Klein v. Maine Department of Labor

Name

Insurance Company

State Workers' Compensation Division

Date Decided

February 20, 2015

Panel Members

Elizabeth Elwin

Glen Goodnough

Tom Pelletier

File Size

156 KB

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Summary from the Troubh Heisler Attorneys

When a prior decree finds the employee’s mental health symptoms are not a compensable sequela of her work injury, a subsequent decision must adopt that prior factual finding.

Klein had injured her arms at work and lost her job two years later. In the first proceeding, H.O. Smith found her mental stress arose not from her injury but from the “workplace disciplinary action” that was unrelated to her injury – grounds that are expressly made non-compensable by §201(3). Ms. Klein continued to receive mental health treatment and soon filed another petition which included those bills. An orthopedic §312 IME was performed, and the IME doctor said he thought her mental health issues related to the injury. H.O. McElwee felt bound by that opinion and granted the employee’s petition. The Appellate Division, however, noted that the employee/appellee had not presented any “comparative medical evidence” to show a change in circumstances since the first decision.

Comparative medical evidence is a medical opinion which compares the employee’s medical condition at the time of the earlier decision with the employee’s current medical condition and states that there has been medical change. The hearing officer then determines whether the change is sufficient to permit a new determination on a medical issue previously decided. The Appellate Division held that, despite the normally “binding” effect of the §312 IME opinion, the legal doctrine of res judicata barred an award of medical benefits for her mental health treatment, given the absence of comparative medical evidence to permit the hearing officer to revisit the causal relationship between her mental condition and her injury.

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