42-11WC. Loren Ingalls v. Hearthstone Quality Home Heating Products Inc.

• Court: Vermont

Vermont Workers Compensation 2011. 42-11WC. Loren Ingalls v. Hearthstone Quality Home Heating Products Inc Loren Ingalls v. Hearthstone Quality Home Heating Products Inc.(December 20, 2011)STATE OF VERMONT DEPARTMENT OF LABORLoren Ingalls v. Hearthstone Quality Home Heating Products, Inc.Opinion No. 42-11WCBy: Phyllis G. Phillips, Esq. Hearing OfficerFor: Anne M. Noonan CommissionerState File No. X-51064RULING ON DEFENDANT'S MOTION TO STAY INTERIM ORDER Procedural Background Claimant suffered a work-related lower back injury on July 25, 2005. Defendant accepted the injury as compensable and paid workers' compensation benefits accordingly. Specifically, it paid temporary total disability benefits on account of a "lower back strain"(fn1) from July 25, 2005 to March 28, 2008. Claimant having reached an end medical result by that point, thereafter Defendant paid permanent partial disability benefits for a 12% whole person permanent impairment referable to a "herniated disk/low back."(fn2) The medical opinion upon which this permanency agreement was based specifically apportioned the ratable impairment to Claimant's lower back, totaling 22% whole person, between the 12% attributable to the compensable injury and 10% attributable to a pre-existing, non-work-related injury that Claimant had sustained in 1997. On February 2, 2010 Claimant filed a Notice and Application for Hearing (Form 6) in which he claimed entitlement to permanent total disability benefits on account of his July 25, 2005 work injury. Subsequently, the parties entered into a Form 14 Settlement Agreement by the terms of which Defendant agreed to pay $250,000.00 in full and final settlement of all claims (excluding those for medical benefits) arising out of that injury. The Department approved the settlement agreement on March 28, 2011. On May 13, 2011 Claimant's treating physician corresponded with Defendant's adjuster, requesting preauthorization for permanent implantation of a spinal cord stimulator. In response, Defendant exercised its right, under 21 V.S.A. §640b(a)(3), to obtain a medical records review and opinion from its own expert, Dr. Backus, as to whether the proposed treatment was reasonable, necessary and causally related to Claimant's compensable injury. From his review, Dr. Backus concluded that Claimant's current low back condition was not causally related to his July 25, 2005 work injury in any way:

The work [Claimant] did on 7/25/2005 is not judged to have led to an objective change or increase in the underlying well established

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