MISSOURI WORKERS' COMPENSATION CASE
APRIL 2012-JUNE 2012
Injury on Parking Lot Found in the Course and Scope of Employment and Compensable
Joseph Duever v. All Outdoors, Inc. and Treasurer of Missouri as Custodian of the Second Injury Fund, Case No. ED97596 (Mo. App. E.D. 2012)
FACTS: The claimant was the owner/operator of a landscaping business. During the winter months, the employer provided customers with services such as snow and ice removal. In addition to running the business, the claimant performed manual labor along with his employees. The employer leased a warehouse from Scott Properties and the lease included access to a parking lot and the specific use of four parking spaces. In the lease terms, Scott Properties was responsible for ice and snow removal from the parking lot. The claimant held a safety meeting with his employees in the parking lot. After the meeting, the claimant was walking back to the shop when he slipped on a patch of ice, falling and hitting his left shoulder.
The claimant kept his scheduled appointment the following day with his endocrinologist, Dr. Oikine, for treatment of his diabetes. In the doctor's notes, there is no mention of the accident. The claimant then saw an orthopedist, Dr. Thomas, three weeks later, who ordered an MRI which revealed tears of the tendons. The claimant underwent surgery. The claimant filed a Claim and the ALJ determined the claimant's work was the prevailing factor in causing his left shoulder injury. The Commission affirmed the ALJ's Award and Decision.
HOLDING: The employer argued that the accident did not arise out of and in the course of the claimant's employment because the risk involved, walking on an ice covered parking lot, is one that the claimant would have been equally exposed to in daily life, and therefore, his injury was not compensable. The Court found that the claimant was in an unsafe location, an icy parking lot, instructing his employees on the importance of safety. The claimant sustained an injury due to an unsafe condition over which he had no control, given that the owner of the parking lot had hired another company to remove ice on the lot. The Court further noted that the claimant sustained an injury on the job, and therefore, the claimant's injury was compensable.
Claim Denied because Claimant Failed to Prove He Sustained an Accident
Arsenio Arciga v. AT&T, Case No. WD74226 (Mo. App. W.D. 2012)
FACTS: The claimant worked as a systems technician for AT&T. On February 23, 2010, the claimant's supervisor instructed him to travel to a nearby location where a company truck driven by a co-worker, Shane Curphey, had become stuck in mud. According to the claimant, when he arrived at the location he got behind the truck and attempted to lift and push the back of the truck out of the mud while Mr. Curphey pressed on the accelerator in an effort to move the truck. The claimant alleged that he injured both shoulders at that time.
The claimant admitted that he did not immediately notify his employer about the incident, and he continued to perform his regular job duties which resulted in an ongoing worsening of his shoulder symptoms. In mid March, the claimant talked with his supervisor about his shoulder discomfort but never said anything about how he hurt his shoulders. The claimant's supervisor advised him to see a chiropractor. When the claimant presented to the chiropractor, he did not say anything about the incident with the truck. The claimant asked his supervisor if he could file a Claim, the supervisor asked for what incident, and the claimant said that he was not sure. A few days later, the claimant then advised that he wanted to file a claim for the incident when he was helping his co-worker get the truck out of the mud.
Shane Curphey, the claimant's co-worker, testified that he could not recall any time the claimant was behind the truck. Mr. Curphey noted that the truck was very deep in the mud, and therefore, it would seem silly to do that. Mr. Curphey also said that he thought the claimant was clean when he left, and noted that if a person had been behind the truck while he revved his tires, he would have been completely drenched with mud. The ALJ found that the claimant failed to meet his burden of proving that he sustained an injury on February 23, 2010. The Commission affirmed the ALJ's Decision.
HOLDING: The claimant argued that because Mr. Curphey testified he did not recall the claimant pushing or attempting to lift his truck out of the mud, Mr. Curphey's testimony did not contradict his. Therefore, the Commission's conclusion that he did not push or attempt to lift the vehicle from behind is without any substantial or competent support in the record. The Court noted that Mr. Curphey stated on cross-examination that he didn't recall the claimant behind the truck, however, he stated that if a person had been behind the truck, that person would have been completely drenched with mud and water and he did not remember the claimant being muddy. Therefore, the Court found the competent and substantial evidence supports the Commission's conclusion that the claimant failed to prove that he suffered an accident arising out of his employment.
