TJ MAXX v. Blagg

274 S.W.3d 436, 2008 Ky. LEXIS 315, 2008 WL 5272771
CourtKentucky Supreme Court
DecidedDecember 18, 2008
Docket2007-SC-000939-WC
StatusPublished
Cited by2 cases

This text of 274 S.W.3d 436 (TJ MAXX v. Blagg) is published on Counsel Stack Legal Research, covering Kentucky Supreme Court primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
TJ MAXX v. Blagg, 274 S.W.3d 436, 2008 Ky. LEXIS 315, 2008 WL 5272771 (Ky. 2008).

Opinion

OPINION OF THE COURT

The Workers’ Compensation Board vacated the opinion and order that dismissed this claim on the ground that the Administrative Law Judge (ALJ) relied on an invalid university evaluation. The Court of Appeals affirmed. Appealing, the employer argues: 1.) that the ALJ erred by ordering an evaluation after the claim was submitted for a decision; and 2.) that the Board usurped the ALJ’s function by finding Dr. Goldman not to be a valid university evaluator. We reverse and remand for further proceedings. KRS 342.315 permits a university evaluation whenever a medical question is at issue but evinces no intent to depart from the regulations that govern the taking of proof. The ALJ erred by ordering a university evaluation after taking the claim under submission rather than deciding it based on the evidence of record at that time.

The claimant was born in 1966 and began working for the defendant-employer in 1993. Her job required her to unload incoming stock and to help re-stock the store. She alleged that she sustained a work-related back injury on October 9, 2002, while unloading boxes from a convey- or belt and that the injury produced a psychiatric condition. Among other things, the contested issues included causation, whether she sustained an injury as defined by KRS 342.0011(1), and the ex *437 tent and duration of disability. The parties submitted extensive lay and medical evidence, submitted witness lists, and participated in a benefit review conference.

After a hearing and briefing, the ALJ took the claim under submission. Sometime thereafter, the ALJ entered an order holding the matter in abeyance and directing the claimant to undergo a university evaluation. The order explained that the evidence was “in great conflict” concerning whether the claimant suffered an injury as defined by KRS 342.0011(1) and whether it produced a severe disability or no disability; thus, “an error in judgment on this claim would be a big one.” The employer petitioned for reconsideration, objecting and arguing that the need for another medical opinion after the claim was taken under submission showed that the claimant failed to meet her burden of proof. The claimant responded that the evaluation would assist the ALJ and also requested a university evaluation concerning her psychiatric complaints. Objecting to the request, the employer pointed out that she could have done so during normal proof time but did not. The ALJ denied the employer’s petition and deferred a decision on the claimant’s motion pending the evaluation of the physical complaints.

The University of Louisville selected Dr. Goldman of the Medical Assessment Clinic to perform the evaluation. A letter from the Department of Workers’ Claims informed the claimant of the time and place of the evaluation and indicated that “maps of the examination site within the university facility” were enclosed. The claimant underwent the evaluation, after which Dr. Goldman submitted a Form 107 report that was unfavorable to the claim. He concluded that she did not sustain a work-related injury on October 9, 2002, noting that she performed the same work that she had been performing for 19 years and that nothing unusual happened on that day. He also noted that her complaints “far exceed the objective verification on this examination” and assigned a 0% permanent impairment rating.

The claimant moved to strike Dr. Goldman’s report, asserting that it was confusing, self-contradictory, and difficult to understand. Although the Form 107 listed the purpose of the examination as being a university evaluation, she seized on a statement in the accompanying narrative, which indicated that the report would be “sent to the referring client who is unknown to this examiner.” On that basis, she asserted that Dr. Goldman seemed to be unaware that the evaluation was requested under KRS 342.315. She also moved to hold the claim in abeyance and/or for an extension of proof time, asserting that the evaluation did not occur at a medical school and that her attorney needed time to investigate. The employer objected to the motions.

Noting that the claimant’s objections to Dr. Goldman’s report affected its weight rather than its admissibility, the ALJ denied the motion to strike it. The ALJ also denied the motion for a university psychiatric evaluation and ordered the claim to be re-submitted. Relying on Dr. Goldman’s report, the ALJ dismissed the claim for permanent income and medical benefits. After expressing agreement with Dr. Goldman’s opinion that no good history indicated an injury actually occurred, the ALJ stated, “In this instance, the [ALJ’s] initial feelings were confirmed by the university evaluator’s finding that the plaintiff had not sustained a permanent injury....”

Appealing to the Board, the claimant argued that the ALJ erred by concluding that her symptoms resulted from longstanding, pre-existing psychiatric problems rather than a work-related injury. She also argued that Dr. Goldman’s report was *438 inadmissible as a university evaluation under KRS 342.315. The employer responded that the claimant failed to meet her burden of proving that her complaints resulted from a work-related injury and that substantial evidence supported the ALJ’s decision. In a cross-appeal, the employer argued that the ALJ erred as a matter of law by failing to decide the claim based on the evidence of record when it was submitted; that the claimant failed to meet her burden of proof; and that appointing a university evaluator after the claim was submitted constituted an abuse of the ALJ’s discretion.

The Board found no error in the decision to order a university evaluation in a situation where an ALJ found the medical evidence to be too disparate to reach a just outcome. It also determined from Office of Workers’ Claims records that the medical qualifications form for Dr. Goldman indicated that he was employed by the Medical Assessment Clinic. Relying on Morrison v. Home Depot, 197 S.W.3d 531 (Ky.2006), the Board determined that the claim must be remanded for a decision that excluded his opinions. The Board found it appropriate under the circumstances for the ALJ to reopen proof time for both of the parties, order a second university evaluation, or both. The court explained in Magic Coal Co. v. Fox, 19 S.W.3d 88, 95-98 (Ky.2000), that the purpose of KRS 342.315 is to provide ALJs with clinical findings and opinions from unbiased medical experts and to assure sufficient numbers of such experts. In Morrison v. Home Depot, supra, the ALJ ordered a university evaluation within normal proof time. The University of Louisville assigned the matter to Dr.

Free access — add to your briefcase to read the full text and ask questions with AI

Related

Sunz Insurance Company v. Henry J. Decker
Kentucky Supreme Court, 2018
Saint Joseph Hospital v. Frye
415 S.W.3d 631 (Kentucky Supreme Court, 2013)

Cite This Page — Counsel Stack

Bluebook (online)
274 S.W.3d 436, 2008 Ky. LEXIS 315, 2008 WL 5272771, Counsel Stack Legal Research, https://law.counselstack.com/opinion/tj-maxx-v-blagg-ky-2008.