The Legal Buzz – Lee & Brown Newsletter and Case Law Update September 2019
Colorado, Arizona and Utah.
Noteworthy Cases – Colorado
Members John Abraham and Fran McCracken successfully defended against Claimant’s claim of a compensable occupational disease in Vargas v. Cargill Meat Solutions, W.C. 8-093-534-001. Claimant worked as a snout trimmer and alleged to have suffered bilateral carpal tunnel syndrome as a result of an occupational disease. At hearing, Ms. McCracken elicited testimony from Respondents’ expert that Claimant’s duties as a snout trimmer did not meet the causation requirements for carpal tunnel syndrome. Furthermore, Claimant’s job duties lacked the sufficient force to cause a work-related condition pursuant to Rule 17, Exhibit 5 of the Division’s Medical Treatment Guidelines. The ALJ credited the opinion of Respondents’ expert and found Claimant failed to prove that he suffered an occupational disease in the form of bilateral carpal tunnel syndrome. The claim was denied and dismissed.
In Gammill v. Walmart Associates Inc., Member Fran McCracken successfully defended against Claimant’s claim of compensability for a back injury. Respondents sought to withdraw a General Admission of Liability, based on prior medical records indicating that Claimant’s back injury was pre-existing. Respondents’ medical expert also testified that Claimant’s congenital deformity was an incidental finding not related to the work injury and that fusion surgery to treat low back pain should only be considered after conservative treatment was exhausted. The ALJ found that Claimant failed to meet his burden of proving entitlement to workers’ compensation benefits by a preponderance of the evidence. Respondents were therefore permitted to withdraw the GAL as improvident.
Member Fran McCracken also successfully defended against a claim for penalties for the alleged failure to timely pay a lump sum settlement amount to Claimant within fifteen days in McDonald v. Walmart Associates Inc. The ALJ found that Claimant failed to demonstrate that penalties should be assessed for Respondents’ untimely payment of the settlement check. Specifically, the ALJ noted that Respondents acted reasonably in ensuring that Claimant timely received the check by stopping payment on a first check that was issued and requesting a new check be overnighted to Respondents’ counsel while consistently communicating with Claimant’s counsel regarding the arrival of the check. Additionally, the ALJ found that Respondents cured the issue of delayed settlement prior to Claimant filing the Application for Hearing and Amended AFH, which resulted in the curing of the alleged violation as allowed by statute.
Noteworthy Cases – Arizona
Before The Industrial Commission of Arizona, Associate Daniel Mowrey defended Claimant’s full contest claim in Johnson v. KWD Enterprise, Inc., ICA No. 20183310358. Claimant alleged a low back injury as a result of her employment as a home health care nurse. Claimant stated that she was injured while lifting a patient in her bed. At hearing, Mr. Mowrey elicited testimony from Claimant that she did not initially report the injury or seek treatment for over two weeks following the alleged injury. Claimant further admitted to not filing a claim for workers’ compensation until her unemployment benefits were denied. Mr. Mowrey also submitted an expert medical opinion that the claim was not compensable. The ALJ found the testimony and corresponding medical records did not meet the standard to establish an industrial injury. The ALJ denied and dismissed the claim.
Enough of this Horseplay!: In Rifle Tequilas, Inc. and Truck Insurance Exchange v. Pena Alvarez, No. 18CA1367 (July 11, 2019), Claimant was a restaurant employee who sustained injuries to his facial area as a result of an altercation with another employee. Claimant, as permitted by the employer, had a beer after the restaurant closed. The altercation regarding the beer arose while Claimant was washing dishes. The ALJ found the claim to be compensable, notwithstanding the Respondents’ argument that Claimant was engaged in horseplay at the time of injury. Specifically, the ALJ used the four factor test from Lori’s Family Dining, Inc. v. ICAO to determine whether the horseplay deviated so substantially that Claimant’s resulting injury was not compensable: (1) the extent and seriousness of the deviation; (2) the completeness of the deviation, i.e. whether it was commingled with the performance of a duty or involved in an abandonment of duty; (3) the extent to which the practice of horseplay had become an accepted part of the employment; and (4) the extent to which the nature of the employment may be expected to include some horseplay. The ALJ found the claim to be compensable, noting that Claimant was permitted to drink beer while working, the altercation involved the beer, and there was “no credible evidence” that Claimant was reprimanded for prior altercations. Thus, the ALJ concluded that horseplay was “an inherent part of the workplace.” The Court of Appeals noted that the finding of the extent of a deviation is a question of fact for the ALJ and that a claimant is not required to prove every element of the four-part test. Rather, the ALJ’s finding only needs to be sound and readily discernible based on the factors.
Moral of the story: Horseplay may be considered an inherent part of the workplace when there are no consequences for prior acts of horseplay.
Grant or Deny? The Director Will Decide: In Webster v. Czarnowski Display Service Inc., W.C. No. 5-009-761 (July 16, 2019), Claimant sought to change his physician under C.R.S. § 8-43-404(5)(a). The Director of the Division of Workers’ Compensation denied Claimant’s request, as Claimant sought treatment for injuries and conditions not related to his work injury. The ICAO held that the Director has broad discretionary authority to grant a Claimant’s request for a change of physician. In this case, Claimant’s request was based on his personal dissatisfaction with his physician. The ICAO upheld the Director’s denial of Claimant’s request, as there was no abuse of discretion.
Moral of the story: The Director and ALJ have broad discretion in granting a request for change of physician under C.R.S. § 8-43-404(5)(a).
IME on My Way: In Wanner v. Patterson UTI Drilling Co, W.C. No. 5-065-967-001 (July 17, 2019), ICAO affirmed an ALJ’s Order that found Claimant’s claim compensable. Claimant was initially injured at work on December 22, 2017, when he was struck by a board on his left side. Claimant sustained additional injuries on March 28, 2018, while driving home from an IME. There were two primary issues in this claim: 1) whether the initial injury on December 22, 2017 was a compensable claim; and 2) whether Claimant was entitled to ongoing medical benefits following the motor vehicle accident on March 28, 2018. Respondents argued on appeal that the motor vehicle accident was an intervening event that severed the causal connection. The ALJ opined that Respondents’ intervening event argument was based on the mistaken premise that an injury during travel to an IME appointment is an intervening event. The ALJ ruled, and the ICAO agreed, that under the “quasi-course of employment” doctrine, an injury occurring during travel to and from authorized medical treatment is compensable. The ALJ’s Order was affirmed.
Moral of the story: Injuries that occur during travel to and from authorized medical treatment are compensable.
Safety First? Sometimes: In Burd v. Builder Services Group Inc., d/b/a Mato, W.C. No. 5-058-572-01 (July 9, 2019), Respondents sought review of the ALJ’s Order that denied a reduction in disability benefits due to a safety rule violation and increased the average weekly wage (AWW). Claimant was injured when he fell off a roof while installing fire insulation products. Claimant was not attached to a safety line, as was required; therefore, Respondents reduced his temporary benefits by 50% due to the imposition of the safety rule penalty pursuant to C.R.S. § 8-42-112(1)(b). The ALJ found that the employer did not prove Claimant willfully violated the safety rule, as the employer’s management did not consistently understand the rule itself. Additionally, the ALJ found that the employer did not enforce the safety rule. The ICAO found that there was substantial evidence to support the ALJ’s ruling. The ALJ’s Order was affirmed.
Moral of the story: If the safety rule is not regularly understood and enforced, you will not be successful in taking the 50% safety rule violation reduction.