ALJ Does Not Have to Find that Claimant is Lying to Find Testimony Not Credible
Weldon Poarch v. Treasurer of the State of Missouri, Custodian of the Second Injury Fund, Case No. WD74219 (Mo. App. W.D. 2012)
FACTS: The claimant performed work for the employer's rental properties, and alleged that on April 26, 2006, he inhaled muriatic acid while spraying an apartment. Seven to ten days later, the claimant believed that he was having a heart attack as a result of his exposure. However, he did not seek medical treatment, and therefore there was no evidence that the he actually had a heart attack. He did have heart attacks two years later in 2008 and 2009. The claimant also didn't present any evidence that the spray he had used was muriatic acid.
The only evidence the claimant presented was the testimony of Dr. Parmet, who stated that the claimant told him that he had been exposed to muriatic acid, and the doctor noted that this exposure was the prevailing factor in causing disability to the claimant's heart and provided a rating of 20% PPD of the body. The ALJ found that the claimant did not prove that he sustained a compensable injury and denied the claim. The Commission affirmed the ALJ's decision.
HOLDING: The Court noted that the claimant's entire argument was premised on his assertion that the Commission never found that he was not credible. The Court noted that the ALJ found that the claimant's whole case was based on his uneducated self-diagnosis that he had a heart attack, but there was no medical evidence to support that diagnosis. Also, the claimant made the determination that he was exposed to muriatic acid, however, this substance was never tested and therefore there was no proof that the claimant was in fact exposed to it. In light of the fact that the claimant did not have any evidence to support his testimony that he was exposed to muriatic acid which caused a heart attack, the ALJ did not find his testimony credible. The Court noted that in order for an ALJ to find that a claimant is not credible, he does not have to find that the claimant was intentionally fabricating testimony. The Court noted that credibility involves more than the witness' own subjective belief. Therefore, the Court affirmed the Commission's Decision that the claimant did not meet his burden of proving that he sustained a compensable injury.
Court Looked to Claimant's Statements or Lack Thereof to Determine Permanency
Shawn Claspill v. Fed Ex Freight East, and Treasurer of the State of Missouri, Custodian of the Second Injury Fund, Case No. SD 31346 (Mo. App. S.D. 2012)
FACTS: On July 28, 2006 the claimant fell from a fork lift, injuring his lower back. He did not seek immediate medical treatment, nor did he immediately report the injury to his supervisor. Shortly thereafter he treated on a few occasions with his primary care physician and did not mention a work injury. He also presented to the emergency room a week after his injury at which time he didn't report a work injury. The claimant eventually reported his injury and was sent to Concentra by the employer, and was diagnosed with a contusion of the buttocks. The claimant also continued to follow-up with his primary care physician. It was noted the claimant had a prior history of back problems.
The ALJ found that the claimant did sustain an accident when he fell from the fork lift. However, the ALJ found that he only sustained a contusion-type injury to his back and the fall was not the prevailing factor in causing the claimant's current pain and condition, for which he was treating. Therefore, the employer was not liable for any past or future medical treatment. The Commission affirmed the ALJ.
HOLDING: The Court noted that the Commission pointed out numerous contradictions in the claimant's testimony and the history presented by the claimant in the medical records. The Commission found that the claimant went to the doctor three times after his alleged fall from the fork lift, and did not mention this work accident. Furthermore, the claimant's personal physician noted that only a week and a half after his accident, the claimant reported he was pretty much back to normal. The Court found the Commission had ample substantial and competent evidence to find that the claimant sustained 10% PPD as a result of the fall off of the fork lift, and that the employer was not responsible for any past or future medical care.
Claim Denied Because Injury Flowed as Natural Consequence of Prior Injury Which Had Been Settled
Lisa Meinczinger v. Harrah's Casino, Case No. ED97415 (Mo. App. E.D. 2012)
FACTS: On August 12, 2002, the claimant tripped over a manhole cover at the employer and injured her left knee. She was terminated in 2003. The claimant filed a claim for the August 12, 2002 injury to her left knee. Then, on July 16, 2008, the claimant filed another claim reporting an injury to her right knee and left hip in August 2007. She alleged the same incident, that she fell over a raised manhole sustaining injuries to her left lower extremity and because of the injury to her left knee, the claimant compensated by placing stress on her right knee and left hip, causing injury to the same. She reported that the accident took place at the employer's place of business. On October 29, 2008, the claimant, employer and insurer entered into a Stipulations for Compromise Settlement, for the 2002 injury.
