1

RONALD MALAM, ) 

 ) 

 Claimant-Appellant, ) 

 ) 

v. ) No. SD33620 

 ) 

STATE OF MISSOURI, DEPARTMENT ) Filed: June 24, 2015 

OF CORRECTIONS, ) 

 ) 

 Employer-Respondent. ) 

 

APPEAL FROM THE LABOR AND INDUSTRIAL RELATIONS COMMISSION 

AFFIRMED

PER CURIAM. On August 12, 2011, Ronald Malam ("Claimant"), a correctional 

officer employed by the Missouri Department of Corrections ("Employer"), was involved 

in an incident where he was "required to 'take down' an uncooperative inmate." Although 

Claimant felt nothing unusual at the time, other than "an adrenaline rush," the incident 

started a chain of events that ultimately resulted in a significant amount of hospitalization 

and medical treatment for a "hypertensive crisis" suffered by Claimant. The Labor and 

Industrial Relations Commission ("the Commission") ultimately found the largest portion 

of that medical treatment to be non-compensable under section 287.020 of the workers' 

compensation law.1

 

1

 All statutory references to section 287.020 are to RSMo Cum.Supp. 2010. All other statutory references 

are to RSMo Cum.Supp. 2005. 
2

Claimant raises two points on appeal. The first claims that the Commission erred 

in finding that Claimant failed to meet his burden of proving that his "accident was the 

prevailing factor under [section 287.020.3(1)] in causing [Claimant's] hypertensive crisis" 

because his medical expert's report "unambiguously" opined that it was. It further asserts 

that the Commission "only considered the medical opinions" and ignored evidence and its 

own findings regarding other circumstances surrounding the accident. 

Claimant's second point asserts the Commission erred in finding that Claimant 

failed to prove that his work accident was the prevailing factor in causing his 

hypertensive crisis because "the Commission failed to first determine whether a 

compensable injury of any kind occurred, in that a compensable physical and emotional 

injury did result from the sudden and extreme stresses of the accident that in turn caused 

the need to treat the hypertensive crisis." 

Finding no merit in either claim, we affirm the decision of the Commission. 

Governing Law and Applicable Principles of Review 

We review the findings of the Commission, not those of the Administrative Law 

Judge ("ALJ"). Clark v. FAG Bearings Corp., 134 S.W.3d 730, 734 (Mo. App. S.D. 

2004). To determine whether Claimant suffered a compensable injury, the Commission 

was required to utilize the statutory scheme set forth in section 287.020. Armstrong v. 

Tetra Park, Inc., 391 S.W.3d 466, 472 (Mo. App. S.D. 2012). In pertinent part, that 

statute provides: 

2. The word "accident" as used in this chapter shall mean an unexpected 

 traumatic event or unusual strain identifiable by time and place of 

 occurrence and producing at the time objective symptoms of an injury 

 caused by a specific event during a single work shift. An injury is not 

 compensable because work was a triggering or precipitating factor. 
3

3. (1) In this chapter the term "injury" is hereby defined to be an injury 

 which has arisen out of and in the course of employment. An injury by 

 accident is compensable only if the accident was the prevailing factor in 

 causing both the resulting medical condition and disability. "The 

 prevailing factor" is defined to be the primary factor, in relation to any 

 other factor, causing both the resulting medical condition and 

 disability. 

 (2) An injury shall be deemed to arise out of and in the course of the 

 employment only if: 

(a) It is reasonably apparent, upon consideration of all the 

circumstances, that the accident is the prevailing factor in causing 

the injury; and 

(b) It does not come from a hazard or risk unrelated to the employment 

to which workers would have been equally exposed outside of and 

unrelated to the employment in normal nonemployment life. 

