Illinois employer's reliance on medical opinion nixes assessment of penalties
The Illinois Workers' Compensation Commission vacated the arbtriator's decision awarding penalties to the claimant under Sections 19(k) and 19(I) of the Illinois Workers' Compensation Act.
Case name: Treadway v. Munch's Supply Co., 17 ILWCLB 58 (Ill. W.C.Comm.2009).
Treadway was working as a truck driver for the employer when he twisted his right ankle and injured his right knee. He was diagnosed with a right ankle and knee sprain and was treated with pain medication. After cointinuing complaints of pain and discomfort, Treadway was diagnosed with complex regional pain syndrome (CRPS) in the right ankle. Based on the testimony of two examining doctors, the defendant stopped paying for Treadway's treatment. However, the arbitrator ordered the defendant under Section 8(a) to pay for the reasonable and necessary medical care prescribed for CRPS, and arthroscopic knee surgery.
Furthermore, the arbitrator found the defendant's decision to disallow ongoing treatment for the Treadway's condition was vexatious and unreasonable. Therefore, Treadway was entitled to penalties pursuant to Sections 19(k) and 19(I) of the Illinois Workers' Compensation Act.
Multiple doctors either diagnosed or assented to Treadway as suffering from CRPS of the right ankle. Treadway had the clinical signs of this condition, including swelling, color changes, temperature changes, hair loss, and a shine to the skin, in addition to hypersensitiviy to toch and paresthesia in the foot.
The employer's examining doctor focused his report on Treadway's contention of right ankle pain. The doctor suggested that Treadway was shaving his foot and using some sort of device to make his right ankle swell and be colder in temperature when compared to the left ankle. A second examining doctor, a foot and ankle specialist, did note the swelling, hair loss and temperature changes experienced by Treadway, but stated that he did not have a sufficient background to comment on whether Treadway suffered from CRPS. He recommended an IME by another doctor. The arbitrator explained that based on the reports of these two doctors, the employer chose to terminate Treadway's right to medical care for treatment of his right ankle. The arbitrator found such choice by the defendant was not objectively reasonable under the circumstances.
However the Illinois Workers' Compensation Commission vacated the award of penalties. The Commission determined that the defendant was not unreasonable or vexatious in relying on the opinions of the examining docotrs. The opinions were not objectively unreasonable.
