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Disability claimant’s condition ‘pre-existed’ work accident

A Rhode Island Superior Court judge has determined that an injured worker was properly denied accidental disability retirement benefits because she was not incapacitated as a “natural and proximate result” of a workplace accident.

In seeking benefits, the claimant, plaintiff Kellie Wallace, alleged she suffered debilitating memory loss, depression and anxiety after banging her head on a fire extinguisher when she picked up paper from the floor while working as a hospital janitor. Her physician corroborated her claim.

The Disability Subcommittee of the Employees’ Retirement System of Rhode Island, however, found that Wallace’s alleged condition was not due to the accident in question, given her history of suffering from a traumatic brain injury 30 years earlier and her treatment for psychiatric issues that pre-dated the incident.

Judge Jeffrey A. Lanphear affirmed.

“Contrary to Ms. Wallace’s assertion that the Retirement Board’s decision is contrary to the law and facts because the Board based its decision on the accident that occurred 30 years ago rather than the most current accident, the Board and the doctors did take all of Ms. Wallace’s medical history into account to come to their decision,” Lanphear wrote. “Importantly, the Board’s decision was based on the determination that Ms. Wallace’s condition, which is the basis of her application for retirement benefits, pre-existed the 2015 accident.”

The 18-page decision is Wallace v. Employees’ Retirement System of Rhode Island.

Harry J. Hoopis of Warwick, Rhode Island, represented the plaintiff. Michael P. Robinson of Providence represented defendant ERSRI. Neither attorney responded to requests for comment.

Workplace accident

Wallace, a state employee, worked as a janitor at Zambarano Hospital in Burrillville, Rhode Island.

On Feb. 13, 2015, she filed an injury report form over an injury that occurred while she was working at the hospital. According to Wallace, she was picking up paper from the floor that day and banged her head on a fire extinguisher when she stood up, leading to bad headaches, dizziness, forgetfulness, anxiety and depression.

Wallace maintained that the incident left her unable to handle multiple tasks at a time while causing her trouble with confusion and performance.

The plaintiff’s physician, Albert Marano, indicated on the plaintiff’s application that she was disabled and that the disability was a result of the accident. He concluded that she was permanently and totally disabled from work and that, based on his examination, she had reached maximum medical improvement.

Marano also referred the plaintiff to a neuropsychologist, who concluded that the plaintiff’s two most recent head injuries were on the mild end of the concussion spectrum, though she was vulnerable to longer recovery periods and greater deficits from injuries due to the severe head trauma she suffered in the early 1990s.

The neuropsychologist also concluded that Wallace’s cognitive symptoms would improve over time.

In a second assessment, the neuropsychologist concluded that Wallace had persistent post-concussion syndrome, adding that her pre-existing traumatic brain injury led to the less severe workplace injury resulting in such a poor outcome.

Wallace submitted additional records from the emergency department where she was treated after the accident and from her therapist.

The report from the emergency department indicated evidence of chronic damage to brain tissue, likely due to “old trauma,” and the therapist diagnosed her with major depressive disorder.

Meanwhile, Wallace was examined by three independent medical examiners in conjunction with her claim for benefits.

One of the independent medical examiners, Thomas Morgan, concluded that her disability was not a result of the Feb. 13, 2015, incident and that she was not permanently and totally disabled. Specifically, Morgan associated Wallace’s symptoms with pre-existing traumatic brain injury, depression and anxiety, all of which were being actively treated before the incident and did not previously interfere with her ability to work.

A second independent medical examiner, Naureen Attiullah, came to a similar conclusion, citing “ample evidence” that Wallace’s anxiety and depression existed prior to the accident, that Wallace had not reached maximum medical improvement since she had neither engaged in systematic desensitization nor exhausted medication trials, and that she was not disabled from doing her job.

A third independent medical examiner, David DiSanto, however, concluded that Wallace’s disability was, in fact, a result of the Feb. 13, 2015, incident and that she was permanently and totally disabled from work.

On Oct. 6, 2017, ERSRI’s Disability Subcommittee considered Wallace’s application for benefits and recommended denial, concluding that she was not physically or mentally incapacitated as a “natural and proximate result” of an accident while on duty.

In its finding, the subcommittee cited the “thorough and comprehensive opinions” of Morgan and Attiullah, while discounting DiSanto’s finding, which apparently did not address Wallace’s pre-existing therapy and treatment or a June 2014 incident in which she also hit her head.

The full retirement board affirmed the subcommittee’s recommendation on Nov. 8, 2017.

At a March 9, 2018, reconsideration hearing before the subcommittee, Wallace testified that the conditions leading to her claim — notably forgetfulness, nervousness around groups, fatigue and severe headaches — were caused by the Feb. 13, 2015, incident and that she had fully recovered from the incident 30 years earlier.

Nonetheless, the subcommittee remained unable to conclude that her current condition indeed was the proximate result of the workplace incident in light of her history of severe brain injury and treatment for psychiatric issues.

On May 11, 2018, the full retirement board affirmed the subcommittee’s findings and issued a final denial decision, of which Wallace sought judicial review in Kent Superior Court.

Denial affirmed

On judicial appeal, Wallace argued that the retirement board wrongly ignored her physician’s statement. She contended that because he was her treating physician, his determination should be given greater weight and consideration than the board’s physicians.

Lanphear disagreed.

“[G.L. 1956 §36-10-14(c), the accidental disability retirement statute] states that the retirement board may grant accidental disability benefits if a medical examination conducted by three physicians engaged by the retirement board determine that the member is physically or mentally incapacitated for the performance of service as a natural and proximate result of an accident,” the judge said. “In other words, the statute requires the Retirement Board to consider these three medical examinations and does not require the board to consider the opinion of the applicant’s physician.”

The reason for that requirement is that independent medical examiners have greater impartiality and fairness compared to an applicant’s physician, Lanphear explained.

“Therefore, the Retirement Board properly considered the independent medical examinations, placing less reliance upon the opinion of Ms. Wallace’s physician regarding her disability status,” he said.

Lanphear additionally found that the board’s factual determinations were supported by the evidence and entitled to judicial deference.

“Because the Court should not substitute its judgment for that of the agency as to the weight of the evidence on questions of fact and because this Court finds that the Retirement Board’s decision was not clearly erroneous in view of the evidence on the whole record, the Retirement Board’s decision is affirmed,” Lanphear wrote.

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