June 16, 2011
Employee ST, a resident of Camp Hill, Cumberland County, suffered a work injury on March 2, 2009, while employed by GGNSC Camp Hill III, LLP. While performing her duties as a Certified Nursing Assistant, she twisted her knee while helping to move a patient from an ambulance.
The workers’ compensation insurance company accepted the injury only as a “strain” in their documents, despite an MRI in March of 2009 which revealed medial and lateral meniscal tears, mild fraying of the central portion of the patella and exposed bone of about 1 cm in diameter. She underwent an arthroscopy performed by Dr. William J.Polacheck on April 15, 2009. The Claimant received total disability until she returned to light duty employment in July of2009.
The Employer filed a Notification of Suspension, alleging that the Claimant had returned to work at earnings equal or greater to her time-of-injury earnings. The injured worker, in response, filed an Employee Challenge to the Notification of Suspension. In a decision rendered by Judge Karl Peckmann, the Defendant was ordered to continue payment of partial disability benefits, because the Notice of Suspension and affidavit’s allegation that the injured worker was earning at least as much in gross pay per week as prior to the injury was not true.
Her knee condition continued to deteriorate. She indicated her pain was throughout her left knee and said she couldn’t put all her weight on it because it would buckle. She couldn’t stand or walk for very long periods of time, and her knee would become swollen every day. She couldn’t do her regular patient care duties which required bending, lifting and stooping. The Claimant underwent treatment with Dr. David C. Baker, who indicated it was impossible to rule out the medial and lateral meniscal tears as being the immediate cause of her symptoms and that those symptoms and restrictions at the time were directly related to her March 2, 2009 injury. The Claimant underwent a knee replacement surgery on April 14, 2010. She was unable to work due to postoperative restrictions and returned to work July 19, 2010, when she was released by Dr. David Baker for full duty. Dr. David Baker indicated that the Claimant’s diagnosis at the time was status post meniscal tear with aggravation of underlying osteoarthritis and status post total knee replacement. He also stated her period of disability from April 2010 to July 2010 is related to her work injury and would have been her postoperative course. The Claimant underwent an IME with Dr. Sotereanos who reported that the Claimant had twisted her left knee and was diagnosed with medial and lateral meniscal tears of the left knee and some degenerative arthritis, and the Claimant underwent an arthroscopy confirming the diagnosis. Dr. Sotereanos commented that the diagnosis was a left knee sprain and chronic bilateral degenerative arthritis due to Claimant’s weight. They refused to pay compensation for her earning loss for missing work due to the surgery.
On September 23, 2009, the Claimant filed a Petition to Review Compensation Benefits requesting the description of the injury be amended to include medial and lateral meniscus tears of the left knee and aggravation of degenerative osteoarthritis. On April 21, 2010, the Claimant filed a Petition to Reinstate Compensation requesting reinstatement of temporary total disability benefits as of April 7, 2010, requesting payment of costs, interest, attorney fees for an unreasonable contest and fifty percent (50%) penalties. On or about May 4, 2010, the Claimant filed a Penalty Petition requesting payment of benefits, interest, costs, attorney fees for an unreasonable contest and fifty percent (50%) penalties, alleging that the Defendant failed to automatically reinstate temporary total disability benefits. The Petitions were all assigned to Judge Francis Williamson in Harrisburg.
The Judge found the Claimant’s testimony to be credible. The Judge rejected the opinions of Dr. Sotereanos because the doctor was unaware that the Claimant was diagnosed with and treated for medial and lateral meniscal tears and some degenerative arthritis soon after the injury. Yet, Dr. Sotereanos insisted that the appropriate diagnosis was a left knee sprain and chronic bilateral degenerative arthritis of the knees, contradicting the fact that the knee was sprained in a twisting incident at work that has been accepted as a compensable injury and indicated it was due to the “fact” that it was due to Claimant’s weight. The Judge found the description of the injury should be amended to include medial and lateral meniscus tears of the left knee and aggravation of degenerative arthritis. The Claimant’s Review Petition was granted, the Claimant’s Reinstatement petition was granted and the Claimant’s Penalty Petition was granted. The Judge ordered the reinstatement of temporary total disability benefits as of April 7, 2010, to July 19, 2010. The Judge ordered GGNSC Camp Hill, III, LP, Chartis Claims Inc to pay the above benefits, interest and costs, attorney fees for unreasonable contest in the amount of $2,655.00, and fifty percent (50%) penalties, due to the fact that the Employer failed to automatically reinstate temporary total disability benefits.
Note: it is normal for workers’ compensation insurance companies to under-report injuries and to blame the work injury on obesity. The Notice of Compensation Payable should have the correct description of injury listed (for example, a herniated lumbar disc is not a strain). If not, a Petition to Review should be filed so the injured worker is protected for future medical expenses and earning loss caused by the real injury.
