Wilson v. Workers' Compensation Commissioner

328 S.E.2d 485, 174 W. Va. 611, 1984 W. Va. LEXIS 519
CourtWest Virginia Supreme Court
DecidedMarch 29, 1984
Docket15990, 16005 and 15993
StatusPublished
Cited by24 cases

This text of 328 S.E.2d 485 (Wilson v. Workers' Compensation 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
Wilson v. Workers' Compensation Commissioner, 328 S.E.2d 485, 174 W. Va. 611, 1984 W. Va. LEXIS 519 (W. Va. 1984).

Opinion

MILLER, Justice:

We have consolidated these three workers’ compensation appeals as they contain a similar legal issue. Each of these appeals involves questions surrounding the termination of additional temporary total disability benefits. Each claimant filed an application for modification to obtain additional temporary total disability benefits. The Commissioner awarded the additional temporary total disability benefits. The employers objected to the awards and, after hearings, the temporary total disability benefits were deemed to have been improperly awarded and repayment of the benefits was ordered under W.Va.Code, 23-4-lc.

The claimants contend that the Commissioner is barred from collecting over-payments of temporary total disability benefits by virtue of Mitchell v. State Workmen’s Compensation Commissioner, 163 W.Va. 107, 256 S.E.2d 1 (1979), because the employer did not protest the initial com-pensability of the claim within thirty days of its original filing. We disagree and conclude that a reopening should be treated as a new step in the proceeding where resumption of temporary total disability benefits is sought.

It is clear that under W.Va.Code, 23-5-la (1939), an injured claimant is entitled to petition the Commissioner to make further adjustments of his claim. 1 The evidentiary standard for obtaining a reopening is set out in W.Va.Code, 23-5-lb, which we summarized in the single Syllabus of Harper v. State Workmen’s Compensation Commissioner, 160 W.Va. 364, 234 S.E.2d 779 (1977):

“For purposes of obtaining a reopening of a Workmen’s Compensation claim under the provisions of W.Va.Code, 23-5-la and -lb, the claimant must show a prima facie cause, which means nothing more than any evidence which would tend to justify, but not to compel the inference that there has been a progression or aggravation of the former injury.” *614 determines in a W.Va.Code, 23-5-1, proceeding, that the claimant was not lawfully entitled to the temporary total disability benefits originally by virtue of the fact that the claim did not jurisdictionally qualify.”

*613 The issue of whether there is a progression or aggravation of a claimant’s original injury turns upon facts which arise after the initial compensable injury. The inquiry is whether these new facts give rise to a condition that can be connected to the original injury.

In Harper, the question was whether a subsequent psychiatric disability was related to the claimant’s original compensable injury. There is a plethora of cases dealing with the question of what subsequent conditions can be treated as progressions or aggravations of the original injury. See A. Larson, 1 Larson’s Workmen’s Compensation Law § 13.10, et seq. (1982).

We stated in Mitchell that the repayment of temporary total disability benefits provisions of W.Va.Code, 23-4-lc, were not applicable unless there has been an initial protest to the original award of temporary total disability benefits. The reason for this rule is that W.Va.Code, 23-4-lc, provides for repayment only if the claimant is found to be not lawfully entitled to the benefits. We pointed out in Syllabus Point 4 of Mitchell 2 that a claimant is not lawful *614 ly entitled to temporary total disability benefits when his claim does not jurisdictionally qualify—such as when the injury did not arise out of and in the course of employment. 3

*613 "The overpayment provisions of W.Va.Code, 23-4-lc, apply only where the Commissioner

*614 The important point is that Mitchell’s requirement for a timely protest to the original temporary total disability award in order to obtain the benefits of W.Va.Code, 23-4-lc, is predicated on the fact that the employer will ordinarily know if the initial claim is jurisdictionally defective. On an initial injury the chief inquiry is whether the injury happened in the course of and arising out of the employment. Since the facts surrounding the injury are fairly concise and involve the employer’s workplace, he is assumed to have knowledge of them or at least a readily available means of acquiring such knowledge.

For this reason, we held in Mitchell that if the employer wished to defeat the jurisdictional basis, he had to file a timely protest under W.Va.Code, 23-5-1. If he did not desire to defeat the claim jurisdictionally but only contest continued payment of temporary total disability benefits, he could then file a petition to modify under W.Va. Code, 23-5-lc.

However, where a claimant’s temporary total disability payments have been terminated and he desires to have them reinstated, such reinstatement must be based upon new facts showing an aggravation or progression of the injury or other facts not theretofore considered. W.Va. Code, 23-5-la and -1b; Syllabus Point 2, Buckalew v. State Compensation Director, 149 W.Va. 239, 140 S.E.2d 453 (1965). Obviously, such new facts are not something that the employer could have anticipated when the original claim was filed. It is this inability to anticipate the circumstances upon which a claimant may base his application to reopen that forecloses the application of Mitchell to reopening petitions under W.Va.Code, 23-5-la.

Consequently, we conclude that an employer’s initial decision not to contest the original jurisdictional basis of an award of temporary total disability does not preclude the employer from contesting a subsequent application to reopen for temporary total disability benefits under W.Va. Code, 23-5-la, on the ground that the aggravation or progression is not related to the original injury. 4

With these principles in mind, we turn to the individual cases.

I.

THE CLAIM OF RICHARD L. WILSON

On January 24, 1977, the claimant sustained a low back injury while shoveling coal in the course of and as a result of his employment with Bethlehem Mines Corporation. The claimant filed a claim for workers’ compensation benefits, and the claim was ruled compensable on February 23, 1977. The employer did not protest the compensability ruling, and the benefits were paid. The claimant subsequently returned to work on March 9, 1977, and worked approximately twenty-one months.

On January 2, 1979, Dr. C.Y. Amores wrote the Commissioner and stated that the claimant had been in his office on December 29, 1978, complaining of low back pain. Dr.

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Bluebook (online)
328 S.E.2d 485, 174 W. Va. 611, 1984 W. Va. LEXIS 519, Counsel Stack Legal Research, https://law.counselstack.com/opinion/wilson-v-workers-compensation-commissioner-wva-1984.