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This article discusses the likelihood that employee exposure to COVID-19 at work may result in a recognized work-related injury/illness.

H&W New York Workers' Compensation Defense Newsletter
Vol. 4, Issue 4

H&W Publishes White Paper on Coronavirus and New York Workers' Compensation

Many of our clients have had questions regarding the novel coronavirus (COVID-19) and whether the contracture of COVID-19 by an employee is compensable in New York State. Yesterday, we published awhite paper that provides an analysis of relevant case law and Board decisions to assist in determining whether or not to controvert a claim for COVID-19, or whether, once controverted, a claim is likely to be established or disallowed. Our paper also provides recommendations should you receive a such a claim, and links for instruction on preventative measures.

Our white paper is available for download here. For any questions or concerns on this topic, please do not hesitate to contact our partnersMelanie M. Wojcik at (716) 854-1539 or David L. Snyder at (585) 568-8314.

Appellate Division Allows PPD Award to Continue After Death

On 3/5/20 the Appellate Division, Third Department decided Green v. Dutchess County BOCES. In what can only be described as an astonishing decision, the court held that when a claimant with a capped permanent partial disability (“PPD”) dies for reasons unrelated to established injuries, any remaining weeks on the PPD cap are payable to the deceased claimant’s surviving relatives enumerated in WCL §15(4). We believe this decision is wrongly decided and fails to apply long-standing precedent requiring causally related lost time / lost wages as a prerequisite to permanent partial disability awards.
 
In this case, the deceased claimant had 38.8 weeks remaining on his PPD cap at the time of death. The deceased claimant’s son requested payment of those remaining 38.8 weeks. The Board held that the death resulted from non-causally related reasons, and that no permanent partial disability awards were payable after the date of death because the claim had abated. Claimant’s son appealed to the Appellate Division, arguing that the remaining weeks were payable pursuant to WCL § 15(4).
 
The relevant portion of WCL §15(4) states, "an award made to a claimant under subdivision three shall in case of death arising from causes other than the injury be payable to and for the benefit of [enumerated surviving relatives]." The court’s decision states, "Until now, we have not had the occasion to address whether any remaining portion or weeks of a nonscheduled permanent partial disability award is payable to the beneficiaries identified in [§15(4)] upon a claimant's death arising from causes other than the [established] injury."  (internal quote marks omitted).  
 
The court stated, "[§15(4)] neither distinguishes SLU awards from nonscheduled permanent partial disability awards, nor contains any limiting language excepting nonscheduled permanent partial disability awards from its scope." The court rejected the notion that upon a non-causally related death, there is no longer a causally-related reduction in wages attributable the nonscheduled permanent partial disability.  
 
We believe the court’s decision fails to correctly interpret the crucial word, “award,” in §15(4). For PPD claims, there can be no "award" of indemnity benefits without causally related lost time / lost wages. If there is no “award” then there is nothing to pay out under §15(4). The court’s decision appears to assume that capped permanent partial disability awards automatically become payable at the time of classification, which has simply never been the case.  
 
Over the years, the Appellate Division, and New York’s highest appellate court, the Court of Appeals, have issued many decisions stating that a claimant cannot receive indemnity awards in non-SLU cases for periods of lost time / lost wages that are not causally related to the established injury. See e.g..  Zamora v. New York Neurologic Assoc., 19 N.Y.3d 186 (2012); Burns v. Varriale, 9 N.Y.3d 207 (2007); Florentino v. Mount Sinai Medical Center, 126 A.D.3d 1279 (3d Dept., 2015); German v. Target Corp., 77 A.D.3d 1126 (3d Dept., 2010); Thompson v. Saucke Brothers Construction, Inc., 2 A.D. 3d 993 (3d Dept., 2003); Turetzky-Santaniello v. Vassar Brothers Hospital, 302 A.D. 2d 706 (3d Dept., 2003); Tisko v. General Aniline & Film Corp., 27 A.D.2d 619 (3d Dept., 1966); Roberts v. General Electric Company, 6 A.D.2d 43 (3d  Dept.,1958).

