Name
Daniels v. SD Warren
Insurance Company
ESIS
Date Decided
December 7, 2017
Panel Members
Glen Goodnough
Evelyn Knopf
Mike Stovall
Categories
Medical EvidenceTags
Partial Incapacity Benefits Change of Circumstances Medical Evidence
File Size
187 KB
DownloadSummary from the Troubh Heisler Attorneys
Mr. Daniels injured his shoulders at work in 2003, and S.D. Warren paid him partial incapacity benefits per a 2011 decree. The following year, S.D. Warren filed a Petitions for Review and PI seeking to discontinue Mr. Daniels’ partial benefits pursuant to the durational limit in §213.
Mr. Daniels testified that his condition was worse than it was the prior year, and Dr. Graf’s §312 IME found him to be totally disabled. Judge Collier found, however, that Mr. Daniels had not provided any “comparative medical evidence” showing a change in his economic or medical circumstances since the prior decree, and he granted S.D. Warren’s petition, terminating Mr. Daniels’ incapacity benefits.
Mr. Daniels appealed, but the Appellate Division affirmed Judge Collier’s decision, holding that Dr. Graf’s finding of total disability was insufficient to prove a change in circumstances, because he did not actually compare Mr. Daniels’ incapacity in 2011 and 2012.
Dr. Graf did find Mr. Daniels’ range of motion to be less than it was when Dr. Esponnette measured it in 2008, but the Appellate Division found that an administrative law judge cannot, without specific medical support, make a medical judgment as to whether this increased Mr. Daniels’ incapacity. Instead, the panel held that the judge must depend on expert medical evidence directly comparing the employee’s condition at the time of the last decree to his condition at the time of hearing.