SIGNIFICANT CASE SUMMARIES

West Virginia Case Summary

Frank R. Workman v. C.J. Hughes
Intermediate Court of Appeals of West Virginia
No. 23-ICA-261

Decided: December 27, 2023

Even if an employer has a strong case on the substantive merits, that case can be sabotaged by the employer’s failure to issue timely and appropriate orders relative to a claimant’s benefit requests.

Background

The Claimant reported a work-related low back injury, after which the claim administrator (Employer) issued an order denying compensability. The Claimant protested, with the Office of Judges (OOJ) issuing an Order reversing the Denial and holding the claim compensable for a lumbar sprain. The OOJ further ordered the Employer to issue an order regarding TTD benefits, with the Claimant then also requesting payment of TTD benefits. The Employer did not issue any order.

The Claimant later requested a reopening of the claim for TTD, alleging aggravation of his low back condition. The Employer issued an Order denying that request, with the Claimant filing a protest with the Board of Review (BOR). The BOR upheld the Employer’s Order, holding based on the medical evidence that the Claimant did not sustain an aggravation. The Claimant appealed to the ICA.

Holding

The ICA reversed the BOR’s order, holding that the BOR was clearly wrong in upholding the Employer’s Order denying reopening. However, they did not do so on the substantive merits. Rather, the ICA noted that the BOR failed to consider the Employer’s failure to address the OOJ’s original Order directing the Employer to issue an order regarding TTD benefits and, indeed, failed to take any action regarding TTD benefits, even when requested by the Claimant after the OOJ Order. The ICA remanded the case to the BOR for findings consistent with its opinion.

Takeaway

This case underscores the importance of abiding by the procedures mandated by the statute, regulations, and previously OOJ (now BOR as court of original jurisdiction). Even if an employer has a strong case on the substantive merits, that case can be sabotaged by the employer’s failure to issue timely and appropriate orders relative to a claimant’s benefit requests.

Questions about this case can be directed to Evan Jenkins at (412) 697-7403 or ejenkins@tthlaw.com.