## Facts

- Alexander Michau worked for Georgetown County operating a motor grader for long shifts over many years.
- He alleged a repetitive-trauma injury to both shoulders and reported the claim as arising from his work activities.
- Michau had a longstanding history of arthritis-related complaints and treatment, including diagnoses and treatment for rheumatoid arthritis and degenerative arthritis, and he underwent left-shoulder surgery before the claimed injury date.
- Michau’s treating orthopedist provided a causation letter stating, to a reasonable degree of medical certainty, that repetitive work activities resulted in severe osteoarthritis in both shoulders.
- The County obtained an independent medical examination; the IME physician concluded the shoulder condition reflected the natural progression of a preexisting condition and was not work-related, but did not state the causation view to a reasonable degree of medical certainty.
- The Workers’ Compensation Commission denied benefits, finding the greater weight of the medical evidence showed the condition was due to preexisting osteoarthritis and/or rheumatoid arthritis rather than work, and it relied in part on the IME report.

## Issues

1. Whether S.C. Code Ann. § 42-1-172 requires a medical causation opinion offered against a claimant in a repetitive-trauma case to be expressed to a reasonable degree of medical certainty to be admissible and competent evidence.
2. Whether the Commission erred by admitting and relying on the IME report’s causation conclusions that were not stated to a reasonable degree of medical certainty.
3. Whether the proper remedy was reversal and remand for reconsideration based only on remaining admissible medical evidence.

## Decision

- The Supreme Court of South Carolina reversed and remanded.
- The court held the IME report contained a medical “opinion” within the meaning of § 42-1-172 because it was obtained to assess compensability and disputed causation.
- The court held the IME causation opinion was inadmissible under § 42-1-172 because it was not expressed to a reasonable degree of medical certainty (or equivalent formulation).
- Because the Commission relied on the inadmissible opinion in denying benefits, the case was remanded for the Commission to decide whether the remaining competent evidence supports the claim.

## Legal Principles

- In repetitive-trauma workers’ compensation claims governed by S.C. Code Ann. § 42-1-172, medical causation opinions must be stated to a reasonable degree of medical certainty to constitute competent, admissible evidence.
- An employer-retained IME report disputing causation can qualify as a medical “opinion” subject to § 42-1-172’s admissibility requirements.
- When the Commission admits and relies on a medical causation opinion that does not meet § 42-1-172’s certainty requirement, the appropriate remedy is reversal and remand for decision based on remaining admissible evidence rather than appellate fact-finding on compensability.

## Conclusion

The court required strict compliance with § 42-1-172’s reasonable-medical-certainty standard for medical causation opinions in repetitive-trauma cases, excluded an IME causation opinion that lacked the required certainty language, and remanded for the Commission to reassess compensability using only competent evidence.


Michau v. Georgetown Cnty., 396 S.C. 589, 723 S.E.2d 805 (S.C. 2012)