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Timestamp: 2019-04-24 11:02:57+00:00

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In 2002, the court in Hydrolics Inc. v. Industrial Commission determined that the doctrine enunciated in Petrillo v. Syntex, which disallows ex parte communications between an opposing party and a Petitioner’s doctor, does apply to Illinois workers’ compensation cases Therefore, it is important for employers to go through the provisions allowed in the Illinois Worker’s Compensation Act as well as the Commission rules to obtain information from treating doctors.
What is allowed under Petrillo?
Gilliland v. Niemann Foods Respondent attorney sent treating doctor medical records prior to the doctor’s deposition and gave a copy to the opposing attorney. The court found that this was a technical violation of Petrillo, but not a violation that warranted barring of the doctor’s deposition.
Hutchinson v. D to Z Sports In this case, an employer contacted the treating doctor to request another examination of the Petitioner. This was allowed by the court.
Compton v. Lynncrest Manor In this case, a doctor contacted a nurse case manager, asking for Petitioner’s job description. The court ruled that a doctor can initiate contact outside of the physician patient privilege.
What is not allowed under Petrillo?
Since the Petrillo decision, courts in Illinois have found that a number of things are not allowed under the Petrillo doctrine. The following are just two of the most common examples of actions which are not allowed under Petrillo.
Abriam v. DSI Corp. In this case, a doctor’s deposition was barred for a letter to the treating doctor asking questions about the physical condition of Petitioner or about causal connection of a claim.
Hostetler v. Lennar Homes The court here ruled that you cannot send surveillance tapes to a treating doctor, asking whether Petitioner in those films should see another doctor or have an MRI. In this case, after receiving this information, the doctor’s report was barred from evidence.
Can an adjuster contact a doctor to see if Petitioner can return to light duty work that is being offered?
Commission Rule 7110.70 When an employer takes the position that it has insufficient medical information to determine its liability for the initial payment of temporary total compensation, or the continuation of such payment, such employer shall have the initial responsibility to promptly seek the desired information from those providers of medical, hospital and surgical services of which the employer has knowledge.
We interpret this rule to mean that, if an employer or company has a question on this issue, this rule makes an argument that they can contact the doctor, give a description of the proposed light duty work and ask whether the Petitioner can return to that work.
Of note: Our interpretation of this rule has not been tested either at the Commission or in the Courts.
Discussion: Under Illinois Worker’s Compensation law, where a petitioner has a pre-existing condition that must first be cured in order to successfully treat a compensable work-related injury, a respondent is liable to pay medical expenses for the preliminary treatment regardless if the pre-existing condition is “related” to the work injury. Timothy Wilson v. Siegles Home & Building, 02 IL. W.C. 18002 (Ill. Indus. Com’n 2008). A petitioner must show through the advisement of a treating physician or through secondary opinions that the preliminary treatment is “reasonable and necessary” and incurred as a “necessary part” of treating the compensable work injury. Wesley J. Whitten v. Central Cartage, 94 IL. W.C. 49516 (Ill. Indus. Com’n 1999); Edwina Ellegood, v. Burwell Oil Serv., 04 IL. W.C. 26563 (Ill. Indus. Com’n 2008). Furthermore, this rule holds true if a compensable work-related injury either exacerbates a pre-existing condition or causes a new condition to form. Timothy Wilson, 02 IL. W.C. 18002. A pre-existing condition “exacerbated” by a work-related injury, is a “reasonable and necessary” medical expense and is causally related if pre-treatment is necessary to safely cure an underlying work injury. In Wesley J. Whitten v. Central Cartage, the petitioner sustained a compensable work injury after he slipped on ice and fractured his hip. 94 IL. W.C. 49516. The petitioner had a pre-existing, ten-year history of peptic ulcers. Prior to authorized hip surgery, the petitioner’s treating physician found evidence of an actively bleeding ulcer, which was confirmed through an ordered endoscopic exam. The ulcer was first treated to stop the bleeding before the hip surgery proceeded. First, the arbitrator found that the respondent’s unpaid medical bills for the GI treatment were reasonable and necessary medical expenses incurred as a necessary part of conducting hip surgery. Because the petitioner had lost blood from his hip fracture, the arbitrator reasoned that the petitioner could not have had hip surgery without first doing the GI work-up to evaluate the safety of the surgery. Second, the petitioner’s treating physician testified that the petitioner’s pre-existing condition was aggravated by the work-related injury. The arbitrator reasoned from this testimony that all medical treatments, including the GI work-up, were causally related if they were incurred to cure the petitioner’s work injury.
