5 Year Gap in Treatment Undermines Causation Argument

In 2007, Claimant was working for Employer when a box fell on her back, causing low back pain and pain in her right leg.  Claimant underwent treatment with numerous providers, including three of her choosing, a defense medical examiner, and an OWC appointed independent medical examiner.  All of the providers found that the MRI films were normal, and that Claimant could return to work.  After December of 2009, there was no medical evidence from a treating physician until January of 2015, when Claimant began treating at a pain center with complaints of neck pain, thoracic back pain, low back pain, hip and foot pain, and pain in both shoulders.  Claimant demanded ongoing medical benefits from Employer, which were denied.  The workers’ compensation judge found in favor of Employer, stating that the five year gap in treatment made it impossible to relate her current pain and injury complaints to her 2007 work accident.

Claimant appealed the decision to the Court of Appeal of Louisiana, Third Circuit.  The appellate court addressed whether Claimant was entitled to ongoing medical treatment and whether Employer was responsible for penalties and attorney fees due to termination of benefits.  An employer is responsible for a claimant’s medical expenses only if they are caused by a work related injury.  The claimant must establish his or her claim for medical benefits and show that they are related to the work accident to a reasonable certainty and by a preponderance of the evidence.

The appellate court agreed with the workers’ compensation judge, citing the five year gap in treatment and the different complaints identified in the medical records.  The court found that the five year gap undermined Claimant’s causation argument, and that there was not sufficient evidence to support her position that Employer is responsible for her continuing medical treatment.  The court further awarded considerable weight to the OWC medical examiner’s opinion that there was no evidence of injury on the MRI scan of injury.  In light of the evidence, the appellate court affirmed the workers’ compensation judge’s ruling denying medical treatment and attorney fees and penalties.

Academy, Ltd. v. Smith