ILLINOIS WORKERS’ COMPENSATION COMMISSION
NOTICE OF ARBITRATOR DECISION
____________________ Case #
Employee/Petitioner
____________________
Employer/Respondent
On 12/28/2010, an arbitration decision on this case was filed with the Illinois Worker’s Compensation Commission in Chicago, a copy of which is enclosed.
If the Commission reviews this award, interest of 0.22% shall accrue from the date listed above to the day before the date of payment; however, if an employee’s appeal results in either no change or a decrease in this award, interest shall not accrue.
A copy of this decision is mailed to the following parties:
1067 ANKIN LAW OFFICE LLC
162 W GRAND AVE
CHICAGO, IL 60654
STATE OF ILLINOIS )
)SS.
COUNTY OF COOK
ILLINOIS WORKERS’ COMPENSATION COMMISSION
ARBITRATION DECISION
____________________ Case#__________
Employee/Petitioner
v Consolidated cases: _______
____________________
Employer/Respondent
An Application for Adjustment of Claim was filed in this matter, and a Notice of Hearing was mailed to each party. The matter was heard by the Honorable , Arbitrator of the Commission, in the city of Chicago, on 8/20/2010. After reviewing all of the evidence presented, the Arbitrator hereby makes findings on the disputed issues checked below, and attaches those findings to this document.
DISPUTED ISSUES
A.____Was Respondent operating under and subject to the Illinois Worker’ Compensation or Occupational Disease Act?
B.____Was there an employee-employer relationship?
C._x__Did an accident occur that arose out of and in the course of Petitioner’s employment by respondent?
D._x__What was the date of the accident?
E.____Was timely notice of the accident given to Respondent?
F._x__Is Petitioner’s current condition of ill-being causally related to the injury?
G.____What were Petitioner’s earnings?
H.____What was Petitioner’s age at the time of the accident?
I.____What was Petitioner’s marital status at the time of the accident?
J.__x_Were the medical services that were provided to Petitioner reasonable and necessary? Has Respondent paid all appropriate charges for all reasonable and necessary medical services?
K._x__What temporary benefits are in dispute?
TPD Maintenance _x__TTD
L._x__What is the nature and extend of the injury?
M._x__Should penalties or fees be imposed upon Respondent?
N.____Is Respondent due any credit?
O.____Other ___________________
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FINDINGS
On 9/12/2008, Respondent was operating under and subject to the provisions of the Act.
On this date, an employee-employer relationship did exist between Petitioner and Respondent.
On this date, Petitioner did sustain an accident that arose out of and in the course of employment
Timely notice of this accident was given to Respondent.
Petitioner’s current condition of ill-being is causally related to the accident.
In the year preceding the injury, Petitioner earned an average weekly wage was $163.23.
On the date of the accident, Petitioner was 57 years of age, married with 1 dependent child.
Petitioner has received all reasonable and necessary medical services.
Respondent has not paid all appropriate charges for all reasonable and necessary medical services.
Respondent shall be given a credit of $0.00 for TTD, $0.00 for TPD, $0.00 for maintenance, and $0.00 for other benefits, for a total credit of $0.00.
Respondent is entitled to a credit of $0.00 under Section 8(j) of the Act.
ORDER
Temporary Total Disability
Respondent shall pay Petitioner temporary total disability benefits of $163.23/week for 6 weeks, commencing 1/27/2009 through 2/23/2009 and 4/1/2009 through 4/14/2009, as provided in Section 8(b) of the Act.
Respondent shall pay Petitioner temporary total disability benefits that have accrued since 4/15/2009, and shall pay the remainder of the award, if any, in weekly payments.
Respondent shall be given a credit of $0.00 for temporary total disability benefits that have been paid.
Medical benefits
Respondent shall pay reasonable and necessary medical services of $28,208.01*, as provided in section 8(a) of the Act.
*In accordance with the Medical Fee Schedule (Section 8.2 of the Act), the above amount breaks down as follows: $8,167.93 to , $2,526.75 to $2,791.69 to
, $10.406.84 to , and $4,314.80 to
Permanent Partial Disability: Person as a whole
Respondent shall pay Petitioner permanent partial disability benefits of $163.23/week for 62.5 weeks, because the injuries sustained caused the 12.5% loss of the person as a while, as provided in Section 8(d)2 of the Act.
Penalties
Respondent shall pay to Petitioner penalties of $0.00, as provided in Section 16 of the Act; $0.00, as provided in Section 19(k) of the Act; and $0.00, as provided in Section 19(l) of the Act.
RULES REGARDING APPEALS Unless a party files a Petition for Review within 10 days after receipt of this decision, and perfects a review in accordance with the Act and Rules, then this decision shall be entered as the decision of the Commission.
STATEMENT OF INTEREST RATE If the Commission reviews this award, interest at the rate set forth on the Notice of Decision of Arbitrator shall accrue from the date listed below to the day before the date of payment; however, if an employee’s appeal results in either no change or a decrease in this award, interest shall not accrue.
