Murray American Energy, Inc. v. Connie Titus
20-0290
| W. Va. | Jul 19, 2021Background
- Connie Titus, a coal-miner bus driver, was injured in a January 12, 2018 bus collision and treated for cervical, lumbar, right hip and left shoulder complaints.
- Imaging showed a right hip posterior labral tear and later left shoulder degenerative changes with partial rotator-cuff tearing; cervical MRIs showed foraminal narrowing at C5-6.
- Treating physicians (including Dr. Schweizer) recommended surgery, injections and ongoing physical therapy for the right hip and left shoulder; Dr. Schweizer performed right hip arthroscopy and later left shoulder surgery.
- Independent medical evaluator Dr. Soulsby concluded MMI for the cervical spine, lumbar spine, and left shoulder and questioned causation for some shoulder findings, but he acknowledged ongoing right hip weakness and recommended hip strengthening PT.
- The claims administrator denied multiple treatment requests (second neurology opinion, right hip PT and injection, left shoulder PT) and closed TTD; the Office of Judges reversed, authorized the treatments, added the right hip labral tear and certain left-shoulder diagnoses to the claim, and kept the claim open for TTD at least through May 1, 2019; the Board of Review and this Court affirmed.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether a second neurology/neurosurgical opinion should be authorized | Titus: complex cervical/shoulder symptoms, delayed addition of cervical claim, treating docs support further neuro evaluation | Employer/claims admin: prior evaluations and IME found no acute neurological injury and MMI | Authorized: Office of Judges and Board approved a second neurosurgical opinion; Court affirmed as reasonable |
| Whether right hip PT and corticosteroid injection are compensable/necessary | Titus: labral tear and surgeon recommend PT and injection after arthroscopy; ongoing hip weakness | Claims admin/IME: patient at MMI; additional treatment unnecessary | Authorized: PT and injection approved based on treating surgeon’s opinion and ongoing symptoms; Court affirmed |
| Whether left shoulder PT is compensable | Titus: surgeon performed left shoulder surgery and recommended PT | Claims admin/IME: questioned causation and degenerative nature of findings; denied PT earlier | Authorized: PT approved after left-shoulder diagnoses added to claim and surgeon recommendation; Court affirmed |
| Whether temporary total disability (TTD) closure was appropriate | Titus: not cleared to return to unrestricted work until May 1, 2019; employer accommodation unclear so remained TTD at least until then | Claims admin/IME: MMI finding supported closure of TTD | Reversed: claim remained open for TTD through at least May 1, 2019; Court found treating physician more persuasive than IME |
Key Cases Cited
- Hammons v. W. Va. Off. of Ins. Comm'r, 235 W. Va. 577 (2015) (sets out standard of review and deference to Board findings)
- Justice v. West Virginia Off. Ins. Comm'r, 230 W. Va. 80 (2012) (articulates de novo review standard for legal questions)
- Davies v. W. Va. Off. of Ins. Comm'r, 227 W. Va. 330 (2011) (addresses appellate review scope for workers' compensation decisions)