Zurich ordered to reinstate comp benefits to injured workerReprints
Zurich American Insurance Co. unreasonably terminated workers compensation disability and medical benefits to an employee with a back injury because it improperly weighed the opinion of an independent medical examiner over the worker’s treating physician, the Workers’ Compensation Court of Montana ruled Wednesday.
Danial Floyd was a 50-year-old employee for Enid, Oklahoma-based natural gas supplier Hiland Partners L.P. in 2014 working as a gauger, a position that required heavy labor activity. Mr. Floyd was a smoker and had developed osteoporosis and osteopenia, which made him more susceptible to fractures, according to court documents in Floyd v. Zurich American Insurance Co. of Illinois.
In December 2014, Mr. Floyd was en route between job sites in Montana when his truck developed a flat tire. While trying to apply force to a stuck lug nut, Mr. Floyd twisted his body and felt several pops in his back with subsequent pain in his legs, groin, lower back and between his shoulder blades. Unable to get up, Mr. Floyd lay in the snow for up to 45 minutes waiting for his supervisors to arrive to take him to the hospital, court records show.
Mr. Floyd’s injury, which was diagnosed as spinal compression fractures, was accepted by his employer and insurer Zurich American Insurance Co. of Illinois as work related, according to court documents. Mr. Floyd received treatment and was restricted from working. In April 2015, he moved to Texas and transferred treatment to doctors there, who prescribed medication and physical therapy, according to court documents.
In June 2015, Mr. Floyd underwent a bone density test, which revealed osteoporosis and osteopenia, which his doctor described as unusual for his age. In July 2015, Zurich declined to authorize additional physical therapy, saying he had not shown sufficient progress, court records show.
Mr. Floyd then received steroid injections to help with continuing symptoms. Zurich inquired whether Mr. Floyd could return to modified work involving lifting, bending and stooping. His doctor said he could not, according to court documents.
The doctor then recommended a conservative pain management program, where he was diagnosed with chronic pain syndrome. The pain management clinic requested authorization for 80 hours of pain management treatment, court records show.
In December 2015, Mr. Floyd underwent an independent medical examination, which reviewed 11 of about 30 records. The physician who conducted the exam made several mistakes and omissions, which he acknowledged during testimony, and questioned the diagnosis and origin of the injury. The doctor said he believed Mr. Floyd had reached maximum medical improvement, had undergone all reasonable and appropriate treatment, and that he should be able to return to work. The examination assigned a 14% whole-person impairment to Mr. Floyd. Zurich subsequently terminated workers comp benefits and declined to pay the impairment award, according to court documents.
The workers comp court disagreed with Zurich on its arguments that the cause of the injury was unknown, that the independent medical examiner’s opinion should be given more weight than the treating physician’s opinion, and that Mr. Floyd’s pre-existing conditions justified termination of benefits.
The court determined that the independent medical examination physician’s opinion should carry no weight and that Zurich’s actions were unreasonable because it accepted the examiner’s opinion that the injury could possibly be unrelated to work as fact. The court also determined it was unreasonable for Zurich to accept the independent examiner’s opinion on the injury but disregard his impairment award.
“It is unreasonable for an insurer to disregard uncontroverted medical evidence and take an inconsistent position,” the court said. “This court therefore finds that Zurich’s termination of benefits and its refusal to reinstate benefits were unreasonable.”
The court determined that Mr. Floyd has not achieved maximum medical improvement and that he is entitled to temporary total disability and medical benefits from the point of termination of benefits until those benefits may be lawfully terminated. The court also awarded Mr. Floyd attorney fees, costs and a penalty.
Representatives of Zurich were not immediately available to comment.