MICHAEL BURBAGE
v.
YOUNG LIFE ACE AMERICAN INS CO (TRAV INDEMNITY CO), Insurance Carrier
ESIS, INC, Claim Administrator
Jurisdiction Claim No. VA00000665515
Virginia Workers’ Compensation
Virginia In The Workers’ Compensation Commission
March 12, 2021
Date
of Injury September 11, 2012.
Claim
Administrator File No. C494C298121X.
Charlene A. Morring, Esquire For the Claimant.
Kevin
W. Cloe, Esquire For the Defendants.
REVIEW
on the record by Commissioner Marshall, Commissioner Newman,
and Commissioner Rapaport at Richmond, Virginia.
OPINION
MARSHALL Commissioner.
The
defendants request review of the Deputy Commissioner’s
October 16, 2020 Opinion finding them responsible for the
claimant’s left total knee replacement. We AFFIRM.
I.
Material Proceedings
On
September 11, 2012, the claimant sustained a work-related
injury to his left knee. An Amended Award Order issued
February 11, 2014 provided medical benefits for as long as
necessary for left knee cleaning of scar tissue/debridement
of patella.
1
A May
25, 2016 Stipulated Order authorized a partial knee
replacement. Based on Dr. Campbell’s deposition, the
Order stated the “parties specifically agreed that the
defendants are not responsible for a total knee replacement,
and the partial knee replacement fully addresses the issues
caused by this injury.”
An
October 2, 2017 Stipulated Order agreed the claimant was
entitled to an additional 9% permanent partial disability to
the left leg as assigned by Dr. Campbell.
The
claimant filed an October 19, 2019 change in condition claim.
He alleged failure of the prosthetic implant and the need for
a left knee total knee replacement. The defendants denied a
causal relationship between the injury and the requested
treatment. They denied the claimant could satisfy his burden
to prove the surgery was related to the injury.
After
review of the claimant’s testimony and the medical
evidence, the Deputy Commissioner found the defendants
responsible for the total knee replacement. She concluded:
It is the claimant’s burden to prove his claim by a
preponderance of the evidence. Therefore, he is not required
to unequivocally establish that there was a loosening of the
implant. The totality of Dr. Lambert’s opinions, as set
forth in his notes and clarified in his deposition, supports
a finding that it is more probable than not that the implant
is loose. Treatment necessitated by the implant is causally
related to the claimant’s work injury. The recommended
treatment for such a situation is a total knee replacement,
and, on these facts, we find that the defendants are
responsible for the same.
(Op. 8.)
The
defendants request review.
II.
Findings of Fact and Rulings of Law
The
claimant has the burden to prove that the medical treatment,
for which payment is sought, is causally related to the work
accident. Watkins v. Halco Eng’g, Inc., 225
Va. 97, 101 (1983) (citing Ins. Mgmt. Corp. v.
Daniels, 222 Va. 434, 438-39 (1981)). The factual
determination regarding causation is usually proven by
medical evidence. Clinch Valley Med. Ctr. v. Hayes,
34 Va.App. 183, 192 (2000) (citing Reserve Life Ins. Co.
v. Hosey, 208 Va. 568, 570 (1968)). In reviewing the
medical evidence, the Commission generally gives great weight
to the opinion of the treating physician. Pilot Freight...
