Claims Adjuster’s Blackout Injury Not Compensable

Knight v. Department of Labor and Industries,No. 69514-2-I (Wash. Ct. App. 04/07/14)

Ruling: The Washington Court of Appeals held that an adjustor for State Farm was not entitled to benefits for his brain injury.

What it means: In Washington, under the traveling employee doctrine, the worker bears the burden of proving that he is eligible for benefits, including that he was not on a distinct departure from the course of employment at the time of the injury.

Summary: A catastrophic claims adjustor for State Farm was based in Seattle but was working on assignment in Texas after a hurricane. After returning to Texas from a trip home, he was not scheduled to work but drove 30 miles from his hotel to survey the devastation. While driving back to his hotel, he noticed some men riding dune buggies on the beach, and he stopped to watch. The adjustor did not remember anything else from the day. Later that day, paramedics found the adjustor lying in the surf and treated him for hypothermia and intoxication. A CT scan in the hospital showed a subarachnoid hemorrhage in his brain. The emergency room doctor admitted that there was no way to know for sure how the adjustor was injured. The adjustor sought workers’ compensation benefits. The Washington Court of Appeals held that he was not entitled to benefits.

A traveling employee is generally considered to be in the course of employment continuously during the entire trip except during a distinct departure on a personal errand. The court found that a traveling employee who drank to the point of intoxication engaged in a distinctly personal activity outside the scope of employment.

The Department of Labor and Industries argued that the adjustor was on a personal errand when he stopped to watch the dune buggy riders and when he drank to the point of intoxication. The court pointed out that it was impossible to determine whether the adjustor was injured before or after he became intoxicated.

The court found that the adjustor had the burden to show a genuine issue of material fact that he was within the scope of employment at the time of his injury. The adjustor failed to do so because any theory as to how his injury occurred was “purely speculative.”

Employer Can’t Establish That Shock Was Intentional

Smith v. Tippah Electric Power Association,No. 2012-CT-00502-SCT (Miss. 04/03/14)

Ruling: The Mississippi Supreme Court held that a lineman who suffered an electrical shock was entitled to benefits.

What it means: In Mississippi, injuries due to the worker’s willful intention to injure or kill himself are excluded from workers’ compensation coverage. The employer must show that the worker intentionally injured himself.

Summary: A lineman for Tippah Electric Power Association was working on installing electrical service to a trailer. He was in the bucket when a foreman told him to come down because management wanted him to submit to a drug test. Crew members heard a buzzing sound and observed the lineman lying in the power lines, with one hand on the neutral line and one hand on the primary line. The lineman was wearing leather gloves that were burned on the palms. Workers were required to wear rubber gloves if they were going to be within two feet and one inch of the primary line. The lineman’s injuries resulted in an amputation of both arms below the elbow. He sought workers’ compensation benefits. Tippah denied compensability, arguing that he intentionally injured himself in an attempt to commit suicide. The Mississippi Supreme Court held that he was entitled to benefits.

The court found that Tippah did not show that the lineman intentionally injured himself. The lineman’s crew members did not actually witness the accident. The fact that the lineman did not remember exactly what happened leading to his injuries was not evidence that he intentionally grabbed the power lines. The court found that assumptions that the lineman was depressed or suicidal were not supported.

A dissenting judge opined that it could be “reasonably inferred” that the lineman intentionally grabbed the power lines. The judge pointed out that the distance between the primary line and neutral line made it unlikely that the lineman would accidentally come into contact with both lines simultaneously. The judge also noted that the lineman was under investigation for murder, his coworkers said his demeanor was different on the day of the accident, and Tippah was suspicious that he had been using drugs.

Incomplete Form Doesn’t Invalidate Claim

Cochran Industries VA v. Meadows,No. 1377-13-3 (Va. Ct. App. 04/01/14)

Ruling: The Virginia Court of Appeals held that a manager was entitled to medical benefits for his right hand injury.

What it means: In Virginia, a written form is sufficient to constitute a claim if it identifies the employer, the date of the accident, the location of the accident, and the injuries suffered, and fairly apprises the Workers’ Compensation Commission that a claim is being made.

Summary: A manager for Cochran Industries sustained an injury to his right hand when a concrete cinder block fell on it. He filed a claim for benefits. The manager only completed Part A of the claim form. Part B of the form was left blank because the manager did not know what benefits would be needed. For the first two years after the injury, the manager was compensated for all of his medical treatment. His treating physician sought authorization to perform surgery. Cochran denied the request, explaining that the two-year statute of limitations had expired. Cochran asserted that the manager’s claim form did not constitute a claim because it did not indicate what benefits he sought. The Virginia Court of Appeals disagreed, holding that the manager’s claim form was a claim and that he was entitled to medical benefits for his right hand injury.

The court explained that the workers’ compensation statute does not define the term “claim.” The court concluded that the manager’s completion and filing of Part A of the claim form constituted a claim under the workers’ compensation law. Although he did not complete Part B of the form identifying the benefits sought, the information in Part A identified the employer, the date of the accident, the location of the accident, and the injuries suffered. It also fairly apprised the Workers’ Compensation Commission that a claim was being made on behalf of the manager.

