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Court Overturns Denial of Claim for CRPS

  • State: New York
  • Topic: NORTH
  • -  247 views
  • - Average time spent on item: 29 minutes
  • - Popular with: Legal
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A New York appellate court upheld a decision by the Workers’ Compensation Board to provide a former school district employee with temporary partial disability benefits, but it overturned the determination that she did not have complex regional pain syndrome.

Case: Matter of DiBenedetto v. Rochester City School District, No. 529001, 01/30/2020, published.

Facts and procedural history: Claire DiBenedetto worked for the Rochester City School District. She established a workers’ compensation claim for an injury to her left shoulder in 2012.

Dr. Hossein Hadian provided stellate ganglion block injections from 2013 to 2017. He implanted a spinal cord stimulator in April 2014 and diagnosed DiBenedetto with complex regional pain syndrome of the left upper extremity.

DiBenedetto requested that her claim be amended to include the condition.

In March 2017, Dr. Yaqi Hu, of the Cleveland Clinic's Pain Management Center, diagnosed CRPS in both of DiBenedetto’s upper extremities.

Hadian requested authorization for injections to DiBenedetto's right shoulder, and she sought to amend her claim to also include CRPS of the right upper extremity.

The School District opposed both requests to amend and it objected to the request for further injections. The district further protested payment for services DiBenedetto received from the Cleveland Clinic and for the injections administered by Hadian.

A workers’ compensation law judge granted the requests to amend, approved the requested injections and resolved the disputed medical bills in favor of the health care providers. The judge also found that DiBenedetto was entitled to benefits after February 2017 at a total temporary disability rate.

Upon review, the Workers' Compensation Board found DiBenedetto had not established CRPS of the left or right upper extremities. The board also found that she was only temporarily partially disabled and denied authorization for the injections.

Additionally, the board ruled that the district was not liable for payment of the disputed bills.

Analysis: The Appellate Division’s 3rd Department noted that there was conflicting medical testimony on the extent of DiBenedetto’s disability.

Although Hadian opined that she suffers from a temporary total disability, an independent medical examiner said she had only a partial disability. The court said the resolution of credibility issues is the exclusive province of the board, and its finding of a temporary partial disability was adequately supported by the record.

As for the compensability of DiBenedetto’s CRPS diagnoses, the court noted that an independent medical examiner opined that she did not have the condition. The board found the examiner’s opinion more persuasive than that of Hadian, but it did not appear to have reviewed Hu’s opinion.

The court said it could not ascertain what decision the board would have reached had it reviewed Hu's report. Therefore, the case had to be sent back to the board for further proceedings.

Disposition: Reversed and remitted.

To read the decision, click here.

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