Penalties Awarded Against Employer Who Relied On Physician’s Opinion

Case name:  Lupisan v. Federal-Mogal

Ruling:  An arbitrator’s decision that awards penalties against the employer is affirmed and adopted by the Commission

What it means: When denying a claim, an employer cannot rely on an unreasonable physicians opinion that the work-related injury did not cause the claimant’s current condition when the employer also has clear and un-rebutted evidence that the injury caused the current condition.

Summary:  The arbitrator awarded penalties and attorney’s fees against the employer, finding the employer’s reliance on it’s physicians recommendation unreasonable in light of the clear facts surrounding the claimant’s injury.  The 30-year-old claimant experienced left shoulder pain while moving a handcart.  He reported to the employer’s medical department and underwent physical therapy for one month.  Several months later the claimant requested medical attention, complaining of  “popping, grinding sounds” in the same shoulder. An employee in the medical department wrote a note that she did not “like what she felt on this shoulder.” An MRI revealed that if trauma occurred, a contusion might exist.  A physician, at the employer’s request, examined the claimant’s records without examining the claimant himself and concluded that the previous work-related injury did not cause the claimant’s current MRI findings because the MRI findings showed a degenerative disease.  However, this opinion was dismissed by the claimant’s surgeon, who performed surgery and corrected his condition.  The surgeon stated that the claimant’s injury was a well-know cause of the type of tear found in his shoulder.  Because the employer relied on the unreasonable opinion of its physician to deny the claimant benefits when the circumstances of his injury were clear, the arbitrator awarded statutory penalties and attorney’s fees against the employer.

The arbitrator awarded the claimant a total of $18,554.40 in penalties and $3,710.88 in attorney’s fees.