He Got Workers’ Comp, But Now He Wants More: Court Says …

Idaho’s highest court upheld a finding that an employee who received workers’ comp benefits was not further entitled to total and permanent disability benefits as well.

While working for Dependable Auto Sales in late March of 2018, Robert Nelson injured his back while lifting a garage door.

An x-ray showed degenerative disease of the lower spine, and a doctor issued a diagnosis of “acute back pain with left radiculopathy.”

Employee Files for Workers’ Comp Benefits

Nelson stopped working and filed a workers’ comp claim in mid-April of 2018. In the same month, he had an MRI that showed degeneration at his L5-S1 joint. A doctor said that lifting the door probably caused a flare-up of arthritis and a possible disc bulge in his back. Nelson never went back to work.

In August of 2018, the employer hired a doctor to perform an independent medical examination. That doctor said Nelson’s back problems were caused by his morbid obesity and were unrelated to work.

That doctor also said the door-lifting injury would have resolved in a few weeks, adding that Nelson could return to work with no restrictions.

A third doctor later agreed that Nelson’s back problems were unrelated to his work.

A fourth doctor then said that the work injury caused a permanent impairment and assigned an 11% permanent partial impairment.

Before the March 2018 injury, Nelson had suffered knee, ankle and shoulder injuries.

Vocational Assessments Differ

A vocational assessment made in December of 2020 concluded that Nelson was totally and permanently disabled, but another one completed in July of 2021 found he had no restrictions as a result of the March 2018 injury.

After an April 2018 workers’ comp claim was settled in September of 2019, Nelson filed a claim for total and permanent disability benefits in March of 2020.

At the hearing on that claim, it came to light that he had been charged in 1996 with felony insurance fraud in connection with a workers’ comp claim and had pleaded guilty to a misdemeanor in that matter.

The referee who heard the later claim for total and permanent benefits determined that Nelson was not a credible witness and that his claim should be denied. The referee noted that Nelson had provided inconsistent testimony.

Application for Benefits Is Denied

A state commission adopted the referee’s recommendation and denied his claim for benefits. It said Nelson did not show that he was totally and permanently disabled or that he suffered a permanent impairment as a result of the March 2018 accident. Nelson then filed an appeal, which reached the Supreme Court of Idaho. He said the commission improperly found that he was not a credible witness, and that the finding improperly influenced its decision.

The question on appeal, the reviewing court explained, was whether “substantial and competent” evidence supported the commission’s determination.

The court noted that a preexisting permanent impairment is not an absolute bar to the recovery of total and permanent disability benefits. But to recover, a claimant must show that the combined effects of the preexisting injury and the work injury resulted in total and permanent disability – or that the work injury “aggravated or accelerated” the prior condition to cause total and permanent disability.

Reviewing Court Affirms Denial of Benefits

The reviewing court concluded that there was enough evidence for the commission to find that Nelson was not totally and permanently disabled.

It said that in evaluating Nelson’s credibility as a witness, the commission permissibly considered his 1996 misdemeanor conviction for insurance fraud.

Nelson argued that the conviction should not have been considered because it was irrelevant, but the court disagreed. It said that despite its age, the conviction went “to the very heart of this matter since it establishes Nelson previously lied in order to obtain workers’ compensation benefits.”

The order of the commission was affirmed.

Nelson v. State of Idaho, No. 50485-2023 (Idaho 8/6/24).