“Hello Again” (Neil Diamond)
We sometimes question whether appeals from bad CCH decisions end up in File 13, as the few decisions that are rendered each month by the Appeals Panel often address trivial issues like a “stipulation…incorrectly identifies a cervical strain rather than cervical sprain” (APD 231661). So we get excited when the Panel issues a decision that actually addresses the merits of a case. This month, we present two examples of decisions that give us hope:
The Appeals Panel reversed an ALJ who adopted a designated doctor’s 20% impairment rating, which was assessed for “requiring routine use of cane” when the records reflected the claimant did not require routine use of a cane. The Appeals Panel refused to adopt a certification by the post-DD required medical examiner because the doctor assigned impairment ratings based only on his observations of the claimant while in and outside the office due to the claimant’s refusal to complete paperwork or undergo an examination unless he was allowed to record the exam and have a witness other than his treating doctor. The Panel thus remanded the case to the ALJ with instructions to ask the DD why he assigned an IR that required routine use of a cane when the claimant was independent with ambulation activities without the need of an assistive device. (AP Decision No. 231830) Note: The Appeals Panel did not address what the Carrier’s remedy is when they are thwarted by a claimant from obtaining an opinion from an RME doctor, although they did reference Rule 126.6(j) in a footnote and state that this was not an issue in the instant case. Rule 126.6(j) merely provides a carrier the right to suspend TIBs if a claimant fails to attend an RME and fails to reschedule.
The Appeals Panel reversed an ALJ who found that a carrier did not sufficiently raise a defense of horseplay on its PLN-1 and therefore, the carrier was deemed liable for an injury despite the fact that the claimant’s horseplay was a producing cause of the injury. The Panel noted that “magic words are not necessary to contest the compensability” of a claim and reversing the ALJ, said that the carrier had sufficiently described the reasons for the dispute when it wrote “Investigation reveals the injured worker was riding a co-workers [sic] motorcycle recklessly at the time of the injury and was not furthering the affairs of the employer at the time of this incident.” (AP Decision No. 231750)
