What Makes a Doctor’s Report Ambiguous for Workers’ Compensation Purposes? A New Supreme Court Case Attempts to Make That …Unambiguous

It is well settled law that the Industrial Commission cannot base its decisions on “equivocal” medical evidence.  State ex rel. Eberhardt v. Flxible Corp. Equivocation occurs when a doctor: 1) repudiates an earlier opinion, 2) renders contradictory or uncertain opinions, or 3) fails to clarify an ambiguous statement. A Supreme Court case released last week, State ex rel. Pilarczyk v. Geauga County, 2019-Ohio-2880, addressed the last of those three tests, namely, an ambiguous statement by a physician.  The takeaway from that case is that a statement is ambiguous if it is “susceptible of more than one reasonable interpretation.” 

Pilarczyk was a permanent total disability case.  The controversy surrounded the following two answers in a physician’s report:

 

  • “Can the injured worker return to his/her former position of employment? If yes, are there any restrictions or modifications?

 

The claimant’s mental health issues likely do prevent him from returning to his former position of employment. His problems with depression continue to manifest including problems with focus and motivation. It is believed that his problems with distractibility and motivation inhibit his ability to return to work at this time.

 

  • Please provide a summary of any functional limitations solely due to the psychological condition in this claim. In other words, please indicate the type of work the injured worker can perform and supportive rational[e] for your opinion.

 

Given his current mental health issues, he is unlikely to thrive in a moderate to high stress job setting. He is more likely able to work a job in an office where there is less stress to trigger his depressive based condition.”

According to the majority opinion, the report presented an ambiguity—whether “return to work” as the doctor used the term in his response to the first question meant return to his former position of employment  or return to work in general.   The majority said the answer to the second question was also ambiguous. According to the majority, while it was not clear that Dr. Gruenfeld was even attempting to offer a firm opinion on whether he believed that Pilarczyk could work, it was possible that he believed that Pilarczyk was not psychologically capable of any work.

Two justices dissented, finding that, when read as a whole, the report was clear that the injured worker was capable of working in a low stress position.

Personally, I agree with the dissent.  “Inhibit” does not necessarily equal “prohibit”.  But that’s not really the point.  The takeaway for we workers’ compensation practitioners is to make sure that your physicians’ reports are crystal clear.  If a report is susceptible to more than one interpretation, I will certainly be arguing that it should be rejected as ambiguous under the Pilarczyk standard.

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