On May 5, 2009, the claimant filed an amended Claim for the August 2007 injury to her right knee and left hip, reporting that she sustained an injury at the physical therapy center, while receiving physical therapy for a work-related injury to her knee. The ALJ denied benefits for the 2007 injury, noting that the claimant sustained this injury in the course of her physical therapy treatment for the 2002 injury, and she testified to the same during her deposition. The ALJ concluded that the claimant's August 2007 injury flowed from her August 2002 injury, which was settled in October 2008. Therefore, the Division no longer had jurisdiction over the 2002 injury or settlement. The Commission affirmed the ALJ.
HOLDING: The Commission did not err in denying benefits based on lack of jurisdiction because the claimant sought benefits for an injury that flowed as a natural consequence of an earlier work injury and the parties had entered a settlement that closed out all claims from the prior injury.
Employer Not Liable to Replace Prosthesis
Herbert Robbins v. Web Co, Inc., Case No. SD31607 (Mo. App. S.D. 2012)
FACTS: The claimant lost his lower right leg to cancer at age 19. He went through 3 or 4 prostheses before working for employer. In January 2004, at a prior job, his knee frame shattered during heavy lifting and he got a replacement, which was enough to support his body weight plus nearly 140 pounds. The employer hired the claimant in 2006, and he carried material which weighed less than 50 pounds to his work station, up to 30 times daily. In June 2008, his knee unit's hydraulic pump failed, and he sought to obtain one through workers'compensation. It was not disputed that the wear and tear from use caused this failure, and expert testimony established that the prosthesis should have lasted about 4 years, and therefore, it had reached the end of its life span. The ALJ found that the failure was due to wear and tear not associated with a particular event, and work was not the prevailing factor in causing this wear and tear. The Commission affirmed the Decision of the ALJ.
HOLDING: The Court held that the employer did not have to replace the claimant's prosthesis because the claimant did not prove that his work activities were the prevailing factor in the need for a new prosthesis.
Falling Off Shoe While At Work Not Compensable
Sandy Johme v. St. John's Mercy Healthcare, Case No. SC92113 (Mo. S.Ct. 2012)
FACTS: The claimant was a billing representative and sustained an injury while making coffee. It was noted that it was customary in the office that the employee who took the last cup of coffee, would make another pot. While making coffee, employees remained clocked in. On the day of the injury, the claimant was wearing sandals with a thick heel and flat bottom. There were no irregularities or hazards on the kitchen floor. The medical records from the emergency room indicated that the claimant reported that she had tripped at work because of the shoes she was wearing. The ALJ denied her claim because she was not performing her work duties at the time of her fall. She simply fell and would have been exposed to the same hazard or risks in her normal, non-employment life.
The Commission reversed the ALJ's Decision, noting that the coffee in the office kitchen was provided by the employer for use by its employees, the employees were not required to clock out before getting coffee and it was customary for the employee who took the last cup of coffee to make a new pot. The Commission also noted that the claimant testified that she did not make coffee at home. The Commission found that the claimant's injury was compensable after applying the Personal Comfort Doctrine, because the act of making coffee was incidental and related to her employment. Therefore, it found that it did not need to determine whether the claimant would have been equally exposed to the hazard or risk that caused her injury during her normal non-employment life.
HOLDING: The Court noted that for the claimant's injury to be deemed to arise out of and in the course of her employment, the claimant must show a causal connection between the injury and the claimant's work activities.
The Court looked to Miller, wherein the claimant's knee popped and began to hurt while he was walking briskly toward his truck, which contained repair material that was needed for his job as a road crew member. In Miller, the Court determined that the claimant's injury was not compensable because the uncontested facts showed that his knee pop injury occurred at work, in the course of his employment, but that it did not arise out of the employment. The Court noted that an injury will not be deemed to arise out of the employment if it merely happened to occur while working, but work was not a prevailing factor in the risk involved. In Miller, the risk was walking which he would have been equally exposed to in non-employment life. The Court noted that nothing about his work caused his knee to pop. Therefore, the injury arose during the course of his employment but did not arise out of the employment. The Court noted that the Miller holding is controlling.
The Court noted that the Commission erred in focusing its assessment on whether the claimant's activity of making coffee was incidental to her employment. Instead, the Court noted that the issue in the case was whether the cause of her injury, falling off her shoe, was connected to her work activity, other than the fact that it occurred in her office kitchen while she was making coffee. The Court noted that the ALJ and Commission should have considered whether her risk of injury, falling off her shoe, was a risk to which she would have been equally exposed to in her non-employment life. The Court noted there was no evidence showing that the claimant was not equally exposed to falling off her shoe while at work and outside of work in her normal non-employment life. Therefore, the Court found that she did not show that her injury was caused by a risk related to her employment that she would not have been equally exposed to in her normal non-employment life. As such, her claim was not compensable.
