Recent Workers’ Compensation Case Shows Importance of Accurate Impairment Evaluation

BY STEVE FRANCO

In a significant decision by the Workers’ Compensation Appeals Board (WCAB) involving Sammy Vigil versus the County of Kern, the intricacies of impairment evaluation and apportionment were thoroughly examined. This case sheds light on the complexities of determining permanent disability in workers’ compensation claims and highlights why it’s crucial for injured workers to have expert legal representation.

Case Summary

Sammy Vigil, a maintenance painter for the County of Kern, sustained injuries to his hips and back, leading to bilateral hip replacement surgeries. Following these surgeries, a Qualified Medical Evaluator (QME), Dr. Peter Newton, assessed Vigil’s impairments and assigned whole-person impairment (WPI) ratings of 15% for each hip and 7% for the lumbar spine. Dr. Newton recommended adding the impairments for each hip, rather than combining them using the Combined Values Chart (CVC), due to the synergistic effect of the bilateral impairments.

Key Issues and Rulings

1. Impairment Rating and Synergy: The WCAB’s en banc decision emphasized that the CVC, which combines impairment ratings to account for overlapping effects on activities of daily living (ADLs), can be rebutted. In Vigil’s case, the QME argued that having impairments in both hips resulted in greater limitations than if the impairments were assessed separately. The WCAB agreed that impairments could be added if it was shown that the impairments’ effects on ADLs did not overlap or created a synergistic effect.
2. Apportionment and Surgical Outcomes: The case also delved into the apportionment of disability, especially following surgical interventions. The WCAB found that Dr. Newton’s apportionment opinion was not substantial evidence because it did not adequately explain what non-industrial factors contributed to the need for hip replacements. This decision clarified that successful industrial surgeries do not automatically exempt the resulting disability from apportionment, but detailed medical reasoning is required to establish non-industrial causation.

Practical Implications

This case underscores the importance of detailed medical evaluations and the necessity for workers to understand their rights under workers’ compensation law. The nuances of impairment evaluation, particularly when surgeries are involved, can significantly impact the disability benefits an injured worker receives.

For injured workers, this decision highlights several critical points:

• Detailed Medical Evidence: Ensuring that medical reports are thorough and well-reasoned is essential. In Vigil’s case, the lack of detailed explanation from the QME on the impacts of ADLs and the non-industrial causation of impairments played a pivotal role in the WCAB’s decision.
• Understanding Synergy: Workers and their representatives should be aware that the combined impact of multiple impairments can sometimes justify higher disability ratings. Demonstrating how impairments amplify limitations on daily activities can be crucial.
• Legal Representation: Navigating the complexities of workers’ compensation claims, especially with issues like impairment rating and apportionment, often requires expert legal assistance. Knowledgeable attorneys can help ensure that workers receive the full benefits they are entitled to by thoroughly developing the medical record and challenging inadequate evidence.

If you or someone you know has been injured at work and is navigating the workers’ compensation system, it’s vital to have experienced legal support. The Franco Munoz Law Firm is dedicated to helping injured workers get the benefits they deserve. Call us at (510) 257-4141 for a free consultation and let us assist you in securing the compensation you are entitled to.