Abt v. Mississippi Lime Co.
2012 Mo. App. LEXIS 1547
| Mo. Ct. App. | 2012Background
- Claimant sustained a January 2001 work injury (primary injury) including left calf degloving, back and rib injuries; he later returned to work in May 2001.
- In 2005 Claimant developed left leg swelling with cellulitis and lymphedema, requiring hospitalization and subsequent therapy through 2006.
- Claimant sought workers’ compensation benefits in 2003; ALJ initially considered permanent partial disability (PPD) with Fund liability for a preexisting left wrist condition, and medical expense reimbursements.
- ALJ found Dr. Poetz’s 2004 opinion most credible, rejected later opinions as lacking records of 2005 injuries, and denied some past medical expenses while ordering reimbursements for expenses tied to the primary injury via Employer and Fund liability.
- Commission reversed in part, finding Fund liability based on preexisting disabilities for a broader set of preexisting conditions, and awarding total PPD benefits; issues remained regarding reimbursement and assessment of PTD causation.
- This court affirms some credibility determinations, reverses others, and remands for more explicit factual findings and reconsideration of reimbursement and PTD causation.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether the Commission properly rejected Dr. Poetz’s 2007/2010 opinions and Swearingin’s 2007 opinion. | Claimant argues Poetz/Swearingin considered 2005 records; their opinions were credible. | Employer contends the Commission correctly deemed their opinions not credible for insufficient review of 2005 records. | Partly reversed; 2007 opinion credibility affirmed; 2010 opinion credibility reversed. |
| Whether PTD was properly attributed to subsequent deterioration of preexisting conditions. | PTD resulted from combination of primary injury and preexisting conditions; not sole deterioration. | PTD due to subsequent deterioration alone. | Claimant’s PTD not solely due to deterioration; remanded for reconsideration. |
| Whether Claimant is entitled to reimbursement of 2005-2006 medical expenses. | Expenses related to primary injury and should be reimbursed; Employer authorized/paid or waived authorization matter. | No proven causal link or lack of authorization; expenses not reimbursable. | Remanded for explicit factual findings; current record insufficient. |
| Whether the Fund liability was properly calculated with respect to preexisting disabilities. | All preexisting disabilities should be included in Fund liability. | Only certain preexisting disabilities meeting thresholds affect Fund liability. | Remanded for explicit findings; partial reversal to consider broader preexisting disabilities. |
Key Cases Cited
- Highley v. Von Weise Gear, 247 S.W.3d 52 (Mo.App. E.D.2008) (Corp rule applied when reviewing expert consideration of full work history or records)
- Copeland v. Thurman Stout, Inc., 204 S.W.3d 737 (Mo.App. S.D.2006) (Tribunal may not base findings on conjecture when undisputed evidence exists)
- Carver v. Delta Innovative Services, 379 S.W.3d 865 (Mo.App. W.D.2012) (Remand for explicit factual findings when insufficient context to review)
- Stegman v. Grand River Reg’l Ambulance Dist., 274 S.W.3d 529 (Mo.App. W.D.2008) (Requires explicit findings of fact and law in workers’ comp awards)
- Michael v. Treasurer, 334 S.W.3d 654 (Mo.App. S.D.2011) (Total disability requires medical causation showing through more than post-accident worsening)
- Angus v. Second Injury Fund, 328 S.W.3d 294 (Mo.App. W.D.2010) (Medical causation for PTD must be supported by expert testimony)
- Van Winkle v. Lewellens Prof'l Cleaning, Inc., 258 S.W.3d 889 (Mo.App. W.D.2008) (Causation under PTD requires medical support; work history alone insufficient)