Section 287.020.2–3 (emphasis added).2

 

The determination of whether an accident is the "prevailing factor" causing a 

claimant's condition is an inherently factual one. Maness v. City of De Soto, 421 S.W.3d 

532, 539 (Mo. App. E.D. 2014). Under our standard of review, we "must examine the 

whole record to determine if it contains sufficient competent and substantial evidence to 

support the award, i.e., whether the award is contrary to the overwhelming weight of the 

evidence." Hampton v. Big Boy Steel Erection, 121 S.W.3d 220, 222-23 (Mo. banc 

2003). 

We do not review issues involving the credibility of witnesses and the weight to 

be given to their testimony; instead, we defer to the Commission's determination of all 

such issues. Caldwell v. Delta Exp., Inc., 278 S.W.3d 251, 253 (Mo. App. S.D. 2009). 

The Commission, as the trier of fact, is free to believe all, part, or none of the evidence 

 

2

 Neither party disputes that the requirements of section 287.020.3(2)(b) were satisfied in this case. 
4

presented. Mihalevich Concrete Constr. v. Davidson, 233 S.W.3d 747, 755 (Mo. App. 

W.D. 2007). 

The Evidence 

After Claimant's "take down" of the inmate, he and another officer were escorting 

the inmate to another location within the prison. While doing so, Claimant began to 

notice that he was short of breath, and he "felt like his lungs were filling up." Claimant 

went to get a drink of water, and he began to spit up blood. A nurse noticed what was 

happening and called an ambulance. 

Claimant was transported by ambulance to Texas County Memorial Hospital, 

where he lost consciousness. Chest x-rays revealed the presence of a pulmonary edema. 

The impression of the treating physician, Dr. Thomas Stubbs, was that Claimant had 

"severe pulmonary contusions" and "possibly had aspirated." 

Claimant was eventually intubated and transported to Lester E. Cox Medical 

Center ("Cox") in Springfield, where he remained unconscious for approximately a week. 

During this period, Claimant was evaluated by several doctors. Dr. Timothy Woods, a 

pulmonary specialist, noted an abrasion to Employee's left knee, but "no other external 

trauma [was] noted." Dr. Woods found, "It does not appear that the patient’s disease 

process is related to trauma. It is likely that trauma precipitated the medical processes he 

has going on." Dr. Douglas Ham’s impression was "significant congestive heart failure, 

pulmonary edema." Dr. Ham further stated, "It is unclear whether this was all related to a 

possible cardiac contusion tipping him into the congestive heart failure or whether he 

could have also had a pulmonary contusion which worsened his respiratory and cardiac 

status or could have been secondary to the stress of the altercation." According to Dr. 
5

Mark Anderson, a cardiologist, Claimant was suffering from a "hypertensive crisis" with 

acute renal and respiratory failure and that he had hypotension and shock associated with 

the hypertensive crisis.3 

Claimant ultimately recovered with no permanent disability, and he has since 

returned to work. He sought workers' compensation reimbursement from Employer in 

the amount of $138,010.15 for medical expenses billed by Cox.4 An ALJ denied his 

claim. Claimant appealed that decision to the Commission, which unanimously affirmed 

the denial of benefits but modified the award. The Commission found that, although 

Claimant had suffered a work-related accident, he had failed to prove that the accident 

was the prevailing factor causing his injuries. See section 287.020. 

The Commission's Findings 

The Commission, unlike the ALJ, concluded that Claimant had suffered an 

"accident" pursuant to section 287.020.2. More specifically, it stated: 

We conclude that the incident on August 12, 2011, was (1) unexpected, 

(2) traumatic, (3) identifiable by time and place of occurrence, and (4) 

produced at the time objective symptoms of an injury caused by a specific 

event during a single work shift-namely, employee's difficulty breathing 

and his spitting up blood. We conclude, therefore, that employee suffered 

an accident. 

 

3

 Claimant quotes the Mayo Clinic's website for the definition of hypertensive crisis in his brief. According 

to that website: 

A hypertensive crisis is a severe increase in blood pressure that can lead to a stroke. 