Unlike schedule of loss of use awards, which are payable regardless of whether the claimant has any lost time or lost wages, permanent partial disability awards have always been contingent on the claimant having lost time or lost wages causally related to an established injury. Even when a permanent partial disability award is under a direction for a carrier/employer to continue payment pursuant to Rule 300.23(c), such a direction does not mandate that the Board direct “awards” after a claimant’s death (in the absence of an established death claim). Rather, in the absence of an established death claim, the non-causally related death of a claimant has always been considered an ultimate and final severance of the causal nexus between the established work injuries and lost time/lost wages.
 
In support of its holding rejecting the requirement for causally related lost time/lost wages, the court highlighted a series of Board Panel decision's describing capped PPD awards as a "real benefit that vests with [a] worker upon classification." (Internal quote marks omitted). However, the manner in which the Board characterizes capped PPD awards in Board Panel decisions does not overrule well-established Court of Appeals and Appellate Division case law requiring causally related lost time / lost wages to support permanent partial disability "awards."  Astonishingly, the court’s decision does not cite, or in any way attempt to distinguish, any of its previous decisions referenced above, or the Court of Appeals’ decisions. The last several paragraphs of its decision suggest that the court's holding is based on a desire to avoid perpetuating what it perceives as unfair distinctions between schedule of loss of use and permanent partial disability awards, which it states the legislature aimed to eliminate with the 2007 statutory revisions. In support of this reasoning, the court cites language from the Court of Appeals’ decision in Mancini v. Office of Children and Family Services, stating that the 2007 statutory revision creating capped PPD awards modified PPD awards to be similar to schedule loss of use awards. While this is true in a general sense, the statutory revisions did not do away with the requirement for causally related lost time/lost wages for permanent partial disability awards, and until now, no legal authority has suggested that this requirement no longer exists. The only similarity between capped PPDs and schedule loss of use awards is that each uses a statutorily defined number of weeks. The legal eligibility requirements for PPD and SLU awards has always differed, and the body of case law surrounding these two types of awards acknowledges those differences. When the superficial layer of similarity is peeled back, capped PPD and SLU awards differ in significant substantive ways. It appears the court has mistaken a superficial similarity as a legislative mandate for wholesale judicial revision of the law governing a claimant’s eligibility for PPD awards.
 
The court’s decision includes language suggesting that a claimant's eligibility for permanent partial disability awards results from the mere act of classification with a permanent partial disability combined with the finding of a wage-earning capacity/loss of wage earning capacity. However, this is inconsistent with previous decisions from the court stating that the loss of wage earning capacity sets the duration of the cap for PPD awards, and that the wage earning capacity (as opposed to the loss of wage earning capacity) is a number which is used to determine the payment rate for non-working claimants. Rosales v. Eugene J. Felice Landscaping, 144 A.D.3d 1206, (3d Dep’t 2016); Till v. Apex Rehabilitation, 144 A.D.3d 1231 (3d Dep’t 2016). A non-waivable prerequisite for PPD awards has always been causally related lost time or lost wages.
 
It remains to be seen whether the self-insured employer in this case will seek leave to appeal to the Court of Appeals. 

Appellate Division Reverses Board's Jacobi Decision

On 02/20/2020, the Appellate Division, in Sanchez v. Jacobi Medical Center, reversed the Board's decision from a little over a year ago (Jacobi Medical Center, WCB #00825967 (02/11/2019)), which ruled that post-classification awards at total count towards the cap on permanent partial disability benefits. Jacobi was a favorable Board Panel decision for the defense bar because it allowed us to argue that awards following the claimant's classification with a permanent partial disability should be limited to the permanent partial disability rate and also argue that such awards always be subject to the cap on permanent partial disability benefits under WCL §15(3)(w).

