MAURICE ETTEDGUI, Employee,
v.
MASTERCRAFT CABINETS and GENERAL ACCIDENT GROUP, Employer-Insurer/Appellants.
No. 474-21-3183
Minnesota Workers Compensation
Workers' Compensation Court of Appeals
January 13, 1999
HEADNOTES
CAUSATION
- SUBSTANTIAL EVIDENCE. Substantial evidence, including
extensive medical treatment records, supports the
compensation judge's determination that the employee
sustained a work-related injury to his low back on December
8, 1993.
NOTICE
OF INJURY - SUBSTANTIAL EVIDENCE. Substantial evidence
supports the compensation judge's finding that the
employer and insurer had actual knowledge of the claimed low
back injury within the 180-day limit set forth in Minn. Stat.
§ 176.141.
EVIDENCE
- RES JUDICATA. Where the issue of maximum medical
improvement (MMI) for the employee's low back condition
had not been litigated or specifically decided previously,
the compensation judge properly held the issue of MMI for the
employee's lumbar spine condition and his claim for
temporary total disability benefits were not barred by the
doctrines of res judicata or collateral estoppel.
MAXIMUM
MEDICAL IMPROVEMENT - SUBSTANTIAL EVIDENCE. Substantial
evidence, including the opinions of Dr. Davenport and Dr.
Bower recommending a physical rehabilitation or chronic pain
program, supports the compensation judge's finding that
the employee had not reached MMI as of the date of hearing.
TEMPORARY
TOTAL DISABILITY - SUBSTANTIAL EVIDENCE. The
compensation judge's finding that the employee had not
been released to return to work and was entitled to temporary
total disability benefits from September 20, 1995, through
the date of hearing is not manifestly contrary to the
evidence and must be affirmed.
CREDITS
& OFFSETS. The compensation judge properly denied a
credit for overpayment of benefits between August 15, 1994,
and September 13, 1995, where the employee had not attained
MMI for his December 8, 1993, low back injury and was found
temporarily totally disabled through the date of hearing.
MEDICAL
TREATMENT & EXPENSE - SURGERY. Substantial evidence
supports the compensation judge's determination that the
employee's July 25, 1997, lumbar spine surgery was
causally related to his December 8, 1993, work-related low
back injury and was reasonable and necessary.
Affirmed.
Determined by Johnson, J., Hefte, J., and Pederson, J.
Compensation Judge: Karen C. Shimon
OPINION
THOMAS
L. JOHNSON, Judge
The
employer and insurer appeal from the compensation judge's
findings that the employee sustained a work-related low back
injury on December 8, 1993; the employer and insurer had
actual knowledge of the claimed low back injury within the
meaning of Minn. Stat. § 176.141; the principles of
collateral estoppel or res judicata did not bar
determination of maximum medical improvement (MMI) and the
employee's claim for temporary total disability benefits;
the employee had not reached MMI as of the date of hearing;
the employee was not required to conduct a job search and was
entitled to temporary total disability benefits from
September 20, 1995 through the date of hearing and
continuing; the employee did not fraudulently collect
workers' compensation benefits from August 15, 1984
through September 13, 1995; and the July 25, 1997 lumbar
spine surgery was causally related to the December 8, 1993
work injury and was reasonable and necessary. We affirm.
BACKGROUND
The
employee, Maurice Ettedgui, slipped and fell at work,
sustaining an admitted, work-related injury to his cervical
spine on December 8, 1993, while working for the employer,
Mastercraft Cabinets, then insured by General Accident
Group. The employee was treated for neck pain at the
Methodist Hospital emergency room on the date of the
injury. He was off work for two and a half days,
returning to his job with the employer on Monday, December
13, 1993. That same day, he was seen for follow-up by
his family physician, Dr. Aaron Mark, reporting an injury to
the "neck and back." On about January 13,
1994, the employee was terminated by the employer.
The
employee returned to Dr. Mark on January 25, 1994,
complaining of neck, shoulder, arm and low back
pain. Dr. Mark referred the employee to an orthopedist,
Dr. Nolan Segal, who saw the employee on January 27,
1994. Dr. Segal diagnosed myofascial neck and low back
injuries aggravating underlying degenerative disc disease and
arthritis in the cervical and lumbar spines. He took the
employee off work and prescribed medications and a course of
physical therapy. The employee did not show significant
improvement, and on March 14, 1994, Dr. Segal took the
employee off work indefinitely.
On
March 18, 1994, the employee fell down some stairs at his
house. He was taken to Methodist Hospital where he was
treated for back pain and a left ankle sprain. He
remained in the hospital for four days. On April 13,
1994, an independent medical examination (IME) was performed
by Dr. W. Robert Leslie. Dr. Leslie concluded the
employee had sustained a cervical injury on December 8, 1993,
but did not believe there had been any significant injury to
the low back. Dr. Leslie opined the employee could
return to work with restrictions.
In
April 1994, the employee began treating with Dr. Andrew
Smith, a neurosurgeon, who saw the employee primarily for his
cervical problems. Dr. Smith, in turn, referred the
employee to Dr. John T. Anderson for evaluation of the
employee's ongoing shoulder complaints. The employee
completed another course of physical therapy and had several
cortisone injections into the subacromial space, with little
lasting improvement of his cervical, shoulder or low back
symptoms.
On
August 2, 1994, the employee was seen by Dr. David Ketroser
for a second IME. The employee described immediate onset
of neck and low back pain following the December 8, 1993 work
injury. He reported continuing neck and shoulder pain,
and constant low back pain radiating into the
buttocks. Dr. Ketroser concluded the employee had
sustained a work-related cervical injury, but that his low
back symptoms were not related to the fall at work. The
doctor found no objective findings on examination, and opined
that the employee had reached maximum medical improvement
(MMI). He further opined the employee was capable of
full time work without restrictions. The employer and
insurer served the employee with Dr. Ketroser's MMI
report, along with a notice of intent to discontinue benefits
(NOID), on August 15, 1994. The employee requested an
administrative conference. In a decision served and
filed September 16, 1994, a settlement judge at the
Department of Labor and Industry allowed discontinuance of
temporary total disability benefits 90 days after service of
Dr. Ketroser's report.
On
November 10, 1994, the employee filed an Objection to
Discontinuance alleging continuing entitlement to temporary
total disability benefits from and after November 14, 1994,
based solely on his cervical spine injury. Following a
hearing on February 3, 1995, Compensation Judge David Barnett
found the employee's shoulder symptoms were causally
related to his admitted cervical injury. He further
concluded that the employee had shown no...
