CLAIMANT AWARDED TEMPORARY TOTAL DISABILITY BENEFITS (ALJ AVERY)

ATOSHA C. JAMES V. HUNTINGTON INGALLS INCORPORATED-PASCAGOULA OPERATIONS
Read Full Decision Here

Excerpts

Claimant is 30 years old and has a GED.  She started working for Employer on October 18, 2006.  She began her career as a firewatcher, but by the time of her accident on September 1, 2010, she was a pipe fitter.  On September 1, 2010, Claimant fell and twisted her left ankle.  She was taken to an emergency room where she said she also complained of left-sided back pain but was told to discuss those complaints with Dr. Warfield, Employer’s resident physician.  She did so on September 2, 2010, and Employer’s Exhibit 1 is the accident report.  

Claimant testified she continued working but went back to the emergency room on September 5, 2010, complaining of back and side pain.  On September 8, 2010, she saw Dr. Stewart, who took her off work.  On September 9, 2010, Claimant returned twice to the emergency room with what she described as contraction-type pains and was operated on by Dr. Horn.  He found a twisted left ovary with a ruptured cyst, both of which he removed. Claimant is seeking temporary total disability from September 8, 2010, to October 28, 2010, when she reached maximum medical improvement (MMI) and returned to work.  The ankle is healed, and what Claimant seeks is compensation while recovering from the surgery, plus medical expenses involved.   She also seeks future medical treatment because she will need hormone therapy.

Conclusion

The Employer is liable for all medical expenses which are the natural and unavoidable result of the work injury.   In order for medical expenses to be assessed against an employer, the expenses must be both reasonable and necessary.   Parnell v. Capitol Hill Masonry, 11 BRBS 532, 539 (1979).  The claimant establishes a prima facie case for compensable medical treatment  by showing a qualified physician deems the treatment necessary for the claimant’s work-related injury.   Turner v. Chesapeake & Potomac Telephone Co., 16 BRBS 255, 257-58 (1984).  When the employer or carrier learns of the claimant’s injury, it must authorize medical treatment by the claimant’s chosen physician.  Once the claimant has made her initial free choice of physician, she may change physicians only with prior written approval from his employer or carrier, or from the district director.  33 U.S.C. § 907(c). As stated above, I have found Claimant’s lower backside pain and ovary torsion compensable under the Act; the parties stipulated that Claimant’s ankle injury was caused by the workplace accident.  Therefore, I find Claimant is entitled to reasonable and necessary treatment for these conditions.  However, I found that the symptoms allegedly related to Claimant’s hormone changes after her oophorectomy are not compensable under the act.  Consequently, I find Claimant is not entitled to hormone treatment.