Exclusive Remedy Shields Directors of Charitable Corporation

Moulton v. Puopolo, No. SJC-11357 (Mass. 03/14/14)

Ruling: The Massachusetts Supreme Judicial Court held that a suit brought against the directors of a charitable corporation for a worker’s death was barred under the exclusive remedy provision of workers’ compensation.

What it means: In Massachusetts, directors of a charitable corporation are “employers” under workers’ compensation and are immune from suit under the exclusive remedy provision.

Summary: A residential treatment counselor for North Suffolk Mental Health Association, a charitable corporation that provided mental health and rehabilitation services, was alone with one of the facility’s residents. The resident assaulted her, causing her death. The counselor’s estate sued the directors of North Suffolk, asserting that their gross negligence caused the counselor’s death. Specifically, the estate alleged that the directors adopted policies that prevented staff from being aware of the resident’s violent past. The Massachusetts Supreme Judicial Court held that the directors were immune from suit under the exclusive remedy provision of workers’ compensation.

In a matter of first impression, the court held that directors of a charitable corporation were “employers” for workers’ compensation purposes. The court explained that the adoption of corporate policies is achieved by a note of the board of directors, acting as the corporation. The court found that to the extent the suit alleged that the counselor’s death arose from the adoption of or failure to adopt corporate policies, it alleged conduct by the charitable corporation that could have been occasioned only by a vote of its directors. Because the corporation was immune from suit under the exclusive remedy provision, so too were the directors whose action made that conduct possible.

The court found that to the extent that the suit alleged that the directors had the ability to implement workplace safety, the suit implied that the directors were acting in the capacity of an employer. As the counselor’s employer, the directors were immune from suit for workplace injuries sustained due to the board’s actions.

Employer Can’t Cut Benefits for Worker After Denying Light Duty

Metropolitan Atlanta Regional Transit Authority v. Thompson,No. A13A2304 (Ga. Ct. App. 03/27/14)

Ruling: The Georgia Court of Appeals held that the Metropolitan Atlanta Regional Transit Authority improperly reduced a worker’s benefits after it no longer allowed her to work with restrictions in its transitional program.

What it means: In Georgia, an employer cannot unilaterally reduce a worker’s benefits when the worker worked on light duty for one year but then the employer refused to allow her to work light duty, causing her to cease work.

Summary: A worker suffered an injury, which the regional transit authority accepted as compensable. The employer began paying temporary total disability benefits. The worker worked in the employer’s transitional program on light duty but suspended her benefits. After one year, the worker was not allowed to remain in the program. She was unable to return to regular-duty work and stopped working. The employer resumed paying TTD benefits, but five months later suspended her TTD benefits and began paying temporary partial disability benefits. The worker requested that her TTD benefits be reinstated. The Georgia Court of Appeals held that the employer improperly reduced the worker’s benefits.

The court rejected the employer’s argument that it could unilaterally reduce the worker’s benefits because she was not working at the time of the reduction and it had been determined that she was capable of performing work for 52 consecutive weeks. The court explained that the purpose of a statute was to allow an employer to unilaterally reduce benefits when a worker was released to return to work with restrictions but did not return to work. The court said it would be “incongruous” with the statute’s incentive for workers to return to work to allow a reduction of benefits when the worker was unable through no fault of her own to return to work since she was only allowed to participate in the transitional program for one year.

The court found that the worker was entitled to attorney’s fees because the employer acted without reasonable grounds in unilaterally reducing her benefits. The worker elected to return to work in the transitional program. The court pointed out that there was no evidence indicating why the employer allowed the worker to work in the program for only one year.

Inadmissible Drug Test Results Entitle Widow to Benefits

Gerding v. Dart Cherokee Basin Operating Co., LLC,No. 109,207 (Kan. Ct. App. 03/21/14, unpublished)

Ruling: In an unpublished decision, the Kansas Court of Appeals held that a worker’s widow was entitled to death benefits and funeral expenses.

What it means: In Kansas, the results of a drug test are not admissible unless the test was performed by a laboratory approved by the U.S. Department of Health and Human Services or licensed by the state’s department of health and environment.

Summary: A worker for Dart Cherokee Basin Operating Company was driving a company truck when he was involved in an accident. The worker died. A toxicology test performed as part of the autopsy indicated that the worker’s blood contained metabolites of cocaine and marijuana. The worker’s widow sought workers’ compensation benefits. Cherokee argued that benefits were not warranted because the worker was impaired by drugs at the time of the accident. The Kansas Court of Appeals held that the widow was entitled to death benefits and funeral expenses.

Employers seeking to avoid liability and submit the results of a drug test to show that a worker’s drug use contributed to his death must establish the proper credentials of the laboratory that performed the test. The results of a drug test are not admissible unless the test was performed by a laboratory approved by the U.S. Department of Health and Human Services or licensed by the state’s department of health and environment. In this case, the laboratory did not meet the statutory requirements but was accredited by other entities. Cherokee argued that it satisfied the purpose of the statute to ensure the quality of the laboratory completing testing. However, the laboratory was not approved by the statutorily named authorities.

The court also said it did not matter that Cherokee did not choose the testing laboratory. The results of the drug test were not admissible.