Preliminary treatment of an exacerbated pre-existing condition or newly acquired condition that results from a work injury need not be causally related to become a “reasonable and necessary” medical expense. In Timothy Wilson v. Siegles Home & Building, the petitioner sustained a work-related neck injury. 02 IL. W.C. 18002. The petitioner was obese with a large frame. A post-myelogram CT scan showed multi-level abnormalities, including nerve root and spinal cord compression, which in the treating physician’s opinion required surgery. At the request of the respondent, an IME physician opined that the petitioner did not need surgery. The petitioner’s inactivity from his injury caused him to gain more weight and as a result, developed Diabetes Mellitus. The respondent denied any requested surgery.
A treating physician “must recommend” that pre-treatment, such as gastric bypass surgery, is a medical necessity prior to treating a work injury. The pre-treatment cannot be a secondarily beneficial to the petitioner. In Edwina Ellegood, v. Burwell Oil Serv., petitioner sustained a work-related knee injury. Post-injury the petitioner had undergone gastric bypass surgery, and as a result had lost one-hundred pounds. 04 IL. W.C. 26563. The respondent disputed liability for payment of the gastric bypass procedure. The arbitrator found that although the petitioner’s leg condition improved as a result of the surgery, the petitioner ultimately failed to prove the procedure was reasonable and necessary. The arbitrator reasoned that the improvement to her leg from the gastric bypass was a secondary benefit. Although evidence from the treating doctor retroactively stated the petitioner benefited, the doctor did not specifically recommend any type of weight loss prior to the gastric bypass. Although not law, Hennessy and Roach’s defense of respondent, City of Chicago, in Dave Antunez, v. City of Chicago, 06 WC 36891, provides an example of a how to approach a treating doctor’s recommendation for bariatric surgery. Here, a morbidly obese petitioner sustained a back injury during the course of employment. The petitioner’s treating doctor recommended that he undergo a lumbar fusion. It was determined by the physician that the fusion would have a better success rate if the petitioner first underwent gastric bypass surgery in an effort to relieve stress and strain on the treated area. The physician reasoned that, because the petitioner was morbidly obese and had actually gained weight as a result of the immobilizing nature of his injury, other forms of weight loss would be futile. Respondent scheduled two IMEs for second opinions. The IMEs also confirmed that the fusion would be more successful if the petitioner underwent gastric bypass surgery. The respondent conceded and reasoned that the cost of multiple fusion attempts would be greater than the cost of gastric bypass surgery. Otherwise, the respondent would have disputed the surgery.
Although not governing in this jurisdiction, a recent Indiana case awarded gastric bypass surgery to a six-foot, 340 pound petitioner who sustained a back injury in the course of employment. PS2, LLC., v. Childers, 910 N.E.2d 809 (Ind. App. Ct. 2009). As a result of the immobilizing nature of his injury the petitioner started to gain weight. The petitioner’s treating physician, as well as an IME doctor, suggested that he should seriously consider lap-band surgery in order to decrease the risk and increase the success of the prescribed spinal fusion. The Indiana Appellate Court held that claimant’s weight condition, combined with his work-related injury to his back, produced a single injury. Therefore, the claimant was entitled to receive secondary medical treatment, in the form of lap-band surgery. This would help the claimant lose weight, as a precursor to back fusion surgery to treat the work-related back injury. There was no evidence that claimant had a weight condition prior to his injury that impaired his health or required intervention. Furthermore, the claimant’s lower back pain following the injury rendered him nearly immobile, which contributed to weight gain.
United Airlines, Inc. v. The Illinois Workers’ Compensation Commission, 2008 WL 1931316 (1st Dist. 2008).
