NWCDN Members regularly post articles and summary judgements in workers’ compensations law in your state.
Select a state from the dropdown menu below to scroll through the state specific archives for updates and opinions on various workers’ compensation laws in your state.
Contact information for NWCDN members is also located on the state specific links in the event you have additional questions or your company is seeking a workers’ compensation lawyer in your state.
Temporary Total Disability (TTD) Benefits and Credit for
Wages Paid
General
Motors, LLC v. Giovanni Smith, 2024-CA-0367-WC (7/12/24 KY
Court of Appeals, To Be Published, not final)
Smith was employed by GM for 13 years working on the assembly
line. In February of 2021, he began having pain in his right hand and wrist
which he reported in March. He was pulled off the line on August 10, 2021 due
to his injury and moved to a different position until March 29, 2022, when he
first went off work. He underwent carpal tunnel surgery on July 13, 2022 and
was released to full duty, without restrictions, on September 12, 2022. He
returned to a different position following surgery and testified that he did
not believe he could return to his pre-injury position. Smith testified that
his position from August 2021 through March of 2022 involved cleaning and
make-work projects, or no work at all. Dr. Bloemer (PL IME) diagnosed an
arthritic condition as well as CTS due to work, opining that Smith is incapable
of returning to his pre-injury position. Dr. Nicoson (Def IME) found the CTS to
be work-related but felt the arthritis was not. He assessed permanent
restrictions that would not prevent a return to the pre-injury position. Both
doctors agreed that Smith reached MMI on October 13, 2022.
The ALJ awarded TTD from August 1, 2021 to October 13, 2022, with no credit for
wages paid and PPD benefits with a 3x multiplier. GM appealed, arguing that TTD
should not begin until March 29, 2022 or, in the alternative, that they should
receive a credit for wages paid during this time. The Court of Appeals affirmed
the TTD award, finding that Smith was not at MMI and had not reached a level of
improvement that would permit a return to employment. The Court also upheld the
denial of the credit because GM failed to provide paystubs showing the net
wages after taxes. GM also appealed the application of the 3x multiplier. The
Court of Appeals upheld the award of the 3x multiplier, finding that the
substantial evidence supported the award.
Should you have any questions or wish to discuss any related matters, please contact us at your convenience.
H. Douglas Jones, Esq. – djones@jsbattorneys.com, 859.594.4200
Margo Menefee, Esq. – mmenefee@jsbattorneys.com, 859.594.4200
Should you have any questions or wish to discuss any related matters, please contact us at your convenience.
H. Douglas Jones, Esq. – djones@jsbattorneys.com, 859.594.4200
Margo Menefee, Esq. – mmenefee@jsbattorneys.com, 859.594.4200
There are two new administrative law judge appointments pending. First is Phil Rich of Louisville, KY. Phil Rich has been practicing law for more that 30 years. He worked as an insurance defense attorney for 10 years before transitioning to the representation of Plaintiffs in workers' compensation, social security disability and personal injury claims. Second is Kimberly O'Bryan of Paintsville, KY. She has been practicing for more than 20 years representing Plaintiff's in personal injury, social security disability, and workers' compensation claims.
Scott M. Miller will be reappointed to the Workers' Compensation Board for a four year term beginning January 5, 2024. Judge Miller was previously appointed in December of 2021 to replace R. Scott Borders, for a term expiring January 4, 2024.
KRS 342.020(4) states medical providers shall submit billings within 45-days of service. Claimant’s medical providers did not submit billings for multiple visits until several months after the visits. The medical obligor rejected the bills since they were not submitted within 45 days of the date of service.
The ALJ determined the 45-day rule did not apply until after an award of benefits. The Workers’ Compensation Board affirmed the decision, relying partly on Wonderfoil, Inc. v. Russell (holding 60 day time limit for Claimant to submit unpaid medical bills for reimbursement only applies after an award). P & P appealed arguing that the Wonderfoil decision was not applicable to the statutory duties of medical providers.
The Supreme Court of Kentucky held that medical providers must bill within 45 days of treatment, regardless of whether claim has been adjudicated as work-related, or they have lost the right to be compensated for their services under workers’ compensation.But note, the Court does reference 803 KAR 25:096 Sec. 6, which states if the provider fails to submit a statement for services as required by KRS 342.020(4) without reasonable grounds, the medical bills shall not be compensable. There was no evidence in this claim of reasonable grounds for the late submissions.
