Filtered workers' comp decisions

The Labor and Industrial Relations Commission modified the Administrative Law Judge's award in a death benefits claim for deceased employee Winfred S. Caldwell, focusing on the calculation of average weekly wage and corresponding death benefits compensation rate. The Commission found that the deceased employee's gross wages should include non-taxable per diem payments received by the driver, as these were part of total compensation for services rendered.

The Commission modified the administrative law judge's award to include future medical care for the employee's hip condition, which was causally related to a work injury on February 28, 2004. The employee is entitled to ongoing medical treatment and hip replacement surgery as needed, as the necessity for future care was established through competent medical testimony.

The Commission modified the administrative law judge's award by reversing the grant of temporary total disability benefits from January 14, 2006 to June 2, 2006, finding insufficient evidence that the employee was totally disabled during that period. The Commission affirmed all other aspects of the original award.

The Missouri Court of Appeals reversed a portion of the Commission's award denying costs to the deceased employee's dependents under §287.560, remanding the matter for reconsideration. The Commission on remand reversed the cost award, finding that the employer/insurer had reasonable grounds to withhold benefits based on evidence of drug use as a potential proximate cause of the injury.

The Commission modified the ALJ's award, increasing the employee's permanent partial disability enhancement from the Second Injury Fund from 26.66 weeks to 84.32 weeks ($30,783.55) based on the synergistic combination of a primary right shoulder injury (30% PPD) with multiple pre-existing disabilities. The Commission found that the pre-existing disabilities of both shoulders, lumbar spine, both knees, and both hands created a synergistic effect warranting a 20% loading factor enhancement.

The Commission modified the administrative law judge's award regarding past medical expenses in a workers' compensation case, reducing the award from $35,789.24 to $32,697.58. The modification excluded medical expenses lacking supporting documentation in the record while affirming expenses related to Dr. MacMillan's treatment, including an L5-S1 lumbar interbody fusion performed on June 3, 2005.

The Commission modified the administrative law judge's award of past medical expenses, reducing the amount from $35,789.24 to $32,697.58 by excluding medical bills not supported by evidence in the record. The Commission affirmed that the employee's treatment, including an L5-S1 lumbar interbody fusion, was causally related to the work injury and that the employer/insurer failed to prove the medical expenses were unreasonable.

The Commission modified the administrative law judge's award regarding temporary total disability benefits, finding that the employee was underpaid rather than overpaid. The employee was entitled to temporary total disability benefits from October 16, 2002 through April 14, 2005 (130 2/7 weeks at $647.36/week), totaling $84,341.76, but the employer only paid between $73,564.37 and $73,769.40, resulting in an underpayment of $10,572.36 to $10,777.39.

The Labor and Industrial Relations Commission modified the administrative law judge's award, affirming the determination of 25% permanent partial disability of the left lower extremity but reversing the award of future medical care and treatment. The Commission found that while the employee sustained a work-related left knee injury on April 30, 2004, the evidence did not establish that the April 30, 2004 accident was the substantial contributing factor requiring future medical treatment due to the employee's prior knee injury and preexisting degenerative changes.

The Labor and Industrial Relations Commission affirmed the administrative law judge's award of workers' compensation benefits to employee Rusty Sprouse but reversed the portion assessing costs and attorney's fees against the employer, finding the employer had reasonable grounds to defend based on conflicting medical testimony and discrepancies regarding the accident date. The Commission determined that while employee benefits were properly awarded, the employer's defense was not unreasonable and therefore costs and attorney's fees should not be assessed.

The Labor and Industrial Relations Commission modified the administrative law judge's award, finding the employee sustained multiple injuries including a primary injury with preexisting neck and knee conditions that synergized to create greater disability. The Commission awarded 45% permanent partial disability for the primary injury plus additional disability weeks from the Second Injury Fund based on the combined effect of injuries, and addressed the employee's appeal regarding permanent total disability status.

