Debbie Maher v. Hannibal Clinic

Employee: Debbie Maher

Injury No. 00-112981

Dependents: N/A

Employer: Hannibal Clinic

Additional Party: N/A

Insurer: Reliance Insurance/MIGA

Hearing Date: July 30, 2007 Checked by: RFH/tmh

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: August 2, 2000.
5. State location where accident occurred or occupational disease was contracted: Hannibal, Marion 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 or 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 occurred or occupational disease contracted:

Typing/keyboarding with hands in awkward position over a number of years.

1. Did accident or occupational disease cause death? No. Date of death? N/A.
2. Part(s) of body injured by accident or occupational disease: Hands/wrists.

- Nature and extent of any permanent disability: 17 1/2\% left wrist; 15\% right wrist; 10\% multiplicity; two weeks disfigurement.

1. Compensation paid to-date for temporary disability: $\ 293.23.
2. Value necessary medical aid paid to date by employer/insurer? $\ 6,973.50.
3. Value necessary medical aid not furnished by employer/insurer? N/A.
4. Employee's average weekly wages: -
5. Weekly compensation rate: $\ 293.23.

- Method wages computation: By agreement.

- Amount of compensation payable:

PPD: 171 / 2 % left wrist; 15 % right wrist; 10 % multiplicity and two weeks disfigurement: $\mathbf{\$ 1 8 , 9 3 1 . 6 6}

TOTAL: \mathbf{\$ 1 8 , 9 3 1 . 6 6}$

- Future Requirements Awarded: N/A.

Said payments to begin immediately and to be payable and 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 the claimant: Nile Griffiths

Employee: Debbie Maher

Injury No: 00-112981

Before the

DIVISION OF WORKERS'

COMPENSATION

Department of Labor and Industrial Relations of Missouri

Jefferson City, Missouri

Dependents: $\quad \mathrm{N} / \mathrm{A}$

Employer: Hannibal Clinic

Additional Party: N/A

On July 30, 2007, Debbie Maher ("Employee") appeared in person and by her attorney, Mr. Nile Griffiths, for a hearing for a final award on her claim against Hannibal Clinic ("Employer") and its insurer, Reliance Insurance/Missouri Property \& Casualty Insurance Guaranty Association ("Reliance/MIGA"). The employer and its insurer were represented at the hearing by their attorney, Mr. Benjamin Shelledy. At the same time this case was heard, evidence was also taken on Employee's two companion Claims with Injury Numbers of 00-164838 and 02024100. Separate Awards are being issued for those companion Claims. At the time of the hearing, the parties agreed on certain stipulated facts and identified the issues in dispute. These stipulations and the disputed issues, together with the findings of facts and rulings of law, are set forth below as follows:

- Employee has alleged an occupational disease claim with a date of injury of August 2, 2000.

- Employee was employed by the employer on or about August 2, 2000.

- Venue is proper.

- Employer received proper notice.

- The Claim was filed within the time prescribed by the law.

- At the relevant time, Employee's compensation rate for permanent partial disability (PPD) benefits was $\ 293.23.

- Employer has paid medical expenses in the amount of $\ 6,973.50.

- Employer has paid temporary total disability benefits in the amount of $\ 293.23, representing one week of lost time.

- Did Employee sustain an occupational disease?

- Did the occupational disease arise out of and in the course of her employment?

- Are Employee's injuries and continuing complaints medically causally connected to her alleged occupational disease at work on or about August 2, 2000?

- Application of last exposure rule/liability of insurer.

- Nature and extent of any permanent partial disability.

- Disfigurement.

The following exhibits were admitted into evidence:

1. Medical bills (relating to injury number 00-164838 neck/shoulder only)
2. Hannibal Clinic medical records
3. Deposition of Dr. Volarich
4. Dr. Hosley medical records
5. Dr. Bukstein medical records
6. Letter from Missouri Property \& Casualty Insurance Guaranty Association to Dr. Bukstein

- Deposition of Dr. Strecker

- Deposition of Dr. Lange (relating to injury number 00-164838 neck/shoulder only)

- Dr. Davis medical records (relating to injury number 00-164838 neck/shoulder only)

- Certified insurance coverage records

This case, Injury Number 00-112981, involves a claim for occupational disease/repetitive motion at work on or about August 2, 2000. The employer is Hannibal Clinic. The insurer is Reliance Insurance and following liquidation MIGA. The claim was filed March 31, 2004.