Injury Claim Existing But Not Joined at Time of Settlement of Prior Injury Claim is Barred
Rodarte v. BlueLinx Corporation, 2022-SC-0423-WC rendered 9/28/23
Claimant sustained a work-related knee and ankle injury in 2016 and work-related shoulder injury in 2018. In 2019, Claimant filed an application for resolution of a claim (Form 101) for the knee and ankle injuries. At that time he was receiving TTD for the 2018 shoulder injury. Claimant and employer settled the 2016 knee and ankle injury. There was no language in the agreement regarding the 2018 shoulder injury. Eleven months after settling the 2016 claim, the Claimant's TTD benefits for the 2018 shoulder claim were stopped and he filed a Form 101 three months later. The Employer denied the claim, arguing it was barred under KRS 342.270 which states an employee must join all accrued causes of action against the named employer and failure to join will result in those claims being barred.
The ALJ dismissed the 2018 claim. The Board reversed, stating the 2018 claim had not yet accrued at the time of the settlement of the prior claim, because Claimant was not yet at Maximum Medical Improvement (MMI). Claimant also filed a motion to reopen the 2016 claim, arguing it was a mutual mistake that the shoulder claim was not addressed in the 2016 agreement. The Motion to Reopen was denied by the ALJ and the Board upheld the denial.
The Supreme Court of Kentucky affirmed the ALJ opinion that the 2018 claim was barred, holding Claimant was required to join his 2018 shoulder claim to his 2016 knee and ankle claim prior to finality of that settlement. The Court found that the shoulder injury claim accrued on the date of the injury and had therefore accrued at the time of the settlement of the prior claim. The Court also upheld the denial of the Motion to Reopen finding no basis for same as there was no evidence the Employer mistakenly failed to include reference to the shoulder claim when settling the 2016 claim.
Timely Notice to Subsequent Employer of Harmful Change in Pre-existing CWP Condition
Tennco Energy, Inc. v. Lane, 2023-SC-0028-WC rendered 9/28/23
Claimant was a coal miner for more that 30 years. He had been diagnosed with CWP (black lung disease) on multiple occasions starting in 2003. In 2005 he settled a CWP workers' compensation claim against his then employer. He continued working in coal mining, joining Tennco in 2009 and remaining there until his last day of employment on 1/21/19. On 7/11/19, Claimant advised Tennco he was filing a CWP claim. The medical evidence established a worsening of his CWP. Tennco argued that Claimant's prior CWP diagnoses in 2003 and 2004 rendered his 2019 notice untimely and the ALJ agreed.
The Supreme Court of Kentucky reversed, holding that evidence of a harmful change in one's CWP condition attributable to the new employer is a likely prerequisite to any successful subsequent CWP claim, thus the Claimant's awareness of such change is the event triggering the statutory obligation to provide notice rather than the original CWP diagnosis.
Should you have any questions or wish to discuss any related matters, please contact us at your convenience.
H. Douglas Jones, Esq. – djones@jsbattorneys.com, 859.594.4200
Margo Menefee, Esq. – mmenefee@jsbattorneys.com, 859.594.4200
Exclusivity Provision of Workers’ Compensation Act Does Not Preclude Civil Recovery For Non-Work-Related Injuries
Schneider Electric USA, Inc. f/k/a Square D v. Williams, et. al. (2022-CA-0190-MR) KY Court of Appeals 7/7/2023, not final
Plaintiff was six years old when adopted by Ken Baxter in 1967. Plaintiff lived with Baxter until the mid-1980s and during that time Baxter worked for Square D who manufactured plastic electrical parts from molding compounds, some of which contained asbestos until around 1974. Plaintiff also worked for Square D for a few months in 1978. Plaintiff was diagnosed with mesothelioma in 2016 and died a year later. Prior to her death she filed suit against Square D claiming she was exposed to asbestos from her father’s contaminated work clothes and directly during her brief employment in 1978. During discovery, all of the medical and expert proof attributed her mesothelioma to asbestos from her father’s work clothes. Square D moved for summary judgment based partly on the exclusivity provision of the Workers’ Compensation Act. The trial court denied summary judgment. Square-D argues the trial court wrongly concluded Plaintiff’s claims were not barred by the Workers’ Compensation Act.
