A Tale of Three Blisters in Three States

There are about 29 million diabetics in America, many of whom are working. Their diabetes, a complex, risk-laden co-morbidity, can turn a simple injury into a career-ending event. Here we have three tales involving blisters, two resulting in amputations, but only one determined to be compensable under workers’ comp. When it comes to compensability, the devil is in the details.

Outdoors in NY

Our first case involves Daniel Phelan, a groundskeeper in Bethpage State Park, New York. He developed a diabetic ulceration on the first metatarsal of his right foot, which led to a bone infection and ultimately to amputation. Phelan attributed the infection to the cold conditions in which he regularly worked. A workers’ comp judge initially agreed, but at the Board and Appellate levels, Phelan’s claim was denied. There was no medically demonstrable link between work and the ulceration. The cold work environment may have been a factor, but a root cause other than diabetes could not be established.

Outdoors in AR

Our second case comes from Arkansas. John Pearson was sent by his employer, Workforce, a temporary employment agency, to a steel fabricating plant. The plant gave him the requisite steel-toed boots to wear while he covered warm steel bundles with blankets. By the end of his first day, he had developed a large blister on his left great toe. The next day he requested wider boots, but none were available. He could not afford to purchase boots on his own until he got paid, so he continued working in his company boots.

Two weeks into the job Pearson was diagnosed with “diabetic neuropathy and cellulitis.” He underwent surgery on the toe, which fortunately did not require amputation. He filed for comp benefits and initially prevailed, only to be denied at the Commission level. However, the Court of Appeals ruled in Pearson’s favor, finding that the work required “rapid repetitive motion” — running around outside with blankets to cover the warm steel. Because the injury involved both “repetition” and “rapidity” — qualifying factors under state law — the injury was deemed compensable.

INSIDE IN MS

Our third blister case takes us to Mississippi, where Earl Sterling, a machinist, purchased the steel-toed boots required by his employer, Eaton. His feet hurt immediately; a blister developed within a week. However, Sterling was not forthcoming with his employer. He took a week off, complaining of a sprained ankle. Eventually, when the blister popped, Sterling sought treatment from his family doctor. He ran a high fever, was hospitalized, developed a staph infection, and ended up with an amputation below his knee.

Sterling filed for workers’ comp, but his case was undermined by his own contradictory testimony. He was unclear about the exact nature of the injury: He testified that the blister was on top of his fourth and fifth toes, but medical records indicated it was between the toes, where a friction blister is less likely to occur. To complicate matters further, his diabetes was out of control for 90 days prior to his employment with Eaton.

In this unfortunate case, Sterling ends up literally without a leg to stand on. We could conjecture that his failure to tell the truth from the beginning stemmed from his fear of losing the job, but in the long run, that would not matter. Comp standards are clear: The injury must arise out of and in the course of employment. A blister between the toes does not meet this standard.

The Diabetic’s Dilemma

In these three blister tales, the two most severe were deemed not compensable because work activity was not the primary cause of the disability. The compensability decisions had nothing to do with severity itself, but stemmed from comp’s strict standards. Workers’ comp is a remarkable program with robust benefits, but the bar for eligibility is very high indeed. 

 About the Author:

Since 1990 Jon Coppelman has trained thousands of business owners from Main Street to Fortune 500 on the fundamentals of workers’ compensation cost control. From 2006 to 2012 he was a principal writer for the Workers’ Comp Insider, LynchRyan’s first-in-the-nation blog dedicated to risk management issues. He currently divides his time between his consulting businesses and his role as Senior Workers’ Compensation Consultant for the Renaissance Alliance, an aggregator based in Wellesley, MA serving more than 90 local agencies across New England.

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