InSanchez, the court noted that WCL §15 allows the claimant to be classified under one and only one of the four categories of disability (permanent total, temporary total, permanent partial, or temporary partial) at any given time. The court felt that the Legislature's silence on whether non-schedule awards for permanent partial disability should include preceding or intervening periods of temporary total disability was a purposeful legislative choice to not include any periods of temporary total disability in non-schedule awards. Accordingly, the court felt that the Board in Jacobi should have ruled that the duration of the claimant's permanent partial disability non-schedule award should have been tolled during the post classification award of temporary total disability benefits. The court also held that awards for temporary total disability after a PPD classification should be at the total rate. 

This decision leaves us with two rules moving forward: 1) post classification awards of temporary total disability do not count against the claimant's durational limit (cap) on permanent partial disabilities for awards on cases with a date of injury before 4/10/2017 and 2) the claimant can apply for reclassification of his or her disability status at any time.

Parenthetically, we note that it is our belief that the court’s decision does not impact the interpretation of the credit for temporary partial disability awards created for claims with dates of accident on and after 4/10/17 in WCL section 15(3)(w). Pursuant to the plain language of that statutory provision, all temporary partial disability awards made after 130 weeks of temporary partial payments in post-4/10/17 claims should be subject to a credit against the PPD cap.

Court Affirms in Three Decisions the Taher Rule that Claimant May Receive Both SLU and PPD in the Same Case at the Same Time

On 2/27/20 the Appellate Division, Third Department, decided Arias v. City of New YorkSaputo v. Newsday LLC, and Fernandez v. New York University Benefits. These decisions squarely hold that the Court’s previous decision in Taher v. Yiota Taxi is controlling, and that a claimant may receive both a schedule loss of use award and a permanent partial disability classification in the same case at the same time. It is unclear as of this writing if this decision will be appealed to New York’s highest appellate court, the New York Court of Appeals.

After the Appellate Division issued its previous decision in Taher, the Board and the workers’ compensation defense bar both took the position that it was incorrectly decided and should not be followed. The Court’s new decisions in AriasSaputo, and Fernandez. reject that argument. In particular, the Court rejected the argument that the 2018 schedule loss of use guidelines warrant departure from the Taher decision. The Court stated that language in the 2018 schedule loss of use guidelines requiring no residual impairment in the systemic area of the injury before a schedule of loss of use award can be made is ambiguous and therefore does not automatically require one form of permanent disability finding over another.

The take away from these decisions is that, for the time being, unless the New York Court of Appeals reverses them, claimants may receive both a schedule of loss of use award and a permanent partial disability classification in the same case at the same time, and may receive a lump-sum schedule loss of use award payment as long as they are not losing time or wages from work.

Court Rules that Reduction of Employer Reimbursement to Cover Attorney Fee in SLU Award Improper Because It Resulted in Windfall to Claimant

In Enoch v. New York State Department of Corrections and Community Supervision, decided by the Appellate Division, Third Department, on 1/30/2020, the Court ruled that the Board correctly allowed a carrier to reduce a claimant's schedule loss of use award by the amount of outstanding employer reimbursement remaining where there was sufficient money moving on the SLU to pay for both the claimant's attorney's fee and provide for the remaining reimbursement.

The court stated that “Continuing to reduce the employer's reimbursement credit by the counsel fee award after claimant received his schedule loss of use award would result in a windfall to claimant, essentially making the employer subsidize a portion of claimant's legal expenses."

The claimant in Enoch injured his right knee during a training activity and filed a workers’ compensation claim. While he was off work, the employer paid the claimant his regular wages and filed a claim for reimbursement of those wages with the Board. In 2017, the Board awarded the claimant benefits payable as a credit to the employer to partially reimburse it for the wages paid. The claimant's attorney was paid $700 as a lien on the employer's wage reimbursement credit.

A workers’ compensation law judge ("WCLJ") found that the claimant had a 20% schedule loss of use ("SLU") of the right leg and directed reimbursement to the employer for remaining wage reimbursement request. The carrier filed an Application for Board Review because the WCLJ reduced the employer's reimbursement credit by the amount of the previous $700 attorney fee.

