After an accident on October 6, 2019, Timothy Ambuehl requested compensation regarding a shoulder injury. He appealed for coverage of a surgical procedure, temporary total disability benefits (TTD) and temporary partial disability benefits (TPD) at the behest of his employer, Cox Communications.
In examination of the case, the employer refused to provide compensation under the defense that the workplace accident not the major contributing cause (MCC) for the claimant’s ongoing shoulder issues.
The claimant was treated by Dr. Turnage for his workplace-related incident, but was reported to have withheld information about his treatments by Dr. Pilcher and Select PT. Dr. Turnage claimed that the claimant withheld reporting three separate injections he received by Dr. Pilcher, as well as his previous medical referrals for a future MRI and total shoulder replacement. The claimant stated that Dr. Turnage’s claims were false.
It was concluded that the claimant was not hiding their former medical issues, as their workplace supervisor testified that they were aware of Ambuehl’s limitations prior to the accident.
The judgement of this case did not grant the claimant coverage of their requested surgery. The denial of coverage was based on additional factors that proved the surgery to not be medically necessary. TTD benefits were denied based on section 440.15, since the claimant was working with light duty restrictions for 90 days following their accident. TPD benefits were granted due to the claimant receiving no income after the 90 days.
E/C fraud defense DENIED; shoulder surgery DENIED; TTD DENIED; TPD GRANTED for periods prior to the accepted MMI date. Claimant appealed, but voluntarily dismissed the appeal prior to court rendition.
Source: The 440 Authority