West Virginia high court affirms review board comp decisionsPosted On: May. 30, 2018 1:50 PM CST
West Virginia’s highest court affirmed a review board’s decisions in a slew of workers compensation cases all published Tuesday.
In Asplundh Tree Expert Co. vs. John Lafon, the West Virginia Supreme Court of Appeals affirmed the Board of Review’s decision to modify the date of an injury and remand the case to the claims administrator with instructions to assess the merits of the compensability of the claim. Mr. Lafon, a groundsman for the tree care company, injured his left knee on May 26, 2015, and received first aid treatment at a local health care facility, although he continued to experience pain and discomfort. The injury was not initially reported as a workers comp claim and the claims administrator concluded that the claim was submitted outside the six-month window to file a claim in the state. Mr. Lafon protested the claims administrator’s decision and testified that his boss essentially talked him out of filing a comp claim that day.
“The medical record in this appeal demonstrates that the self-insured employer had actual knowledge of Mr. Lafon’s injury and the information necessary to proceed with a workers’ compensation claim,” the Supreme Court stated in its ruling.
In Kelly E. Heal-Ortiz vs. Drs. Ortiz and Heal-Ortiz, the Supreme Court affirmed the review board’s own affirmation of a claims administrator’s denial of a request for additional medical treatment. Ms. Heal-Ortiz, a dentist, sustained an injury to her upper extremities while treating patients and was diagnosed with right carpal tunnel syndrome and taken off work for several weeks. Dr. Heal-Ortiz’s claim was originally denied by the claims administrator, but was ruled compensable for a herniated disc in August 2010. The claims administrator denied the request for additional medical treatment on April 8, 2016, as Ms. Heal-Ortiz had not had significant medical treatment in the last five years, according to the Supreme Court’s decision.
In West Virginia United Health Systems Inc. vs. Tammy Price, the Supreme Court affirmed the review board’s Feb. 1 decision to reverse and remand a claims administrator’s decision to deny Ms. Price’s requests to reopen her claim for temporary total disability benefits and medical treatment. Ms. Price’s initial claim was held compensable for a low back sprain or strain and she continued to experience symptoms due to the Feb. 5, 2016, injury as late as June 13, 2016. The treating physician opined that a July 20, 2016, event in which Ms. Price felt a “pop” in her spine during cardiopulmonary resuscitation training was not a new injury, but an aggravation of the previous injury. The review board did not err in relying on the treating physician’s opinion and Ms. Price was entitled to the additional period of temporary total disability benefits and a lumbar spine MRI, as well as a pain management consultation, according to the Supreme Court’s ruling.
In McMechen Volunteer Fire Department Inc. vs. Jeannette Rose, widow of Garry Rose, the Supreme Court affirmed the review board’s affirmation of the awarding of dependent benefits to Ms. Rose. Garry Rose, a firefighter and emergency medical technician, died in February 2015. A treatment note indicated Mr. Rose, who was 67, was performing his duties as an EMT when he brought a patient to the emergency room. While there, Mr. Rose collapsed, was unable to be revived, and died. The clinical impression was cardiac arrest. The claims administrator denied Ms. Rose’s request for dependent benefits in March 2015, following a file review in which a physician determined that the cardiac arrest was most likely caused by arrhythmia and had no relation to his employment, but the Office of Judges reversed the decision and granted dependent’s benefits, according to the decision.
“The evidence of record indicates Mr. Rose had an exceptionally strenuous EMS call immediately prior to his death and it is just as likely as not that the physical and emotional exertion contributed to his sudden cardiac death,” the Supreme Court said in its ruling.
In Paul Harrison vs. City of Charleston, the Supreme Court affirmed the review board’s affirmation of a decision by the claims administrator to close a claim for temporary total disability benefits after a physician performing an independent medical exam determined Mr. Harrison had reached maximum medical improvement and needed no further treatment.
In Edwin E. Copeland vs. Mt. Olive Correctional Complex, the Supreme Court affirmed a review board’s affirmation of a claim administrator’s denial of a request to add a bucket handle tear of the meniscus of the right knee to Mr. Copeland’s claim and to authorize surgery. The administrator held the claim was compensable for a right knee sprain or strain, but a physician performing an independent medical exam opined that Mr. Copeland’s meniscus tear and anterior cruciate ligament deficiency were the result of preexisting degenerative changes. The Supreme Court determined that the doctor’s opinion was “reliable and credible” and surgery to treat the conditions was therefore properly denied, according to the ruling.
In Murray American Energy Inc. vs. Clark Gump, the Supreme Court affirmed a review board’s decision to uphold the compensability of a claim based on a nerve problem determined to be related to a work injury despite Mr. Gump’s significant pre-existing component to his lumbar spine problem. The review board also accepted a physician’s determination that Mr. Gump was unable to work due to the nerve condition and was entitled to additional payment of temporary total disability benefits.
In Elaine Squire vs. Augmentation Inc., the Supreme Court affirmed a decision denying a request to add left shoulder impingement as a compensable component to Ms. Squire’s claim. Ms. Squire, a laborer, injured her left thumb and elbow while using a drill that slipped and caught the glove on her left hand. Her claim was compensable for a left elbow sprain, but Ms. Squire failed to prove her left shoulder impingement was related to her injury, according to the decision.
In CCBCC Inc. vs. Kendal T. Creppel, the Supreme Court affirmed the reversal of a claim administrator’s denial and found that Mr. Creppel, a warehouse worker whose duties involved repetitive lifting, had a compensable claim for carpal and cubital tunnel syndromes.
In Thomas Carpenter vs. GMS Mine Repair and Maintenance Inc., the Supreme Court affirmed the review board’s own affirmation of a decision reversing a 10% permanent partial disability award by a claims administrator. Mr. Carpenter, a coal miner, alleged that he developed occupational pneumoconiosis as a result of his employment, but the Office of Judges reversed the award, relying on testimony by a physician with the Occupational Pneumoconiosis Board that there was insufficient evidence to establish a diagnosis of occupational pneumoconiosis. The physician stated that Mr. Carpenter’s smoking history was sufficient to have caused permanent pulmonary impairment.
In BB&T vs. William A. Whipple, the Supreme Court upheld the review board’s affirmation of an order reversing a claims administrator’s decision to deny the comp claim of Mr. Whipple, who sustained a closed fracture of the right tibial plateau when he fell in BB&T’s parking lot. The claims administrator determined the injury did not occur during the course of his employment, but the Office of Judges held the claim to be compensable.
“Mr. Whipple was returning to work after his lunch break when he fell while trying to pick up his credit card,” the court said in affirming the denial reversal. “The fall occurred on BB&T’s property.”
Lawyers for several of the parties involved in the cases could not immediately comment or could not be immediately reached for comment.