The Board ruled that the employer was entitled to full reimbursement of wages paid at the time of the SLU award without any reduction for attorney fees. The Board modified the WCLJ's decision by directing that the fee be paid out of the claimant's portion of the SLU award.

The Appellate Division reasoned that when the Board initially made the award of counsel fees payable as a lien on the claimant's reimbursement credit, he was receiving temporary total disability payments, and the employer's reimbursement credit was limited to the amount of the payments and at that time, the employer' wage reimbursement was the source from which the attorney could be paid.

Once the claimant was awarded a SLU, however, there were sufficient funds from which the employer could receive full reimbursement of the wages paid to the claimant during his period of disability, leaving him with an excess from which counsel fees could be paid.

This decision from the Appellate Division ensures that employers will be able to secure full reimbursement of wages paid in lieu of compensation in most cases.

Court Affirms Genduso Decision Holding that SLUs Reduced by SLU Award to Same Limb, Even if Different Part of Limb

On 2/6/2020, the Appellate Division, Third Department, decided Johnson v. City of New York. This decision reaffirms the court’s previous holding in Genduso v. New York City Dept. of Education (2018) that a claimant’s schedule loss of use award will be subject to an automatic deduction for previous schedule loss of use awards to the same limb (hand, foot, arm, leg, etc.). This decision also squarely holds that schedule loss of use awards are made only for the specific body members enumerated in the statute (WCL §15(3)(a) through (l)). This means that a claimant cannot receive separate schedule loss of use awards for sub-parts of the same body member, such as the knee and hip of the same leg. In cases where multiple sub-parts of the same body member are injured, the schedule loss of use award must be calculated only for the body member as a whole. That schedule loss of use award then is subject to an automatic deduction for any previous schedule loss of use awards to the same body member.

The facts in Johnson involved a claimant with an overall 80% loss of use for his left leg and an overall 40% loss of use for his right leg based on hip and knee injuries. The Board deducted a previous 50% schedule loss of use award for the left leg and a previous 52.5% schedule loss of use award for the right leg. This resulted in a functional 30% loss of use payable for the left leg and a 0% loss of use payable for the right leg. Claimant appealed, and the court affirmed, citing Genduso and Bell v. Glens Falls Ready Mix Co., Inc., holding that:

"SLU awards are . . . limited to only those statutorily-enumerated members listed in Workers’ Compensation Law §15(3) . . . In this regard, to authorize separate SLU awards for a body member’s sub-parts is not authorized by statute or the guidelines and would amount to a monetary windfall for a claimant that would compensate him or her beyond the degree of impairment actually sustained to the statutorily-enumerated body member." (Internal citations omitted)

The court also held that the Board properly deducted the previous schedule loss of use awards automatically from claimant’s overall schedule loss of use assessments.

The Johnson decision shows that Genduso is not an anomaly and will be applied by the court as controlling authority. The practical impact is that claimants can no longer receive separate schedule loss of use awards for multiple injuries to the same limb (knee and hip for the leg, shoulder and elbow for the arm, etc.). In such cases, the schedule loss of use would be payable only for a single leg or arm, respectively. Likewise, automatic deduction for previous schedule loss of use awards to the same body member applies even if the previous schedule loss of use award was for a different sub-part of that body member.

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Dear Clients:

             We are continuing to monitor the Corona Virus (COVID-19) outbreak, and we want to take a moment to reach out and let you know that we are handling this developing situation at ConnorsO’Dell, as responsibly as possible, noting that our main priority is to insure the health and safety of our staff and our clients.

             Safety being our top priority, we are implementing the following:

 ·         We are taking every precaution possible, to include conducting extra cleanings of our offices, and frequently touched surfaces.

·         We have implemented screening measures to insure the safety of our staff and clients, and we have postponed most in-person appointments, and, to the extent available, are engaging in remote consultations and appointments.

·         We have instructed our staff that if they are not feeling well or are still recovering from illness, we have asked them to self-isolate, for the protection of all.

·         As of 3/16/20, we will also be working remotely for safety.

In reliance upon CDC recommendations, we suggest the following:

 ·         Wash your hands often with soap and water for at least 20 seconds.

