What If the Company's Doctor Disagrees with Mine about My Impairment Rating?

It often happens that the doctor employed by the workers compensation insurance company disagrees with the impairment rating assigned for the work injury by the injured worker's doctor. Such a disagreement in a Kentucky workers compensation case is resolved by the ALJ, who acts as the factfinder. A recent case decided by the Kentucky Supreme Court, Toyota Motor Manufacturing v. Prichard, illustrates and helps explain how this works.

Prichard suffered a neck injury while working on the assembly line at Toyota in March 2005. She was diagnosed with a cervical strain and degenerative disc disease in her neck area. In November 2007, an ALJ found that she had a permanent impairment rating of 8% and awarded permanent partial disability benefits (PPD benefits) on this basis. Prichard's condition worsened, she reopened her Kentucky workers compensation claim, and in September 2011, the ALJ determined that her impairment rating has increased from 8% to 28%. Prichard's condition continued to deteriorate and her doctor concluded in April 2014 that she was no longer physically capable of working in any capacity,  even in a sedentary job. His conclusion would support a finding that Prichard's impairment rating was 100%.

Toyota offered expert medical testimony from its own doctor, Dr. Timir Banerjee. Dr. Banerjee concluded in testified that Prichard's condition had remained unchanged with an impairment rating of 8% since he first examined her in 2009.

The ALJ agreed with Prichard and found that she was totally disabled (her impairment rating is 100%) based on the "persuasive, compelling and reliable" medical evidence. Toyota argued to the Kentucky Supreme Court that its doctor, Dr. Banerjee, was right and Prichard's doctor was wrong. That argument went nowhere as the Court explained: "Dr. Banerjee's opposing view constitutes merely a battle of the experts, the resolution of which is properly left to the ALJ as the individual privileged to view first-hand the totality of the evidence and the credibility of the witnesses."

So the answer is this: where the injured worker's doctor and the doctor hired by the company or by its workers compensation insurance company disagree as to the scope of the permanent impairment created by the work-related injury, it is up to the ALJ to decide which to credit. Only in very, very, very rare circumstances will the ALJ's decision as to this type of fact be overturned on appeal.

Lexington, Kentucky workers compensation lawyer Robert Abell represents individuals and families on Kentucky workers compensation claim; contact him at 859-254-7076.