Perry County Board of Education v. Mark Campbell
2021 CA 000605
| Ky. Ct. App. | Feb 24, 2022Background
- On April 11, 2018, Mark Campbell fell at work and later underwent right knee arthroscopic meniscal repair in November 2018 but continued to have pain and stiffness.
- Campbell scheduled and received a right total knee replacement (TKR) on December 4, 2019; Employer disputed responsibility and filed a Form 112 medical fee dispute asserting the TKR treated non-work-related osteoarthritis.
- ALJ bifurcated the case to decide the pre-award medical-fee dispute first; evidence included three orthopedic reports for Employer (each denying work-causation) and claimant evidence: Dr. Sharma’s treatment notes (surgeon) and Dr. Madden’s medical report.
- In August 2020 the ALJ found the TKR compensable; Employer sought reconsideration and appealed; parties settled all other claims but preserved the medical-fee dispute and sought WCB review of the ALJ’s ruling.
- The WCB affirmed the ALJ; Employer appealed to the Court of Appeals arguing improper burden allocation, insufficient causation proof, and that the TKR was not reasonable/necessary.
Issues
| Issue | Campbell's Argument | Employer's Argument | Held |
|---|---|---|---|
| Burden of proof for pre-award medical-fee dispute | Not squarely contested by Campbell; ALJ found claimant prevailed on the evidence | WCB misstated burden (cited reopening standard); employer argued burden incorrectly placed on it | Court: WCB’s misstatement was harmless; KRS 342.735(3) places pre-award burden on claimant, but ALJ findings reviewed for substantial evidence |
| Medical causation (Did the Apr. 11, 2018 work incident cause need for TKR?) | Dr. Madden and Dr. Sharma’s records support a reasonable inference that the work event aroused preexisting osteoarthritis into symptomatic condition requiring TKR | Three orthopedic experts opined explicitly that TKR was not causally related to the work incident and was for age/degenerative OA | Court: ALJ’s inference that the TKR was work-related is supported by substantial evidence (ALJ may draw reasonable inferences from medical reports) |
| Medical reasonableness and necessity of the TKR | Dr. Madden’s report and Dr. Sharma’s performance of surgery support that TKR was reasonable and necessary | Employer’s experts explicitly opined TKR was not reasonable/necessary for any work-related injury | Court: ALJ reasonably credited claimant evidence; substantial evidence supports finding that TKR was reasonable and necessary |
| Weight and admissibility of medical opinions; inferences from non‑explicit reports | Medical testimony should be evaluated for substance not magic words; ALJ can assess credibility and infer causation/necessity from overall reports | Employer argued Dr. Madden’s report was too vague/speculative to prove causation and should not outweigh explicit contrary opinions | Court: ALJ entitled to assess credibility, draw reasonable inferences; WCB properly declined to substitute its judgment and affirmed ALJ |
Key Cases Cited
- Western Baptist Hosp. v. Kelly, 827 S.W.2d 685 (Ky. 1992) (standard of review for WCB decisions: overturn only for overlooked statutes/precedent or flagrant error causing gross injustice)
- Brown-Forman Corp. v. Upchurch, 127 S.W.3d 615 (Ky. 2004) (medical testimony judged by substance not specific "magic words")
- National Pizza Co. v. Curry, 802 S.W.2d 949 (Ky. App. 1991) (earlier discussion of burden in pre-award disputes; subsequently superseded by statute)
- Transportation Cabinet v. Poe, 69 S.W.3d 60 (Ky. 2001) (ALJ may draw reasonable inferences from the evidence)
- Finley v. DBM Technologies, 217 S.W.3d 261 (Ky. App. 2007) (arousal of a dormant preexisting condition into symptomatic disabling condition is compensable)
- Copar, Inc. v. Rogers, 127 S.W.3d 554 (Ky. 2003) (ALJ may choose among conflicting medical opinions)
- Combs v. Stortz, 276 S.W.3d 282 (Ky. App. 2009) (medical testimony that is merely speculative may be excluded)