·         Always cover your mouth when coughing and sneezing.

·         Maintain social distancing of 3 feet or more between yourself and other persons.

·         Avoid touching your eyes, nose and mouth with unwashed hands.

·         Clean and disinfect frequently used surfaces.

·         Get medical attention early if you have a fever, cough, or difficulty breathing.

·         Mild symptoms should seek medical care and stay home until recovered, if possible.

Please reference the CDC website for the latest updates about the Corona Virus (COVID-19).

We remain vigilant in representing the interests of our clients in this challenging situation facing our communities.

Justin Wild, a licensed funeral director, was diagnosed in 2015 with cancer and was prescribed marijuana under the New Jersey Compassionate Use Medical Marijuana Act.

In May 2016 Wild was working a funeral when his vehicle was struck by another vehicle that ran a stop sign.  Wild advised a treating doctor at the hospital that he had a license to possess medical marijuana.  The doctor concluded it was clear that Wild was not under the influence of marijuana and therefore he would not need to be tested to return to work.

Wild returned to work, but several days later Wild was told that the company was unable to “handle” his marijuana use and that he was “being terminated because they found drugs in your system.” The company wrote Wild a letter stating that he had been terminated not because of his drug use but because he failed to disclose his use of medication that might adversely affect his ability to perform job duties. Plaintiff’s mother later heard a rumor going around that Wild was fired because he was “a drug addict.”

Wild sued his employer, Carriage Funeral Holdings, Inc., alleging that his employer discriminated against him based on disability due to his use of medical marijuana off site.  His employer tried to stop the law suit in its tracks by moving to dismiss the case for failure to state a claim upon which relief can be granted.  The employer argued that the Compassionate Use Act does not contain employment –related protections, relying on language in the Compassionate Use Act that states, “nothing in this Act shall be construed to require … an employer to accommodate the medical use of marijuana in any workplace.”

Wild countered that this language does not mean that the LAD may not impose its own obligations on the employer.  Wild said he was not seeking an accommodation to use marijuana in the workplace, only an accommodation that would allow his continued use of medical marijuana off-site and off work hours.

Wild lost at trial but obtained a reversal in the Appellate Division.  On March 10, 2020, the New Jersey Supreme Court affirmed the decision of the Appellate Division, allowing Wild to proceed with his case. The Court held that there is no conflict between the Law Against Discrimination and the Compassionate Use Act. It said, “The Compassionate Use Act does have an impact on plaintiff’s existing employment rights.  In a case such as this, in which plaintiff alleges that the Compassionate Use Act authorized his use of medical marijuana outside the workplace, the Act’s provisions may be harmonized with the law governing LAD disability discrimination claims.”

This is the first case in which the New Jersey Supreme Court has addressed the right of an individual who uses medical marijuana to pursue employment litigation for termination of employment due to use of medication outside the workplace. While this case did not arise out of workers’ compensation, the case is instructive to practitioners because there are many injured workers using medical marijuana in New Jersey.  This is one of the first decisions on the state’s Compassionate Use Medical Marijuana Act.

 

 

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John H. Geaney, Esq., is an Executive Committee Member and a Shareholder in Capehart Scatchard's Workers’ Compensation Group.  Mr. Geaney concentrates his practice in the representation of employers, self-insured companies, third-party administrators, and insurance carriers in workers’ compensation, the Americans with Disabilities Act and Family and Medical Leave Act. Should you have any questions or would like more information, please contact Mr. Geaney at 856.914.2063 or by e‑mail at jgeaney@capehart.com. 

The concept of legal causation is fundamental to master in handling claims. If there is no legal causation, the claim should be dismissed.  The claimant must prove an accident which arises from the employment.  There must be a work connection.  When a case poses a serious issue of legal causation, the most common mistake is to send the injured worker immediately to the doctor for an opinion on causation. 

