Denise Pile v. Lake Regional Health System

the activity is related to employment. In such a case, there is a clear nexus between the work and the injury. Where the work nexus is clear, there is no need to consider whether the worker would have been equally exposed to the risk in normal non-employment life. Only if the hazard or risk is unrelated to the employment does the second step of the analysis apply.

Id. at 463 .

As to this claim, the Court concluded, "the work nexus is clear: [employee] was injured because of her exposure to the excess walking at work and it should not have been necessary to consider whether she would have been equally exposed to the risk in her normal non-employment life."

The Court held:

The Commission in this case, in fact, found that the accident arose out of and in the course of employment. As the Commission found, the twisting of [employee's] right foot as she turned the corner to go into the medicine room was the accidental event that was the prevailing factor that caused the injury. That is to say, the twisting of the ankle shattered the calcified bone which had developed by excess walking at her workplace.

We conclude employee's injury arose out of and in the course of her employment.

Employee treated conservatively with Dr. Hoeft for several months. Dr. Hoeft ordered x-rays and diagnosed employee with fractures in her right foot. Employee's foot was not healing sufficiently, so Dr. Hoeft put employee's foot in a cast. Dr. Hoeft eventually referred her to Dr. Helfrey. Employee underwent an MRI and physical therapy. Dr. Helfrey performed surgery on February 13, 2007, during which he removed some accessory bones and debrided an infection. For 8 weeks, employee used a wheelchair, then a walker to ambulate. Employee then participated in 6 weeks of physical therapy during which time she weaned herself from the walker.

Dr. Helfrey last saw employee on July 2007 at which time he recommended a calf flexibility protocol to address employee's tight calf. Dr. Helfrey released employee to work with no restrictions on September 21, 2007.

Employee offered Exhibits I through O, which consist of medical billing statements. Employee claims past medical expenses in the amount of $\ 20,648.76, as detailed in the table at the end of this section.

We have reviewed the bills and compared them to the medical records in evidence. We have considered employee's testimony regarding her treatment. Finally, we have reviewed medical records and physician opinions pertaining to the treatment.

Exhibits J and K are account summaries for St. Peters Bone \& Joint Surgery. The exhibits reflect charges of $\ 667.00 and $\ 873.00, respectively. The record contains medical records evidencing the treatment corresponding with each charge. We award to employee past medical expenses of $\ 1540.00 relating to medical care provided her by St. Peters Bone and Joint Surgery. We have found no bills or statements reflecting that St. Peters Bone \& Joint Surgery billed employee other charges totaling \$8,028.00 as claimed by employee in her medical expense summary.

We find that Exhibit N, the medical bills from Lake Regional Hospital, contains a charge of $\ 89.00 incurred on February 9, 2007, for a routine screening. The underlying medical record confirms the charge is for a routine screening. We disallow this charge.

As to all other medical expenses claimed, we find that the record contains the medical records underlying the claimed expenses and that employee's testimony and the opinion of Dr. Swaim establish that each treatment flowed from the injury and was reasonably necessary to cure and relieve employee of the effects of her work injury.

Employer/insurer put employee to proof as to her medical expenses but employer/insurer does not specifically contest the reasonableness of any charges. Rather, employer/insurer argues that any medical expenses found to be proven should be paid directly to the health care providers or employee's health care insurer so that employee does not receive a windfall due to discounts accepted by health care providers.

Below is a summary of expenses claimed and allowed:

Employee had the burden and has produced documentation detailing the past medical expenses summarized above and has testified to the relationship of such expenses to her compensable workplace injury. Farmer-Cummings v. Pers. Pool of Platte County, 110 S.W.3d 818 (Mo. banc 2003). She has done so in this case. It is a defense of employer to establish that employee was not required to pay the billed amounts, that her liability for the disputed amounts was extinguished, and that the reason that her liability was extinguished does not otherwise fall within the provisions of § 287.270. Id. Employer has not done so.

