Chaz Jacobs v. Walsworth Publishing Co.

Employee: Chaz Jacobs

Injury No.: 07-056930

Employer: Walsworth Publishing Co.

Additional Party: Second Injury Fund

Insurer: The American Insurance Company

Hearing Date: December 20, 2007

Checked by: RBM

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 25, 2007.
5. State location where accident occurred or occupational disease was contracted: Marceline, Linn 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: Employee was loading books onto a binder machine.
12. Did accident or occupational disease cause death? No.

1. Part(s) of body injured by accident or occupational disease: Neck, left shoulder, and left upper extremity including left arm, left elbow and left hand.
2. Compensation paid to-date for temporary disability: $\ 3,575.00 at the rate of $\ 165.00 per week.
3. Value necessary medical aid paid to date by employer/insurer? $\ 5,763.73.
4. Value necessary medical aid not furnished by employer/insurer? None.
5. Employee's average weekly wages: $\ 330.00 per week.
6. Weekly compensation rate: $\ 220.00 per week for temporary total disability and permanent partial disability.
7. Method wages computation: Section 287.250.4, RSMo.

1. Amount of compensation payable:

Temporary total disability: (a) The underpayment of temporary total disability benefits in the amount of $\ 1,045.00 for the period April 26, 2007 through September 20, 2007; (b) In addition, temporary total disability benefits from September 21, 2007 through December 20, 2007, the date of hearing in this case, or 13 weeks at the rate of $\ 220.00 per week, which is the amount of $\ 2,860.00 for the period September 21, 2007 through December 20, 2007; (c) In addition, Employer/Insurer is to pay Claimant temporary total disability benefits at the rate of $\ 220.00 per week from December 21, 2007 until Claimant has reached maximum medical improvement, or is able to compete in the open labor market for employment, or until 400 weeks of temporary disability benefits have been paid, or until Claimant's death, whichever first occurs, pursuant to Section 287.170, RSMo.

Medical aid: Employer/Insurer is directed to authorize and furnish additional medical treatment to cure and relieve Claimant from the effects of his April 25, 2007 work injury, including the further diagnostic testing in the form of a cervical MRI, EMG, and nerve conduction study Dr. Jacques Van Ryn has recommended, and such additional medical treatment based upon the findings from those diagnostic tests, in accordance with Section 287.140, RSMo.

Each of said payments to begin immediately and be subject to modification and review as provided by law. This award is only temporary or partial, is subject to further order, and the proceedings are hereby continued and the case kept open until a final award can be made.

IF THIS AWARD IS NOT COMPLIED WITH, THE AMOUNT AWARDED HEREIN MAY BE DOUBLED IN THE FINAL AWARD, IF SUCH FINAL AWARD IS IN ACCORDANCE WITH THIS TEMPORARY AWARD.

The compensation awarded to 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: David J. Jerome.

Employee: Chaz Jacobs

Injury No: 07-056930

Employer: Walsworth Publishing Co.

Additional Party: Second Injury Fund

Insurer: The American Insurance Company

Hearing Date: December 20, 2007

Checked by: RBM

A Section 287.203, RSMo temporary hearing was held in this case on December 20, 2007 in Linneus, Missouri. Employee, Chaz Jacobs ("Claimant") appeared in person and by his attorney, David J. Jerome. Employer, Walsworth Publishing Co. ("Employer") and its Insurer, The American Insurance Company ("Insurer") appeared by their attorney, Lisa A. Reynolds. James Payden, Safety and Training Manager for Employer, was also present at the hearing. No one appeared on behalf of the Second Injury Fund. The Second Injury Fund is a party to this case, but was not represented at the hearing since the parties agreed to leave the Second Injury Fund claim open. Attorneys for Claimant and Employer/Insurer agreed that although the hearing was a Section 287.203, RSMo hearing, neither party was requesting penalties or attorneys' fees from the other pursuant to Section 287.203, RSMo in connection with the hearing. David J. Jerome requested an attorney's fee of 25 % from all amounts awarded. It was agreed that proposed Findings of Fact and Conclusions of Law would be due on January 5, 2008.

At the time of the hearing, the parties stipulated to the following issues:

1. On or about April 25, 2007, Chaz Jacobs ("Claimant") was an employee of Walsworth Publishing Co. ("Employer") and was working under the provisions of the Missouri Workers' Compensation Law.
2. On or about April 25, 2007, Employer was an employer operating under the provisions of the Missouri Workers' Compensation Law, and was duly insured by The American Insurance Company

("Insurer").