Let me explain this further.  Let’s say your case involves an employee whose allegation is that she got up from a chair and felt sudden low back pain, or was walking down the corridor to speak with her supervisor when she felt knee pain, or she put on her coat to leave for home and felt sharp pain in her shoulder.  These are examples of normal and routine activities that happen at work (and everywhere else in life) that manage to find their way into workers’ compensation files.  What is it that all these scenarios have in common?  The answer is the absence of legal causation.

The natural impulse of an adjuster or defense lawyer is to get a medical opinion when a claim is filed.  That is how we are trained.  That impulse must be resisted when there is no legal causation.  Why?  Because the doctor is going to advise you in the first instance that rising from the chair caused low back pain, in the second instance that walking down the corridor led to pain from some defect in the knee, and in the third instance that putting on the coat may have caused a tear in a weak shoulder.  That is medical causation, not legal causation.  Opposing counsel will argue:  “Why hasn’t this case been accepted?  The doctor says the condition is causally related, right?”  A deep hole has been dug, and the defense dug it.

After a certain amount of backtracking on why the doctor’s opinion really doesn’t matter, the defense must eventually argue that there is no legal causation.  Secondarily, the defense must concede that the medical opinion was unnecessary as it clearly placed the defense in an awkward position in court.  In essence, the defense must contend that there was no accident that arose from the employment.  Not everything that happens at work arises from work.

Sometimes it helps to look at issues like this from a different vantage point.  Imagine sitting comfortably in your chair on a Sunday afternoon watching a football game.  At a commercial break, you get up to get a snack and suddenly feel sharp pain in your back as you come to a standing position.  You begin a course of treatment for a severe sprain.  Would you argue that home caused your back injury?  Of course not.  People would laugh at such a suggestion because this could have happened anywhere, arising from a chair in church, at a movie or on a bus.  It just so happened that it occurred at home during the Sunday ritual of watching a football game, but home was not the proximate cause of any injury.  In workers’ compensation there must be a true work connection between the activity performed and the injury experienced.  Mere coincidence does not substitute for causation. In contrast, a chair that breaks while one sits in it certainly would meet the test of an accident.

Claims that lack legal causation happen every day in every state and often become the subject of extensive medical, temporary disability and permanency payments.  Some routine activity that we all engage in, like bending to tie one’s shoes, causes pain and leads to treatment, but often the activity is not work connected to begin with.  A doctor is consulted and gives an opinion on medical causation, and everyone forgets about the legal causation requirement.  The claim gains momentum and the costs mount. 

Common sense tells us that if an employee turns to look out the window at work or turns to speak with a colleague and feels a spasm in her neck, this is not a workers’ compensation accident.  The neck may need treatment nonetheless.  Medically speaking, the action of turning one’s neck can occasionally lead to pain but legally speaking, there is no accident arising from work by just turning to look at a person or a thing.  So when you encounter a case like this, the best advice is to stop, analyze the facts, and try not to snatch defeat from the jaws of victory, as the old saying goes.


--------------------------------

John H. Geaney, Esq., is an Executive Committee Member and a Shareholder in Capehart Scatchard's Workers’ Compensation Group.  Mr. Geaney concentrates his practice in the representation of employers, self-insured companies, third-party administrators, and insurance carriers in workers’ compensation, the Americans with Disabilities Act and Family and Medical Leave Act. Should you have any questions or would like more information, please contact Mr. Geaney at 856.914.2063 or by e‑mail at jgeaney@capehart.com. 

Infectious diseases such as COVID-19 can be compensable in Minnesota as either a personal injury or occupational disease in certain situations. CWK attorneyWhitney Teel did a deep dive into the issue during the H1N1 outbreak in 2009, and the caselaw is applicable to the current COVID-19 outbreak.

The quick answer is that it is possible for COVID-19 to be a compensable workers’ compensation injury in Minnesota, but as always, the burden of proof is on the Employee. With infectious diseases, such as polio, influenza, tuberculosis, or COVID-19, proving point of contraction is critical.  Employers are encouraged to let their workers’ compensation insurer know if an employee tests positive for COVID-19. 

