Workers’ Comp Docket
Video Surveillance Doesn’t Block Award of PTD Benefits
State of Louisiana v. Berry,No. 49,186-WCA (La. Ct. App. 08/13/14)
Ruling: The Louisiana Court of Appeal held that a laborer was entitled to permanent total disability benefits.
What it means: In Louisiana, occasional spurts of physical activity as shown on video surveillance will not defeat a valid permanent total disability claim.
Summary: A laborer for the state Department of Transportation and Development was working with a crew to clear brush and foliage from the side of a highway. While operating a chainsaw, he lost his footing on a steep ditch bank and fell, badly injuring his lower back. The department placed him on temporary total disability, later converting this to supplemental earnings benefits. After his injury, the laborer became a volunteer firefighter. He never went to a fire but made phone calls and scheduled training sessions for other volunteers. He claimed a tax credit for his services as fire chief. He also cut wood, talked to customers, and sold furniture to help out his son’s business. He admitted that he reported income from his son’s business on his tax return but explained that it was to protect his son from creditors.
The department’s claims adjuster conducted video surveillance on the laborer. The investigator observed the laborer riding a tractor and dragging garbage cans out to the road while riding a scooter. The department asserted that the laborer forfeited all benefits for fraud. The Louisiana Court of Appeal held that he was entitled to permanent total disability benefits.
The court explained that a worker seeking PTD benefits must prove his inability to engage in any type of employment. The worker explained that he had not worked since his retirement from the fire department.
The court found the record showed that his condition reached a level at which any employment or self-employment was not physically possible. He admitted that he could sit for a short time, but the pain was a distraction to concentration. He also said that his prescribed medications impaired his memory.
The laborer explained that the income he reported on his tax forms was actually his son’s income. Also, the tax credit was a statutory benefit for volunteer firefighters and did not reflect actual income. The department did not contradict these explanations.
The court also pointed out that over three days of surveillance, the investigator captured six minutes of the laborer performing physical activity. The court found the occasional spurts of activity did not defeat a valid PTD claim.
Quitting Job Doesn’t Prevent Award of Benefits to Technician
Marazas v. Workers’ Compensation Appeal Board,No. 337 C.D. 2014 (Pa. Commw. Ct. 08/11/14)
Ruling: The Pennsylvania Commonwealth Court held that a technician was entitled to benefits.
What it means: In Pennsylvania, a worker can be entitled to benefits for an injury that occurred after he quit his job if he was performing a task that was furthering the employer’s interests.
Summary: A driver technician for Vitas Healthcare quit his job after his manager refused to remove some stops from his itinerary. The manager informed the technician that he had to remove his personal belongings from the truck, and she escorted him to do so. After the technician removed items from the truck, he tripped over a pallet jack while walking to the warehouse on Vitas Healthcare’s premises. He fell on his side and sustained injuries. The technician sought workers’ compensation benefits. The Pennsylvania Commonwealth Court held that he was entitled to benefits.
Vitas Healthcare argued that the technician’s injury was not covered under workers’ compensation because he terminated his employment before he was injured. The court found that the technician was within the course and scope of his employment at the time of the injury.
There was no dispute that the technician’s injury occurred on Vitas Healthcare’s premises. The court pointed out that the technician sustained the injury on his last day of employment, in temporal proximity to quitting, within a reasonable time of being required to be on premises. Also, when the injury occurred, he was performing a task required by Vitas Healthcare. The court concluded that even though the technician quit before he was injured, he was still within the scope of employment because he was acting at Vitas Healthcare’s direction and furthering its interests.
Hospital Doesn’t Win Automatic Payment for Cost of Worker’s Treatment
Gamble v. Twin Cities Concrete Products,No. A13-1409 (Minn. 08/13/14)
Ruling: The Minnesota Supreme Court held that a hospital was not entitled to automatic payment of its medical bill for treatment of an injured worker.
