Why a Trial Firm
Hearing Summary: A Strain Diagnosis That Surgery Proved Wrong
Diagnosed as a strain. Found at surgery: two herniated discs compressing nerve roots.
This is an anonymized summary of a real Missouri workers’ compensation case our firm tried at a final hearing in January 2026. Names are removed to protect the client’s privacy, and the parties are referred to as Employee, Employer, and Insurer, the same convention the Division uses.
The dollar figures below are the amounts our firm presented and asked the Division to award at the hearing. Every case is different; results depend on the facts.
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The Case
What Happened
In October 2015, Employee, a carpet installer, fell onto his buttocks with a 300 pound roll of carpet on his shoulder, injuring his low back and right elbow. He had no prior back pain, no prior back treatment, and no prior back limitations. From the first records forward, he reported severe low back pain with numbness running down his right leg.
The authorized physician diagnosed a lumbar strain only, while at the same time recommending the epidural injections that are used for radiculopathy, radiating nerve pain that a simple strain does not explain. In June 2016 that same doctor referred Employee to a back surgeon for treatment.
The referral never turned into treatment. Instead of sending Employee to the surgeon, the Insurer sent him to an IME.
The IME
An Opinion Surgery Proved Wrong
The IME doctor examined Employee once. He diagnosed a strain, declared him at maximum medical improvement with no further treatment, cleared him for unrestricted work, and wrote that Employee was embellishing his symptoms.
Surgery later found two extruded disc herniations compressing nerve roots. On cross-examination, the IME doctor could not point to any medical record supporting his theory of a prior condition, because there were none. Employee had never treated for his back before the fall.
The Hearing
Strain or Herniation: The Difference Is the Whole Case
The Employer stipulated that Employee suffered a compensable low back injury, but only to a strain. The difference between a strain and herniated discs is the difference between a small case and a lifetime of consequences: the surgery, the work restrictions, the wage benefits, and the future care all turn on the resulting medical condition, which Missouri law tests under the prevailing factor standard.
The firm’s hearing memo also answered a second fight. The Employer asked the Division for permission to bypass Employee’s attorney and negotiate the denied bills directly with his doctors. The firm met that request with the Missouri case law that prohibits it.
The Ask
What the Firm Asked the Division to Award
At the hearing, our firm asked the Division to hold the Employer and Insurer responsible for:
- $191,659.58 in denied medical bills, including the back surgery
- $64,290.65 in denied temporary total disability, covering more than 98 weeks
- Permanent total disability benefits for life at $654.12 per week
- Future medical care for life for Employee’s low back and right arm
This case shows the accepted-claim trap from start to finish: an accepted claim, a minimized diagnosis, a release without the referred treatment, and a hearing to set the record straight. More of the firm’s tried and settled cases are on our case results page.
A Trial Firm
The Record That Answers a Minimized Diagnosis
In 2025 alone, our firm spent over $700,000 on expert witnesses. Cases like this one turn on that record: surgical findings, deposition admissions, and treating records lined up against a one visit opinion.
Our firm handled roughly 1 in 4 of recent workers’ compensation trials at the St. Louis Division of Workers’ Compensation, out of hundreds of attorneys representing Missouri workers. Insurers know which firms will actually try a case, and it changes how they negotiate.
A minimized diagnosis is an argument, not a fact. A trial firm answers it with the record.
Common Questions
Questions About Minimized Diagnoses
What if the company doctor says my injury is just a strain?
The diagnosis drives everything that follows: treatment, restrictions, ratings, and settlement value. If the label does not match your symptoms, a second opinion can put the real condition on paper before the strain label becomes the record of your case.
What is permanent total disability in Missouri workers’ comp?
It means the worker is unable to compete for work in the open labor market given the injury, considering age, education, and work history. When proven, it is paid as a weekly benefit for life.
Can the Insurer skip treatment its own doctor recommended?
It happens. Here, the authorized physician referred Employee to a surgeon for treatment, and the Insurer sent him to an IME instead. Written demands, documentation, and ultimately a hearing are how that gets answered.
Does every case end with numbers like these?
No. These figures are what our firm requested on the facts of this one case, and they are not a prediction for any other. Every case is different; results depend on the facts.
About Attorney Hoffmann
Talk directly with Attorney James M. Hoffmann
For more than 30 years, James M. Hoffmann has represented injured Missouri workers, and only injured Missouri workers.
When you call, you talk with the attorney handling your case, not a call center and not a junior associate. Questions about insurance surveillance are exactly the kind to ask before you settle, not after.
Told it is just a strain while the pain says otherwise?
A diagnosis that does not match your symptoms is worth a second look before it becomes the record of your case. Free consultation. No fee unless we recover compensation.