Home > Uncategorized > Injury Sustained Traveling to AME Eval Not Compensable

Injury Sustained Traveling to AME Eval Not Compensable

If an injured worker gets into a car accident on the way to an AME evaluation, is the injury compensable?

Consider the recent panel decision in the case of Evans v. San Joaquin Regional Transit District.  The unfortunate applicant, having suffered a history of back injuries, now claimed a cumulative trauma to the back.  She was evaluated by an AME, who offered several conflicting opinions, wavering back and forth on the issue of whether there was an industrially caused cumulative trauma to her back, in excess of those past claims for which she had already been compensated.

While en route to an evaluation by the AME, applicant was in a car accident and sustained additional injuries, which she claimed were compensable.  As applicant was rear-ended while at a red light, presumably the compensation would be recoverable from the third-party insurer or the third party him/herself.  However, the unfortunate facts of the workers’ comp system would require the defendant, if the injury is admitted, to pay out first and seek credit or recovery later.

The matter proceeded to trial and the WCJ found both injuries compensable, awarding 15% permanent disability for the cumulative trauma, and an additional 14% permanent disability for the car accident as a compensable consequence.

On review, the WCAB reversed – the AME ultimately settled on the conclusion, after much back and forth, that there was no cumulative trauma injury to the back.

Additionally, the car accident claim was not compensable for two reasons: the first was that it was a consequence of a non-injury, and such no more compensable than applicant getting into a car accident while traveling to receive treatment for a non-industrial skiing injury.

Finally, the WCAB relied on the case of Rodriguez v. WCAB, where the Court of Appeal held that injuries sustained as a result of the litigation process were not compensable as consequences of an industrial claim.

Accordingly, the WCJ was instructed to issue a take-nothing order.

This case offered a good result for the defense, and a good reminder of AOE/COE boundaries.  The workers’ compensation claim is not a part of the job description, and while the events that give rise to the original claim might have compensable consequences, attending an AME evaluation certainly does not.

Categories: Uncategorized Tags:
  1. No comments yet.
  1. No trackbacks yet.