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MOUNT VERNON, Ill.—A worker's testimony about his neck injury was sufficient evidence by itself to support a workers compensation award and medical expense reimbursement for an out-of-town surgery, an Illinois appellate court has ruled.
In 2008, Continental Tire North America Inc. was ordered by a workers comp arbitrator to pay temporary total disability benefits to Bryan Simpson, as well as more than $235,000 in costs and travel expenses for a disc replacement surgery that Mr. Simpson underwent in Missouri, court records show.
The Illinois Workers' Compensation Commission and a Jefferson County circuit court upheld that decision.
Continental appealed, saying the “sole support for an award rests upon the claimant's own testimony” about the 2006 work injury, according to records. The company also argued that Mr. Simpson's testimony wasn't credible because he didn't report or seek treatment for his injury until nearly two weeks after it occurred.
In a decision Thursday, the 5th District Illinois Appellate Court rejected Continental's argument, saying “it is well-settled that a claimant's testimony standing alone may be sufficient to support an award of benefits under” the state's workers comp law.
“In this case, the claimant's own testimony that he was symptom-free prior to the accident on June 30, 2006, and exhibited symptoms after the accident, is sufficient, if believed, to establish a causal connection between the claimant's work-related accident and his subsequent condition of ill-being,” according to the ruling.p>
Mr. Simpson, who worked as a tread line operator for Continental Tire, injured his neck while changing a large, solid-steel die. He was treated by several doctors for neck and back pain, and three of them testified that his injuries appeared to be work-related.
Mr. Simpson, who lives in southern Illinois, sought treatment from an orthopedic specialist in St. Louis, and later underwent a disc replacement surgery in St. Louis. He later submitted medical bills and travel expenses from those visits to a workers comp arbitrator, and said he could not find a local physician to perform the surgery.
Continental said the St. Louis medical treatment should not qualify for reimbursement because Mr. Simpson did not receive a proper referral for the orthopedic specialist. However, the state appellate court disagreed with the company and ruled that Mr. Simpson's testimony showed the treatment was "medically necessary but unavailable in the local area."
NCCI Holdings Inc. has asked for a 3.5% increase in workers compensation rates for Illinois next year, despite recent reforms that are expected to reduce the state's workers comp costs.