Fernandez v. Smithfield Foods, Inc.

Appeal from the Labor and Industrial Relations Commission

Before Cynthia L. Martin, Presiding Judge, Mark D. Pfeiffer, Judge and Edward R. Ardini, Jr., Judge

Cynthia L. Martin, Presiding Judge

Juan Fernandez ("Fernandez") appeals from the Labor and Industrial Relations Commission's ("Commission") final award denying his claim for workers' compensation benefits relating to an injury suffered to his left knee. Fernandez argues on appeal that the Commission was without jurisdiction to review the temporary award of workers' compensation issued by an administrative law judge. Fernandez alternatively asserts that the Commission erred in denying his claim for workers' compensation because his doctor's testimony was sufficient to establish that an accident was the prevailing factor in causing Fernandez's medical condition and disability even though the doctor never used the phrase "prevailing factor," and because the overwhelming weight of the evidence established that Fernandez's accident was the prevailing factor in causing Fernandez's

medical condition and disability. Finding no error, the Commission's final award is affirmed.

Factual and Procedural History^[1]

Fernandez began working for Smithfield Foods, Inc. ("Smithfield Foods"), a pork processing plant in Kansas City, Missouri, in 2014. Fernandez worked for Smithfield Foods for nearly eight years as a laborer on the facility's production floor. Fernandez worked eight-hour shifts, during which he stood in order to lift and cut hams weighing up to approximately thirty-five pounds. Fernandez received two 15-minute breaks, one in the morning and one in the afternoon, and a 30-minute lunch break every day.

On February 22, 2021, Fernandez took his morning break. To reach the facility's break room from the facility's production floor, employees had to climb stairs to the main floor before going down another set of stairs to the break room. On the way to the break room that morning, Fernandez was walking down the stairs when he lost his footing. Fernandez was able to keep himself upright while holding on the railing, but his left foot "skidded" down three steps. Fernandez reported the fall to his supervisor, completed his workday, and returned home. While at home, Fernandez noticed that his left knee was swollen.

The next day, February 23, 2021, Fernandez went to work, but he experienced pain in his left knee while working on the facility's production floor. Fernandez went to his supervisor's office and reported the pain in his left knee. Fernandez's supervisor told him to visit the nurse's station located in the processing plant. A nurse examined Fernandez's knee and "placed something on [his] knee . . . like a hot pack" while Fernandez rested. There was a shortage of meat to process that day. When the supervisors asked for volunteers to go home for the day, Fernandez volunteered to do so though his seniority would have permitted him to stay.

Fernandez returned to work on February 24, 2021, and again visited the nurse's station complaining about pain in his left knee. The nurse drove him to Concentra, an occupational medicine provider, for examination at Smithfield Foods's expense. The physician assistant who examined Fernandez diagnosed him with a strain to his left knee, prescribed medication, ordered Fernandez to use a cane, instituted work restrictions requiring Fernandez to sit 100 percent of the time, and cleared Fernandez to return to work that day. The physician assistant also ordered an MRI on Fernandez's left knee. The next day, February 25, 2021, Fernandez worked a full day, accommodated by the restrictions put into place by the physician assistant.

Fernandez was examined by a doctor at Concentra on February 26, 2021, at Smithfield Foods's expense. The doctor directed Fernandez to continue taking the medications prescribed, to continue using a cane, and to continue the work restrictions instituted by the physician assistant. The doctor also gave Fernandez a knee brace.

Fernandez returned to Concentra at Smithfield Foods's expense on March 5, 2021. The physician assistant who treated Fernandez that day noted that the order for an MRI was still pending, and advised Fernandez to continue with the prescriptions, orders, and work restrictions provided during Fernandez's two earlier visits.

Smithfield Foods's worker's compensation insurer denied coverage for Fernandez's claim. As a result, the MRI ordered by Concentra's medical providers was never authorized by the insurer. Neither Smithfield Foods nor the worker's compensation insurer paid any other benefits to Fernandez or on his behalf. Given the denial of Fernandez's claim by the insurer, Fernandez's work restrictions were not further accommodated. Fernandez's last day of employment with Smithfield Foods was March 17, 2021.

