March 18, 2013

Annals of Compensability: A Tale of Two Blisters

Back in November we blogged the story of John Pearson, a diabetic whose tight workboots - provided by his Arkansas employer - caused a blister that led directly to diabetic neuropathy. The injury was deemed compensable under workers comp. Today we examine a similar blister saga involving Earl Sterling, a machinist for Eaton Corporation in Mississippi. Like Pearson, Sterling was diabetic, but his is a story with a grim outcome. When it comes to compensability, the devil is definitely in the details.

Once again, the story begins innocently with new boots. Sterling began wearing new steel-toed boots - required by his employer - in June 2008. His feet started throbbing immediately; within a week, a blister had developed. He took a week off, telling his supervisor that he had twisted his ankle: he did not report the blister problem. After the blister popped, Sterling sought treatment from his family doctor. Within three weeks of first putting on the boots, Sterling had developed a high fever and was delirious. During his hospitalization, he developed a staph infection, resulting in the amputation of his leg below the knee. By the end of the year, Sterling had reached maximum medical improvement and had been cleared for seated work.

Work Related?
In July 2008 Sterling filed for workers comp benefits, claiming the blister was the result of wearing the boots. But in the course of his testimony, numerous contradictions and inconsistencies emerged. His initial report only involved a swelling of his feet - nothing about a blister. Hospital records indicate that his diabetes was out of control for at least 90 days prior to hospital admittance. In his testimony, he was unclear about the exact nature of the blister: he stated it was on top of his fourth and fifth toes, but medical records indicated it was between the toes, where a friction blister is less likely to occur.

Given the inconsistencies, the administrative law judge denied the claim. The denial was upheld at the appeals level.

It turns out that Sterling's family physician may have misdiagnosed - or at least mistreated - the diabetes: while two years prior to the injury, the doctor had given Sterling medications for regulating blood sugar, he mistakenly believed that Sterling's current blood sugar levels were within normal ranges. They were not. Three physicians testified that the blister was a result of the swollen feet and Sterling's uncontrolled diabetic condition and was independent of the wearing of steel-toed boots.

"Arising From and In the Course and Scope of Employment"
Thus we have two cases involving diabetes: one in which the co-morbidity leads to a work-related and compensable infection (Pearson), and one where the co-morbidity itself - and not the work-required boots - leads to the infection that ultimately requires an amputation (Sterling). Pearson is able to return to productive employment, supported every step of the way by the robust benefits of the workers comp system. Sterling finds himself without a job and without benefits, literally, without a leg to stand on.

In this tale of two blisters, one has a reasonably happy ending, the other does not. In the annals of compensability, eligibility for comp benefits is - in this particular case, at least - subject to the highly rigorous and presumably objective scrutiny of medical science. Sterling ultimately loses his case because his narrative is full of holes and his devastating condition apparently did not arise from and in the course of his work as a machinist.

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About this Entry

This page contains a single entry by Jon Coppelman published on March 18, 2013 12:02 PM.

Health Wonk Review, Compensability Challenges, Accommodations & More was the previous entry in this blog.

News roundup: risk, happiness, state fund in Illinois, new hire compliance & more is the next entry in this blog.

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