Proof of total disability established through nonmedical evidence

In O'Connor v. Med-Center Home Health Care, Inc., the Appellate Court of Connecticut discussed the proof requirements to establish eligibility for total disability benefits under the state's workers' compensation laws. The Appellate Court held that the question as to whether a claimant is totally disabled is not simply a medical determination regarding the physical limitations affecting the claimant's work capacity. The claimant's own testimony adequately proved that she was unemployable even without expert medical evidence that she was totally disabled.

Background and procedural history

The claimant worked as a duty nurse. In 1996 she slipped and fell on ice in a patient's driveway and suffered injuries to her hand, wrist, right knee, and left shoulder. The defendants, the nurse's employer and the employer's workers' compensation insurance carrier, accepted the claim and covered the injuries.

Several years later, after the claimant requested coverage for a partial knee replacement, the claimant was evaluated by two orthopedic physicians, independent medical examiners provided by the defendants. Both physicians concluded in their reports that the claimant had the capacity to do sedentary work. As a result, the defendants filed a notice of their intention to discontinue or reduce the payments to the claimant.

At the hearing, the plaintiff submitted medical reports from her treating physician, indicating that the claimant was capable of only the most sedentary of work duties and was "functionally disabled." The reports stated that the claimant was unable to endure standing for long periods, high-stress walking, or duties requiring her to arise repeatedly from a seated position, or lifting, twisting, or other high-impact workplace activities. The reports also stated that the claimant was severely limited in her ability to travel to and from her residence to a job.

The claimant also testified herself that her pain prevented her from even performing a desk job because she could not sit for extended periods of time without experiencing numbness and muscle spasms in her leg .

Following the hearing, the workers' compensation commissioner determined that the claimant was totally disabled. The ruling was upheld by the compensation review board. The defendants then filed an appeal in the Appellate Court.

The appellate court's ruling

The appellate court stated that evaluations of total disability claims involve a "holistic determination of work capacity," rather than simply a medical determination. A claimant seeking total disability benefits must submit proof that he or she is unemployable. A medical report concluding that the claimant is total disabled is just one way a claimant can prove total incapacity to work. There are other types of evidence the commissioner can consider in making a finding of total disability. The claimant can also establish diminished earning capacity through proof that the claimant actively sought employment but was unable to obtain gainful employment.

The medical reports submitted by the claimant proved that she had significant physical limitations regarding her work capacity. Although the reports did not expressly state that the clamant was totally incapacitated from working, the claimant's own testimony that she was unable to even do desk work because of the pain from sitting for long periods of time and because of her limited mobility provided sufficient proof to show that she was temporarily totally disabled.

Individuals seeking benefits provided under the workers' compensation laws should consult the professional services of a competent attorney, experienced in such matters, to ensure that their rights are fully protected.