What it means: In Minnesota, when an employer fails to give a medical provider notice of its right to intervene in a workers’ compensation proceeding, the medical provider is not entitled to automatic payment of its medical bill, unless the medical provider can show the lack of notice resulted in prejudice.
Summary: A worker for Twin Cities Concrete Products injured his back when he fell six or seven feet from a ladder. His doctor recommended surgery, but Twin Cities objected on the ground that it was not reasonable and necessary. The worker obtained approval for the surgery from his union-sponsored benefit plan and underwent surgery. A workers’ compensation judge conducted a hearing and determined that the surgery was not reasonable and necessary. The WCJ ordered Twin Cities to reimburse the benefit plan for the medical bills and concluded that Twin Cities could seek reimbursement of the expenses from the medical providers. The hospital where the worker underwent surgery was not given notice of the hearing. The hospital sought to obtain payment of the unpaid balance of the worker’s medical bills. The Minnesota Supreme Court held that the hospital was not entitled to automatic reimbursement of its charges.
The court explained that a medical provider that treats an injured worker has the right to intervene in the workers’ compensation case. The court previously held that a group health insurer who intervened in a matter and was excluded from participating in settlement negotiations should be awarded full reimbursement by the settlement award. Here, the court held that when an employer fails to give a medical provider notice of its right to intervene in a workers’ compensation proceeding, the medical provider is not entitled to automatic payment of its medical bill, unless the medical provider can show the lack of notice resulted in prejudice.
The court explained that intervention rules adequately protect the rights of an interested party, including a medical provider, that is not given notice of its right to intervene and participate in a hearing or settlement negotiations. Also, the court found that the hospital was not prejudiced by its absence from the hearing.
A judge who dissented in part disagreed with the majority’s opinion that suggested that the hospital had an obligation to reimburse Twin Cities.
Worker’s Self-Reported History of Allergic Reactions Doesn’t Support Award
Ribeau v. Russell Stover Candies,No. 110,533 (Kan. Ct. App. 08/29/14)
Ruling: The Kansas Court of Appeals held that a worker was not entitled to benefits for her claimed allergy.
What it means: In Kansas, a worker cannot prove the existence of an allergy when the only evidence of her exposures and reactions was her own testimony.
Summary: A cook and service worker for Russell Stover Candies claimed that she began developing symptoms of allergies to peanuts and nuts after she was accidentally sprayed in the face with metrin oil and peanut oil. A doctor diagnosed her with peanut and nut allergy based on her self-reported medical history of reactions after exposure to peanuts and nuts. A blood test to screen for allergies was normal. The worker sought workers’ compensation benefits. The Kansas Court of Appeals held that the worker was not entitled to benefits.
The court found that the worker failed to prove the existence of an injury. All objective testing was negative for an allergy to peanuts, nuts, or any other allergy. Also, none of the doctors who examined the worker noted a physical reaction present at the time of treatment that was determined to be an allergic reaction. Nothing in the record corroborated the worker’s history of exposures and reactions except her own testimony.
The court also found that the worker failed to prove a causal connection between the alleged allergy and her work. She admitted to being exposed to peanuts and nuts outside of work throughout the course of her life. Also, the record did not contain evidence about the quantity and quality of the worker’s exposure at Russell Stover, aside from generic statements that there was nut dust in the plant and a comment that the worker could not totally avoid exposure to peanuts and nuts even by wearing a protective mask and gloves. The court concluded that the worker failed to prove a compensable injury.
Comp Denied for Director’s Accident During Lunchtime ‘Personal Frolic’
Jones v. Multicare Health & Educational Services, Inc., et al.,No. 100773 (Ohio Ct. App. 08/28/14)
Ruling: The Ohio Court of Appeals held that a director was not entitled to benefits for the injuries he sustained in a motor vehicle accident.
What it means: In Ohio, a worker’s injury during a personal frolic does not occur in the course of employment and is not compensable.
