Schramel v. Belgrade Nursing Home

Schramel v. Belgrade Nursing Home, et. al., No. WC14-5749 (May 21, 2015)

This matter concerned an appeal of the compensation judge’s determination that the employee sustained a permanent injury to her low back and SI joints, the treatment was reasonable and necessary, the employee was entitled to rehab benefits, and the employee was temporarily and totally disabled from October 13, 2012 through the date of the hearing. The appellants also contended that a QRC intervenor claim for benefits should have been denied because the QRC did not attend the hearing.

The employee had a histry of back issues and underwent a decompression/fusion in 1997. In 2008, she was diagnosed with cervical, thoracic, and lumbar subluxation and myofascitis, and received treatment through 2010. She received her CNA license, and started working for the employer in Jan 2012. February 17, 2012 she was sitting in the office at nurses station when chair broke, and tipped backwards. Her right wrist struck desk as she landed. The employee stated she had back pain and spasm immediately after.

Low back pain continued to worsen. An August 22, 2012 IME said injury had resolved, not substantial contributing cause of current condition. It stated no restrictions would be necessary. As a result, the insurer denied referral to TC Spine Center. A June 14, 2013 employee IME said the February 2012 accident was a substantial contributing case of her injury.

Imaging done on Sptember 8, 2013 showed abnormal position of a pedicle screw and moderate to severe bilateral L5-S1 neuroforaminal stenosis, as was seen on a 2012 EMG. She underwent a hardware injection at level of L4/S1 pedicle screws, and experienced 80% relief. On December, 3, 2013 she underwent a sacrococcygeal region injection, and experienced 60-70% relief.

The employee appeared better for a time, but had more problems long term. It was opined that her neck problems easiest to deal with at first, so she underwent a fusion surgery in February of 2014. A 2014 IME said non-work related cervical and lumbar degenerative disease, and the February 17, 2012 injury was not a substantial contributing cause and that none of medical treatment after May 17, 2012 was related to her injury.

In May of 2014- the employee underwent SI joint injections which provided 85-90% relief for several hours. Medial branch blocks were then recommended, which didn’t provide nearly as good of pain relief as SI joint injections. The employee filed a claim petition on November 14, 2012 seeking temporary total disability benefits, medical expenses, and rehabilitation. Judge found employee sustained an injury to SI joints and perm aggravation of a preexisting lumbar spine condition; that care was reasonable and necessary; that the employee cooperated with rehab plan and that job search would’ve been futile due to restrictions; and temporary total disability was awarded from October 13, 2012 through date of hearing. The insurer and employer appealed.

The employer and insurer also argue that intervenors are required to personally attend and participate in hearings to ensure issues are fairly determined. The appellants argue as intervenor QRC did not appear, the claim should’ve been denied.

The WCCA found there was substantial evidence to support the compensation judge’s findings. The judge found the employee’s testimony credible as well as the opinions of the employee’s IME doctor. The judge’s findings regarding causation, reasonableness and necessity, rehabilitation benefits and an award of temporary total disability benefits were supported by substantial evidence in the record.

The WCCA also found that attendance by an intervenor may, however, be waived at the discretion of the compensation judge who can assess from the statute the issues and whether the presence of the intervenor at the hearing is necessary. The entitlement to rehab services was at issue before the judge and was presented for determination, thus the judge properly determined the employee’s qualification for rehabilitation services and payment for rendered services.