________________________________ December 27, 2012
Signature of Arbitrator Date
STATEMENT OF FACTS
The Petitioner worked for the Respondent as a warehouse worker. The Petitioner testified that she specifically worked at the warehouse and her job duties included affixing labels to boxes stacked on pallets. The Petitioner testified that on September 12, 2008, she was working for the Respondent and affixing labels to boxes in the warehouse when a forklift operator pushed a pallet against her and injured her. The Petitioner testified that her right foot became stuck in the pallet and that she was pinned between two pallets at the abdomen and lower back. The Petitioner testified that she reported the incident to her supervisor, and that she was sent to sit in the Human Resources office. The Petitioner testified that she was sent by the Respondent to
The Petitioner was treated at on September 12, 2008 for an injury to her right ankle, abdomen, and lower back. (Pet. Ex. #2) The medical history taken by the staff indicates that the Petitioner was injured on September 12, 2008 in a work-related accident. (Id.) The Petitioner testified that she sought follow-up treatment at on September 16, 2008 for pain to her right ankle, abdomen, and low back. The Petitioner testified that she was referred to Hospital for diagnostic testing.
On September 18, 2008, the Petitioner underwent an x-ray of her lumbar spine It was interpreted as revealing no fractures. (Pet. Ex. #3)
The Petitioner testified that she was seen at again on September 22, 2008 due to pain in her lower back and abdomen and was referred to their physical therapy department. The Petitioner underwent a course of physical therapy at from September 22, 2008 to November 3, 2008. (Pet. Ex. #2) The Petitioner testified that this course of therapy did not help to alleviate the pain in her lower back.
However, the November 3, 2008 records indicate that Petitioner’s low back pain (“LBP”) is “much improved” and that “[t]he patient is resolving with therapy intervention.” The records also indicate that Petitioner’s “[o]nly deficit is c/o LBP with lifting but lifts with safe body mech.” (ld.)
The Petitioner testified that on December 1, 2008, she had an MRI of her lumbar spine taken. This MRI was interpreted as showing that Petitioner had central spinal stenosis at L4-L5 and marked left foraminal stenosis at L5-S1 related to a disk herniation. (Pet. Ex. #5) The Petitioner testified that she continued to have pain in her lower back and continued to treat with Dr.
The Petitioner testified that on January 27, 2009, she sought medical treatment at . The Petitioner testified that she was told about by a friend. On the intake form, Petitioner responded to the question “cuando comenzo esta condicion?/When did this condition begin?” by writing “12/9/08.” The Arbitrator notes that on the same form, she indicates that her date of birth is “7/4/51” and the date of signature is “1/27/09.” (Resp. Ex. 1) On January 27, 2009, Petitioner began a course of chiropractic care at and was taken off work for four weeks. (Pet. Ex. #4)
The Petitioner testified that she was referred to Dr. at On February 2, 2009, the Petitioner was seen by Dr. at The Petitioner complained of pain in her right leg and back after being crushed between two pallets at work. (Pet. Ex. #5) The Petitioner was referred by Dr. to one of his associates, Dr. (Id.). The Petitioner testified that she saw Dr. on February 5, 2009 and that Dr. instructed the Petitioner to continue her course of physical therapy at .
The Petitioner testified that she sought follow-up treatment with Dr. on February 23, 2009. On February 23, 2009, the Petitioner complained of continued pain in her right leg and low back. Dr. referred the Petitioner to his associate, Dr. and released the Petitioner to light-duty work. (Pet. Ex. #5) The Petitioner testified that she saw Dr. on march 10, 2009 for a pain consultation. Dr. noted on March 10, 2009 that the Petition
was a good candidate for an epidural steroid injection. (Pet. Ex. #5) The Petitioner testified that she received her first epidural steroid injection with Dr. on March 18, 2009 and her second injection on April 1, 2009.
The medical records indicate that on March 18, 2009 and again on April 1, 2009, Dr. administered a bilateral, L4-L5 and L5-S1 transforaminal epidural steroid injection. On April 1, 2009, Dr. took Petitioner off work for two weeks. (Pet. Ex. #5)
The Petitioner testified that on April 7, 2009, she sought follow-up treatment at The Petitioner testified that she was discharged from care on that day due to the Respondent’s refusal to pay the medical bills for her treatment. The medical notes of April 7, 2009 corroborate Petitioner’s testimony. (Pet. Ex. #4) The Petitioner testified that she has been unable to seek additional medical treatment due to her lack of insurance. The Petitioner testified that as of the date of the arbitration hearing, she continues to have pain in her low back and legs.
The Respondent did not have a Section 12 physician examine the Petitioner.
The Respondent did not produce any witnesses at the arbitration hearing.
