A claimant must demonstrate not only that he had an "accident" but also an "injury." An injury is not compensable unless the accident was the prevailing factor in both the medical condition and disability.
Claimant had an "accident" at work in 2010 when his right shoulder hurt moving some cartons weighing about 28 pounds, but he didn't prove his "accident" was the prevailing factor in his shoulder tendonitis or labral fraying. Claimant had sought a temporary award for further treatment.
The pivotal issue in the case was an MRI. The employer's expert, Dr. Lehman, indicated the MRI did not demonstrate an acute labral tear to support causation, although the MRI revealed degenerative arthritis, tendonitis and labral fraying. Another medical expert observed the employee's job as a line feeder personally and in his opinion it was not very challenging. The Commission, unlike the ALJ, concluded claimant sustained an accident based on his testimony that he reached above shoulder level at work during a rush job and experience sudden pain. Claimant failed, however, to demonstrate that the accident was the prevailing factor in his medical condition and disability. Claimant denied prior problems with his right shoulder but may not have disclosed previous permanent lifting restrictions of 15 pounds. He re-opened his own business as a martial arts instructor after the 2010 accident. Armstrong v Tetra Pak Inc., 2012 Mo. WCLR Lexis 34 (3-8-12).
Although it is not mentioned in the decision, the case is similar to Gordon v City of Ellisville, 268 S.W.3d 454 (Mo. App. 2008). In that post-reform case, claimant denied limitations with his shoulder although he had a prior shoulder surgery. The pivotal issue in that case was the operative findings. An MRI suggested a massive rotator cuff tear but Dr. Lehman in that case did not identify at the time of surgery any acute cuff pathology.
Source: Martin Klug, Huck, Howe & Tobin. Read Martin Klug's Mo. Workers' Comp Alerts.
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