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Disability comp. can be denied if injured worker refuses additional exams

Supreme Court
Public Information Office

Published: February 19, 2019

An injured worker seeking workers’ compensation benefits may be subjected to additional medical examinations if the state explains why other exams would be necessary or helpful in determining the worker’s eligibility, the Ohio Supreme Court ruled recently.

In a unanimous per curiam decision, the Supreme Court affirmed the right of the Ohio Industrial Commission to suspend the application of Mary Mignella, a former Warren City Schools teacher, for permanent-total-disability (PTD) benefits until she submits to a second examination. Mignella sought a writ of procedendo from the Court directing the commission to proceed in reviewing her application for PTD benefits after she completed her first examination by a state-selected physician.

The opinion stated that under state law and rules, the commission can order that workers’ compensation applicants submit to multiple examinations, but noted in past cases, additional exams were permitted only when “necessary or of assistance in determining PTD.”

Teacher Reports Fall at School

According to an Industrial Commission report, Mignella, a 35-year employee of Warren schools, stated she injured herself in March 2011 from a fall at school. Her husband took her to St. Elizabeth Hospital’s emergency room for treatment.

In 2015, Mignella filed for PTD benefits, providing a report from her treating chiropractor that stated she was incapable of work. At the commission’s request, Mignella was examined by Dr. Elizabeth Mease, who reported that Mignella could perform “light physical demand activities,” but could not sit or stand longer than 15 to 20 minutes at a time.

In a deposition that followed her report, Mease admitted she made mistakes when examining Mignella, including not examining her according to American Medical Association guidelines. Because of the mistake, a state hearing officer ruled that the decision on PTD benefits could not proceed until Mignella submitted to a second medical examination.

Worker Refuses Exam, Seeks Court Order

Mignella refused to undergo a second exam, and sought a writ from the Tenth District Court of Appeals ordering the commission to decide her application. The court denied the request, and Mignella appealed the decision to the Supreme Court, which is required to hear the case.

Mignella argued that because she was already examined by a commission specialist, the state could not require her to submit to a second exam simply because the doctor did not follow the appropriate guidelines.

Law Permits Multiple Exams

The Supreme Court noted that under R.C. 4123.53(A) and the Ohio Administrative Code, the commission can order a person claiming a right to compensation to submit to a medical examination “at any time, and from time to time, at a place reasonably convenient for the employee....” The law states that if the employee refuses to submit or obstructs the exam, the workers’ compensation claim will be suspended.

The opinion cited the Court’s 1997 State ex rel. Clark v. Indus. Comm. decision, in which it found the commission has “broad discretion with regards to requiring a claimant to submit to medical examinations.” In the ruling, the Court noted the law does not specifically limit the number of medical exams the commission can require. However, the Court determined that the commission’s power is not unlimited and that it abuses its discretion when the record fails to indicate that additional exams are necessary or helpful.

The Court supported its ruling by relying on the hearing officer’s observation that Mease’s flawed report prevented the commission from accurately deciding Mignella’s application. Mignella had argued that, notwithstanding Mease’s report, there was enough other evidence in the record to decide the application.

The Court concluded that in light of the standards articulated in past court cases, “the order was proper because it identifies why another examination of Mignella was necessary or would be helpful.” And because it was proper for the commission to require the second exam, the hearing officer acted properly in suspending the application.

The decision affirmed the Tenth District’s ruling denying the writ.

The case is cited 2018-0085. State ex rel. Mignella v. Indus Comm, Slip Opinion No. 2019-Ohio-463.