Simpson v. WV. OFFICE OF INS. COM'R

678 S.E.2d 1
CourtWest Virginia Supreme Court
DecidedApril 30, 2009
Docket34368
StatusPublished
Cited by3 cases

This text of 678 S.E.2d 1 (Simpson v. WV. 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
Simpson v. WV. OFFICE OF INS. COM'R, 678 S.E.2d 1 (W. Va. 2009).

Opinion

678 S.E.2d 1 (2009)

Thomas D. SIMPSON, Appellant,
v.
WEST VIRGINIA OFFICE OF the INSURANCE COMMISSIONER, and
Independence Coal Company, Inc., Appellees.

No. 34368.

Supreme Court of Appeals of West Virginia.

Submitted April 8, 2009.
Decided April 30, 2009.

*4 Gregory S. Prudich, Sanders, Austin, Flanigan & Aboulhosn, Princeton, WV, for Appellant.

*5 Daniel G. Murdock, Associate Counsel, Offices of the Insurance Commissioner, Charleston, WV, for Appellee, West Virginia Office of the Insurance Commissioner.

Sean Harter, Charleston, WV, for Appellee, Independence Coal Company, Inc.

DAVIS, Justice:

The appellant herein, Thomas D. Simpson [hereinafter "Mr. Simpson"], appeals from an order entered January 23, 2007, by the Workers' Compensation Board of Review [hereinafter "the Board"]. By that order, the Board affirmed prior orders entered by the Workers' Compensation Commission [hereinafter "Commission"], which awarded Mr. Simpson a 13% permanent partial disability award [hereinafter "PPD"], and the Workers' Compensation Office of Judges [hereinafter "OOJ"], which upheld that award. Mr. Simpson argued below that he was entitled to a higher impairment rating and should have been awarded an additional percentage of PPD benefits. On appeal to this Court, Mr. Simpson contends that the Board erred by upholding his award of benefits calculated in accordance with W. Va. C.S.R. Table § 85-20-C (2004)[1] because, he claims, this Rule is unconstitutional because it violates the separation of powers doctrine. Upon a review of the parties' arguments, the record submitted for appellate consideration, and the pertinent authorities, we affirm the Board's order finding Mr. Simpson to be entitled to a 13% PPD award.

I.

FACTUAL AND PROCEDURAL HISTORY

Before recounting the factual history of Mr. Simpson's work-related injury, a review of the relevant procedural history will assist in understanding the context of Mr. Simpson's arguments on appeal to this Court.

A. Procedural History

The procedural history of this case begins in 2002 with this Court's prior decision in Repass v. Workers' Compensation Division, 212 W.Va. 86, 569 S.E.2d 162 (2002). In Repass, this Court rejected the use of the Diagnosis-Related Estimate Model for the evaluation of spine injury claims as invalid and unreliable. Specifically, we held, in Syllabus point 9 of Repass, that,

[b]ecause the Diagnosis-Related Estimate Model for the examination of spine injury claims, as set forth in The American Medical Association's, Guides to the Evaluation of Permanent Impairment, Fourth Edition (1993), cannot be reconciled with several specific workers compensation statutes promulgated by the West Virginia Legislature, any medical examination conducted in accordance with that model is invalid and unreliable.

212 W.Va. 86, 569 S.E.2d 162.

In response to this Court's decision in Repass, the Legislature amended W. Va. Code § 23-4-3b in 2003 to add subsection (b). See W. Va.Code § 23-4-3b(b) (2003) (Spec. Supp. Aug. 2003). W. Va.Code § 23-4-3b(b) (2005)[2] (Repl. Vol. 2005) directs:

In addition to the requirements of subsection (a) of this section, on or before the thirty-first day of December, two thousand three, the board of managers shall promulgate a rule establishing the process for the medical management of claims and awards of disability which includes, but is not limited to, reasonable and standardized guidelines and parameters for appropriate treatment, expected period of time to reach maximum medical improvement and range of permanent partial disability awards for common injuries and diseases or, in the alternative, which incorporates by reference the medical and disability management guidelines, plan or program being *6 utilized by the commission for the medical and disability management of claims, with the requirements, standards, parameters and limitations of such guidelines, plan or program having the same force and effect as the rule promulgated in compliance herewith.

Pursuant to W. Va.Code § 23-4-3b(b), the Workers' Compensation Board of Managers [hereinafter "Board of Managers"] repealed former W. Va.C.S.R. § 85-20-1, et seq., and replaced it with an amended version of this Rule, the original filing of which was effective June 14, 2004.[3] The scope of this Rule is defined as follows:

W. Va.Code § 23-4-3b(b) requires the Workers' Compensation Board of Managers to promulgate a rule establishing the process for the medical management of claims and awards of disability which includes, but is not limited to, reasonable and standardized guidelines and parameters for appropriate treatment, expected period of time to reach maximum medical improvement and range of permanent partial disability awards for common injuries and diseases or, in the alternative, which incorporates by reference the medical and disability management guidelines, plan or program being utilized by the commission, insurance commissioner, self-insured employer or private carrier, whichever is applicable, for the medical and disability management of claims, with the requirements, standards, parameters and limitations of such guidelines, plan or program having the same force and effect as the rule promulgated in compliance herewith. This Rule satisfies this statutory requirement.

W. Va.C.S.R. § 85-20-1.1 (2004) (citations omitted).

More specifically, W. Va.C.S.R. § 85-20-64.2 and Table § 85-20-C set forth the methodology for evaluating lumbar spine impairments, such as that sustained by Mr. Simpson in the case sub judice. W. Va. C.S.R. § 85-20-64.1 (2004) explains preliminarily that,

[p]ursuant to W. Va.Code § 23-4-3b(b), the Commission or Insurance Commissioner, whichever is applicable, hereby adopts the following ranges of permanent partial disability for common injuries and diseases. Permanent partial disability assessments shall be determined based upon the range of motion models contained in the Guides Fourth.[[4]] Once an impairment *7 level has been determined by range of motion assessment, that level will be compared with the ranges set forth below. Permanent partial disability assessments in excess of the range provided in the appropriate category as identified by the rating physician shall be reduced to the [sic] within the ranges set forth below[.]

(Footnote added).

With respect to lumbar spine impairments, in particular, W. Va.C.S.R. § 85-20-64.2 (2004) instructs that

[t]he range of motion methodology for assessing permanent impairment shall be used. However, a single injury or cumulative injuries that lead to a permanent impairment to the Lumbar Spine area of one's person shall cause an injured worker to be eligible to receive a permanent partial disability award within the ranges identified in Table § 85-20-C. The rating physician must identify the appropriate impairment category and then assign an impairment within the appropriate range designated for that category.

Additionally, W. Va.C.S.R.

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Bluebook (online)
678 S.E.2d 1, Counsel Stack Legal Research, https://law.counselstack.com/opinion/simpson-v-wv-office-of-ins-comr-wva-2009.