Extremely high blood pressure — a top number (systolic pressure) of 180 millimeters of 

mercury (mm Hg) or higher or a bottom number (diastolic pressure) of 120 mm Hg or 

higher — damages blood vessels. They become inflamed and may leak fluid or blood. 

As a result, the heart may not be able to pump blood effectively. 

MAYO CLINIC, http://www.mayoclinic.org/diseases-conditions/high-blood-pressure/expertanswers/hypertensive-crisis/faq-20058491 (last visited June 19, 2015). Upon admission to Cox, 

Claimant's blood pressure peaked at 252/140. 

4

 At the time of Claimant's reimbursement request, Employer/insurer had already paid $6,085.46 in medical 

aid for Claimant, and Claimant had also received $2,284.95 in temporary disability benefits. 
6

With regard to whether Claimant's accident was the prevailing factor causing 

Claimant's resulting medical condition, the Commission considered the written reports of 

two medical experts. One of these experts, Dr. Anne-Marie Puricelli, had conducted an 

independent medical examination of Claimant at Employer's request. In her conclusions, 

where she noted Claimant's preexisting hypertension and cardiomyopathy, Dr. Puricelli 

opined: 

It is my opinion that [Claimant] went into acute hypertensive crisis and 

developed hemoptysis due to the elevated pulmonary capillary pressure 

that occurred due to his left ventricular failure secondary to the 

hypertensive crisis. He did not admittedly sustain any trauma. There was 

minimal exertion that occurred surrounding the subduing of the inmate. 

He had not been adequately treated for his hypertension or his 

cardiomyopathy and he was drinking, admittedly, excessive amounts of 

fluid per day which, in my opinion, exacerbated both his hypertension and 

his underlying cardiomyopathy. It is my opinion that none of [Claimant]'s 

current diagnoses are related to any work event that occurred on August 

12, 2011. 

The Commission disagreed with Dr. Puricelli's conclusion, however, explaining: 

This is because Dr. Puricelli did not have the correct facts; she believed, 

for instance, that [Claimant] did not fall to the ground during the take 

down of the inmate. She also based her opinion, in part, on her 

determination that [Claimant]'s preexisting hypertension was inadequately 

treated before August 12, 2011, but we find no clear indication in the 

record that this was the case, and Dr. Puricelli does not explain how or 

why she believed [Claimant]'s hypertension to have been inadequately 

treated. [Claimant]'s unimpeached and credible testimony suggests (and 

we so find) that he was taking medications for hypertension and was 

regularly seeing a physician for checkups regarding his high blood 

pressure before August 12, 2011. 

 The Commission then noted that the only evidence offered by Claimant on this 

issue was the written report of Dr. Brent Koprivica, who had conducted an independent 

medical examination on behalf of Claimant. In his report, Dr. Koprivica detailed 
7

Claimant's medical history and offered medical observations and opinions. As to 

causation, Dr. Koprivica opined: 

1. [Claimant]'s described work-related incident with the takedown of the 

 offender on August 12, 2011, is felt to represent the direct, proximate 

 and prevailing factor precipitating his hypertensive crisis. 

 I would like to point out that but for the work injury, it would be 

 impossible to predict that [Claimant] would have developed the 

 hypertensive crisis that has necessitated the care and treatment that 

 followed that event. 

2. Clearly, [Claimant] had an underlying hypertensive cardiomyopathy 

 identified as far back as 2005. Nevertheless, the prevailing factor 

 precipitating the specific event were the unexpected emotional and 

 physical stresses associated with restraining the offender. 

(Emphasis added). Noting the word "precipitating," as used in section 287.020.2, the 

Commission concluded, "While we believe an accident may be both a precipitating and

the prevailing factor causing a compensable injury, this does not appear to be Dr. 