CONCLUSIONS OF LAW
C. WITH REGARD TO ISSUE (C) DID AN ACCIDENT OCCUR THAT AROSE OUT OF AND IN THE COURSE OF PETITIONER’S EMPLOYMENT BY RESPONDENT, THE ARBITRATOR RENDERS THE FOLLOWING FINDINGS OF FACT AND CONCLUSIONS OF THE LAW:
The Petitioner testified that she was working for the Respondent on September 12, 2008 at the warehouse. The Petitioner’s job duties at that time consisted of affixing labels to boxes that were stacked on pallets. The Petitioner testified that while affixing these labels, a forklift operator pushed a pallet into her. The Petitioner testified that as a result, her foot became caught in a pallet on the floor and her body was pinned between pallets. This accident occurred while the Petitioner performed her job duties for the Respondent. Accordingly, the Arbitrator concludes that the Petitioner suffered a work-related injury that arose out of and in the course of her employment with the Respondent.
WITH REGARD TO THE ISSUE (D) WHAT WAS THE DATE OF THE ACCIDENT, THE ARBITRATOR RENDERS THE FOLLOWING FINDINGS OF FACT AND CONCLUSIONS OF LAW:
The Petitioner testified that on September 12, 2008, she sustained a work-related injury while employed by Respondent. Further, on September 12, 2008, the Respondent sent the Petitioner to for medical treatment. (Pet. Ex. #2)
The Arbitrator finds that Petitioner made a mistake in Respondent’s Exhibit #1 when she inverted the date and wrote “12/9/08.”
Accordingly, the Arbitrator concludes that the date of the Petitioner’s work-related, accidental injury was September 12, 2008, and that no accident occurred on December 9, 2008
F. WITH REGARD TO ISSUE (F) IS PETITIONER’S CURRENT CONDITION OF ILL-BEING CAUSALLY RELATED TO THE INJURY, THE ARBITRATOR RENDERS THE FOLLOWING FINDINGS OF FACT AND CONCLUSIONS OF LAW:
The Petitioner continuously treated for her injury from September 12, 2008 through April 9, 2009. The Petitioner’s low back complaints persisted following her September 12, 2008 work injury. All of the medical testimony presented at arbitration indicates that the only mechanism of injury in this case was the Petitioner’s September 12, 2008 work injury. Respondent did not present any medical or testimonial evidence to contradict the Petitioner. The Arbitrator finds the medical evidence presented to be credible. Further, the Arbitrator finds the Petitioner’s testimony to be credible. Accordingly, the Arbitrator concludes that Petitioner’s current condition of ill-being is causally related to her September 12, 2008 work injury.
J. WITH REGARD TO ISSUE (J) WHERE THE MEDICAL SERVICES THAT WERE PROVIDED TO PETITIONER REASONABLE AND NECESSARY, AND HAS RESPONDENT PAID ALL APPROPRIATE CHARGES FOR ALL REASONABLE AND NECESSARY MEDICAL SERVICES, THE ARBITRATOR RENDERS THE FOLLOWING FINDINGS OF FACT AND CONCLUSIONS OF LAW:
Following her pallet-pinning injury, Petitioner underwent a course of physical therapy, chiropractic care, diagnostic testing, two epidural steroid injections, and office examinations. The Arbitrator finds that all of the foregoing constitutes reasonable and necessary care for her work injury. Accordingly, the Arbitrator concludes that the Respondent is liable for all reasonable and necessary medical bills incurred as a result of the Petitioner’s September 12, 2009 work injury, in accordance with Sections 8(a) and 8.2 of the Act, as amended. The Arbitrator calculates the total, fee-scheduled adjusted amount to be $28,208.01. therapy and underwent two epidural steroid injections in her lumbar spine. (Pet. Ex. #4 and Pet. Ex. #5 Further, the Petitioner testified that as of the date of arbitration, she still has pain in her low back and legs.
Accordingly, the Arbitrator concludes that the Petitioner sustained a loss of use, man as a whole, to the extent of 12.5%.
M. WITH REGARD TO ISSUE (M), SHOULD PENALTIES OR FEES BE IMPOSED UPON RESPONDENT, THE ARBITRATOR RENDERS THE FOLLOWING FINDINGS OF FACT AND CONCLUSIONS OF LAW:
The Arbitrator concludes that penalties and fees are not warranted in this case as it was not unreasonable for the Respondent to suspect that an intervening accident may have occurred.
The November 3, 2008 records indicate that Petitioner’s low back pain (“LBP”) is much improved and that the “patient is resolving with therapy intervention.” The records also indicate that Petitioner’s “[o]nly deficit is c/o LBP with lifting but lifts with safe body mech.” (Id.) Petitioner underwent a lumbar spine MRI on December 1, 2008.
On January 27, 2009, Petitioner sought treatment with . In the intake form, she wrote that the condition began on “12/9/08.” in the same form, Petitioner correctly indicated that her date of birth was “7/4/51” and the date on which she signed the intake form was “1/27/09.”
The burden is on the party seeking an award to prove by a preponderance of credible evidence the elements of the claim, particularly the prerequisites that the injury complained of arose out of and in the course of the employment. Hannibal V. Indus. Comm’n, 28 Ill.2d 473, 231 N.E.2d 409, 410 (1967)
