Bowers v. West Virginia Office of the Insurance Commissioner

686 S.E.2d 49, 224 W. Va. 398, 2009 W. Va. LEXIS 93
CourtWest Virginia Supreme Court
DecidedOctober 29, 2009
Docket35036, 34672
StatusPublished
Cited by4 cases

This text of 686 S.E.2d 49 (Bowers v. West Virginia Office of the Insurance Commissioner) 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
Bowers v. West Virginia Office of the Insurance Commissioner, 686 S.E.2d 49, 224 W. Va. 398, 2009 W. Va. LEXIS 93 (W. Va. 2009).

Opinion

DAVIS, Justice:

The instant matter consists of two appeals from the Workers’ Compensation Board of Review (hereinafter “the Board”) that have been consolidated because they present the same issue for this Court’s consideration and resolution. In both cases, the claimant suffered a work-related injury in the course of and as a result of his employment. Both claimants have continued to experience pain from their work-related injuries, neither claimant has been able to return to work or resume normal activities, and both claimants have developed depression that their treating physicians have attributed to their work-related injuries. Throughout the proceedings underlying the instant appeals, the claimants’ requests to add a diagnosis of depression as a compensable component of their claims has been denied. On appeal to this Court, the claimants assert that the Insurance Commissioner of West Virginia (hereinafter “the Commissioner”) 1 erred by refusing to add a depression diagnosis to their claims because they were not diagnosed with depression “within 6 months of the[ir] injury or significant injury-related complication” 2 as required by W. Va.C.S.R. § 85-20-12.2.a (2005) to render such a diagnosis compensable. Upon a review of the parties’ arguments, the records presented for appellate consideration, and the pertinent authorities, we reverse the decision of the Board in both cases. We further remand both cases with directions to add a diagnosis of depression to each of the claimant’s underlying claims.

I.

FACTUAL AND PROCEDURAL HISTORY

Although the instant appeals have been consolidated because they raise the same legal question, we will separately discuss the facts relevant to each appeal to provide the proper context for our decision.

A. Case Number 35036 — Ernie Bowers

Ernie L. Bowers (hereinafter “Mr. Bowers”), one of the appellants herein, was injured in the course of and as a result of his employment on July 12, 2002. At the time of his injury, Mr. Bowers was employed as a mechanic in a coal mine; he injured his back *401 when he slipped and fell while using a bar to lift a heavy motor. Mr. Bowers underwent back surgery in January 2003, and has undergone pain management therapy, but he has been unable to return to work due to the ongoing pain and decreased mobility resulting from his work-related back injury. By decision dated November 18, 2005, the Workers’ Compensation Commission granted Mr. Bowers a 34% permanent partial disability award due to his work-related cervical and lumbar injuries; Mr. Bowers ultimately withdrew his subsequent appeal of this award.

In April 2004, Mr. Bowers’s treating physician, Dr. Richard Trenbath (hereinafter “Dr. Trenbath”), first observed that Mr. Bowers “ha[d] a very depressed affect,” and prescribed him medication for depression. On May 26, 2004, Dr. Trenbath requested the Workers’ Compensation Claims Administrator (hereinafter “Claims Administrator”) to authorize a prescription for medication to treat Mi-. Bowers’s depression that had resulted from his work-related injury; however, it does not appear from the record that the Claims Administrator authorized this medication.

Dr. Trenbath continued to observe and recount Mr. Bowers’s symptoms of depression in his subsequent treatment notes. Nearly two years after first prescribing medication for Mr. Bowers’s depression, Dr. Trenbath, on May 24, 2006, requested that major depression be added as a compensable diagnosis to Mr. Bowers’s workers’ compensation claim resulting from his July 12, 2002, work-related back injury. The Office of Medical Management (hereinafter “the OMM”) denied this request on July 11,2006, 3 citing W. Va.C.S.R. § 85-20-12.2.a, which requires a psychiatric diagnosis be made within six months of the work-related injury, or a significant complication thereof, upon which such psychiatric diagnosis is based to be held compensable. In turn, the Claims Administrator upheld the OMM’s denial of a depression diagnosis by order entered October 3, 2006. Likewise, the Office of Judges (hereinafter “the OOJ”), by decision dated February 5, 2007, and the Board, by order entered March 26, 2008, upheld these rulings. From these adverse decisions, Mr. Bowers appeals to this Court.

B. Case Number 34672 — Darrell Dotson

Darrell W. Dotson (hereinafter “Mr. Dotson”), the other appellant herein, was injured in the course of and as a result of his employment on March 23, 1998. At the time of his injury, Mr. Dotson was employed as an underground coal miner; he injured his back while pulling a miner cable. Mr. Dotson briefly returned to work, but severe lumbar pain resulting from his work-related back injury forced him to cease employment in June 1998. Since that time, Mr. Dotson has undergone pain management therapy, but he has been unable to return to work due to the ongoing pain and decreased mobility resulting from his work-related back injury. By decision dated February 25, 2003, the Workers’ Compensation Division granted Mr. Dotson a 5% permanent partial disability award due to his work-related injury. Mr. Dotson appealed this award, and, by order entered March 18, 2004, the OOJ reversed Mr. Dotson’s earlier award and granted him, instead, a 19% permanent partial disability award due to his work-related lumbosacral injury; the Board of Review affirmed Mr. Dotson’s 19% permanent partial disability award by order entered December 29, 2004. This Court refused Mr. Dotson’s subsequent appeal of this award.

On June 1, 1999, Mr. Dotson’s treating physician, Dr. Margaret S. Wantz (hereinafter “Dr. Wantz”), first recorded that Mr. Dotson is “becoming more and more depressed due to pain and being unable to work.” Thereafter, on June 4, 1999, Dr. Wantz prescribed medication to treat Mr. Dotson’s symptoms of depression; the Workers’ Compensation Commission authorized this medication.

Dr. Wantz continued to observe and recount Mr. Dotson’s symptoms of depression in her subsequent treatment notes. Nearly seven and one-half years after first observing *402 Mr. Dotson’s depression, Dr. Wantz, on February 1, 2006, requested that major depression be added as a compensable diagnosis to Mr. Dotson’s workers’ compensation claim resulting from his March 23, 1998, work-related back injury. The Office of Medical Management (the OMM) denied this request on February 13, 2006, citing W. Va.C.S.R. § 85-20-12.2.a, which requires a psychiatric diagnosis be made within six months of the work-related injury, or a significant complication thereof, upon which such psychiatric diagnosis is based to be held compensable. In turn, the Claims Administrator upheld the OMM’s denial of a depression diagnosis by order entered February 15, 2006. Likewise, the Office of Judges (the OOJ), by decision dated July 25, 2006, and the Board, by order entered April 5, 2007, upheld these rulings. From these adverse decisions, Mr. Dotson appeals to this Court.

II.

STANDARD OF REVIEW

On appeal to this Court, both claimants contend that error occurred in the decisions to deny their requests to add a diagnosis of depression as a compensable component of their claims for their work-related back injuries.

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Bluebook (online)
686 S.E.2d 49, 224 W. Va. 398, 2009 W. Va. LEXIS 93, Counsel Stack Legal Research, https://law.counselstack.com/opinion/bowers-v-west-virginia-office-of-the-insurance-commissioner-wva-2009.