Stipulations by Parties at Hearing are Controlling and Conclusive
Michael Hutson v.Treasurer of Missouri as Custodian of Second Injury Fund, Case No. ED97321 (Mo. App. E.D. 2012)
FACTS: In 2003, the claimant injured his low back while working for the employer. The claimant also had a prior injury in 1999 while working for a prior employer, which he settled for 15% PPD of the right shoulder. The claimant settled his 2003 back injury with the employer and proceeded to a hearing against the SIF. At the hearing, the claimant and the SIF stipulated to several facts, including that the claimant agreed not to pursue PTD benefits against the SIF, and, in exchange, the SIF agreed not to contest the synergistic combination of the injuries. At the hearing, the ALJ determined that the claimant's testimony regarding his pre-existing shoulder injury was not credible and that his pre-existing disability from this injury was at most 10%. Therefore, it did not meet the threshold percentage to trigger SIF liability, and the ALJ denied the claimant benefits. The Commission affirmed the ALJ noting that the claimant had not presented evidence showing that the disability resulting from his current injury had combined with his pre-existing shoulder disability to produce a greater disability.
HOLDING: The Court noted that the issue in this matter was whether the SIF's agreement "not to contest" the synergistic combination of the claimant's injuries relieved the claimant of his burden to present evidence showing a synergistic combination. The claimant argued that because of the parties' stipulation, the Commission wrongly concluded the claimant failed to produce sufficient evidence to show his pre-existing disability synergistically combined with his current disability. The Court agreed.
The Court noted that the rules of the Department of Labor & Industrial Relations which cover workers' compensation hearings, state that prior to the hearing the parties shall stipulate to uncontested facts and present evidence only on contested issues, such stipulations are controlling and conclusive, and the courts are bound to enforce them. Therefore, the Court found that the synergistic combination of the claimant's disabilities was not a contested fact at the hearing, and therefore, the Commission was without power to conclude the claimant was required to put forth evidence of such combination in order to be entitled relief.
Claimant Found Credible Therefore Statute of Limitations was 3 Years
Howard Moreland v. Eagle Picher Technologies, LLC, Case No. SD31692 (Mo. App. S.D. 2012)
FACTS: The claimant worked for the employer, who was involved in the manufacturing of batteries, fertilizer and boron, from 1984 through 1994. The claimant worked in departments which manufactured nickel cadmium and nickel hydrogen for battery cells. The claimant first became ill in the summer of 2005. On July 29, 2005, the claimant called his supervisor when he received his diagnosis of multiple myelomas and advised that the cause of his disease was exposure to chemicals with the employer. The supervisor testified that the claimant did advise him of his diagnosis, however, he did not recall the claimant telling him that his diagnosis was related to his work with the employer. The employer did not file a Report of Injury until after the claimant filed his original claim on December 17, 2007. The ALJ awarded the claimant unpaid medical expenses and PTD benefits. The Commission affirmed the ALJ's Award.
HOLDING: The employer argued that the claimant did not timely file a claim because the stated date of injury was July 29, 2005, however, the claimant did not file a claim until December 17, 2007, which is not within the two year statutorily mandated time period. The Court noted that the Statute of Limitations in this case was three years because the employer failed to file a timely Report of Injury after the claimant notified the employer of a potential work-related occupational disease. The Court noted that the Commission found that the claimant's testimony was credible in that he advised the employer on July 29, 2005 that he was diagnosed with multiple myelomas and his disease was caused by his exposure to chemicals at the employer. Therefore, the Commission found that the employer had notice and had 30 days from July 29, 2005 to file a timely Report of Injury, which it did not do. Therefore, the Statute of Limitations was three years.
Award Against Insured Employer Does Not Bar Claim Against Second Uninsured Employer In Civil Court
Stacey Lewis & McCartney M.E. Lewis, a minor, by and through their next friend, Burle Brown and DOT Transportation v. Nathan Gilmore and Buddy Freeman, Case No. SC91834 (Mo. S.Ct. 2012)
FACTS: The claimant died when a tractor trailer in which he was a passenger overturned. The driver, Nathan Gilmore, was driving the tractor trailer in the course of his employment with Buddy Freeman. Freeman operated his company pursuant to a contract with DOT Transportation. Freeman did not carried workers'compensation insurance, however, DOT did. The claimant's dependents filed a claim for workers' compensation against both Freeman and DOT. The dependents also filed a wrongful death action against Freeman and Gilmore.