Summary: The director of nursing for Multicare was required to travel to the homes of patients to provide in-home care. After taking a patient’s prescription to be filled at a pharmacy and learning that it would take 30 to 45 minutes to fill the prescription, the director traveled to a restaurant eight miles away for lunch. While returning from lunch to pick up the prescription and deliver it to the patient, the director’s vehicle was struck by another motor vehicle, and he was injured. The director sought workers’ compensation benefits. The Ohio Court of Appeals held that he was not entitled to benefits.
The director argued that because he had discretion as to “when, what, and how” to take his lunch break, and that he was in the process of obtaining prescriptions for a patient, he was within the scope of his employment. However, the court found evidence supporting that the director was not within the scope of his employment. His lunch break took him a significant distance from the pharmacy where he was engaged in his job duties. Also, the accident occurred on the exit ramp of a highway that the director had no job-related reason to travel. The court found the injury was related to a personal frolic and did not occur in the course of the director’s employment.
Worker Is Employee of Contractor While Performing ‘Side Work’
OKN Construction Co., LLC v. Isaacs,No. 2014-CA-000408-WC (Ky. Ct. App. 09/05/14, unpublished)
Ruling: In an unpublished opinion, the Kentucky Court of Appeals held that a worker was an employee of a construction company and was entitled to benefits.
What it means: In Kentucky, a contractor can be considered the employer of a subcontractor’s employee if it entered into a contract of employment with the employee for “side work” that was separate and distinct from the contract it entered into with the subcontractor.
Summary: A worker owned and operated a masonry business. The business purchased a workers’ compensation policy which covered its employees but not the worker. The masonry business contracted with OKN Construction to perform masonry work at a store. The owner of OKN also used employees of the masonry business to perform odd jobs at the construction site, paying $25 per man, per hour.
OKN asked employees of the masonry business to help remove old refrigerators and freezers at the site. As the worker helped move a freezer, he tripped over a forklift, and the freezer fell on him. The worker sued OKN and filed a workers’ compensation claim. The lawsuit was settled. The Kentucky Court of Appeals held that the worker was entitled to benefits.
OKN argued that the worker should be bound by his argument during the lawsuit proceedings that he was not an employee of OKN. The court disagreed, explaining that the worker acknowledged that his status as an OKN employee was unclear. OKN agreed to settle the lawsuit before a determination in the workers’ compensation proceedings could be made.
The court found that the worker was an employee of OKN at the time he was injured. The court found that the circumstances indicated that the parties understood that the masonry work required at the jobsite was to be undertaken by the masonry business at a negotiated rate. Other work was made available to the worker at different times and at a different negotiated rate. The court found this established a contract of employment between OKN and the worker for the “side work” that was separate from the contract entered into between OKN and the masonry business.
Snow Plow Driver Wins Benefits for Injury Sustained on Food Run
Kosal v. Sanilac County Road Commission, 28 MIWCLR 61 (Mich. C.A.C. 2014)
Ruling: The Michigan Compensation Appellate Commission found that a driver suffered an injury arising out of and in the course of his employment and that the injury rendered him totally disabled.
What it means: A slight deviation to carry out a personal mission will not bar a worker’s claim for benefits.
Summary: The commission affirmed the magistrate’s finding that a snow plow driver’s injury, sustained during his work shift when he slipped and fell in a parking lot while exiting his truck to get carry-out food from a restaurant to eat later, arose out of and in the course of his employment. The driver’s work, which required him to drive under treacherous conditions, was inherently dangerous. He provided public safety by ensuring that the roads were passable. Because he was confined to his truck during his workday, it was necessary for the driver to exit the truck for basic human needs. Although the deviation was personal in nature, if completed as intended, it would have only involved a short amount of time. The employer benefited from the driver’s agreement to postpone his lunch period by having the roads timely plowed. Also, the employer acquiesced in the driver’s actions. Under these circumstances, the driver’s injuries were compensable.
A majority of the commission also affirmed the finding of total disability because the driver’s restrictions due to his medication for debilitating headaches rendered him not capable of performing any of the jobs that pay him the maximum wage he earned in the past. Also, the driver did not have a residual wage earning capacity.