When a worker files a workers' compensation claim, a major hurdle can
be proving that the injury or illness was caused by or at work. Too
frequently, the employer and/or insurance provider may try every means
possible to deny responsibility. One tactic is to deny a claim by
stating that the injury or illness is due to some factor other than
those at work. But a recent ruling by the Illinois Appellate Court may
help workers whose claims are wrongly denied on the inflated basis of
preexisting or mitigating factors.
William Gross worked for the Freeman United Coal Mining Company for
nearly forty years until 2003. Beginning in 1999, he began to notice
breathing problems. He noted that, "there was often so much coal dust
blowing around in the area the coal was loaded that he could not see."
As time progressed, his ability to perform regular activities such as
walking, exercising, chores and hobbies became limited by shortness of
breath. In 2005, he filed an adjustment of claim for benefits under the
Workers' Occupational Diseases Act. In the application, he stated that
he received lung injuries as a result of "inhalation of coal mine dust
including but not limited to coal dust, rock dust, fumes and vapors."
Among workers in coal mines, illnesses like black lung disease
and chronic obstructive pulmonary disease (COPD) are often more common
as a result of the cumulative effect of breathing in coal dust.
Gross's physician, Dr. Houser, diagnosed him with mild COPD caused by
long-term inhalation of coal and rock dust combined with Gross' past
use of cigarettes. Dr. Houser, a pulmonary specialist and medical director for a hospital specializing in black lung disease, noted, however, that even in nonsmokers he had seen similar damage in those exposed to coal dusts.
Gross' employer requested his records be reviewed by another physician, Dr. Renn. Dr. Renn,
who never actually examined Gross directly, disagreed with the
diagnosis, instead diagnosing him with mild emphysema from tobacco
smoking. He stated, "None of his diagnosis were either caused, or
contributed to, by his exposure to coal mine dust." He admitted,
however, that smoking and dust inhalation damage is indistinguishable
from one another on a cellular level and that COPD can have multiple
contributing factors. He also failed to explain how testing could or
would differentiate between COPD caused by smoking versus coal dust.
In 2008, a Workers' Compensation Commission arbitrator denied Gross'
claim, finding that his illness was not an occupational illness. Gross
appealed this finding to the Appellate Court, citing "the Commission
erred in accepting the opinion of Dr. Renn that coal dust exposure did not contribute to cause his COPD when Dr. Renn failed to give an adequate explanation of the basis of his opinion."
The Appellate Court agreed. Specifically, they acknowledged that Dr. Renn gave no evidence to support that smoking was solely to blame for Gross' illness. As Dr. Renn agreed that smoking and dust exposure both contribute to lung disease,
and that there was no way to determine if one was to blame over the
other, he could not have sufficiently shown coal dust was not totally or
partly to blame for Gross' medical problems.
As this case shows, when it comes to proving their injuries are real
and significant, workers are too often treated as though they are
"guilty until proven innocent." Their employer and/or insurance provider
hopes that with enough resistance, an injured worker will give up his
or her claim. With the help of a legal advisor, however, many such
workers are able to successfully receive the care and benefits they
deserve. If you've been injured at work, contact a Chicago workers compensation attorney who can assist you.
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