To read Whitney's research article on this topic, click the link below:

 https://cwk-law.com/wp-content/uploads/2020/03/COVID-19-Research.pdf

Claimant proceeded to Board Hearing on the issue of initial compensability of a 1/12/18 injury and seeking payment of a then recommended left knee arthroscopic surgery. The Board found his claim compensable, and awarded the surgery, but did not rule on total and/or partial disability benefits, because Claimant did not request same. Claimant proceeded with surgery on 4/10/19, and filed a Petition seeking total disability and/or partial disability benefits from the 4/1/18 date of termination from employment and ongoing.

The Board found that Claimant did not meet his burden of proof on the Petition for total and/or partial disability, because he did not conduct a good faith job search following his termination from employment on 3/31/18. He was terminated for simply stopping showing up at work. He unilaterally stopped communicating with Employer. He did not respond to calls or letters sent by Employer. He abandoned his job. Claimant was capable of working with restrictions for nearly all of the ensuing two years with the exception of 4-6 weeks associated with his surgery yet testified to the Board that he made absolutely no job search during this time without any justifiable excuse. He did not even apply to any of the 9 positions that his own vocational rehabilitation specialist identified 4 months before the Board Hearing. The Board also noted that at 62 years old, claimant was at normal retirement age. Therefore, considering the totality of the circumstances, his withdraw from the workforce was due to personal reasons, rather than the work injury.

Should you have any questions regarding this Decision, please contact Greg Skolnik, or any other attorney in our Workers’ Compensation Department.

Jeffrey Legg v. Shurline Construction, IAB Hrg. No. 1472667 (Mar. 2, 2020).

NWCDN Case Summaries

Claimant worked as a flagger at a constructions site. She reported that a truck hit her in the back of the leg and hit her sign, causing it to hit her in the head. She told different versions of the incident to her coworkers and supervisor and did not seek medical treatment for two weeks. Respondents denied the claim and a full contest hearing took place. The ALJ denied and dismissed the case based on a review of the medical records that revealed claimant did not have any ongoing pain complaints. Claimant appealed and the ICAP panel affirmed the ALJ. Claimant appealed again to the Court of Appeals. Claimant alleged that the respondent-employer “cherry picked” the evidence used in the claim and that the ALJ did not consider certain evidence that she presented. However, the evidence and testimony in the records supported the ALJ’s factual and legal findings. An ALJ does not have to address all evidence in the record in his or her order and has discretion to consider whatever evidence he or she chooses. 

Lisa Martinez v. ICAO, Anytime Labor Colorado, LLC, and XL Caitlin Insurance (Co. App. No. 19CA0560, November 14, 2019) *unpublished

Claimant was working the night laundry shift when he thought he heard a noise coming from the washing machine. He thought he saw a soda bottle in the washing machine and tried to reach into the machine during the spine cycle to grab the bottle. Claimant did not use the emergency or stop switch before reaching into the machine. When reaching into the machine, a sheet wrapped around his arm, flipped him and severed his arm at the elbow. Claimant admitted to smoking black tar heroin in the employee restroom before the incident. Respondent employer admitted the claim, but took a safety rule violation and reduced claimant’s benefits. Claimant challenged the safety rule violation, but the ALJ and ICAO Panel agreed with the safety rule violation and benefit reduction (50% against indemnity benefits). Claimant appealed again to the Court of Appeals and argued that the ALJ improperly limited his testimony about the plausible purpose for violating the safety rule. Claimant’s testimony about mechanical issues with the safety switch was not allowed because respondents successfully objected, arguing that claimant was not qualified to testify about mechanical issues. However, the Court of Appeals held that nothing precluded claimant from testify about his experience with the safety switch and that it did not work, which was a different issue than the mechanical issue with the switch. As a result, the ALJ did properly limit claimant from testifying regarding his reason for violating the safety rule.

