138 So. 3d 248
Miss. Ct. App.2014Background
- Jo Ann Miller worked at Johnson Controls; reported intense back/hip pain after a December 2003 shift and a more significant episode after a July 2004 shift. She pursued short-term disability and later workers’ compensation for the 2004 event (2003 claim denied and not appealed).
- Treated primarily by neurosurgeon Dr. Jacob Mathis (2003–2009); initial 2004 studies and conservative care led to return-to-work, but symptoms worsened after July 2004 leading to repeated imaging, positive discogram in 2005, and subsequent spinal surgeries (2005–2009).
- Employer commissioned an independent exam by Dr. Howard Katz (May 2005), who could not identify a specific discogenic cause and concluded work only temporarily exacerbated preexisting SI/trochanteric conditions; assigned 3% whole-body impairment and light-duty work capacity.
- After later imaging (Oct 2005 MRI, 2005 discogram) Dr. Mathis diagnosed grade I spondylolisthesis at L4-5 related to the July 2004 work event and recommended surgery; he reversed his earlier max-medical-improvement finding.
- Administrative Judge found the 2004 back and wrist injuries permanently and totally disabling and awarded surgeries; the full Workers’ Compensation Commission reversed as to the back (treating condition as preexisting/only temporarily aggravated) and wrist, and the circuit court affirmed. Miller appealed.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Causation of 2004 back injury | Miller: Dr. Mathis’s diagnosis ties the new spondylolisthesis and pain to July 2004 work event; treating physician’s opinion is unrebutted | Johnson Controls: Back condition preexisted; employer exam (Dr. Katz) attributed symptoms to SI/trochanteric problems and temporary aggravation | Reversed Commission: Dr. Mathis’s later findings are consistent and unrebutted; 2004 work caused/aggravated disabling back condition; remand for benefits |
| Compensability of left wrist injury | Miller: Degeneration worsened and is work-related to 2004 event | Johnson Controls: Wrist preexisted, prior symptoms and no timely report; evidence supports non-compensable conclusion | Affirmed Commission: Evidence permits factfinder to deny compensability; appellate deference applies |
| Extent of disability | Miller: Severe, ongoing disability from 2004 back injury warrants full benefits | Johnson Controls: Limits based on Dr. Katz’s impairment rating and causation view | Reversed and remanded: Commission must determine extent of disability consistent with finding that 2004 back injury is compensable |
| Liability for Dr. Lewis’s surgeries | Miller: Surgeries by Dr. Lewis (neurosurgeon) were necessary and should be paid | Johnson Controls: Second neurosurgeon required preapproval under §71-3-15(1) so costs not recoverable | Reversed: Dr. Mathis was treating physician and referred to Dr. Lewis; referral to a specialist in same subspecialty from treating physician does not require separate preapproval; authorize payment for Dr. Lewis’s services |
Key Cases Cited
- Cook v. Home Depot, 81 So.3d 1041 (Miss. 2012) (standard of appellate review of Workers’ Compensation Commission decisions)
- Raytheon Aerospace Support Servs. v. Miller, 861 So.2d 380 (Miss. 2003) (conflicting expert evidence and deference to Commission)
- Hedge v. Leggett & Platt, Inc., 641 So.2d 9 (Miss. 1994) (burden shift to employer after claimant makes prima facie case)
- Stuart’s, Inc. v. Brown, 543 So.2d 649 (Miss. 1989) (preexisting condition aggravated by work is compensable when not previously occupationally disabling)
- PDN, Inc. v. Loring, 843 So.2d 685 (Miss. 2003) (one-choice-of-physician rule and referral framework under §71-3-15)
- Wal-Mart Stores, Inc. v. Patrick, 5 So.3d 1119 (Miss. Ct. App. 2008) (construction of referral/preapproval limitations under §71-3-15)