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.
Motion to Reopen a Prior Claim Based on Mistake Supported by Subsequent IME Report
Dreibach Wholesale Florists, Inc. v. Leitner, 2021-CA-1495-WC (11/10/22, not final)
Holding: Medical opinion acquired after ruling that could have been obtained prior to closure of case does not justify reopening on ground of “mistake” per KRS 342.125. The purpose of the “mistake” provision is to correct a decision based on misconception concerning the workers’ condition, not to give the losing party an opportunity to bring up reinforcements and relitigate.
Conflicting medical evidence was presented to the Administrative Law Judge ("ALJ") regarding the worker’s condition, including allegations of neck pain. The ALJ awarded medical benefits for the left knee and right shoulder; there was no award for the neck and there was no appeal of the award.
After undergoing cervical surgery to resolve ongoing shoulder pain, the worker submitted an IME assessing a 29% impairment for his neck and opining that the shoulder pain was previously misdiagnosed and was actually a result of the neck maladies. The worker then filed a motion to reopen, claiming that newly discovered evidence, the IME report, supported reopening. Denying the motion to reopen, the ALJ found that the IME report was not newly discovered evidence because it could have been discovered by the exercise of due diligence prior to the hearing. The worker also sought to reopen based on mistake and a change in condition. The ALJ determined that the IME report did not support reopening based on mistake or a change in condition, as there was no original award for any neck condition. The Workers' Compensation Board reversed, holding the worker had made a prima facie showing of mistake as to the original finding that he had not sustained a compensable neck injury.
The employer appealed, arguing that the Board usurped the ALJ’s role as fact finder by reopening a case to allow presentation of evidence discoverable before the initial hearing. The Court of Appeals agreed, finding that when an ALJ considers conflicting medical evidence regarding a workers’ compensation claim in making his ruling upon a final hearing, a subsequent medical opinion that could have been obtained prior to the close of evidence will not justify reopening on the ground of “mistake” as contemplated by KRS 342.125(1)(c).
Language in Settlement Agreement Required Continuation of Survivor Benefits with No Modification of Weekly Amount
Kentucky Employers’ Mutual Insurance Authority v. Fleming, Cl No. 201401039 (11/18/22, Workers' Compensation Board Opinion, not controlling)
KEMI appealed order substituting Debra Fleming, widow of Lenville Fleming, deceased, as a party and continuing indemnity benefits pursuant to KRS 342.730(3)(a). The order also extended the time of benefits to be paid to Debra for an additional 3 years, until Fleming would have turned 70.
KEMI argued proper procedure was to file a separate claim pursuant to KRS 342.750 (death statute) based on Baytos and Calloway County. Furthermore, KEMI contended Debra was not entitled to continuation of benefits because she was 63 at time of death and the 1996 version of KRS 342.730 did not provide for continuation of benefits after age 60. KEMI also argued that reopening rights were waived, and the 110 included waiver of reopening under KRS 342.750 and 342.730.
The Board disagreed that Debra’s sole avenue of relief was to file an action pursuant to KRS 342.750 noting that the death certificate didn’t conclusively show the death was work-related and the fact that Fleming was still owed indemnity benefits per the settlement agreement distinguished this case from Baytos and Calloway County. The Board rejected the notion that the waiver of reopening rights precluded Debra from reopening the claim to enforce the settlement agreement. The Board held that Fleming waived the right to reopen only to seek an increase in benefits and Debra was instead seeking to enforce a valid contract pursuant to KRS 342.265(4).
The Board found the terms of the settlement agreement controlling, construing the agreement as requiring indemnity payments to Fleming, and now to his widow, through 9/6/29, without modification of the amount. Below is the language in the 110:
In Other Information the settlement was stated to encompass any claim which might later arise and be claimed by Fleming and/or his dependents, further supporting the Courts conclusion that KEMI must continue payments through the settlement date without alteration to Fleming’s widow.
The Board reversed the order extending the benefits for 3 years, again stating that the terms of the Agreement control.
Pending Before the Supreme Court of Kentucky: 45-day Requirement for Submission of Medical Bills by Medical Provider
P & P Construction, Inc. v. Farley, 2022-CA-0332-WC
Several cases have gone before the Workers' Compensation Board regarding whether KRS 342.020(4), requiring medical bills to be submitted by the medical provider within 45 days after the date or service, applies prior to an award of medical benefits (either by opinion or agreement). Based on Wonderfoil, the Board has consistently found that the 45-day rule only applies post-award.
In P & P Construction, the Kentucky Court of Appeals overturned the Board, stating that the clear language of the statute requires the submission of medical bills by the provider within 45 days of service, period. This decision has been appealed and is currently before the Supreme Court of Kentucky. We will let you know when a decision has been issued, but it is currently safe to deny any medical benefits submitted more than 45 days from the date of service as untimely per KRS 342.020(4).
New Administrative Law Judge, Kenneth Smith
Kenneth Smith has been appointed to replace ALJ Christina Hajjar, who has resigned. He will serve for the remainder of the term expiring December 31, 2023. ALJ Smith graduated UK law school in 2004 and has spent his career as a Plaintiff attorney handling personal injury, SSD and workers' compensation cases.
New Supreme Court of Kentucky Chief Justice
The justices of the Supreme Court of Kentucky have elected Justice Laurance B. VanMeter as the next chief justice of the commonwealth of Kentucky. Chief Justice-elect VanMeter is the 6th chief justice and will serve a four-year term beginning Jan. 2, 2023.
Chief Justice-elect VanMeter will succeed Chief Justice Minton, who is retiring Jan. 1 after serving more than 14 years as administrative head of the Judicial Branch.
Should you have any questions or wish to discuss any related matters, please contact us at your convenience.
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