Valdez v. Glister Mary Lee Corp.

No. 11-049336 (Mo. Lab. & Indust. Rel. Comm’n Nov. 20, 2015)

Factual Background:

Claimant injured his low back while twisting his upper body on 6/21/11. He received authorized treatment for a back sprain and was released back to work a month later without restrictions. After working regular duty, his symptoms increased and he requested additional medical treatment which was denied. He then treated on his own, undergoing surgery on 12/27/11.

At hearing, the ALJ awarded 7.5% PPD but denied medical causation for the unauthorized care and also denied TTD.

Analysis/Holding:

The Commission modified the Award found that there was no clear evidence of changed symptoms, a prior medical condition, or a subsequent injury that would explain the need for the additional treatment.  As such, the Commission found Dr. Poetz credible. Importantly, this new finding for liability meant that Employer was liable for past medical expenses in the amount of $701,892.59. Applying the precedent set forth in Martin and Farmer-Cummings, they found that Employer did not meet its burden in advancing any evidence to suggest that Claimant’s liability for the bills had been extinguished, or that the charges were not fair and reasonable. As such, the bills as presented by Claimant were considered fair and reasonable and Employer was liable for those bills.

The Commission modified the award of the ALJ and awarded additional PPD benefits, past medical expenses, and TTD.

The Takeaway:

Given the guidelines of Farmer-Cummings, the Employer must be prepared to proffer evidence to dispute the medical bills for unauthorized care. Claimant simply needs to present the medical bills and the supporting medical records in order to meet his burden.