Benjamin Heien v. ICAO, DW Crossland, and Liberty Mutual Insurance (Co. App. No. 18CA2398, December 12, 2019) *unpublished

Claimant felt a sudden and sharp pain on his left arm and thought he was bitten by a bug. However, no bug was found after the alleged bite. A Notice of Contest was filed by the employer. Claimant was seen by an infectious disease specialist and tested positive for Epstein-Barr virus (EBV), an infectious disease, but the specialist was skeptical the EBV caused by the alleged insect bite. Claimant never received an official work-related diagnosis. The ALJ found the Claimant had not established a causal connection between his symptoms and his job. Claimant appealed and the ICAO panel affirmed the ALJ Order. Claimant appealed again to the Court of Appeals on four grounds: that the ALJ was not credible; the Order from the ALJ was inaccurate due to typographical errors; that he was not notified of the reason for the Notice of Contest that his workers’ rights and human rights had been violated. The Court of Appeals affirmed the Order again. The court found the evidence in the record substantially supported the ALJs decision. Further, the typographical errors were harmless, the employer is not required to provide a specific reason for a Notice of Contest and the claim that the ALJ was not credible was not sufficient to warrant setting aside the order. No evidence was presented regarding claimant’s allegations that his human and workers’ rights were violated.

James A. “Butch” Smith v. ICAO, City of Ouray and CIRSA (Co. App. No. 19CA0267, October 24, 2019) *unpublished

Summaries completed by Craig Campos, Esq. from the Fort Collins, CO office of Ritsema & Lyon.

On February 26 the Texas Supreme Court heard oral argument to determine whether the parents and sister of Fabian Escobedo, a truck driver who died from a rollover accident on the job, may sue the Employer. The Employer argued that recovery of benefits under the Texas Workers’ Compensation Act is the exclusive remedy for Mr. Escobedo and that the parents and sister could not bring a wrongful death action under the gross negligence exception in the Act because that exception authorizes actions only by a surviving spouse or heirs of the body of the deceased. The parents and sister pointed out that the supreme court has previously held that the Act does not bar a deceased’s cause of action forintentional injuries which survive to the estate under the Texas Survival Statute. Accordingly, at issue is whether Mr. Escobedo suffered personal injury prior to deathdue to the Employer’s intentional acts or omissions.

To support their claim, the parents and sister pointed to evidence in the record that (1) oil fields in West Texas and South Texas were booming and the Employer could not keep up with the demand for drivers, (2) drivers were required to work unsafe amounts of overtime, (3) the Employer required drivers to work illegal amounts of time, (4) the Employer required drivers to falsify their driver logs to cover up the illegal hours, and (5) a terminal manager warned a supervisor that a driver would be killed because of the unreasonable driving hours and the supervisor said “we will cross that bridge when we come to it.” 

The supreme court has previously held that the intentional failure to furnish a safe workplace does not rise to the level of intentional injury, except when the employer believes his conduct issubstantially certain to cause injury. Thus, in the present case, the task for the supreme court is to decide whether the evidence could support a finding that the trucking company believed its conduct was substantially certain to cause injury to Mr. Escobedo. If so, the parents and sister will be allowed to sue. 

The Corpus Christi court of appeals concluded that the evidence in this case could support such a finding. The supreme court’s decision is expected later this year.  MO-VAC Service Co. v. Primitivo Escobedo, et al
 

-  Copyright 2020, David Swanson, Stone Loughlin & Swanson, LLP

The Division of Workers’ Compensation has initiated a review of the “utility and sufficiency” of the standard form interrogatories for contested case hearings. The form interrogatories are sets of questions, prescribed by DWC, that parties may serve in discovery prior to a CCH. There are two sets of form interrogatories, which are Claimant’s Interrogatories to Carrier andCarrier’s Interrogatories to Claimant. They each contain 11 standard questions prescribed by DWC and allow the party to draft 5 additional questions.

The current interrogatories were adopted in 1991 and they are now widely viewed as inadequate. The DWC is requesting comments and suggestions from stakeholders regarding revisions, and it will hold a stakeholder meeting to discuss possible changes on March 31, 2020 at the DWC Metro building in Austin. 
 

-  Copyright 2020, David Swanson, Stone Loughlin & Swanson, LLP