Cautious Medical Opinion Sinks NY Worker's Knee Injury Claim

Acknowledging that medical opinion evidence need not be expressed with absolute or reasonable medical certainty, but stressing that it nevertheless needed to be based on more than a mere possibility, a New York appellate court reversed a Board decision that found a claimant had established a work-related injury where the Board found that the claimant’s medical expert had expressed an opinion that it was “highly possible” that the injury was causally related to work [Matter of Johnson v. Borg Warner, Inc., 2020 N.Y. App. Div. LEXIS 4991 (Sept. 3, 2020)].

Background

Claimant, a chain manufacturer, submitted a claim for workers’ compensation benefits alleging that he sustained a work-related injury to his left knee. Claimant testified that his job required constant walking in different directions in order to operate machines, sorters and stackers in a specified area. He testified that, on the day of the injury, he was walking through the area and felt a sudden pain in his left knee. Claimant ultimately was diagnosed with a meniscus tear, as well as degenerative changes, in his left knee, and he underwent arthroscopic surgery.

The employer denied the claim, contending there was no causal connection between the employment and the injury. Following a hearing, at which claimant and his treating orthopedist testified, the WCLJ established a work-related injury to claimant’s left knee and awarded workers’ compensation benefits. The Board affirmed and the employer appealed.

Appellate Court Decision

The appellate court noted that claimant’s treating orthopedic surgeon testified that it was difficult to determine when the meniscus tear occurred. The doctor further testified that there was “a strong possibility” that there was an acute or chronic tear of the meniscus and that it was “very reasonable that something could have happened at work that exacerbated a chronic condition.” According to the court, the Board found the medical testimony expressed a conclusion that it was “highly possible” that the injury was causally related to work. The court concluded that this fell short of the reasonable probability that was required to establish a causal relationship between claimant’s employment and his or her injury.

The court stressed that expert medical testimony must signify a probability of the underlying cause that is supported by a rational basis and not be based upon a general expression of possibility. Here, claimant’s medical expert had only established that such a connection was possible.