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Sometimes Subsequent Injuries Are Covered and Sometimes They Are Not.

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By: Fred J. Lewis

On July 20, 2016 the Idaho Industrial Commission filed their Finding of Fact Concussions of Law and Order in Funke v Atkison Logging Company Inc. and Liberty Northwest Insurance. In this case the Claimant suffered a compensable accident which resulted in Total Permanent Disability. It left him with a burst fracture of L1, a right below knee amputation, paraplegia,  neurogenic bowl and bladder, and without sensation below the wrist.  Mr. Funke loved to deer hunt even after his Idaho Worker’s Compensation accident. He was given an ATV for mobility by Liberty. While he was deer hunting on November 18, 2009 on his ATV, he fractured his right femur while getting off of his ATV. The Surety denied the claim. While deer hunting again on his ATV on December 1, 2014 he fractured his left femur. Liberty denied both of the claims taking the position that this was a subsequent accident and not part of his Idaho Worker’s Compensation claim.

The Claimant contended at the hearing that the fractures were the direct and natural consequence of osteoporosis which arose from the Claimant’s paralysis caused by the compensable industrial accident. Two of Claimant’s treating physicians offered their medical opinions in support of the claim that the osteoporosis lead to him breaking the two femurs. The total medical bills calculated to $95,732.93.

The defendants contended that on both occasions, Claimant was riding an ATV while deer hunting. Medical records revealed that both fractures where the result of falls from the ATV.  Defendants had no doctors that offered any opinions as to the role of the osteoporosis in the breaking of the Claimant’s femurs.

After reviewing all the evidence, the Industrial Commission ruled that Liberty was required to pay for the medical bills relating to the 2009 right femur fracture because the Claimant has preformed the mounting and dismounting procedures on his ATV without any problems. The Claimant loved to solo hunt for deer and the Commission could not conclude that the Claimant’s ambitions towards hunting by himself in the mountains in Northern Idaho amounted to negligence. Therefore, the Commission held that the events of the November 18, 2009 did not constitute a superseding/intervening event which breaks the chain of causation between the original accident and the Claimant’s right femoral shaft fracture.

In regard to the December 1, 2014 accident the Commission held that a different outcome was warranted. After his 2009 accident, the Commission believed that the Claimant was on notice that he could hurt himself even if it was a trivial fall or bump because of his osteoporosis. The Claimant persisted in his habits and that resulted in his second femoral shaft facture. The Commission did not require Liberty to pay for the second accident.

The take away from this case is that if you are injured as result of some vulnerability that is brought on by your original Idaho Worker’s Compensation claim it appears the Idaho Industrial Commission may rule in your favor and require the Idaho Worker’s Compensation Insurance company to pay for your medical bills even if it is 18 years after your accident, since there is no statute of limitations on medical benefits associated with your Idaho Worker’s Compensation claim.

 

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