Koprivica's opinion in this case. Rather, Dr. Koprivica says the accident was the 

prevailing factor that precipitated [Claimant's] hypertensive crisis." The Commission

continued: "Even if we were to credit this opinion from Dr. Koprivica, absent further 

explanation as to what Dr. Koprivica meant by choosing those specific words, we simply 

are unable to conclude that [Claimant] has proven the requisite degree of causation to 

satisfy the requirements of the statute." We find no error in this conclusion. 

Analysis 

Claimant's arguments to the contrary fail for several reasons. For one, Claimant 

ignores the fact that he had the burden of proving causation. "Medical causation, which 

is not within common knowledge or experience, must be established by scientific or 

medical evidence showing the relationship between the complained of condition and the 
8

asserted cause." Gordon v. City of Ellisville, 268 S.W.3d 454, 461 (Mo. App. E. D. 

2008) (emphasis added). In such situations, 

an injury may be of such a nature that expert opinion is essential to show 

that it was caused by the accident to which it is ascribed. Where the 

condition presented is a sophisticated injury that requires surgical 

intervention or other highly scientific technique for diagnosis, and 

particularly where there is a serious question of pre-existing disability and 

its extent, the proof of causation is not within the realm of lay 

understanding nor—in the absence of expert opinion—is the finding of 

causation within the competency of the administrative tribunal. 

Silman v. William Montgomery & Assoc., 891 S.W.2d 173, 175-76 (Mo. App. E.D. 

1995) (citations omitted), overruled on other grounds by Hampton, 121 S.W.3d 220. 

"Whether a particular matter is beyond lay understanding has been treated as a question 

of law." Bock v. City of Columbia, 274 S.W.3d 555, 562 (Mo.App. W.D. 2008). 

Here, Claimant argues that the Commission "only considered the medical 

opinions" and, as a result, "overlooked" or "ignored" other evidence. The problem with 

this argument is that a "hypertensive crisis" is a sophisticated injury that could be caused 

by various factors.5

 Further, Dr. Koprivica -- Claimant's own expert -- noted in his 

 

5

 The Mayo Clinic’s website (cited by Claimant) provides: 

A hypertensive crisis is a severe increase in blood pressure that can lead to a stroke. 

Extremely high blood pressure — a top number (systolic pressure) of 180 millimeters of 

mercury (mm Hg) or higher or a bottom number (diastolic pressure) of 120 mm Hg or 

higher — damages blood vessels. They become inflamed and may leak fluid or blood. 

As a result, the heart may not be able to pump blood effectively. 

Causes of a hypertensive emergency include: 

• Forgetting to take your blood pressure medication 

• Stroke 

• Heart attack 

• Heart failure 

• Kidney failure 

• Rupture of your body's main artery (aorta) 

• Interaction between medications 

• Convulsions during pregnancy (eclampsia) 
9

review of Claimant's medical records that Claimant "has a very complex history." As 

such, the evidence Claimant alleges the Commission ignored or overlooked — adequate 

treatment of preexisting conditions, no prior history of hypertensive crisis, and the 

circumstances surrounding the accident — is evidence that would be insufficient to 

establish that Claimant's hypertensive crisis was directly caused by his work-related 

accident instead of some other factor.6

In this regard, Dr. Koprivica's opinion, which purports to address causation, was 

necessary to meet Claimant's burden of proof on this issue. However, as the Commission 

correctly observed, Dr. Koprivica's opinion was limited to a conclusory statement in his 

report that Claimant's accident was the "prevailing factor precipitating" his injury. The 

Commission's inability to determine whether Dr. Koprivica was asserting that Claimant's 

work accident was "the prevailing factor" in causing his resulting treatment and disability 

(the statutory requirement for compensation) or that his work accident was merely the 

main "precipitating factor" of his injury went to the weight that the Commission afforded 

the opinion. Although Dr. Koprivica's phraseology might have permitted an alternative 

interpretation, as Claimant strenuously suggests, this is not the standard by which we 

review the evidence in a workers' compensation appeal. Rather, the weight afforded a 

medical expert's opinion is exclusively within the discretion of the Commission. Sartor 

v. Medicap Pharmacy, 181 S.W.3d 627, 630 (Mo. App. W.D. 2006). 