The Kentucky Court of Appeals affirmed the trial court’s refusal to dismiss claims against Square D based on workers’ compensation exclusivity. It reasoned that there was no evidence that Plaintiff was exposed to asbestos during her brief time working at Square D. The Court also agreed with the trial court that a jury is capable of apportioning work-related and non-work-related injuries, if appropriate. The Court further determined that allowing Plaintiff’s brief summer employment with Square D to immunize Square D against all repercussions from other-than-workplace asbestos exposure would result in an unfair windfall for Square D.
Should you have any
questions or wish to discuss any related matters, please contact us at your
convenience.
H. Douglas Jones, Esq. – djones@jsbattorneys.com, 859.594.4200
Margo Menefee, Esq. – mmenefee@jsbattorneys.com, 859.594.4200
Jurisdiction
of Injured Employee's Claim
Letcher County Board of
Education v. Hall, (2022-SC-0313-WC, 6/15/23) not final
Teacher filed WC claim alleging he developed mesothelioma after being exposed
to asbestos during his employment in county high school. County School Board
argued that the Board of Claims, not Department of Workers’ Claims, had
exclusive jurisdiction over the claim under KRS 49.070(16) which states that
“any claim” against the school district for damages as a result of asbestos
exposure shall be brought before Board of Claims. Rejecting this argument, the
Supreme Court of Kentucky concluded that KRS 49.070(16) pertains to claims by
third parties, not employees. The Court cited the purpose of the Workers’
Compensation Act to compensate injured workers for loss sustained as a result
of work-related injury or disease as well as its exclusivity. Furthermore, the Court
pointed out that KRS 49.020(5) requires the Board of Claims to find negligence
while the Workers’ Compensation Statute requires no showing of fault.
Should you have any questions or wish to discuss any related matters, please
contact us at your convenience.
H. Douglas Jones, Esq. – djones@jsbattorneys.com, 859.594.4200
Margo Menefee, Esq. – mmenefee@jsbattorneys.com, 859.594.4200
Cumulative Trauma - Sufficiency of Evidence
Lexington Fayette Urban County Gov’t v. Gosper, 2021-SC-0386-WC (not final)
Claimant worked exclusively as firefighter and EMT for employer for 18 years. He presented to his treating physician, Dr. Balthrop, in December of 2017 with unbearable bilateral knee pain which his physician stated was work-related. He underwent two total knee replacement surgeries paid through workers’ compensation. Claimant had treated for knee problems for years and was diagnosed with osteoarthritis in 2012. He had a prior right knee work injury in 2007 that led to a meniscectomy. Dr. Balthrop testified that Claimant’s physically exacting work demands combined with his varus deformity accelerated the gradual deterioration of his knees and his occupation worsened his arthritis. The employer’s IME expert, Dr. Prince acknowledged that sustained, repetitive, and strenuous work is a risk factor for arthritis and would have accelerated Claimant’s degenerative changes. Dr. Prince, attributed 75% of his left knee impairment and 50% of his right knee impairment to non-occupational factors, including his varus deformity and being overweight. He testified that without the work-related component, Claimant would likely not have needed the knee replacement surgery at the age he had it. Claimant’s IME expert, Dr. Burke, noted that while Claimant experienced intermittent knee pain, he continued to work, however by the end of 2017 his knees deteriorated to where he couldn’t function with regular duty activities. Dr. Burke diagnosed progressive development of bilateral osteoarthritis contributed significantly by the nature and duration of his work. The employer also had a report prepared by Dr. Lyon, who attributed 50% of Claimant’s right knee condition to work and 0% of the left knee condition. Dr. Lyon emphasized Claimant’s history of knee pain and bowleggedness.
The ALJ found that the nature and duration of Claimant’s work aggravated his degenerative condition into active physical impairment sooner than would have been, awarding PPD benefits with the 3x multiplier and medical benefits. The employer appealed, arguing that the Claimant did not meet his burden of proving a work-related injury, noting injury does not include the effects of the natural aging process. The Supreme Court of Kentucky held that substantial evidence existed to support the ALJ’s determination, finding that three doctors, including one of the employer’s IME experts, acknowledged that the Claimant’s job duties significantly contributed to the acceleration or aggravation of his degenerative knee condition.