United States: Court Provides Guidance To Worker's Comp Practice

Last Updated: October 2 2015
Article by Ann H. Stewart

The Indiana Court of Appeals decided several cases addressing worker's compensation issues last year. While many decisions were unpublished, and may not therefore be referenced in pleadings, they offer insight into various aspects of the worker's compensation practice, including the standard for proving entitlement to statutory compensation and benefits. These decisions reveal the board's position on issues before it and provide practice refreshers and guidance to attorneys who practice before the Worker's Compensation Board of Indiana.

A more detailed review of the worker's compensation decisions will be included in the 2015 edition of the DTCI Indiana Civil Litigation Review, but there are several themes worth highlighting now.

Deferential standard of review

The court first reminds practitioners of the deferential standard of review it exercises when reviewing decisions appealed from the Worker's Compensation Board. When reviewing a negative award, it will leave undisturbed the board's findings of fact unless it concludes undisputed evidence leads to a contrary result, considering only the evidence that tends to support the board's determination together with any uncontradicted adverse evidence. If the appeal presents only factual questions, the court will usually affirm the board's decisions. Despite continued requests, the court declined to reweigh the evidence or reassess witness credibility. Keith v. Indiana Bell, 6 N.E.3d 509, unpub. (Ind. Ct. App. 2014); Sparks v Harborside Nursing Home, 7 N.E.3d 1027, unpub. (Ind. Ct. App. 2014); Ragon v. Eli Lilly & Co., 20 N.E.3d 604, unpub. (Ind. Ct. App. 2014).

The court should reverse the board's decision only if it determines the board incorrectly interpreted the Worker's Compensation Act. In Thompson v. York Chrysler, 999 N.E.2d 446 (Ind. Ct. App. 2013), the court reversed the board's denial of a claim involving an assault by a coworker. The board found that the plaintiff had failed to carry her burden of proving (1) the altercation arose out of employment (because it was unclear which employee was the initial aggressor) or (2) the injury occurred in the course of employment (because a second exchange was unrelated to the employment). The court reviewed the uncontroverted evidence and determined that the altercation occurred while Thompson was leaving work and, therefore, it happened in the course of employment. Id. at 451. In addition, the court rejected the board's findings that it believed were contrary to the parties' stipulations and, so, improper as a matter of law. The court determined that the evidence was undisputed that the coworker verbally assaulted Thompson, making the other employee the initial aggressor. Id. The determination that the injury stemmed from the work relationship established a causal nexus between the injury and the work duties, supporting the conclusion that the injury arose out of Thompson's employment. Based on these conclusions, the court remanded the claim to the board for a determination of benefits.

Burden of proof

Next, the court addressed the burden of proof needed to establish entitlement to statutory compensation and benefits under the Indiana Worker's Compensation Act. The threshold issues in worker's compensation claims are whether an injury occurred and whether that injury arose out of employment. Ind. Code § 22-3-2-2. In other words, was there a causal connection between the employment and the injury?

On several occasions, the court reminded the parties that the burden of proving all the elements of a claim remains on the employee throughout the litigation. In Sparks, 7 N.E.3d 1027, Sparks filed two claims against Harborside Nursing Home, alleging she suffered injuries from falls in 2007 and 2008. Harborside accepted the first claim but denied the second. The court affirmed the board's denial of Sparks' 2008 claim, finding that the record supported its conclusion that Sparks' injuries did not arise out of or in the course of her employment. Id. at 1030. The court first reviewed the medical records to determine that the surgery was unrelated to the earlier claim. It also affirmed the board's decision that the second fall did not arise out of her employment because it stemmed from a personal condition, holding that Sparks' knee giving out on her had no occupational relationship to her work. Id. at 1032. Although Sparks was physically at work, Sparks was simply "[w]alking down the hallway" and "[n]ot doing anything" when the fall occurred. Id. The court likewise affirmed the board's decision to reject Sparks' argument that she fell because she turned to respond to someone calling her name, which she argued was "definitely work related." Id. at 1033. The court found that the board's conclusions of law were supported by its findings and declined Sparks' invitation to reweigh the evidence and judge the credibility of witnesses. Id.

The court also refused to disturb the hearing member's factual findings and affirmed the board's denial in Seacat v. Goodrich Corp., 11 N.E.3d 572, unpub. (Ind. Ct. App. 2014). Seacat injured his ankle while playing hacky sack, but argued it was part of the employer-sponsored stretch break. The board denied the claim, determining Seacat's injury did not arise out of employment because he was engaged in horseplay at the time of this accident. Of note in its analysis, the court repeated that the burden of proving every element of a statutory claim rests on the employee. Id. At 574. Since Seacat failed to carry his burden of proving a causal nexus between the injury and employment, the court did not need to address whether the injury occurred in the course of employment.

Credible evidence

Not only is the burden on the plaintiff to prove every element of a worker's compensation claim, the burden must be carried with credible evidence. As the trier of fact, the board weighs the credibility of the evidence presented, and the court will not second guess the board. In Keith, 6 N.E.3d 509, the board determined that Keith did not present credible evidence to meet his burden of proving that he was permanently and totally disabled and could not return to work. To support his assertion, Keith provided a vocational rehabilitation report that was prepared after an interview with Keith and a review of a selection of his medical records. The hearing member discounted the report because it was based on an inaccurate history and because some of the pertinent medical information was not reviewed. The single-hearing member determined that Keith did not meet his burden of proving that he was permanently and totally disabled with this evidence. The court affirmed the board's denial and declined Keith's request to reweigh the evidence. Id. at 514.