Moreover, the Commission's written decision demonstrates that it found that Dr. 

Koprivica's conclusions, like those of Dr. Puricelli, stemmed from an incorrect 

 

MAYO CLINIC, http://www.mayoclinic.org/diseases-conditions/high-blood-pressure/expertanswers/hypertensive-crisis/faq-20058491 (last visited June 19, 2015). 

6

 For a list of cases in which medical conditions have been found to exceed lay understanding, see Bock, 

274 S.W.3d at 562. 
10

understanding of the facts. Specifically, the Commission noted, and the record reflects, 

that although Dr. Koprivica's report suggested that Claimant had experienced "extreme 

exertion" in taking down the inmate, Claimant had consistently testified that the event 

required only "minimal exertion" on his part.7 When expert testimony is thus impeached, 

the Commission is free to disregard it, even in the absence of other credible testimony. 

See Seifner v. Treasurer of State-Custodian of Second Injury Fund, 362 S.W.3d 59, 67 

(Mo. App. W.D. 2012) (finding that where claimant's unopposed expert testimony 

regarding medical causation had been impeached, the Commission was free to find in the 

other party's favor). For these reasons, Claimant's first point is denied. 

Claimant's second point takes the position that he was not required to prove that 

his hypertensive crisis was a compensable injury, arguing that the Commission should 

have determined "whether a compensable injury of any kind occurred, in that a 

compensable physical and emotional injury did result from the sudden and extreme 

stresses of the accident that in turn caused the need to treat the hypertensive crisis." 

Relying on Tillotson v. St. Joseph Med. Ctr., 347 S.W.3d 511 (Mo. App. W.D. 2011), 

 

7

 The transcript from the hearing reflects that Claimant testified as follows: 

[Employer's attorney:] . . . Now you told me in your deposition that actually the 

exertion that you did taking him down you thought was 

minimal. Is that still your testimony today? 

[Claimant:] Yes. 

[Employer's attorney:] Okay. And do you recall seeing Dr. Koprivica, who your 

attorney sent you to see? 

[Claimant:] Yes. 

[Employer's attorney:] Okay. Now he says in his report, with respect to this incident, 

that you wrestled. I know he uses that term. I want to get it so 

I don't -- okay. Here's the quote from Dr. Koprivica's report. I 

want to make sure I read it correctly. It's on page 7 of Dr. 

Koprivica's first report. He says in this event, in wrestling the 

individual and taking him to the ground, there was extreme 

exertion. You don't agree with that. You told me it was 

minimal exertion, right? 

[Claimant:] Yes. 
11

Claimant asserts that he was only required to show that the treatment for his hypertensive 

crisis "flowed from" the circumstances surrounding his accident. Tillotson does not 

support such an argument. 

Unlike the instant case, there was no dispute in Tillotson that the claimant had 

suffered a compensable injury. See Tillotson, 347 S.W.3d at 517. The dispute there was 

whether the "prevailing factor" requirement in section 287.020 applied to the 

determination of what type and extent of medical treatment a claimant with a 

compensable injury was entitled to receive. Id. at 517-18. The Western District of this 

Court found that the requirement did not apply to such a question; instead, once a 

compensable injury is established, the question becomes whether, pursuant to section 

287.140, the treatment that followed was reasonably required to cure and relieve the 

effects of the injury. Id. at 518. 

