Murray American Energy, Inc. v. Sharon A. Puccio
20-0288
| W. Va. | Jun 23, 2021Background:
- Claimant Sharon Puccio slipped at work on December 5, 2018, injuring her right knee, right hip, and low back; claim compensable for right hip strain, low back strain, and right knee sprain.
- Initial imaging showed no acute abnormalities; conservative treatment (MedExpress visits, physical therapy) produced partial improvement but persistent right knee pain and instability.
- Independent medical evaluations by Dr. Mukkamala diagnosed sprains; he recommended additional PT in February but found Puccio at maximum medical improvement (MMI) in a March IME.
- Claims administrator denied an orthopedic referral (April 2, 2019) and a right knee MRI (April 30, 2019).
- The Office of Judges reversed those denials (Aug. 29, 2019); the Board of Review affirmed (Apr. 14, 2020); the West Virginia Supreme Court of Appeals affirmed the Board (issued June 23, 2021).
Issues:
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Denial of orthopedic referral | Puccio: ongoing knee pain; treating provider recommended ortho consult | Employer/claims admin: IME/MMI indicates no further treatment needed | Court: Referral reasonable; MMI does not bar further treatment; treating opinion entitled to equal weight |
| Denial of right knee MRI | Puccio: persistent pain/instability despite PT; MRI needed to identify cause | Employer/claims admin: IME/MMI supports denial of additional testing | Court: MRI reasonable and necessary to evaluate continued symptoms; denial reversed |
Key Cases Cited
- Hammons v. W. Va. Off. of Ins. Comm’r, 235 W. Va. 577 (2015) (defines standard of review and deference to Board findings)
- Justice v. W. Va. Office Insurance Commission, 230 W. Va. 80 (2012) (applies de novo review to legal questions)
- Davies v. W. Va. Off. of Ins. Comm’r, 227 W. Va. 330 (2011) (confirms de novo review for legal issues)