PPD May Be Awarded Without an AMA Report

June 2016

By Francis M. Brady

In a decision published on June 28, 2016 (Corn Belt Energy Corporation v. The Illinois Workers' Compensation Commission, et al.), the Illinois Appellate Court affirmed an award of 3% loss of the whole person even though the record lacked an AMA Rating. The employer had appealed, arguing that Section 8.1(b) of the Illinois Workers' Compensation Act requires the injured worker provide an AMA opinion. The Court declined to so obligate the injured worker finding that, in fact, neither the worker nor her employer must submit a report. It determined that "clearly, the plain language of Section 8.1(b) places no explicit requirement (regarding submission of an AMA Rating) on either party." The Court conceded that when an AMA report "is admitted into evidence, it must be considered by the Commission, along with the other identified factors, in determining the claimant's level of PPD." But, it reiterated that "...nothing in the plain language of the Act precludes a PPD award when no PPD impairment report is submitted by either party."

The Court's decision also addresses the issue of causal connection. The evidence at trial, consisting only of treating medical records and petitioner's testimony, was clear that his conditions pre-existed the work accident. He had undergone a significant amount of chiropractic care before the trauma, not completely dissimilar from what he underwent afterwards. The employer contended the Commission could not award PPD because the worker "failed to present any medical opinion evidence" affirmatively tying his condition to the work accident. The Appellate Court disagreed, indicating that petitioner's evidence was sufficient to show, on a circumstantial basis, that his back and neck conditions were different, and more significant, after the work trauma.

This decision teaches:

• Petitioner's burden of proof is not heavy.
• That from the outset, you, as the representative of the employer, will have to prove any propositions upon which you hope to prevail.
• To controvert causal connection, you should have an expert medical opinion under Section 12 indicating petitioner's condition is a product of problems and difficulties already existing at the time of the accident.
• Key will be evidence of care predating the accident, the more substantial and involved, the better to defend.
• A petitioner most likely will offer no AMA Rating. It is better, however, for the employer's cause, if we take responsibility for introducing an AMA Rating with a doctor in whom we have confidence.

Should you have any questions, or wish a copy of the decision, please let us know.