Bevins v. OFFICE OF INS. COM'R

708 S.E.2d 509
CourtWest Virginia Supreme Court
DecidedOctober 14, 2010
Docket35548, 35219
StatusPublished

This text of 708 S.E.2d 509 (Bevins v. OFFICE OF INS. COM'R) is published on Counsel Stack Legal Research, covering West Virginia Supreme Court primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Bevins v. OFFICE OF INS. COM'R, 708 S.E.2d 509 (W. Va. 2010).

Opinion

708 S.E.2d 509 (2010)

Charles W. BEVINS, Appellant,
v.
WEST VIRGINIA OFFICE OF the INSURANCE COMMISSIONER and Mountain Energy, LLC, Appellees.
Marty L. Greathouse, Appellant,
v.
West Virginia Office of the Insurance Commissioner and the Wackenhut Corporation, Appellees.

Nos. 35548, 35219.

Supreme Court of Appeals of West Virginia.

Submitted September 22, 2010.
Decided October 14, 2010.

*512 William B. Gerwig, III, Charleston, WV, for Appellant, Charles W. Bevins.

Anna L. Faulkner, Workers' Compensation Defense Division, Charleston, WV, for Appellee, West Virgina Insurance Commissioner.

G. Patrick Jacobs, The Law Office of G. Patrick Jacobs, L.C., Charleston, WV, for Appellant, Marty L. Greathouse.

Jack M. Rife, Workers' Compensation Litigation, Division, Charleston, WV, for Appellee, West Virginia Insurance Commissioner.

DAVIS, Chief Justice:

The instant proceeding consists of two consolidated appeals, both of which present the same issue for this Court's resolution: is an injured worker entitled to receive temporary total disability workers' compensation benefits (hereinafter referred to as "TTD benefits")[1] while he/she also is receiving Social Security disability benefits[2] in connection with the same compensable injury? In both of the claimants' claims, the Workers' Compensation Board of Review (hereinafter referred to as "Board of Review") ruled that their receipt of Social Security disability benefits precluded them from also receiving TTD benefits. On appeal to this Court,[3] both claimants contend that the Workers' Compensation Board of Review has improperly interpreted W. Va.C.S.R. § 85-1-5.2 (2009)[4] in denying their requests for TTD benefits. Upon a review of the parties' arguments, the records presented for appellate consideration, and the governing authorities, we reverse the rulings rendered by the *513 Workers' Compensation Board of Review. Specifically, in Case Number 35548 regarding Mr. Bevins, we reverse the Board of Review's June 4, 2009, order and remand for entry of an order awarding Mr. Bevins TTD benefits in connection with his November 27, 2007, surgery related to his compensable injury. Additionally, in Case Number 35219 pertaining to Mr. Greathouse, we reverse the Board of Review's March 5, 2008, order and remand for further factual development to determine whether Mr. Greathouse is eligible to receive the TTD benefits he has requested.

I.

FACTUAL AND PROCEDURAL HISTORY

Although both of the appeals in this case present the same legal issue, we separately will consider the facts giving rise to each claimant's request for TTD benefits.

A. Case Number 35548—Charles Bevins

On May 30, 2000, Charles W. Bevins (hereinafter referred to as "Mr. Bevins"), a coal miner, injured his back in the course of and as a result of his employment when he attempted to move a loaded wheelbarrow. While treating his back injury, Mr. Bevins' physician discovered that Mr. Bevins also had sustained an injury to his ankle, causing his foot to drop. For this condition, Mr. Bevins underwent two surgeries, the most recent of which was on November 27, 2007. On December 10, 2007, Mr. Bevins filed an application to reopen his workers' compensation claim for the purpose of receiving TTD benefits. On his reopening application, Mr. Bevins did not indicate that he had retired; rather, he left both the "yes" and the "no" boxes next to the retirement question blank. However, Mr. Bevins did state on his application that "I'm receiving Social Security Disability Insurance[;] I no longer work due to this injury." By this application, Mr. Bevins sought TTD benefits for the period from November 27, 2007, to February 27, 2008. At the time he submitted this application, Mr. Bevins was fifty-one years old.

By decision dated March 10, 2008, the Workers' Compensation Claims Manager (hereinafter referred to as "Claims Manager") ruled that Mr. Bevins' claim could not be reopened, explaining:

This claim cannot be reopened because:
Title 85-1-5.2 states, "If an individual retires, he or she is disqualified from receiving temporary total disability indemnity benefits as a result of an injury received from the place of employment."
Title 85-1-5.3 states, "If a period of disability includes a reasonably ascertainable period of time during which the injured worker would not have been compensated from his or her employer, then temporary total disability indemnity benefits shall not be paid during that period."

Thus, the Claims Manager determined that Mr. Bevins was not entitled to receive TTD benefits.

Mr. Bevins appealed this determination. By decision dated October 27, 2008, the Workers' Compensation Office of Judges (hereinafter referred to as "OOJ") awarded Mr. Bevins TTD benefits, thus reversing the earlier determination. In summary, the OOJ stated that "[t]he claimaint [Mr. Bevins] is not disqualified from temporary total disability benefits due to the sole reason that he is receiving Social Security Disability benefits." This ruling was based upon the OOJ's observations that Mr. Bevins is "52 years old" and that "[t]he preponderance of the evidence shows that the claimant has not retired." Therefore, the OOJ awarded Mr. Bevins the TTD benefits he had requested.

Thereafter, the Commissioner appealed the OOJ's decision to the Board of Review. By order entered June 4, 2009, the Board of Review reversed the OOJ's decision, thus denying Mr. Bevins' application for TTD benefits. In this regard, the Board of Review determined that TTD benefits serve as a wage replacement. Thus, because Mr. Bevins is receiving Social Security disability benefits and "has not returned to work since the May 30, 2000[,] injury in this claim," Mr. Bevins "has no wages to replace and is, therefore, not entitled to reopening on a temporary total disability basis or temporary total disability benefits[.]" From this adverse *514 ruling, Mr. Bevins appeals to this Court.

B. Case Number 35219-Marty Greathouse

On December 17, 2003, Marty L. Greathouse (hereinafter referred to as "Mr. Greathouse"), a security guard, injured his arm, neck, and shoulder in the course of and as a result of his employment when a fellow employee pushed him into some office equipment. Mr. Greathouse received treatment for his injuries and ultimately received a six percent permanent partial disability award therefor. Following his maximum degree of medical improvement evaluation on February 28, 2005, however, Mr. Greathouse allegedly experienced an aggravation or progression of his work-related injury. Therefore, on August 16, 2006, Mr. Greathouse filed an application to reopen his workers' compensation claim for the purpose of receiving TTD benefits. On his reopening application, Mr. Greathouse indicated that he had retired and stated that he was receiving benefits from "Social Security." By this application, Mr. Greathouse sought TTD benefits for the period from June 26, 2006, to October 1, 2006. At the time he submitted this application, Mr. Greathouse was forty-one years old.

By decision dated September 25, 2006, the Claims Manager ruled that Mr. Greathouse's claim could not be reopened, explaining:

This claim cannot be reopened because:
WV CODE 23-5-3, AND TITLE 85-20-21 AND 85-20-3.9
This decision was based primarily on the following: REVIEW OF MEDICAL RECORDS.

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