1. Employer had notice of Claimant's injury.
2. Claimant's Claim for Compensation was filed within the time allowed by law.
3. Compensation paid to date of hearing for temporary disability was $\ 3,575.00 that was paid at a temporary total disability rate of $\ 165.00, representing 21 weeks for the period of April 26, 2007 through September 20, 2007.
4. The value of medical aid paid to date of hearing by Employer/Insurer was $\ 5,763.73.

The parties agreed that there were disputes on the following issues:

1. Whether on or about April 25, 2007, Claimant sustained an injury by accident or occupational disease arising out of and in the course of his employment.
2. Whether Claimant's current condition is medically causally related to the work injury of April 25, 2007.
3. Whether Claimant is entitled to past temporary total disability benefits from September 21, 2007.
4. Whether Claimant is entitled to an underpayment of temporary total disability benefits for benefits paid from April 26, 2007 through September 20, 2007.
5. Whether Claimant is entitled to future medical treatment as a result of the work injury of April 25, 2007.
6. Claimant's average weekly wage and the compensation rate.

Claimant testified in person. In addition, Claimant offered the following exhibits which were admitted in evidence without objection:

Claimant's Exhibit A--Deposition of Dr. Jacques Van Ryn.

Claimant's Exhibit B--Medical records of Pershing Memorial Hospital.

Claimant's Exhibit C--Medical Records of Dr. Craig Newland.

Claimant's Exhibit D--Medical Records of Liberty Hospital.

Claimant's Exhibit E--Medical Records of Genesis Plastic Surgery.

Claimant's Exhibit F--Medical Records of Northland General Surgery.

Claimant's Exhibit G--Walsworth Publishing Company Disciplinary Action Form.

Claimant's Exhibit H--Medical Records of Dr. Minerva Concepcion-Rivera.

Claimant's Exhibit I--Correspondence from Employee's Attorney dated 6/14/07.

John Koehl and James Payden testified on behalf of Employer/Insurer. In addition, Employer/Insurer offered the following exhibits which were admitted in evidence without objection:

Employer/Insurer's Exhibit B--Deposition of D. Christopher Main, M.D. dated 11/29/07. This exhibit was offered and admitted subject to the objections contained in the deposition.

Employer/Insurer's Exhibit C--Medical Records of Dr. Timothy C. Hodges of Heartland Health dated 6/8/07 - 7/23/07.

Employer/Insurer's Exhibit D--Medical Records of Dr. T. Reardon of Northland General Surgery, P.C. dated 5/7/04 - 5/19/04.

Employer/Insurer's Exhibit E--Medical Records of Dr. Frederick E. Thompson of Genesis Plastic Surgery, P.C. dated 5/19/04.

Employer/Insurer's Exhibit F--Wage Statement of Employer and Benefits Paid by Employer/Insurer.

Employer/Insurer's Exhibit G--Display Reports of Walsworth Publishing dated 4/25/07.

Employer/Insurer's Exhibit H--Shop Floor Reports dated 4/17/07 - 4/25/07.

Employer/Insurer's Exhibit I--Bindery Ticket from Walsworth Publishing.

Employer/Insurer's Exhibit J--Photographs of bindery machine.

Employer/Insurer also offered Employer/Insurer's Exhibit A, Statement of Employee, dated March 2, 2007, into evidence. Claimant's counsel objected to the admission of Employer/Insurer's Exhibit A, and his objection was sustained. Employer/Insurer Exhibit A was not admitted into evidence.

Claimant testified at the December 20, 2007 hearing. I find that Claimant was a credible witness. Claimant testified that he was born on December 10, 1981 and was twenty-six years old. He said that he injured his neck and left upper extremity on April 25, 2007 while working for Employer. He started working for Employer on March 10, 2007 as a bindery helper. He worked as a temporary employee and was paid $\ 8.25 per hour. He was scheduled to work forty hours per week. He identified a wage statement and said that he worked thirty-two hours in four days the first week, sixteen hours over

two days the next week, thirty-two hours in four days the following week, and forty hours in five days the following week, which was the week before he was injured.

Claimant testified that in June 2004 he was in a car accident. He injured the top half of his body and broke his collarbone. He was treated by Dr. Newland at Liberty Hospital for a fractured left clavicle. A metal plate was inserted in his left clavicle on September 13, 2004. He last treated with Dr. Newland for that injury on September 13,