Filed Under:Risk Management, Loss Control

Challenging a medical expert's opinion in a workers' comp case

The value of a medical expert's testimony in any personal injury case depends on a strong factual basis. That's just as important in a workers' compensation case. (Photo: iStock)
The value of a medical expert's testimony in any personal injury case depends on a strong factual basis. That's just as important in a workers' compensation case. (Photo: iStock)

It's quite common for expert witnesses to present their opinions regarding a party's medical condition in a personal injury suit. Experts are generally required to show that their methodology and reasoning are scientifically valid and apply to the facts of the case in which they’re testifying.

It's also common for those opinions to be challenged. In one recent case, the Minnesota Supreme Court explained how to scrutinize the factual foundation of a medical expert's opinion about a worker's medical condition in a ruling reversing a decision by the Workers’ Compensation Court of Appeals (WCCA).

The case


Eddie Hudson was injured while working for Trillium Staffing when the semi-trailer truck that he was driving jackknifed and veered into a ditch. Hudson filed a workers’ compensation claim for low back, neck and concussion injuries from the accident, as well as psychological injuries.

Two months later, Hudson and Trillium reached a stipulated settlement under which Trillium agreed to pay Hudson a lump sum of $125,000 in exchange for settlement of all of Hudson's injuries for which he claimed permanent partial disability (PPD), with the sole exception of future reasonable medical expenses for his low back and neck injuries. The compensation judge reviewed the stipulation and approved it.

Following the settlement, Hudson began seeing Dr. Savina Ghelfi, a psychiatrist, who diagnosed Hudson with severe major depression, generalized anxiety disorder, and post-traumatic stress disorder. She assigned a 75% PPD rating to Hudson for the traumatic brain injury. The evaluation also resulted, for the first time, in a medical opinion that Hudson was unable to work due to his injuries.

About one year after the settlement, primarily relying on Dr. Ghelfi's opinion, Hudson filed a petition with the WCCA to vacate the award and hold a new hearing “for cause” based on a substantial change in medical condition since the time of the award that could not reasonably have been anticipated at the time of the award.

The WCCA agreed, also relying on Dr. Ghelfi's opinion, and it vacated the award. Trillium challenged the WCCA's decision, arguing the medical evidence the WCCA relied on was legally insufficient.

The court reversed, holding that the WCCA had abused its discretion when it granted Hudson's petition to set aside the award of benefits. Here, Hudson's medical evidence failed to show the substantial change in medical condition.

Related: Why workers' compensation treatment guidelines matter

No factual foundation


The court decided that the WCCA had not sufficiently scrutinized the factual foundation of Dr. Ghelfi's opinion. According to the court, Dr. Ghelfi's opinion was “descriptively flawed” because it never indicated what facts formed the basis of her opinion that Hudson's traumatic brain injury warranted a PPD rating of 75%. It also didn't explain how she had calculated the rating.

Moreover, the court added, the factual support for Dr. Ghelfi's PPD rating was “lacking in the record.” According to Minnesota law, a 75% PPD rating involved constant “moderate to severe emotional disturbances ... and require[d] sheltering with some supervision of all activities.” Nothing in the record indicated that Hudson needed “sheltering” and “some supervision of all activities.”

The court ruled that Dr. Ghelfi had assigned a PPD rating that was “manifestly contrary to the facts in the record.” Dr. Ghelfi's opinion “lacked foundation,” and it had not established a substantial change in Hudson's medical condition because it failed to explain the facts on which it relied, did not provide an adequate explanation of its reasoning, and had no support in the record.

The case is Hudson v. Trillium Staffing, No. A16-2017 (Minn. June 7, 2017).

Related: The end is not the answer: Confronting suicide

Steven A. Meyerowitz, Esq., (smeyerowitz@meyerowitzcommunications.com) is the director of FC&S Legal, the editor-in-chief of the Insurance Coverage Law Report, and the founder and president of Meyerowitz Communications Inc.  This story is reprinted with permission from FC&S Legal, the industry’s only comprehensive digital resource designed for insurance coverage law.

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