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Employee Not Entitled to Hip Replacement Surgery after Compensable Fall Causing Left Hip Injury Due to Pre-Existing Condition, Caesar Gamble v. Miller Industries, Inc.

Employee Not Entitled to Hip Replacement Surgery after Compensable Fall Causing Left Hip Injury Due to Pre-Existing Condition, Caesar Gamble v. Miller Industries, Inc.

February 22, 2017

By Jared S. Renfroe

Caesar Gamble v. Miller Industries, Inc.

Docket No. 2016-01-0372

State File No. 63828-2015

Filed February 9, 2017

Summary

In this case, the Appeals Board reversed the trial court’s finding that the need for hip replacement surgery did not arise primarily out of and in the course and scope of employment, when there was only one opinion of a physician regarding causation using the 51 percent standard.

Facts

It is undisputed in this case that Mr. Gamble, the employee, sustained injuries to his left hip and back as a result of falling out of a chair while in the course and scope of his employment for the employer. The employee received authorized medical treatment for his low back until his symptoms resolved and no further treatment was recommended. With regard to the left hip injury, Mr. Gamble treated with Dr. Alexander Roberts, who opined that his continued intermittent left lower extremity weakness was most likely secondary to his left hip injury/degenerative joint disease. He referred Mr. Gamble to a hip specialist, Dr. Matthew Bernard. Dr. Bernard reviewed an MRI and other objective testing and opined that the employee had a fractured osteophyte from his fall and recommended that he undergo a hip replacement surgery to be able to ambulate fully, secondary to hip pain and the catching from the loose bodies. However, Dr. Bernard later opined that that the fall at work was the proverbial straw that broke the camel’s back; radiographically it was clear that the employee had avascular necrosis well before the subject injury, and this condition represented more than 51 percent of the need for hip replacement.

Procedural

The trial court held an evidentiary hearing upon the request of the employee, without objection by his employer, and held that the employee was likely to prevail at a hearing on the merits as to his request for medical benefits for his low back injury and hip injury. It did, however, deny his request for temporary total disability benefits. Both the employee and the employer appealed.

Holding

Because the employee did not present a brief or argument on appeal, the Appeals Board refused to dig through the record to create issues for appeal. With regard to the employer’s appeal on the issue of entitlement to left hip replacement surgery, the Appeals Board reversed the trial court, holding that Dr. Bernard’s opinion was the only one addressing the 51 percent causation standard, and stating that, without evidence to overcome this opinion, the employee was not likely to prevail at a hearing on the merits.

 

Jared S. Renfroe is an attorney for Spicer Rudstrom PLLC. He focuses his legal practice on litigation throughout Tennessee. His concentrates primarily in premises liability, business and commercial representation, employment practices litigation, professional liability, insurance defense and workers’ compensation.

 

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