The flaw in Claimant's argument is that he incorrectly conflates his hypertensive 

crisis with its ensuing treatment and claims that both flowed from some earlier injury 

attributable to his work accident. A hypertensive crisis is not a medical treatment. It is a 

medical condition. And the "prevailing factor" requirement does apply when a medical 

condition or disability, i.e., an injury, is at issue. Compare section 287.020.3(1) with

section 287.140.1; Tillotson, 347 S.W.3d at 518. As noted in Tillotson, there is a 

"material distinction between determining whether a compensable injury has occurred 

and determining the medical treatment required to be provided to treat a compensable 

injury." 347 S.W.3d at 517. Tillotson involved the latter situation; this appeal involves 

the former. See Armstrong, 391 S.W.3d at 472-73; Jordan v. USF Holland Motor 

Freight, Inc., 383 S.W.3d 93, 95 n.4 (Mo. App. S.D. 2012). 
12

To be entitled to compensation for the treatment that flowed from his 

hypertensive crisis, Claimant was required to first establish that his accident was the 

prevailing factor in causing his hypertensive crisis. As detailed in our analysis of Point I, 

the Commission did not err in finding that Claimant failed to do. Claimant's second point 

is also denied, and the decision of the Commission is affirmed. 

DON E. BURRELL, J. - OPINION AUTHOR 

MARY W. SHEFFIELD, P.J. - CONCURS 

NANCY STEFFEN RAHMEYER, J. - DISSENTS 
1

RONALD MALAM, ) 

 ) 

 Claimant-Appellant, ) 

 ) 

v. ) No. SD33620 

 ) 

STATE OF MISSOURI, DEPARTMENT ) Filed: June 24, 2015

OF CORRECTIONS, ) 

 ) 

 Employer-Respondent. ) 

 

APPEAL FROM THE LABOR AND INDUSTRIAL RELATIONS COMMISSION 

DISSENT

I must respectfully dissent. My problem with the majority opinion is that, 

although a crisis may be caused when a latent medical condition becomes symptomatic 

following an accident, it is undisputed that Claimant had absolutely no symptoms of any 

hypertensive crisis until he “took down” the prisoner. Then, while on the job, he started 

to experience shortness of breath and began spitting up blood. There was no time delay 

where he somehow recuperated; rather, he was transported by ambulance to Texas 

County Memorial Hospital, where he lost consciousness. Chest x-rays revealed the 

presence of a pulmonary edema. Claimant was eventually intubated and transported to 

Lester E. Cox Medical Center (“Cox”) in Springfield, Missouri, where he remained 

unconscious for approximately a week. During this period Claimant was evaluated by 

several doctors. None of the doctors at the hospital provided evidence as to the 
2

prevailing cause; however, Dr. Mark Anderson, a cardiologist, determined Claimant was 

suffering from a “[h]ypertensive crisis,” acute renal failure, respiratory failure, and 

“[h]ypotension and shock following a hypertensive crisis.” 

Claimant had never been diagnosed with a “hypertensive crisis” before the 

August 11, 2012 incident, nor has he suffered one since. The take-down set in motion the 

chain of events that culminated in $138,010.15 for medical expenses billed by Cox; in 

other words, but for the take-down, Claimant would not have had that particular 

“hypertensive crisis.” Did Claimant have a predisposition to having this type of injury as 

opposed to some other, certainly, but the fact is that his injury was an “accident” (which 

the Commission found) that caused the subsequent injury. As noted by the majority 

opinion, the Commission found that, although Claimant had suffered a work-related 

accident, he had failed to prove that the accident was the “prevailing factor” causing his 

injuries. I believe that is a misapplication of the law in parsing out Dr. Koprivica’s 

words. 

As the Commission found: 

We conclude that the incident on August 12, 2011, was (1) unexpected, 

(2) traumatic, (3) identifiable by time and place of occurrence, and (4) 

produced at the time objective symptoms of an injury caused by a specific 

event during a single work shift--namely, employee’s difficulty breathing 

and his spitting up blood. We conclude, therefore, that employee suffered 

an accident. 