[^0]

[^0]: ${ }^{1}$ The billing summary included in Exhibit O is a duplicate of the billing summary included in Exhibit I.

Based upon the foregoing, we award to employee $\ 12,531.06 for her past medical expenses.

The parties stipulated that employee's temporary total disability rate is $\ 718.87. On August 13, 2006, Dr. Hoeft sent employee for an x-ray and recommended she stay off her foot. Dr. Hoeft saw employee on August 16, 2006, at which time he restricted her from work. Employee testified she was unable to perform her regular duties because she could not walk. Employee asked her boss if employer had light duty she could perform and her boss told her employer did not.

Employee was still restricted from work when her care was transferred to Dr. Helfrey. Dr. Helfrey last saw employee on July 2007, at which time he recommended an additional treatment protocol. Dr. Helfrey ultimately released employee to work with no restrictions on September 21, 2007. Employee is entitled to temporary total disability benefits from August 14, 2006 through September 21, 2007.

The parties stipulated that employee's permanent partial disability rate is $\ 376.55. Employee testified she continues to have pain and swelling in her ankle if she is on her feet. She has difficulty walking stairs and walking for long distances. Employee can no longer work in her yard. On October 8, 2007, employee returned to work as a nurse in the post-operative unit of a hospital. Employee testified that her work requires her to spend significant time on her feet but that she sits down whenever she can while working to alleviate the pain. Employee takes Motrin for pain.

Dr. Swaim believes employee sustained a 22.5 % permanent partial disability at the level of the ankle. He attributes the disability to chronic pain, swelling and loss of range of motion.

Dr. Komes assigned a 7\% impairment rating based upon the AMA guidelines.

Employer/insurer did not offer the guidelines into evidence. Dr. Komes did not describe the guidelines, identify the medical criteria he used in reaching his impairment conclusion, or otherwise explain how he arrived at his impairment conclusion. Employer/insurer offered no evidence to indicate that the AMA impairment guidelines provide a rating that is equivalent to an appropriate permanent partial disability rating. Accordingly, Dr. Komes' medical opinion does not persuade us on the issue of permanent partial disability.

Based upon employee's description of her continued ankle problems and Dr. Swaim's explanation of his disability conclusion, we are persuaded by the opinion of Dr. Swaim that employee sustained a permanent partial disability of 22.5 % at the level of the ankle (155week level). Employee is entitled to 34.875 weeks of permanent partial disability benefits.

Dr. Swaim believes employee will need orthotic inserts for her shoes and that the need flows from the work injury. We accept Dr. Swaim's opinion. Employee is entitled to future medical care in the form of orthotic inserts.

We reverse the award of the administrative law judge and award compensation in this matter.

We direct the employer/insurer to pay to employee the sum of $\ 12,531.06 for employee's past medical expenses.

We direct employer/insurer to provide future medical care in the form of orthotic inserts.

We direct the employer to pay to employee $\ 41,386.37 for past due temporary total disability benefits ( $\$ 718.87 \times 57-4 / 7 weeks =\ 41,386.37 ).

We direct the employer to pay to employee $\ 13,132.18 for permanent partial disability benefits $(\$ 376.55 \times 34.875=\ 13,132.18).

Randy C. Alberhasky, Attorney at Law, is allowed of fee of 25 % of the compensation awarded herein for reasonable and necessary legal services, which shall constitute a lien on compensation.

Any past due compensation shall bear interest as provided by law.

Given at Jefferson City, State of Missouri, this $17^{\text {th }}$ day of December 2010.

LABOR AND INDUSTRIAL RELATIONS COMMISSION

William F. Ringer, Chairman

Alice A. Bartlett, Member

John J. Hickey, Member

Attest:

Secretary

Employee: Denise Pile

Injury No. 06-075121

Dependents: N/A

Employer: Lake Regional Health System

Additional Party: None

Insurer: Missouri Employers Mutual Insurance

Hearing Date: October 14, 2008

Before the<br>DIVIS