After the insurance company's denial of his claim, Fernandez sought medical treatment from his own doctor on March 29, 2021. The doctor ordered an MRI on Fernandez's left knee. The MRI, which was performed on March 30, 2021, revealed that Fernandez was suffering severe lateral patellofemoral osteoarthritis in his left knee. Fernandez paid $50 for the doctor's visit and $300 for the MRI of his left knee.

Fernandez filed a claim with the Division of Worker's Compensation ("the Division") on May 18, 2021, and Smithfield Foods filed an answer denying all liability and compensation on May 21, 2021. An administrative law judge ("ALJ") held a hardship hearing on October 12, 2022. Fernandez and Smithfield Foods agreed that the issues to be resolved by the ALJ were as follows: (1) "whether [Fernandez] sustained an injury by accident arising out of and in the course of employment"; (2) "whether

[Fernandez] is entitled to temporary total disability payments from March 18, 2022 to present and ongoing"; (3) "[w]hether [Smithfield Foods] must reimburse [Fernandez] for medical expenses totaling $350"; and (4) "whether [Smithfield Foods] must provide [Fernandez] with additional medical care."

Fernandez testified at the hardship hearing about his fall on the stairs, and that prior to February 22, 2021, he had never visited either Smithfield Foods's nursing station or his own doctor for problems related to either of his knees. Fernandez further testified that his doctor informed him that he needed to see an orthopedic surgeon about the possibility of surgery on his left knee. In addition to Fernandez's testimony, the ALJ received exhibits from both parties, including Fernandez's medical records, and reports and depositions from two doctors who evaluated Fernandez.

Dr. Z., a physician, performed a medical evaluation at Fernandez's request on September 15, 2021. Dr. Z concluded that Fernandez had not yet achieved maximum medical improvement and that additional medical treatment would be required in the future. Dr. Z. opined that Fernandez might benefit from physical therapy, nonsteroidal anti-inflammatory medications, injections of a steroid and a local anesthetic, or orthopedic treatments, including surgery, for his left knee. During his deposition, Dr. Z. testified that it is not unusual for a person with patellofemoral osteoarthritis to be asymptomatic but then to develop pain after an incident. Dr. Z. testified that he believed to a reasonable degree of medical certainty that the current condition of Fernandez's left knee was the result of the accident during which Fernandez fell and jarred his left knee on the steps at Smithfield Foods's pork production plant.

Dr. S., an orthopedic surgeon, was retained by Smithfield Foods's insurer to perform a medical evaluation of Fernandez on May 2, 2022. Dr. S. wrote a report and testified about his findings, all of which were based on a reasonable degree of medical certainty. Dr. S. opined that Fernandez's "underlying arthritic changes, combined with his underlying obesity, are likely the source of his persistent difficulties and problems." Dr. S. determined that the arthritic changes to Fernandez's left knee preexisted the February 22, 2021 accident, that the symptoms were "aggravated at the time of the incident," but that the arthritis itself was not caused by or worsened by the February 22, 2021 accident. Dr. S. further opined that Fernandez "did not sustain any permanent partial impairments or disability" as a result of the February 22, 2021 incident so that the permanent partial disability rating for Fernandez's left knee is 0 percent. Dr. S. believed that the treatment that Fernandez received for his left knee injury was appropriate and that concluding such treatment was appropriate. Dr. S. believed that Fernandez has reached maximum medical improvement from the injury to his left knee that occurred on February 22, 2021.

The ALJ issued a temporary award on November 30, 2022 ("ALJ Temporary Award"). The ALJ Temporary Award recited the evidence presented at the hardship hearing and found that Fernandez's testimony was credible. The ALJ found that Fernandez suffered an injury by accident while in the course and scope of his employment; that Smithfield Foods owes Fernandez $350 for the MRI and consult fee he paid for; that because the slip down the stairs aggravated Fernandez's underlying preexisting condition, Smithfield Foods was required to provide Fernandez with

additional medical care; and that because Fernandez's injury is compensable and occurred within the course and scope of his employment, Fernandez was entitled to temporary total disability benefits from March 18, 2021, and continuing until Fernandez has been released from medical care.

Smithfield Foods sought review of the ALJ Temporary Award from the Commission. Smithfield Foods asserted that the ALJ's finding that Fernandez suffered an injury by...