Ganun v. Vinco, Inc., et al

Ganun v. Vinco, Inc., et al., No. WC15-5851 (WCCA Jan. 19, 2016)

The employee in this matter appealed a compensation judge’s determination that he reached MMI, that he sustained a temporary rather than permanent injury, and that a proposed surgery was not reasonable and not necessary. The employee fell from a ladder at work on January 2, 2014. It is undisputed that he hit his shoulder on an electrical box and landed on his buttocks. The subject of this litigation is the injury to the employee’s sacrum, sacroiliac joint, and coccyx. The employer and insurer admitted liability and paid benefits until they obtained an independent medical examination from Dr. Raih, who stated the injury was a temporary aggravation of the employee’s underlying low back condition with no evidence of fracturing his tailbone. There are multiple conflicting opinions from treating doctors, including Dr. Stark (a surgeon), and Dr. Raih regarding whether there is evidence of a tailbone fracture. Dr. Stark opined that surgery was necessary due to a tailbone fracture from the employee’s alleged work injury. The employee’s medical history also includes a possible tailbone fracture and low back problems predating the work injury.

Based on Dr. Raih’s opinion, the employer and insurer filed a petition to discontinue benefits in December 2014. On March 11, 2015, the employee filed a medical request for payment of outstanding medical expenses and for approval of a proposed SI fusion surgery. The issues tried at the May 6, 2015 hearing included whether there were reasonable grounds to discontinue temporary total disability, whether the employee had reached maximum medical improvement, and whether SI fusion surgery was reasonable and necessary treatment for the work injury.

The compensation judge determined that the employer and insurer had reasonable grounds to discontinue temporary total disability benefits. The preponderance of the evidence supported a conclusion that the work injury was no longer a substantial contributing factor to the employee’s continued symptoms. Finding Dr. Raih’s opinion persuasive over Dr. Stark’s opinion, the judge determined the SI joint fusion surgery was not reasonable and necessary treatment without evidence of fracture or other deformity. The judge then ordered payment of medical expenses through the date of MMI, May 23, 2014.

The employee appealed the compensation judge’s decision. On appeal, the WCCA affirmed the compensation judge’s findings and order. The WCCA determines whether findings of fact and order are “clearly erroneous and unsupported by substantial evidence in view of the entire record as submitted.” Minn. Stat. § 176.421 (2014). There is substantial evidence to support these findings when “supported by evidence that a reasonable mind might accept as adequate.” Hengenmuhle. Findings of fact and order are difficult to disturb because the WCCA must find that they are clearly erroneous, or “manifestly contrary to the weight of evidence or not reasonably supported by the evidence as a whole.” Northern State Power Co.

The employee argued that the compensation judge’s decision was not based in fact and inconsistent with the evidence viewed as a whole. It is the trier of fact’s duty to resolve conflict of opinions between medical experts, and such findings “will not be disturbed unless consideration of the evidence and the inferences permissible therefrom clearly requires reasonable minds to adopt contrary conclusions.” Seversen. The WCCA determined that the compensation carefully weighed the evidence and chose between Dr. Raih’s and Dr. Stark’s opposing opinions. Thus, the compensation judge’s decision was affirmed.