Internally inconsistent medical report could not be used to deny award
In the case of State ex rel. Wyrick v. Industrial Commission, the Ohio Supreme Court, in a 4-3 split decision, ruled that an internally inconsistent medical report could not be used to deny a claim for workers’ compensation coverage for the claimant’s loss of use of his left arm.
Ohio’s workers’ compensation laws permit recovery of medical benefits and lost wages by employees sustaining work-related injuries and diseases. Death benefits may also be recovered by survivors if the death resulted from a work-related injury or disease. Scheduled loss compensation is permitted in cases involving the amputation, loss of use or ankylosis of certain body parts.
Background and procedural history
The claimant sustained injuries while working as a carpenter when he fell from a scaffolding. His claim for workers’ compensation coverage was approved for a torn left rotator cuff, dislocated left shoulder, a superficial injury to his left hand, cellulitis in his left fourth finger, and a herniated disc at C5-6.
The claimant subsequently sought compensation for the loss of use of his left upper extremity. He supported the claim with a report from his attending physician indicating that he had no rotator cuff present and had lost the functional use of his left upper extremity.
The Industrial Commission of Ohio submitted a conflicting report from a physician, who had performed an independent medical examination of the claimant. The Commission’s physician agreed that the claimant had lost the use of his left rotator cuff, but concluded that he still had significant functional use of his left upper extremity including the use of the forearm, wrist and hand without limitation if the elbow is maintained at waist level.
A staff hearing officer denied the claim, finding that the report of the Commission’s physician constituted some evidence that the claimant had not entirely lost the use of his left arm.
The claimant brought proceedings for a writ of mandamus in the Ohio Court of Appeals.
The court of appeals denied the writ, likewise holding that the report issued by the Commission’s physician was some evidence to support the Commission’s decision to deny the claim.
The majority decision of the Ohio Supreme Court
The majority decision of the Ohio Supreme Court stated that the loss of use of a body part need not be absolute. Scheduled loss compensation is permitted if the claimant suffered a permanent loss of use of the body part “for all practical intents and purposes.” The claimant filed sufficient supporting medical evidence from his attending physician, who determined that the claimant had lost the function of his left arm “for all practical purposes.”
The majority wrote that the report by the Commission’s physician was internally inconsistent and, therefore, could not be relied upon as some evidence in support of the commission’s decision, as the report concluded that the claimant retained significant function of the left upper extremity while simultaneously determining that the claimant could use his hand, wrist, and forearm only if the elbow remained at waist level.
Contact an attorney
Workers’ compensation matters can involve complex legal issues. Individuals seeking relief under the workers’ compensation laws are urged to consult the professional services of a competent attorney who is experienced in such matters to ensure that their rights are fully protected.