The Circuit Court stayed the wrongful death action until an ALJ decided if the claimant's death occurred out of, and in the scope of, his employment. An ALJ entered an Award in favor of the claimant's dependents. The ALJ found that the claimant was an employee of Freeman, but Freeman did not carry workers' compensation insurance even though he legally was required to do so. The ALJ determined that DOT was the claimant's statutory employer and ordered DOT to pay death and funeral benefits. After the Workers' Compensation Award, DOT intervened in the wrongful death action. The Circuit Court granted summary judgement in favor of Freeman, finding that the wrongful death action was barred because the claimant's dependents had made an election of remedies when they obtained a Workers' Compensation Award against DOT.
HOLDING: The claimant's dependents asserted that under Workers' Compensation they were allowed to proceed in a civil action against Freeman since he failed to have workers' compensation insurance, even though they obtained a Workers' Compensation Award against DOT. The Court noted that under workers' compensation law if an employer does not have insurance the claimant has three options: file a civil action against the employer, pursue a workers' compensation claim or seek payment from the SIF. The Court noted it was undisputed that Freeman and DOT were separate entities and that each had the responsibility to secure workers' compensation insurance. Under the Statute, the fact that DOT complied with the statute, and therefore was deemed to be the only statutory employer, does not excuse Freeman from his obligation to carry workers' compensation insurance. Therefore, the civil action against Freeman was not barred by their Workers' Compensation Award from DOT. The Court concluded that because the claimant essentially had two employers, obtaining a Workers' Compensation Award from one of them and a potential civil judgement from the other would not be a double recovery because any recovery by the claimants would be subject to DOT's subrogation rights.
Claimant Could Medically Return to Work Therefore No TTD Owed
In Scott Curran v. Johnson Controls, Inc., Injury No. 02-016564, the claimant complained to his plant manager that his shoulder hurt and needed to take pain medicine. Since he was not supposed to work on pain medicine he needed to leave work. He was allowed to leave and he was instructed to provide a note from a medical professional noting that he had to leave work that day, February 3, 2004. The next day the claimant saw Dr. Middleton, who wrote a note saying that the claimant was having headaches which were related to the myofascial pain related to his work injury. When the claimant presented a slip to the employer on two different occasions, he refused to allow the claimant to return to work. The employer's rationale for refusing to let the claimant return to work was that he did not provide documentation that he had to leave work on February 3, 2004 for his work injury. The ALJ denied the claimant's claim for past TTD benefits. The Commission found that the claimant was not permitted to return to work because of separate and distinct labor and management issues. Also, there was no evidence that the claimant was unable to work or that the employer refused to allow him to return to work due to a medical condition. Therefore, the Commission agreed with the ALJ and denied the claimant's claim for past TTD benefits.
Claimant Was Prevailing Party and Entitled to Reasonable Cost of Recovery for Hardship Hearing
In Melissa Donnell v. Trans States Airlines, Injury No. 02-143782, the claimant requested a hardship hearing when the employer denied her request to have ankle surgery, arguing she was at MMI with respect to the work injury. The ALJ issued a Temporary Award ordering the employer to pay for the surgery and resume TTD benefits. Pursuant to the Statute, the claimant argued she was the prevailing party, and therefore, she was entitled to reasonable costs of recovery in the amount that was expended for the hardship hearing. The employer argued the claimant really didn't "prevail" because the ALJ did not address the issue of past TTD benefits. The Commission noted that when the ALJ addressed the issue in his Final Award, he ultimately ruled this issue in the claimant's favor. The Commission noted that the ALJ did not say in his Award why he deferred the issue of TTD benefits to the final hearing, but there was no suggestion that it was the result of any failure of proof on the claimant's part. Therefore, the Commission found that the claimant was the prevailing party and was entitled to reasonable costs of recovery.
Claimant Rushed to ER Which Was Date of Disability Therefore Date of Injury
In Stephen Smith (deceased) v. Capital Region Medical Center, Injury No. 05-140833, the employee worked in the hospital from 1969 - 2006 as a lab technician. At one time the lab technicians pipetted blood samples using their mouths. The claimant testified that he once got blood in his mouth while doing so. Also, in 1970, the claimant received a six unit blood transfusion following a non-work related hunting accident. The claimant was diagnosed with Hepatitis C in December 1999 and ultimately died on February 27, 2007 of sepsis, Hepatitis C and acute tubular necrosis.
