Climbing Fall Not in the Course Of the Employment

WORKERS COMPENSATION CASE WATCH

In Morres v. Earth Treks Crystal City Climb, the claimant worked at a recreational climbing gym.  The employer required employees to clock in before their shifts and prohibited employees from performing personal climbs while on the clock.  Before clocking in for her shift, the claimant did a warm-up climb, which she said was in preparation for performing rope maintenance.  She climbed with another co-worker, who was not scheduled to work that day.  During her warm-up climb, she took a practice fall.  She was injured in the fall.

The Deputy Commissioner found that the claimant was engaged in personal, recreational rock-climbing and was not in the course of her employment when the injury occurred.  On Review, the full Commission agreed, stating “…we do not find whatever ephemeral benefit the employer might receive from the claimant sharpening her climbing skills sufficient to bring

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Telehealth Treatment Did Not Affect Weight Given to Doctor's Opinion

WORKERS COMPENSATION CASE WATCH

On January 6, 2020, the Commission briefly addressed the issue of telemedicine in the treating physician relationship.  In Carter v. Mondelez International, the claimant was injured in a motor vehicle accident and was treating with a psychologist for PTSD

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Limousine Driver’s Accident Did Not “Arise Out Of” the Employment

WORKERS COMPENSATION CASE WATCH

In Sorour v. Avalon Transportation, the claimant, a limousine driver, was injured in a single vehicle accident. At his supervisor’s request, the claimant was driving to the company’s office.  As he exited the highway he hit the guardrail on the exit ramp at a low speed, causing his injuries.

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2019 Study of Virginia Workers' Compensation System Complete


JLARC Recommends 25 Changes - What you must know about JLARC's Report

The Joint Legislative Audit and Review Commission (“JLARC”) conducted a review of the Virginia workers’ compensation system with a special focus on the use of disease presumptions. The JLARC report was released on December 16, 2019 and included 25 recommended changes. This article includes the following:

  • What JLARC's Research Included
  • Summary of JLARC's Findings
  • Highlights from JLARC's 25 Recommendations
  • Important Links to the Actual Report and Recommendations

For this study, JLARC staff conducted research that included:

  • Structured interviews of workers’ compensation attorneys (claimant and defense); leadership and staff of state agencies; representatives of local and state organizations representing police, firefighters, and emergency medical services personnel; and insurers;

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Highlights from the 2019 Virginia Workers' Compensation Educational Conference


1.      Employer’s Applications for Hearing

The Commission closely examines these items to determine if the Application is technically correct:

a.    Claimant’s address

b.    Grounds for the Application

c.     Relief requested

d.    Compensation rate

e.    Date compensation was paid through

f.     Presence of supporting documentation

g.    Application signed

h.    Application dated

i.      Whether the claimant and the attorney, if represented, were sent a copy of the Application.

 

2.      Unauthorized Practice of Law

The Commission provided these tips for adjusters about the unauthorized practice of law:

a.    An adjuster cannot appear at an evidentiary hearing to advocate for an insurer or

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No Obvious Sudden Mechanical or Structural Change

WORKERS COMPENSATION CASE WATCH

In a November 19, 2019 Review, the Full Commission held in Bayne v. Horizon Behavioral Health that the claimant did not establish a mechanical change as a result of her accident, and therefore, did not establish a compensable injury. 

The claimant, a clinical mental health examiner, alleged an injury to her low back as a result of an eight-year old child charging into her ten to fifteen times, causing her back to strike a horizontal door handle.  The claimant had a history of four lumbar surgeries prior to this incident.  The claimant testified that she felt a sharp increase in pain as a result of this incident.  In affirming the Deputy Commissioner’s denial, the Full Commission cited Dr. Vanichkachorn, who treated the claimant before and after the alleged work accident.  The doctor opined that there was no evidence of any structural or mechanical change in comparing diagnostic studies taken before versus after the incident.  He opined

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Claimant Refuses to Attend FCE, Commission Denies Employer’s Application for Hearing

 

Workers' Compensation Case Watch

In Manion v. Northwestern Regional Adult Detention Ctr., the claimant needed a new physician because her doctor was no longer providing pain management. The employer asked a nurse case manager to find a new doctor for the claimant and to obtain a Functional Capacity Evaluation (“FCE”) from the physician. The nurse got an FCE referral from the new doctor and scheduled the appointment. She told the claimant about the appointment in person and left her several message about it. The claimant said she would not attend and cancelled the FCE.                                                                                                                                   

The defendant filed an Employer’s Application for Hearing alleging refusal of medical treatment because the claimant did not go to the FCE. The Deputy Commissioner denied the Application because the scheduled FCE was not medically necessary treatment. On review, the Full Commission cited the longstanding principal that the claimant’s medical treatment is directed by the treating physician and not the defendants. They noted that a

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Chandler Test Must be Applied to Requests for Spousal Care

 

Workers' Compensation Case Watch

In Ross v. Cumberland Hospital, the claimant sustained a severe brain injury. Her doctor said it was medically necessary that she have a home health aide or family member oversight to assist her with activities of daily living and monitor safety concerns. The claimant filed a claim asking that her spouse be paid to provide home health care to her.

The Commission found that spousal care should be authorized. In reaching that conclusion,

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Statute of Limitations Tolling Statute Rewritten

 

Workers' Compensation DEFENSE DIGEST

Virginia has long held that the statute of limitations for filing an initial claim for benefits is two years from the date of accident. Va. Code §65.2-601. However, prior to July 1, 2019, §65.2-602 provided that the two year statute of limitations to file a claim was tolled when (1) an employer had notice of an accident resulting in a compensable injury and paid wages or compensation to the claimant, with or without an award, during incapacity from work or that the employer failed to file a First Report of Injury and (2) that the claimant was prejudiced by the payment of wages or compensation during incapacity from work or by the employer’s failure to file the First Report of Injury.  If a claimant proved both of these conditions, the statute of limitations was tolled for the duration of the payments or wages during the claimant’s incapacity from work or until the First Report of Injury was filed.

Effective July 1, 2019, the statute has been rewritten and there are some significant changes.

The new statute only applies to injuries occurring on or after July 1, 2019. It is not retroactive to injuries occurring before such date.

1. Most importantly, the statute of limitations is tolled if the employer paid TTD, TPD or wages during incapacity from work or furnished medical treatment more than six months after the

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Commission Determines “Out of Work” Note is a “Light Duty” Note

 

Workers' Compensation Case Watch

In Umana v. Clark Construction Group, the claimant was injured in a work accident.  The claimant saw a doctor for his work-related injuries.  In his report, the doctor outlined the claimant’s light duty restrictions but also said “there is no light duty work available, so he remains unable to work at this time.”  In his office notes each month, the doctor repeated that because there was no light duty available, the claimant remained unable to work.  The Deputy Commissioner found that the claimant was totally disabled during those periods.

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