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A 33 year old woman in Marion County hurt her back lifting a box of books, had back surgery and asserts she was unable to work due to nonunion and intractable back pain. The issue in the case was whether the employer owed for life-time benefits when her addiction to smoking prevented her from having another back surgery to potentially improve her condition. Miller v Andersen Merchandisers, 2013 MO WCLR Lexis 168 [2013 MO WCLR Lexis 168] (August 30, 2013). An employer does not owe for medical care if it can prove the employee unreasonably refused treatment. Section 287.140.5 provides:
“No compensation shall be payable for the death or disability of an employee, if and insofar as the death or disability may be caused, continued, or aggravated by any unreasonable refusal to submit to any medical or surgical treatment or operation, the risk of which is, in the opinion of the division nor the commission, inconsiderable in view of the seriousness of the injury.”
The ALJ concluded the employer failed in its burden to show the claimant's inability to stop smoking was "unreasonable" based on testimony that she had smoked for over a decade and was unable to stop and had attempted nicotine patch, hypnosis and participated in a smoke cessation programs offered by the employer. The ALJ further noted that the employer technically had not "offered" surgery, because the two surgeons declined to offer it in claimant's current state of nicotine addiction. The employer in the case stipulated claimant was permanently and totally disabled and stipulated to open medical. Both of claimant's medical experts concluded she was not at maximum medical improvement. A dissent argued that claimant's smoking was likely a contributing factor to non-union in the first place and found claimant was not entitled to total disability because she would not quit smoking. The Commission affirmed the ALJ opinion without comment. The ALJ noted the statute essentially created bad public policy to reward someone for bad lifestyle choices but deferred to the legislature to address that issue. The court of appeals has previously found that a claimant who failed to make lifestyle changes such as losing weight or quit smoking was an unreasonable refusal to deny benefits under 287.140. Sutton v Vee Jay Cement Contracting, 37 S.W.3d 803 [37 S.W.3d 803] (Mo. App. 2000), Kern v General Installation, 740 S.W.2d 691 [740 S.W.2d 691] (Mo. App. 1987). This was not an issue in Miller as the employer stipulated to open medical and claimant demonstrated both a need for surgical treatment and non-surgical pain management with narcotics.The case is important in several respects.The Commission appears to construe 287.140.5 that if the worker makes a good faith effort (as in this case with use of hypnosis, nicotine patches, and participating in the smoke cessation program etc.) there is no refusal or no unreasonable refusal. Claimant also stated she wanted to have the surgery so this is not a case in which the employee refused aggressive treatment. Arguably, the findings could have been the same even if claimant stated she didn't want the surgery and elected to treat conservatively based on expert testimony that nearly a third of re-do surgeries fail even in optimal circumstances.The narrow issue in Miller was whether the employer owed for total or for partial disability because of claimant’s failure to successfully complete a smoking cessation program. Nicotine addiction is arguably a prior condition that combines to render claimant totally disabled although the issue was not addressed as the Second Injury Fund was not a party.
Source: Martin Klug, Huck, Howe & Tobin. Read Martin Klug’s Mo. Workers’ Comp Alerts.
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