The employer argued that the 2005 Amendments were applicable to the claim because the claimant was able to work up until March 2006, and therefore he would have to prove that his work was the prevailing factor in causing his disease. The claimant argued that the appropriate date of injury was April 20, 2005 which is when he was rushed to the emergency room when he suffered a cognitive breakdown caused by hepatic encephalopathy. The ALJ agreed with the claimant and believed the 2005 Amendments did not apply, and therefore the claimant only had to prove by substantial and competent evidence, that he contracted an occupationally induced disease. The Commission also believed that the 2005 Amendments did not apply because review of case law revealed that courts have consistently linked the date of injury to the date the disease first becomes "compensable" which typically has been interpreted to mean the date a claimant first experiences some disability or loss of earning capacity from the disease. The Commission believed that he first experienced some disability related to the injury when he suffered a cognitive breakdown on April 20, 2005 and was hospitalized.
Even using the lesser standard of substantial and competent evidence, the ALJ concluded that the claimant failed to prove that he contracted an occupationally induced disease, and therefore the claim was denied. The Commission was also convinced that the claimant failed to meet his burden because there was no evidence that any person with Hepatitis C treated in the employer's facility while the claimant worked there. The Commission did note that the claimant worked at the employer for many years, and it would seem that someone with Hepatitis C must have at some point treated at the hospital, however, the Commission could not speculate. Therefore, the Commission concluded that the claimant failed to demonstrate that his work for the employer exposed him to Hepatitis C and that there was a direct causal connection between Hepatitis C and the conditions in which he performed his work. Therefore, the Commission affirmed the ALJ.
Occupational Disease is a Subsequent Compensable Injury and Triggers SIF Liability
In Kelly Kirkpatrick v. Missouri as Custodian of Second Injury Fund, Injury No. 09-071622, the SIF argued that "injury" excludes occupational diseases and the claimant's cubital tunnel syndrome is an occupational disease, thus, not an injury. Therefore, it is not a "subsequent compensable injury" that can trigger SIF liability. The Commission disagreed noting that the Statute specifically provides for injuries by occupational disease, and specifically states those injuries are compensable. The Commission noted that the Statute refers to an injury by occupational disease being compensable, and therefore, the legislature specifically provided that the term "injury" includes occupational diseases and that they are compensable. Therefore, the Commission determined that "injury", as it appears in the phrase"subsequent compensable injury", includes the claimant"s cubital tunnel syndrome which is an occupational disease.
Claim Denied Because Witness Testimonies Inconsistent with Claimant's Testimony
In Georgia Goriola v. Alma Cook Union Manor, Injury No. 10-087056, the claimant testified that she worked the night shift as a CNA for the employer and she was attacked by a resident in July 2010, however, she could not recall the exact date. The claimant testified that after the attack, her face was bruised, swollen and scratched, and a co-worker, Ms. Bush, viewed her injuries. She then advised the manager, Ms. Smith, of the attack and completed an incident report. She testified that Ms. Bush was present when she told Ms. Smith of the attack. Ms. Bush testified that she had worked with the claimant on July 9, 2010, and the claimant advised that something bad happened, however, she did not witness the event and did not see any sign of facial injuries. She also did not hear the conversation between Ms. Smith and the claimant. Ms. Smith, the manager, denied being informed of the attack. She noted that had she known of the attack, the resident, who had no history of this type of behavior, would have been transferred to the hospital for further evaluation, as she would have posed a safety risk to other residents and staff. Also, the claimant nor Ms. Bush indicated on their shift reports that any resident caused any problems during their shift.
The ALJ found that the claimant was unable to state what date her alleged injury occurred, the event was unwitnessed, and her co-worker did not corroborate her assertion that the claimant had injuries to her face. Furthermore, the shift reports prepared by the claimant and Ms. Bush on the alleged date of injury noted there had been no problems with any resident. Therefore, the ALJ was of the opinion that the claimant failed to meet her burden to demonstrate that a work accident occurred. The Commission affirmed the decision of the ALJ.
Claimant Must Prove Work Injury was Prevailing Factor Causing Medical Condition and Disability
In Ronald Armstrong v. Tetra Pak, Inc. and Treasurer of Missouri as Custodian of Second Injury Fund, Injury No. 10-039435, the claimant worked on the feeder/checker line. About half of a shift he was performing the feeding, and the other half he was performing the checking, which was quality control. The feeding part involved taking stacks of cartons off of a table and putting them into a machine. There were different sizes of cartons and the stacks weighed anywhere from 10‑12 pounds to 28 pounds. The table was normally shoulder height, it moved with weight and also could be adjusted by air. The claimant testified that on his date of injury when he began work he did not have any shoulder pain. On his date of injury, he was told by his supervisor that a rush order needed to be finished as soon as possible. The job involved moving containers which were stacked higher than normal and the stack weighed 35 pounds. He pulled the first stack of cartons and fed it into the machine without any problem. In attempting to get the second stack into the machine, he reached and stretched above shoulder level and felt a sharp pain in his right shoulder. The following day he was unable to work, and therefore, reported this incident to his supervisor. The ALJ held that the claimant had not met his burden of proving that he sustained a compensable accident or that the alleged accident was the prevailing factor in causing his right shoulder problems.
