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Can I Receive Industrial Disability Benefits Even if My Doctor Claims I’m Fully Healed?

WorkInjury4

Many Iowa workers’ compensation claims involve short-term injuries where the employee is back at work within a few days or weeks. But if a workplace accident leaves you with an industrial disability–that is, a permanent injury to your “body as a whole”–you are legally entitled to permanent partial disability (PPD) benefits. The exact level of benefits depends on an impairment rating assigned by your treating physician.

Industrial disabilities generally involve injuries to an employee’s back, neck, or hip. In assessing an industrial disability, workers’ compensation will look at a number of factors, including any change in your earnings caused by your injury, your overall medical condition before and after the accident, and your potential for future rehabilitation. This is far from an exhaustive list of factors, and no single item is considered controlling when it comes to making a final determination as to whether you have a compensable industrial disability.

The Burden of Proof Is Always on the Employee, Not the Employer

As is often the case with workers’ compensation, the most important consideration is usually your treating physician’s assessment. Even if you think you have been misdiagnosed and ask for a “second opinion,” the original doctor’s diagnosis may be enough to defeat your claim for industrial disability benefits. Remember, the legal burden is on you to prove that you have a permanent disability, not the employer to disprove it.

Consider this recent workers’ compensation decision from the Iowa Court of Appeals. The plaintiff formerly worked for a retirement home, which is owned and operated by the defendants. In the course of her employment, the plaintiff’s right shoulder was injured “when a patient grabbed or struck her arm,” according to court records. This caused the shoulder to “pop” and required immediate medical attention.

The plaintiff’s treating physician initially diagnosed her with capsulitis, an inflammation of the connective tissue surrounding the shoulder joint. The physician cleared the plaintiff to return to work under certain medical restrictions and ordered a course of physical therapy. About four months later, the doctor said the plaintiff was medically clear to work full-time without restrictions, although she never did.

Eventually, the physician determined the plaintiff’s shoulder injury had fully healed and that “she has not suffered a permanent functional impairment.” The plaintiff disagreed, however, noting that she continued to experience “pain and limited movement in her right shoulder.” She sought a second opinion from an independent examiner.

The second doctor concluded the plaintiff had, in fact, sustained permanent shoulder damage. He assigned her an industrial disability rating of 13 percent “whole-person impairment.” The first doctor reevaluated the plaintiff’s condition in light of the second doctor’s diagnosis, which included ordering additional medical tests, but ultimately reaffirmed his view the plaintiff had not suffered an industrial disability.

Based on this, the defendants opposed the plaintiff’s efforts to recover PPD benefits. The Iowa courts sided with the defense. The Court of Appeals, affirming prior rulings of the workers’ compensation commissioner and the district court, said the lower tribunals were entitled to credit the testimony of the first doctor over that of the second doctor. Ultimately, “substantial evidence” supported the decision to deny the plaintiff’s claim.

Need Help With a Workers’ Compensation Claim?

Just because you are injured on the job, you should never assume your employer will pay your workers’ compensation claim without question. If you need help from a qualified Iowa workers’ compensation lawyer in pursuing your case for permanent disability benefits, contact the Noyes Law Office, P.C. today to schedule a free consultation.

Source:

scholar.google.com/scholar_case?case=8387275990823584940

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