Workers’ compensation covers woman’s fall at doctor’s office, court finds

A woman who was treated for exposure to ant spray in the workplace, then hurt her knee at the doctor’s office while being treated, qualifies for permanent total disability, the Court of Appeals Western District ruled.

In May 2009, Mid-Missouri Health Center sprayed the chemical Cypermethrin around its air conditioning system to treat for ants. Lucille Schoen, a charge nurse, complained of throat and eye irritation and coughing. When her symptoms persisted, the center sent her to an occupational and environmental medicine specialist for additional evaluation.

While escorting her to the exam area, the doctor accidentally tripped Schoen. She fell and injured her left knee, left shoulder, back and neck. She continued to be treated during  the next few years both for breathing issues and pain from her fall. By 2015, a doctor declared her to be permanently and totally disabled as a result of those injuries, though only 5 percent of her disability stemmed from effects of the ant spray.

An administrative law judge agreed that Schoen was permanently disabled and found the center was liable for the payments. But in a split decision, the Labor and Industrial Relations Commission reversed that finding. The majority of the commission concluded the Cypermethrin exposure wasn’t the primary cause of Schoen’s disability and that her fall at the doctor’s office wasn’t part of the course of medical treatment for her workplace injury.

In 2005, the legislature tightened the Missouri Workers’ Compensation Law to say that workplace injuries are “compensable only if the accident was the prevailing factor in causing both the resulting medical condition and disability.”

But in its Sept. 3 opinion, the Western District pointed to a line of cases in which injuries that were the “natural consequence” of medical treatment for workplace injuries were compensable under the workers’ compensation system. Most recently, in a 1991 decision, Lahue v. Missouri State Treasurer, the Western District OK’d a claim from a patient who hurt her back in a fall from a chair during whirlpool therapy for her ankle injury.

Schoen’s doctor “directed the location for his patient’s pulmonary testing; Schoen merely followed the directive of her doctor and, while doing so, sustained new injuries,” Judge Mark D. Pfeiffer wrote for the court.

“Therefore, Schoen’s new injuries were sustained in the course of Schoen receiving authorized medical treatment for her original injury and, hence, were part of the natural consequence flowing from her original injury,” he wrote. Judges Lisa White Hardwick and Thomas H. Newton concurred.

Pfeiffer added that it didn’t matter that Schoen’s fall wasn’t the direct result of a medical procedure. To do their jobs, he said, doctors have to perform a series of tests and gather information about the patient.

“Simply put, the doctor cannot do the doctor’s job if the patient refuses to cooperate with the doctor’s directive on how and where the process of diagnosis or medical procedures are to take place,” he wrote.

The court remanded the case to the commission for further proceedings, including whether the liability would fall on the employer or on the state’s Second Injury Fund, which covers claims by workers whose preexisting conditions are made worse by an on-the-job injury.

Truman E. Allen of Allen, Nelson & Wilson in Columbia, an attorney for Schoen, didn’t return a call seeking comment.

The case is Schoen v. Mid-Missouri Mental Health Center et al., WD82258.