The Commission noted that the claimant must establish that he sustained an injury to his right shoulder. In order to show that the injury arose out of and in the course of his employment, the claimant had to prove that the accident was the prevailing factor in causing both the resulting medical condition and disability. The Statute defines the prevailing factor as the primary factor in relation to any other factor, causing both the resulting medical condition and disability. The ALJ found that the more credible evidence showed that the claimant's shoulder complaints were predominantly degenerative in nature and not primarily due to the May 12, 2010 accident. The Commission found that since the claimant had not proved that his May 12, 2010 accident was the prevailing factor in causing both his medical condition and any disability, the ALJ's decision to deny him benefits was affirmed.
Claimant Not Entitled to Total Knee Replacement When Tillotson Applied
In Ervin Hampton v. R.C. Lonestar, Inc., Injury No. 08-013352, the ALJ found that the claimant was not entitled to the medical expenses related to his total knee replacement because he failed to meet his burden of proof on the issue. The Commission noted that in his Award the ALJ stated that the claimant has the burden to prove that the accident was the prevailing factor in causing the resulting total knee replacement. The Commission noted that under Tillotson, this is a misstatement of the law. Rather, the question is whether the claimant has shown that the treatment in question is reasonably required to cure and relieve the effects of the work injury. Furthermore, the claimant must show that the need for treatment flows from the work injury.
The Commission affirmed the ALJ's ultimate decision that the total knee replacement was not reasonably required to cure and relieve the effects of the work injury. The ALJ found Dr. Burke's opinion credible in that the work injury had nothing to do with the claimant's need for a total knee replacement, and the claimant would have required one based on the arthritic changes of his knee alone. The Commission also found Dr. Burke credible. Therefore, the Commission concluded that the need for the total knee replacement did not flow from the work injury and was not reasonably required to cure and relieve the effects of the work injury.
Claimant Alleged Max Rate But Not Entitled to It Even Though Answer Was Filed Late
In Tabitha Hasten v. Sonic Drive-In of High Ridge, No. 06-135802, the claimant alleged in her Claim for Compensation that she was entitled to a "max rate". The employer filed a late Answer, and therefore, the employer was deemed to have admitted the facts in the claimant's Claim for Compensation. Therefore, the ALJ found that the claimant was entitled to the maximum rate. The employer argued that it cannot be deemed to have admitted the claimant's rate was the maximum because the claimant's allegation that her average weekly wage was the "max rate" amounts to legal conclusion rather than a statement of fact. The Commission agreed with the employer and concluded that "max rate" is not a statement of fact, but instead, if anything, it is a legal conclusion. Therefore, the Commission found that the employer did not admit, by filing a late Answer, that the claimant was entitled to a compensation rate of $376.55, which was the maximum rate at the time of her injury.
Climbing Stairs Into Work In Course of Employment
In Debra Fowler v. Compass/Chartwells, Injury No. 05-112444, the employer argued that the claimant's injury did not arise in and out of her employment. The claimant was injured on October 31, 2005 when she was climbing metal dock stairs to enter work. The employer required the claimant to report to work at 6:30 A.M. and the front door did not open until at least 7:00 A.M. The employer instructed the claimant to use the dock stairs when the front door was locked, which was the only way to enter the building before 7:00 A.M. The ALJ found that the physical condition of the work environment created a hazard which was related to the claimant's employment, and gave rise to the injury. At the time of the injury, the claimant was climbing the metal stairs to gain access to her work place to begin her shift. The metal stairs were in the back of the building, and the ALJ noted that the records contained no evidence that the general public had access to them. Therefore, the ALJ found that the claimant's travel up the metal steps was related to her employment. Therefore, the claimant's accident arose out of and in the course of her employment. The Commission affirmed the Decision of the ALJ.
