Workers Comp Appeals Court is Told: Don’t Diagnose the Claimant, Decide the Case

The Workers Compensation Court of Appeals just got slapped down for a ruling that reflected their belief that they could diagnose psychological injuries better than the credentialed expert who testified in the lower court case.

Case Comes to a Head

School Bus Monitor Ellen Gianotti claimed she suffered a significant head injury and severe emotional distress after the bus driver unexpectedly hit the brakes one day, causing her to fall and strike her head.  Although CT scans and X-rays that day did not demonstrate a brain injury, Gianotti quickly started complaining of headaches, confusion and trouble finding words.

She then underwent neuropsychological assessments and was diagnosed with a concussive injury.  She was referred for psychological intervention for emotional distress and then began treatment with a therapist for anxiety, depression and panic attacks that she alleged were related to her head injury.  The workers compensation insurer initially admitted liability and workers’ compensation benefits were paid.

A No-Brainer for the Judge

Gianotti submitted to an independent psychological evaluation at the employer’s request.  The independent psychological examiner reviewed medical records which showed that Gianotti had taken anti-depressant and anti-anxiety medication for at least seven years before the incident.  It was also noted that she had never fully disclosed this condition to the doctors treating her for the bus injury.

Further psychological testing showed that Gianotti’s self-reported psychiatric symptoms including extreme suffering, memory, and cognitive problems were not credible.  The independent psychological examiner concluded that Gianotti did not suffer a concussion, post-concussive syndrome, or a psychological injury.

Based on the report of the independent psychological evaluation, the workers’ compensation insurer sought to stop paying workers’ compensation benefits. The Workers’ Compensation Judge reviewing this request accepted the opinion of the independent psychological examiner and found that Gianotti had not suffered a concussion and/or post-concussive syndrome.  He therefore denied her claim for treatment for emotional and/or psychological conditions and permitted the insurer could discontinue paying wage loss benefits.

The case was appealed to the Workers’ Compensation Court of Appeals (WCCA) which reversed the Compensation Judge’s findings that Gianotti did not suffer a concussion or post-concussive syndrome and vacated the denial of coverage for the emotional and psychological conditions.  The WCCA reasoned that the independent medical examiner was not competent as an expert; he lacked factual foundation for his opinion because he did not review a video from the bus on the date of the injury; and all other evidence indicated that the Gianotti did in fact suffer from post-concussive syndrome.

Supreme Court Caps Appeals Court’s Authority

The WCCA decision was then appealed to the Minnesota Supreme Court, who reversed again, finding that the WCCA acted improperly.  For one thing, the WCCA should never have ruled on the competence of the independent psychological examiner because that issue was not raised on appeal.

Additionally, the Supreme Court found that the WCCA acted improperly in deciding that the independent psychological examiner did not have adequate foundation for his opinion.  They noted that the independent examiner reviewed Gianotti’s pre-injury and post-injury medical history, conducted a battery of tests and interviewed Gianotti herself.  This gave the examiner a good foundation for his conclusions such that the WCCA had no good reason to discredit the opinion simply because he did not review the bus camera video from the date of the injury.

Indeed, the Supreme Court found it noteworthy that despite claiming that the video should have been reviewed, the WCCA never explained why the video would have discredited the independent medical opinion or why the treating doctors were more credible even though they too never reviewed the video either.

As a result, the Supreme Court concluded that the Judge had sufficient evidence to find that the examiner’s opinion was well-founded, and that the WCCA should have supported the Judge’s decision in this regard even if they might have come to a different conclusion.  In short, the WCCA’s job was simply to see if the judge had an adequate basis for his ruling, not to decide if the ruling was ultimately correct or not.

Finally, the Supreme Court found that the WCCA should not have reversed the Compensation Judge’s findings that Gianotti did not suffer a concussion and post-concussive syndrome.  The Court admonished the WCCA that it did not have the authority to substitute their view of the evidence for that of the Compensation Judge.  Again, their job was to determine if the Judge’s findings were supported by evidence that a reasonable mind might accept as adequate.  In this instance, the judge relied on the testimony of an acknowledged medical expert.  A court full of judges had no business second guessing that opinion.

Bottom Line

While this might seem like a technical issue only, our Workers Compensation Department finds this case quite significant since it limits the WCCA’s ability to overturn a well-presented case.

This is why it is so critical to plan your case carefully and present the facts properly at the initial adjudication. The WCCA can only look to whether the compensation judge’s decision is supported by the evidence, and may not simply conclude that the decision was wrong.