Injury Number 02-024100 is also a claim for occupational disease/repetitive motion at work on or about February 18, 2002. The employer is Hannibal Clinic. The insurer is Virginia Surety. The claim was filed March 19, 2004.

Injury Number 00-164838 alleges a specific accident on December 21, 2000, involving the neck and shoulder. The employer is Hannibal Clinic. The insurer is Reliance Insurance and following liquidation MIGA. The claim was filed March 19, 2004.

Any exhibits containing markings, highlighting, etc., were submitted in that manner. The undersigned has made no markings of any kind on any of the evidence. Any objections not specifically addressed in this award are overruled.

Employee's attorney requests a fee of 25 % of all benefits awarded.

Based on a comprehensive review of all the testimony and evidence, I find as follows:

The employee has been employed with the employer for some 29 years. Throughout that entire time period, she has worked as an insurance billing clerk with job duties of answering the telephone, dealing with patient and insurance claims, typing and using the keyboard for the most part of the day.

Employee testified that she began experiencing problems with her hands as far back as 1997 and had gone to the Hannibal Clinic for occasional numbness and tingling in her hands. She was not tested at that time, but was given splints to wear. Around the year 2000, the employer made some ergonomic changes, including putting the keyboards under the desk. Prior to that change, the keyboard had been on the desk and the employee's hands were in an awkward position when typing. Although she did not receive any other treatment for her hands from 1997 until 2000, her hands got progressively worse and she noticed increased symptoms, including more numbness and waking her up at night.

Employee saw Dr. Gysbers for an evaluation in 2000 and had nerve conduction studies performed at that time, which

confirmed bilateral carpal tunnel syndrome. She was referred to Dr. Bukstein, a surgeon, and he scheduled surgery for the right hand in September 2000. The employee was unable to have the surgery done in September, so it was rescheduled and performed on November 30, 2000. She later had surgery on the left hand on February 8, 2001.

While the surgeries did provide some relief, she continued to experience problems, more with the left than the right, but did not have any more treatment until 2002, hence the 02-024100 claim. She then saw Dr. Oullette in March of 2002 and the doctor suggested she return to Dr. Bukstein to determine if her complaints were related to the carpal tunnel. Dr. Bukstein recommended repeat nerve conduction studies. Apparently due to Reliance going through liquidation, authorization to repeat the studies was not given for nearly 17 months after the recommendation. The studies were ultimately performed and Dr. Bukstein noted improvement, although employee was still having symptoms. The doctor did not recommend any additional treatment for the carpal tunnel syndrome.

At the hearing, employee testified that the surgeries did provide some relief, but she still has problems with dropping things, decreased sensation to hot and cold, left hand complaints radiating up to the elbow, mild loss of feeling in the right palm with some swelling and numbness. Her left hand ring and middle finger still go numb on occasion. She also stated that the ergonomic changes had helped as well since she does not have to have her hands in an awkward position now when she does the keyboarding.

The medical treatment for the surgeries and eventually the repeat nerve conduction studies were paid by Reliance or the Missouri Property \& Casualty Insurance Guaranty Association following Reliance's liquidation.

Dr. Strecker examined the employee at the request of Reliance/MIGA in April 2007. Dr. Strecker concurred with the diagnosis of bilateral carpal tunnel syndrome and that the treatment rendered was necessary and reasonable. However, the doctor opined that he did not feel the carpal tunnel was causally related to work based on his interpretation of recent medical literature indicating that repetitious keyboarding activity does not cause carpal tunnel syndrome. Rather the doctor felt the cause or causes in this instance were one or more of age, sex, being post menopausal and being overweight. However, the doctor did acknowledge in his deposition that typing in an awkward position could be the significant factor in developing carpal tunnel syndrome. (Employer/Insurer Exhibit C, pgs. 15 \& 27). Dr. Strecker, while finding the condition was not work related, did assess a permanent partial disability of 5 % at the level of her wrist.

At employee's request, Dr. Volarich examined the employee in April 2006. Dr. Volarich noted that prior to ergonomic changes the employee was required to type on a keyboard on the top of her desk which was much higher than ergonomically advisable requiring the employee's hands to be in an awkward position for s