Claim Denied Because Claimant Not Employee or Statutory Employee
In Mauro Brito-Pacheco (deceased) v. Tina's Hair Salon, Injury No. 09-067542, the ALJ found that the claimant was not an employee. The employer was a Hair Salon owned by Tina Diaz, and she supplied a work station to the hair dressers, one of which was the claimant. Diaz provided salon business cards to which hair dressers could add their name. Diaz did not schedule appointments, limit or mandate work hours, provide employee benefits, pay taxes or mandate fees. Basically, the hair dressers would use the space provided and divide the proceeds of compensation paid by the customers. On August 10, 2009, the claimant was asked by another hair dresser to cover his appointments at the hair salon. During this shift, the salon was robbed and the claimant was killed. Diaz did not call the claimant to work that day and was unaware that he was working. The ALJ noted there was no evidence to support that Diaz had the right to control the claimant's work. Therefore, the claimant was unable to sustain the burden of proof regarding the employer/employee relationship. The ALJ then looked to whether the claimant was a statutory employee. The Court noted that the elements to establish statutory employment were whether the work done was under contract on or about the premises of the employer which was in the usual business of the employer. The ALJ found there was no evidence that the work of the claimant was pursuant to contract either written or verbal, and therefore, Tina's Hair Salon was not the claimant's statutory employer. Therefore, the claim was denied. The Commission affirmed the Decision of the ALJ.
Commission Gave Claimant With Borderline Retardation Benefit of the Doubt With Respect to Injury
In Tommy Mittenburg v. Missouri Pressed Metals, Inc., Injury No. 09-109673, the claimant alleged an injury to his neck, lower back and leg, while manipulating a 500 - 600 pound barrel on November 9, 2009. The claimant testified that he told the safety director that sustained an injury. The safety director testified and acknowledged that the claimant reported an injury to him, that he even took the claimant to the chiropractor twice and the employer paid for these visits. However, he testified that the claimant only reported a neck injury to him. The safety director also testified that the claimant told him on several occasions before and after his date of injury that his back hurt, however, made it clear that his pain was not related to his work. It was noted that the evidence showed that the claimant suffered from borderline mental retardation, was functionally illiterate and his thought processes were comparable to those of a child. The ALJ found the claimant more credible than the safety director and found the injury compensable.
The Commission agreed noting that it was difficult to imagine that the claimant volunteered relatively sophisticated information regarding his back problems described by the safety director. The Commission also found it difficult to believe that the safety director would tell the claimant he could get treatment for the low back during his first authorized visit to the chiropractor if he believed it wasn't a work-related injury, not to mention taking him back again and paying for even more treatment to the lower back. Therefore, the Commission found that the claimant told the safety director that he hurt his neck and back while manipulating a heavy barrel at work on that date, and therefore the injuries to his neck and lower back were compensable.
Insurer Did Not Have to Pay Costs to Employer and Claimant
In Allen Baldwin v. City of Fair Play, Injury No. 11-015959, the claimant was the Chief of Police and had multiple job duties including storm spotting, which required him to go to a location at a high point to begin spotting for tornados, power outages and damage within the city. The claimant used his personal vehicle for storm spotting. In light of the bad weather, the claimant left his residence to storm spot. He walked to his car, grabbed his door handle, at which time he slipped and fell, injuring his shoulder. The Mayor testified that the claimant's duties included storm spotting during severe weather. The employer agreed that the claimant's actions were within the course and scope of employment, however, the insurer refused to provide any treatment, contending that the claim was not compensable. The ALJ found that the claimant's injury was within the course and scope of his employment, and was therefore compensable. The ALJ also determined that the claimant and employer were entitled to costs.
The Commission affirmed the ALJ's opinion, except for with respect to the issue of costs. Pursuant to Statute, if the Division or the Commission determines that any proceedings have been brought, prosecuted or defended without reasonable ground, it may assess the whole cost of the proceedings upon the party who so brought, prosecuted or defended them. The insurer contended that the costs were inappropriate because it had a meritorious defense, or at least an arguable defense. The ALJ noted that the insurer offered no evidence suggesting that the claimant's injury was anything but compensable. Furthermore, the ALJ noted that the sole reason the claimant was out in the rain, wind, hail and severe weather on his date of injury was to benefit his employer and the citizens of the city. The ALJ found that to refuse compensability under the circumstances of this case was unreasonable and found that to ignore even the employer's pleads to provide basic medical treatment was simply wrong. Therefore, the ALJ found that refusal to provide medical treatment warranted an Award of costs. The Commission disagreed noting that based on the facts of the case and arguments proffered by the insurer, it did not find that its defense of the claim was egregious or without reasonable grounds, and therefore, the costs against the insurer were denied.
Interestingly in this case, the ALJ felt that the employer was entitled to costs. This was because the employer hired its own attorney in light of the fact that it believed that this claim was compensable, however, the insurer would not provide medical treatment because it did not believe the matter was compensable.