The Commission modified the administrative law judge's October 5, 2005 award, redesignating it as a temporary or partial award rather than final because the issue of unpaid medical expenses (Medicare claim for payment) remained unresolved. The matter was returned to the Division of Workers' Compensation for further proceedings to address the outstanding medical payment issue.

The Missouri Court of Appeals reversed in part the Commission's denial of compensation for the September 1, 2003 accident and remanded for determination of compensability and medical expenses related to that injury. The Commission found that the employee overcame the untimely notice requirement by demonstrating lack of prejudice to the employer.

The Commission modified the administrative law judge's final award to designate it as a temporary or partial award, finding that issuing a final determination was error since no party sought final disposition of the matter. The case was returned to the Division for further proceedings while the injury causation issue remains unresolved.

The Labor and Industrial Relations Commission modified the administrative law judge's award, which had granted permanent total disability benefits and future medical care for an employee injured in a June 19, 1998 workplace accident affecting his lower extremities and sacral area. The employer/insurer challenged the award, arguing that only permanent partial disability was supported by competent and substantial evidence.

The Commission modified the Administrative Law Judge's award by increasing the preexisting disability rating of the employee's left ankle from 35% to 75% at the 155-week level based on multiple prior injuries requiring surgeries. This modification increased the Second Injury Fund's liability for permanent partial disability benefits from $7,318.21 to $9,515.09.

The Labor and Industrial Relations Commission modified the Administrative Law Judge's award to issue a final award for future medical care rather than a temporary award. The employee suffered permanent total disability from a fall off a broken ladder on April 3, 2002, affecting his neck, right arm, and left hip.

The Labor and Industrial Relations Commission modified the Administrative Law Judge's award allowing workers' compensation for Charles W. Bock's work-related back injury and occupational disease sustained on April 23, 1998. The decision addresses medical necessity, causal relationship to the work injury, medical expenses, and permanent partial disability benefits following remand from the Missouri Court of Appeals.

The Labor and Industrial Relations Commission modified the administrative law judge's January 29, 2007 award in a workers' compensation case involving George Sutton's November 21, 2000 crush injury to his left forearm sustained when caught in a heavy-duty tailgate. The Commission addressed the employee's claims regarding permanent total disability, PTSD, and back condition resulting from the work injury and subsequent carpal tunnel syndrome from overuse.

The Commission modified the administrative law judge's decision to award the employee future medical care and treatment for his back injury sustained on January 2, 2004. The Commission found that competent medical testimony from Dr. Crabtree established a reasonable probability of need for future medical treatment, including possible spinal fusion surgery, contrary to the judge's determination that the evidence was too speculative.

The Commission modified the administrative law judge's award by reversing the award of future surgical medical treatment, finding that the employee failed to establish by competent and substantial evidence that future surgery was reasonably probable. The Commission affirmed the remainder of the award and found the testimony of Drs. Coyle and Suthar more credible than Dr. Volarich regarding the need for future medical care.

The Commission modified the administrative law judge's award, allowing workers' compensation benefits for an employee who died from injuries sustained in a vehicle accident while traveling between customer locations. The employee's dependents received death benefits, disfigurement compensation, and past medical expenses, with a 15% reduction applied under statutory guidelines.

The Labor and Industrial Relations Commission modified the administrative law judge's award, affirming past medical expenses and temporary total disability benefits but reversing the award of costs under section 287.560 RSMo. The Commission found that the employer had reasonable grounds to defend the case based on the employee's deviation from the prescribed route and potential notice deficiency.

The Missouri LIRC modified the administrative law judge's award, finding that the employee is permanently and totally disabled due to the combination of her work-related back injury and pre-existing disabilities (including fibromyalgia), rather than the work injury alone, thus triggering Second Injury Fund liability. The Commission affirmed all other findings regarding medical causation and entitlement to future medical care for the knees and back.

The Labor and Industrial Relations Commission modified the administrative law judge's award, finding that a valid oral settlement agreement existed between the employee and employer despite not being in writing. The Commission approved the settlement agreement as it complied with Missouri workers' compensation law requirements regarding voluntary settlements and the employee's understanding of rights.