, and the record was closed and the hearing completed as of that date.

At the time of the hearing, the parties agreed on certain undisputed facts and identified the issues that were in dispute. These undisputed facts and issues, together with the findings of fact and rulings of law, are set forth below as follows:

1. On or about April 2, 2004, Centene Management was a covered employer operating under and subject to the provisions of the Missouri Workers' Compensation Act, and was fully insured by Hartford Insurance Company.
2. On or about April 2, 2004, Charlotte Rose was an employee of Centene Management, and was working under the provisions of the Missouri Workers' Compensation Act.
3. On or about April 2, 2004, the employee sustained an accident or occupational disease that arose out of and in the course of her employment.
4. The employer had notice of the employee's accident or occupational disease.
5. The employee's claim for compensation was filed within the time allowed by law.
6. The employee's average weekly wage was $\ 590.08. The employee's rate of compensation for temporary total disability and permanent total disability is $\ 393.98, and her rate of compensation for permanent partial disability is $\ 347.05.
7. The employer furnished no medical aid.
8. The employer paid no temporary total disability benefits.

1. Additional medical aid - previously incurred medical expenses and future medical aid
2. Nature and extent of disability - permanent total or permanent partial disability
3. Liability of the Second Injury Fund

The following exhibits were offered and admitted into evidence:

A. Deposition of Samuel Bernstein, Ph.D.

B. Resume of Samuel Bernstein, Ph.D.

C. April 15, 2005 report of Samuel Berstein, Ph.D

D. Deposition of Dr. David T. Volarich

E. Curriculum vitae of Dr. David T. Volarich

F. May 17, 2005 report of Dr. David T. Volarch

G. Report of Dr. George R. Schoedinger, III

H. August 9, 2004 radiology report from St. Anthony's Medical Center

I. August 10, 2004 radiology report from St. Anthony's Medical Center

J. Supplemental report of Dr. George R. Schoedinger, III.

K. Deposition of Dr. George R. Schoedinger, III.

L. Curriculum Vitae of Dr. George R. Schoedinger, III.

M. Medical records of Dr. George R. Schoedinger, III.

N. Functional Abilities Evaluation

1. Deposition of Dr. Frank O. Petkovich
2. Deposition of June M. Blaine, MS, CRC, CDMS.

1. Deposition of Dr. Jerome F. Levy

Based on the employee's testimony, the medical records and the other evidence admitted, I find as follows:

- Charlotte Rose ("employee") was 47 years old at the time of the hearing.

- Her education included graduating from high school and 6 weeks of additional night classes.

- The employee's work history included working in a factory, as a receptionist, a sales clerk, baby sitting, clerical work for an insurance company, and a number of jobs for insurance companies in which she worked with the processing or appeal of claims.

- In 1995 the employee had a motor vehicle accident that caused an injury to her cervical spine. As part of her treatment for that injury, Dr. George Schoedinger performed an anterior cervical discectomy and fusion at the C5-6 level.

- After she recovered from that accident and surgery, the employee had no symptoms or limitations related to her cervical spine. The employee was able to function at work and at home without any restrictions, and did not limit her activities in any way as a result of her prior cervical fusion.

- In May of 2003 the employee started working for Centene Management as a claims analyst. Her job required her to take care of appeals after claims were denied, and she spent most of her time entering data and typing on her computer.

- In February of 2004 the employee started developing pain in the left side of her neck with numbness and tingling in her shoulder. She later developed swelling in her right arm and reported her symptoms her employer.

- After the doctors selected by the employer-insurer failed to correctly diagnose her condition or relieve her symptoms, the employee returned to see Dr. George Schoedinger. Her initial appointment was on June 28, 2004.

- An MRI and a myleogram confirmed the employee had left paracentral disc protrusions at both the C4-5 and

C6-7 levels. After conservative treatment failed to improve the employee's symptoms, Dr. Schoedinger ordered a discography at both levels. Based on the discography, Dr. Schoedinger recommended a fusion at the C4-5 level. After discussing the issue with the employee, Dr. Shoedinger decided not to fuse the C6-7 level because he wanted to avoid a 3-level fusion (employee's exhibit K, page 14).

- On September 9, 2004, Dr. Schoedinger performed an anterior discectomy and instrumented interbody fusion at the C4-5 level (employee's exhibit M).

- Prior to her surgery, the employee had changed employers, and was working for Hawthorne Billing Group from June 25, 2004 until the day before her surgery on September 8, 2004. Following her surgery, Dr. Schoedinger allowed the employee to return to work on October 25, 2004. The employee initially worked part time, and gradually tried to increase her hours. Within a few weeks the employee developed headaches and pain with numbness and tingling down both arms. On November 17, 2004, the employee called Dr. Schoedinger, and he advised her to stop working and scheduled her for an appointment on November 18, 2004. Dr. Schoedinger then recommended additional physical therapy.

- After the physical therapy increased her symptoms, Dr. Schoedinger saw the employee on December 6, 2004, and determined that she had reached her maximum level of medical improvement. Dr. Schoedinger suggested that the employee apply for social security disability, and released her on a "p.r.n." basis (employee's exhibit M). The employee applied for and received social security disability in April of 2005.

- In a follow-up letter dated January 4, 2005, Dr. Schoedinger gave the employee a 20\% impairment rating, but deferred any opinion regarding her ability to work pending a functional capacity evaluation (employee's exhibit M).

- A Functional Abilities Evaluati