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RN Sues After Her Workers’ Compensation Claim Is Denied

A person sing a ball point pen to fill out a form titles Work Injury Claim Form

When the workers' compensation process works as intended, an employee who sustains an injury or illness that is directly related to their job and occurs while they’re working can receive compensation and additional benefits as outlined in the designated plan for work-related injuries.

Workers’ compensation payments and benefits are provided regardless of who is at fault. The sole issue is whether the injury or illness arises during a worker’s employment. 

In a 2023 case, an appeal was filed by an employer after the state workers' compensation commission ruled in favor of the RN.

Facts of the case

Annie, an RN, was hired at a medical center in a supervisory role. Her responsibilities included scheduling, payroll, and credentialing. She was assigned  a third-floor office and was parking in the employee lot on the east side of the building.

Her office had no basic office supplies, but she could order them through the department secretary. Unsure of when they would arrive, Annie decided to purchase her own supplies and bring them to work. After completing her work on her eighth day on the job, Annie decided to take her lunch break and retrieve some items from her car.

According to Annie, as a salaried employee and an RN, she was required to assist in a medical emergency and was also required to stay overnight if the hospital was short staffed, so even though she was on a lunch break, technically she was still on duty.

While making her way to her car, Annie rolled her right ankle on a sunken-in part of the sidewalk, resulting in an awkward fall. With the assistance of her rolling suitcase, she managed to regain her footing and proceeded to her car. 

After retrieving the necessary items, Annie took a few minutes to sit on her heated car seats. She then returned to her office.

Annie didn’t immediately report her injury to her supervisor because she didn’t see her that day, but she did report it the next day. She told the supervisor that the right ankle felt better. However, she said, her left hip was feeling worse and she wanted to see a doctor. 

Her supervisor told her that, since she was still in her probationary period, she would have to do so after business hours.

Annie's left leg pain persisted, leading her to seek treatment on multiple occasions. Eventually, an MRI taken several weeks after the incident revealed the presence of a stress fracture in her left femur. As soon as she received the diagnosis, she promptly notified her supervisor, who then guided her through the process of filing a workers' compensation claim.

Annie files compensation claim

Within a few days, Annie underwent surgery on her left hip, and after approximately three weeks, she received clearance to resume light-duty work. However, she struggled with the amount of walking her role required. Her workers’ compensation claim was denied, and about a month later, she was terminated from her position on the grounds of “unexcused medical” reasons.

Annie's past medical history included a lumbar laminectomy at disc L5-S1, treatment for piriformis syndrome, and fibromyalgia, all prior to her employment at the medical center.

After a hearing on her claim, with testimony from Annie and her supervisor, the hearing officer found Annie’s testimony highly credible. Even so, he ruled that she failed to demonstrate that her injury arose out of and during her scope of employment. Rather, he ruled, she went to her car on her lunch break for her own convenience and benefit, not her employer's. 

Annie appealed this decision to the full commission, which reversed the hearing officer’s decision. 

It held that Annie was a credible witness, that when she went to her car she was “performing duties which at least indirectly benefitted the employer,” and that the surgery she required after her fall was a “natural consequence and was causally related to the compensable injury.”

Medical center’s appeal

After the medical center filed an appeal, the appellate court held that the hearing officer’s “thoughtful assessment” of Annie’s credibility cannot be reversed due to prior state case law on credibility findings by hearing officers.

It also held that Annie’s injury occurred “within the time and space boundaries” of her employment “while carrying out the employer’s purpose or advancing the employer’s interest directly or indirectly.”

Last, it upheld the full commission’s determination that Annie’s back injury was a natural consequence of her fractured hip. It cited an earlier state case decision that held “when a pre-existing injury is aggravated by a later compensable injury, compensation is in order.”

Guidelines for you

Annie fought long and hard to obtain a ruling in her favor, which is oftentimes the case with workers’ compensation cases. The case opinion didn’t include the benefits Annie received, but it’s likely they included payments for the cost of her medical treatments and lost wages. 

Retaining a nurse attorney or attorney who concentrates their practice on workers’ compensation is such an important first step in these situations. They can represent you in the workplace proceedings for your claim and also in a lawsuit if the claim is not resolved in your favor by the employer.

The significance of the case decision cannot be overstated as it highlights several crucial guidelines for you to bear in mind. Your chosen attorney will furnish you with tailored counsel and instructions throughout the process of filing a claim and, if required, during a lawsuit. An attorney will likely impart many directives including the following: 

  • Immediately inform your supervisor or other identified administrative person in writing of any injury or illness arising out of and occurring within your scope of employment, using required forms.
  • Keep a copy of the notification of the injury or illness you provided.
  • Document all subsequent treatments, contacts with work administrative personnel, and actions or inactions of administration.
  • If you suffered from a previous medical condition that is worsened or changed due to the workers’ compensation illness or injury, provide your attorney with all details and treatments surrounding that condition so it can be evaluated within the workplace claim or lawsuit.
  • Always testify truthfully in all workers’ compensation proceedings since credibility is a pivotal factor in determining a favorable ruling in any administrative or judicial proceeding.

You can read more about workers’ compensation, benefits, and specific state requirements by clicking here.

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