The board again addressed the credibility of evidence that was submitted in support of an Occupational Disease Act claim and determined that the plaintiff failed to meet his burden of proving the required statutory elements. Ragon, 20 N.E.3d 604. Ragon's claim that he suffered from occupational asbestosis rested heavily on the veracity of his own representations related to the nature, extent and duration of his alleged asbestos exposure. The single-hearing member found that Ragon was not a credible witness (based on inaccurate historical remarks) and ruled that he had failed to meet his burden of proving exposure sufficient to cause his respiratory condition. In addition, the board determined that the medical reports Ragon submitted were insufficient to carry his burden of proving he suffered an occupational disease because the physicians relied on these incomplete and inaccurate statements regarding Ragon's occupational history. The court affirmed these determinations and declined Ragon's invitation to judge the credibility of witnesses or reweigh the medical evidence before the board. Id. at 609.

In two cases, the court left undisturbed the board's determinations related to the level of evidence needed to prove the "other good reason" exception to Ind. Code § 22-3-3-4(d), established by the Indian Supreme Court in Daugherty v. Industrial Contracting & Erecting, 802 N.E.2d 912 (Ind. 2004). This exception allows an employee to pursue unauthorized medical care at the employer's expense. In the first case, the authorized physicians determined the claimant suffered from degenerative back disease that was aggravated by a repetitive lumbar strain from her work at the printing center. Harrold v. L&D Mailmasters, 5 N.E.3d 810, unpub. (Ind Ct. App. 2014). Harrold declined the care offered. After the authorized physicians determined her work injury had reached maximum medical improvement, Harrold returned to the initial physician and told him that one of the physicians recommended fusions surgery (which was not accurate). The board determined that this subsequent treatment was unrelated to the work accident. The court affirmed, finding that Harrold failed to carry her burden of proving she had "other good reason" to pursue surgery. Id. at 814.

In Marion County Health Department v. Hill, 15 N.E.3d 688, unpub. (Ind. Ct. App. 2014), the board determined that Hill did carry his burden of proving he had "other good reason" to pursue unauthorized care. Like Harrold, Hill had degenerative back conditions in addition to a compensable back injury. The board found that Hill proved he had "other good reason" for pursuing additional medical care since the care provided by the authorized physicians provided no relief. The court did not disturb the board's findings in this case. Id. at 696. Although the board reached different conclusions in these cases, the court left undisturbed the board's assessment of the factual evidence and the credibility of the witnesses.

Evidentiary issues

The court reminds parties of the importance of fully investigating available defenses and presenting all the evidence in support or defense of a claim during the initial hearing before a single-hearing member. Frontline National v. Steinhauer, 23 N.E.3d 859, unpub. (Ind. Ct. App. 2014). After the single-hearing member determined that Steinhauer's injury arose out of and in the course of her employment, based on the credibility of the hearing testimony, Frontline informed the single-hearing member that it had obtained additional documents that purported to discredit that testimony. Specifically, the documents showed the supervisor who testified about the events was not at work on the date of injury. The single-hearing member refused to consider the supplemental evidence, which was readily available at the time of the hearing. The Court of Appeals determined that the board did not abuse its discretion when it denied Frontline's attempt to backfill the record. Id. at 862. This decision emphasizes the importance of submitting evidence related to all issues before the single-hearing member during the initial hearing.

Exclusive remedy provisions

Finally, the court reminds us of the 2001 statutory revision to the definition of "employers" when it held that an employee's exclusive remedy against joint employers in the event of a work injury was the Worker's Compensation Act. Frontz v. Middletown Enterprises, Inc.,15 N.E.3d 666 at 669 (Ind. Ct. App. 2014). Frontz filed a tort lawsuit against both the temporary employment agency and the factory in which she worked. She also filed a worker's compensation claim listing both companies as her employers. The trial court granted both companies' motions for summary judgment in the tort action, based on the Indiana Worker's Compensation Act's exclusive remedy provisions. The Court of Appeals upheld this ruling, reasoning that temporary employees are leased employees and under Ind. Code § 22-3-6-1(a), both a lessor and a lessee of employees are joint employers for the purposes of the Act. Id. Thus, both the agency and the factory were deemed to be employers for purposes of injuries sustained arising out of and in the course of employment and subject to the Act's exclusive remedy provision. These provisions precluded Frontz from pursuing a tort action.

In another case, the court found that the exclusive remedy provisions did allow a tort action when it determined that an injury did not arise out of employment because the individual was fulfilling no employment duties at the time. Wabash County Hospital Foundation v. Lee, 4 N.E.3d 1229, unpub. (Ind. Ct. App. 2014). In addition to presenting procedural questions related to burden of proof, this case also presented a factual situation in which an employee on leave of absence pursued a personal endeavor at the time of the alleged injury. Because Lee's injury was not incidental to her employment, the court determined the Act was inapplicable, and the trial court acquired subject matter jurisdiction over the matter. Id. at 1233. There was disagreement within the court whether a leave of absence removed an individual from her employment status; however, the court concluded that the actions placed the individual outside employment, which allowed her to pursue a tort claim. Id.

This is a sample of the recent decisions the Indiana Court of Appeals issued addressing the Indiana Worker's Compensation Act provisions. It is useful and advisable to read all the decisions that affect the worker's compensation practice to better understand the board and court's positions on standards for this practice area.

Originally published in the The Indiana Lawyer

The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.

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