Practice Area: Workers Compensation
Outcome: Plaintiff Prevailed Before DWC
Description: J.B. was walking on a raised walkway covered in ice after a storm, when he slipped and fell. The employer was self-insured for workers compensation and denied liabiity of anything other than a shoulder strain. J.B., who had been working a heavy duty position, was now in need of shoulder arthroplasty, and could not get treatment because the insurance company would not allow for treatment of anything other than a strain. A state-appointed designated doctor determined that J.B.'s injury was much worse than a strain. He diagnosed a Hill Sachs fracture, tendonitis, and aggravation of underlying degenerative joint disease. In Texas, if a pre-existing condition is aggravated by a work accident, it becomes part of the work injury. Based on this report, the Judge found that the insurance company was liable for the diagnosed conditions. The only evidence to the contrary was a peer review report (the insurance company hired a doctor to review medical records but not to do an exam). It concluded that J.B.'s problems stemmed from a prior shoulder injury, and were not caused by the work accident. The only problem with that conclusion was that the reviewing doctor listed all of the records he reviewed and he did not see any of the medical records from the prior shoulder injury. There was no way he could know what the prior condition of the shoulder was in order to reach that conclusion.