Employee is a 52 year old female who completed high school in the St. Louis Special School District and obtained her Certified Nurse's Assistant (CNA) license in 1982. Claimant worked as a CNA for several years during the 1980's until she sustained a fracture of her L-3 vertebra as a result of a work-related incident in 1987. That incident resulted in a Workers' Compensation settlement of 12.5 % BAW. Claimant sustained several other work-related injuries to her back while working as a CNA for which First Reports of Injury were filed with the Missouri Division of Workers' Compensation.
Since 1987 Claimant has had an on-going series of low back pains and complaints, some of which were severe, that involved multiple visits to her primary care physicians as well as to hospital emergency rooms. Claimant's medical history includes treatment for pre-existing low back problems for a period of nearly 20 years from 1987 up through a date shortly before the injury in this case.
Following her work as a CNA, Claimant worked in a variety of part-time factory positions as well as in several part-time clerk positions for Walmart and Walgreen's stores. During this period Claimant worked in a factory where she assembled writing pens; during that employment Claimant claimed a repetitive twisting injury to her right hand and wrist for which she filed a worker's compensation claim.
In January 1995 Claimant applied to the Social Security Administration for disability income (SSDI). Claimant sought benefits based on a combination of mental health and physical problems. After the review process was completed, which included Claimant being diagnosed with major depression, Claimant was awarded SSDI benefits as of July 1995. Said benefits were provided to Claimant retroactive to January 1994 and she has been receiving monthly SSDI benefits since that time. Claimant's eligibility to continue receiving benefits precludes her from any full-time employment. Continuing eligibility for SSDI requires that Claimant earn no more than a small amount of income per month from employment sources. Claimant has not sought full-time employment since becoming eligible for SSDI. She has limited her hours worked, accepting only part-time employment to keep her earnings below the SSDI limits.
Due to her worsening problems with depression in March 2000 Claimant was referred by her primary care physician to St. John's Mercy Medical Center where she was admitted into a two-week psychiatric Intensive Out-Patient program (IOP). During this period Claimant was again diagnosed with and treated for symptoms of major depression.
Claimant began working as a part-time employee for Employer in July 2005 and continued until May 12, 2007, approximately one month after the date of injury in this case. Claimant has not worked since that time.
At the time of her injury, Claimant was working for Employer as an on-site, part-time caregiver and assisted the patients with their daily personal care needs. Her duties included assisting patients with their feeding, clothing and hygiene needs, performing light housekeeping duties such as doing the laundry and going grocery shopping, as well as transporting clientpatients to medical appointments.
On April 3, 2007 Claimant was working with an elderly couple at a location in Ballwin, Missouri. Claimant was in the process of pulling the patients' trash barrel to the curb. While moving the barrel Claimant lost her balance and fell backward landing on her right wrist and tailbone and also twisting her right ankle. After remaining on the ground for several minutes Claimant was eventually able to get back up on her feet and return to the house where she called Employer to report the fall. Claimant was instructed to drive herself to a Unity Corporate Health facility where she was examined on that same day. Claimant underwent approved treatment at said location on several more occasions through May 11, 2007; contemporaneously Claimant
pursued additional and unauthorized medical care on several occasions at the Emergency Room of St. John's Mercy Medical Center claiming extreme pain.
Unity Corporate Health referred Claimant for additional approved care with Dr. Daniel Sohn on May 23, 2007. Dr. Sohn terminated Claimant's care when she behaved in a threatening manner toward the doctor's staff. Claimant was then referred by Employer to Dr. Tate for a medical evaluation which took place on June 11, 2007. Dr. Tate observed symptom magnification by Claimant and concluded that Claimant's symptoms were not related to the injury on April 3, 2007. Dr. Tate placed Claimant at MMI and released her from further approved medical care. On August 27, 2008, more than a year later, Dr. Tate re-evaluated Claimant. Dr. Tate noted Claimant's extreme pain symptoms, however no objective abnormalities were found. Dr. Tate observed and reported Waddell symptom magnification indicators, and therefore once again released Claimant from care and opined that Claimant had sustained no permanent partial disability as a result of her fall on April 3, 2007.
Meanwhile, in early June 2007 Claimant was referred by her primary care physician Dr. Gunby to a mental health care provider Liss \& Associates. At that point Claimant was once again diagnosed with major depression and anxiety, conditions for which Claimant had been receiving treatment and prescribed medications for many years. Claimant was again referred to St. John's Mercy Medical Center for psychiatric treatment related to these conditions and was admitted to another two-week IOP.
Having been released from Employer-approved medical care per Dr. Tate's reports, Claimant continued to seek unauthorized care for continuing low back pain from several doctors and hospitals through the later part of 2007 and into 2008. Per a referral from Dr. Gunby, Claimant was seen by pain management specialist Dr. Rahimi who beginning in February 2008 performed