According to all doctors, Claimant had preexisting hypertension and 

cardiomyopathy. Even Employer’s expert, Dr. Puricelli, opined: 

It is my opinion that [Claimant] went into acute hypertensive crisis and 

developed hemoptysis due to the elevated pulmonary capillary pressure 

that occurred due to his left ventricular failure secondary to the 

hypertensive crisis. 
3

 At issue are the words of Dr. Koprivica: “Clearly, [Claimant] had an underlying 

hypertensive cardiomyopathy identified as far back as 2005. Nevertheless, the prevailing 

factor[s] precipitating the specific event were the unexpected emotional and physical 

stresses associated with restraining the offender.” The Commission challenged the 

meaning of “the prevailing factor precipitating” the hypertensive event. Noting the word 

“precipitating,” as used in section 287.020.2,

1

 the Commission concluded, “[w]hile we believe an accident may be both a precipitating 

and the prevailing factor causing a compensable injury, this does not appear to be Dr. 

Koprivica’s opinion in this case.” Where both a preexisting cardiovascular condition and 

a work-related activity contribute to cause an employee’s injury, the question becomes 

which of the contributing factors was “the primary factor, in relation to [the] other factor, 

causing . . . the resulting” injury. Section 287.020.3(1); Leake v. City of Fulton, 316 

S.W.3d 528, 532 (Mo. App. W.D. 2010). In making this determination it is important to 

note that “[t]he words a medical expert uses when testifying are . . . important, not so 

much in and of themselves, but as a reflection of what impression such witness wishes to 

impart.” Mayfield v. Brown Shoe Co., 941 S.W.2d 31, 36 (Mo. App. S.D. 1997). 

 At no point in Dr. Koprivica’s opinion does he state that Claimant’s accident was 

merely a “precipitating factor” in relation to another “prevailing factor.” Rather, in 

evaluating the contributing factors at issue, Dr. Koprivica emphasized the role of 

Claimant’s accident while minimizing the role of his preexisting conditions: “Clearly, 

[Claimant] had an underlying hypertensive cardiomyopathy identified as far back as 

2005. Nevertheless, the prevailing factor[s] precipitating the specific event were the 

unexpected emotional and physical stresses associated with restraining the offender.” 

 

1

 All references to statutes are to RSMo Cum.Supp. 2008, unless otherwise specified. 
4

(emphasis added). Given this context, Dr. Koprivica’s use of “precipitating,” rather than 

“causing,” per the precise language of section 287.020.3(1), should not be singled out in a 

manner which defeats his overall impression. I conclude that the Commission misapplied 

the law in finding that the words used did not comply with the statute.2 

The Commission considered two expert opinions on the issue of medical 

causation and explicitly decided to not credit one of those opinions—that of Dr. Puricelli. 

The Commission concluded that Dr. Koprivica’s opinion did not conform to the 

requirements of section 287.020. It defies reason and is a misapplication of the law to 

conclude that Claimant had an “accident” as defined by the statute and found by the 

Commission which caused Claimant to have difficulty breathing and spitting up blood, 

but that the immediate hypertensive crisis was not part and parcel of that accident. 

Moreover “once it is determined that there has been a compensable accident, a 

claimant need only prove that the need for treatment and medication flow from the work 

injury.” Tillotson v. St. Joseph Medical Center, 347 S.W.3d 511, 519 (Mo. App. W.D. 

2011). An employer shall provide, among other things, “hospital treatment, . . . as may 

reasonably be required after the injury or disability, to cure and relieve from the effects of 

the injury.” Section 287.140.1, RSMo Cum.Supp. 2005. I would reverse the decision of 

the Commission. 

Nancy Steffen Rahmeyer, J. - Dissenting Opinion Author 

 

2

 Where the record is silent as to whether the Commission disbelieved an expert medical witness, the 

Commission may not arbitrarily disregard the uncontradicted, unimpeached, and undisputed testimony of 

that witness. Bond v. Site Line Surveying, 322 S.W.3d 165, 171 (Mo. App. W.D. 2010).