Generally, amounts paid as reimbursement for travel expenses are not part of an employee’s earnings for average weekly wage (AWW) calculation. The rationale behind this rule is that such payments merely reimburse the employee for employment-related expenses that would otherwise not be incurred, and therefore, the employee will not suffer any economic loss if she fails to receive such reimbursements once the employment ceases. However, payments designated as travel expenses should be included in an employee’s AWW to the extent that such payments represent real economic gain rather than reimbursement for actual expenses incurred.
Summary: Employee was injured on two separate occasions while she worked as a flight attendant for the employer. In addition to an hourly rate of pay and premiums for certain positions, flight attendants were paid an hourly per diem expense allowance for living expenses, as flight attendants are commonly expected to stay overnight. The employee testified that only a portion of her per diem payments would be used on certain trips. At issue was whether these per diem payments should be included in the employee’s AWW calculation.
The Commission included all per diem payments in the employee’s AWW. The appellate court reversed the Commission’s decision as it was against the manifest weight of the evidence. It specifically noted that the employee was in fact using per diem money for travel expenses, thus the entire payment that the employee received did not constitute real economic gain and should not have been included when the Commission computed the employee’s AWW. The case was sent back to the Commission to determine whether and to what extent these payments exceed the employee’s actual expenses.
Effect: Per diem expense allowances, to the extent they are used for travel expenses, are not included in the calculation of AWW. The employee has the burden to prove whether and to what extent the per diem payments exceed the employee’s actual expenses in order for the excess amount to be included in AWW.
Facts and Procedural PostureClaimant filed a Claim for Compensation alleging injury to the body as a whole and a psychiatric injury sustained on November, 24, 2008 after she was assaulted by a co-worker on the employers’ premises. In the section of the Claim form titled “average weekly wage”, claimant alleged the “max rate”. It was undisputed that the Employer filed its Answer to the Claim late and not within the 30 day period prescribed in 8 CSR 50-2.010(8). Claimant prevailed at trial and was awarded 45% BAW in PPD benefits payable at the maximum rate of compensation of $376.55 per week. The ALJ felt that the Employer had admitted the maximum rate for claimant’s AWW and corresponding rates due to not filing their Answer timely.
The Commission then reversed the ALJ’s award, finding that the allegation of a “max rate” was not an issue of fact and therefore not admitted due to the late filing of the Answer. Instead, it awarded PPD at the minimum rate of $40.00 per week due to claimant not presenting any evidence at trial regarding her earned wages.
IssueIs the allegation of a “max rate” for the average weekly wage on a formal Claim for Compensation an allegation of “fact” that is deemed admitted if the Employer does not timely file its Answer?
RuleThe allegation of an employee’s wage rate on the formal Claim for Compensation is a statement of “fact”.
HoldingThe Missouri Court of Appeals for the Eastern District reversed the Commission’s decision and found that the allegation of a wage rate is an issue of fact. Therefore, as the Employer’s Answer was not timely filed, the “max rate” allegation on the Claim was deemed admitted and claimant was entitled to payment of PPD benefits at the maximum rate of $376.55.
AnalysisThe Court relied upon case law (Aldridge v. Southern Missouri Gas Co., 131 S.W.3d 876 (Mo. App. S.D. 2004) which indicated that when a specific wage rate is alleged on the Claim for Compensation, this is deemed a statement of fact. Therefore if the Employer’s Answer is not timely, this fact is admitted. The Court rejected the argument that this case law did not apply because the Claim in this case pled the AWW at the “maximum rate”. In doing so, it stated that Section 287.190.5(5) provides for a specific method of computing the maximum average weekly wage based on the current state average weekly wage. As the methods for calculating the state average weekly wage are also provided specifically by statute, the Court reasoned that the allegation of a “max rate” was immaterial to the analysis under Aldridge.
The award from the Court pertained to only PPD benefits as those were the only benefits in dispute at the time the case was decided. However, dicta in the case also indicated that the analysis above would also apply to TTD benefits and result in payment of the maximum rate according to the specific date of injury.

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