May 2, 2012
Industrial Injuries and Doctor's Reports

by Justice Paul E. Pfeifer

This case involved a man named Matthew T. George, who injured his right shoulder while on the job at Honda of America Manufacturing, Inc. Matthew had surgery to repair the injury, and his workers’ compensation claim was allowed exclusively for right shoulder conditions.

The surgery for those conditions was first performed by Dr. Larry W. Watson in 2004. The procedure yielded good results, and Matthew returned to work at Honda without medical restrictions.

For four years Matthew had no further treatment to his right shoulder. Then, in February 2008, he returned to Dr. Watson with renewed shoulder complaints. Dr. Watson felt that these symptoms were related to the industrial injury, and he asked Honda – which is a self-insured company – to add new shoulder conditions to the workers’ compensation claim and to authorize shoulder surgery to correct the problems.

In response to these requests, an independent medical examination was performed. The doctor who performed the exam did not believe that Matthew’s shoulder complaints were related to the industrial injury, stressing Matthew’s successful recovery from his earlier surgery, his return to Honda without restriction, and his nearly four years without treatment.

The doctor felt instead that Matthew’s symptoms were related to his work with a property management company – a job Matthew had taken after he left Honda for undisclosed reasons.

Honda also had Matthew examined, by Dr. Walter H. Hauser, who found nothing wrong with Matthew’s shoulder.  The exam did, however, reveal a ruptured biceps tendon, which was not allowed in the claim. Dr. Hauser believed that this rupture was the source of Matthew’s complaints.

In his report, Dr. Hauser wrote that, in his opinion, Matthew “has been a very active individual. This is confirmed by the records. Surveillance indicates that he has been able to use his right shoulder in a very active manner.”

Dr. Hauser said the rupture was totally unrelated to his work-related injury, but rather “to his subsequent activities, including his workouts at the health club.” Matthew had “excellent strength in his upper extremities, and no impairment that can be noted judging by his activities on the surveillance video.” Dr. Hauser concluded that no additional surgery was necessary.

Based on that report, Honda would not authorize shoulder surgery. The Industrial Commission of Ohio – which handles such claims – also denied the surgical request based on that same document.

In response to that denial, Matthew filed a complaint with the court of appeals. The appellate court ordered the Commission to reconsider Matthew’s application for further surgery after finding “troubling inconsistencies” within Dr. Hauser’s report that the court of appeals believed disqualified the report from evidentiary consideration.

After that, Honda and the Commission filed an appeal here – at the Supreme Court of Ohio.

It is well established that authorization for medical treatment requires a causal relationship between the injuries for which the claim was allowed and the proposed services. The Commission did not find a causal connection in this case, based on Dr. Hauser’s report. The viability of that report as evidence was the sole issue in this case.

In previous cases through the years we have determined that the Commission is exclusively responsible for assessing the weight and credibility of evidence. It only needs to cite evidence in support of its decision, and the presence of contrary evidence is immaterial. But it cannot rely on a medical opinion that is equivocal or internally inconsistent.

In this case, the court of appeals concluded that Dr. Hauser’s report could not support the Commission’s decision because it was internally inconsistent in four respects – including two dates that Dr. Hauser confused and a comment that he made on a lack of available medical information after discussing in detail all of the medical reports in the file. But the court’s analysis either ignored or misinterpreted several prior decisions from cases that were before our court.

Two of those cases revolved around medical opinions that were contradicted by or inconsistent with other statements that the doctor had made either in a previous report or within the same report. For instance, in one case the physician’s report indicated that the claimant had a very high degree of impairment, but then concluded that he could perform heavy foundry labor.

Our court concluded that the report could not be relied upon to support denial of compensation because both statements were relevant to the question of the claimant’s ability to work, yet neither could be reconciled with the other, thus undermining the reliability of the document as a whole.

In that case we discussed the important distinction between equivocal opinions and those that were simply ambiguous. Equivocation disqualifies an opinion from consideration and occurs “when a doctor repudiates an earlier opinion, renders contradictory or uncertain opinions, or fails to clarify an ambiguous statement.”

Ambiguous remarks, on the other hand, “are inherently different from those that are repudiated, contradictory or uncertain.” Such statements “reveal that the doctor is not sure what he means and therefore, they are inherently unreliable,” and those types of statements relate to the doctor’s position on a critical issue.

“Ambiguous statements, however, merely reveal that the doctor did not effectively convey what he meant and, therefore, they are not inherently unreliable. Such statements do not relate to the doctor’s position, but to his communication skills.” Under such a view, any doctor’s opinion could be disregarded merely because he failed on a single occasion to employ precise terminology.

In Matthew’s case, the critical question asked of Dr. Hauser was whether additional shoulder surgery was necessary. Dr. Hauser opined that it was not, because his examination revealed nothing wrong with Matthew’s shoulder. Accordingly, the presence of inconsistencies within his report that do not contradict that critical opinion are harmless.

Ultimately, none of the alleged inconsistencies noted in the Hauser report affected the viability of the doctor’s opinion that further surgery was not reasonably related to the original injury. Therefore – by a seven-to-zero vote – we reversed the judgment of the court of appeals.

EDITOR'S NOTE: The case referred to is State ex rel. George v. Indus. Comm., 130 Ohio St.3d 405, 2011-Ohio-6036. Case No. 2010-1841. Decided November 30, 2011. Opinion Per Curiam.