Case Title: KENDALL BURRESS V. DON'S LUMBER, ET AL.

Citation: 

Docket Number: 2010-SC-000211-WC

State: kentucky

Court: Kentucky Supreme Court

Date: 2010-11-18T00:00:00Z

Document:
IMPORTANT NOTICE NOT TO BE PUBLISHED OPINION THIS OPINION IS DESIGNATED "NOT TO BE PUBLISHED." PURSUANT TO THE RULES OF CIVIL PROCEDURE PROMULGATED BY THE SUPREME COURT, CR 76.28(4)(C), THIS OPINION IS NOT TO BE PUBLISHED AND SHALL NOT BE CITED OR USED AS BINDING PRECEDENT IN ANY OTHER CASE IN ANY COURT OF TH IS STATE ; HOWEVER, UNPUBLISHED KENTUCKY APPELLATE DECISIONS, RENDERED AFTER JANUARY l, 2003, MAY BE CITED FOR CONSIDERATION BY THE COURT IF THERE IS NO PUBLISHED OPINION THAT WOULD ADEQUATELY ADDRESS THE ISSUE BEFORE THE COURT . OPINIONS CITED FOR CONSIDERATION BY THE COURT SHALL BE SET OUT AS AN UNPUBLISHED DECISION IN THE FILED DOCUMENT AND A COPY OF THE ENTIRE DECISION SHALL BE TENDERED ALONG WITH THE DOCUMENT TO THE COURT AND ALL PARTIES TO THE ACTION. RENDERED : NOVEMBER 18, 2010 N~.~ BE PUBLISHED ,vuYrtutr Courf of ~irufiirk, 2010-SC-000211-WC KENDALL BURRESS APPELLANT ON APPEAL FROM COURT OF APPEALS V. CASE NO . 2009-CA-001697-WC WORKERS' COMPENSATION BOARD NO. 05-66203 DON'S. LUMBER ; HONORABLE DOUGLAS GOTT, ADMINISTRATIVE LAW JUDGE; AND WORKERS' COMPENSATION BOARD APPELLEES MEMORANDUM OPINION OF THE COURT AFFIRMING An Administrative Law Judge (ALJ) dismissed the claimant's application for benefits as being untimely having found that salary continuation by his employer did not toll the two-year limitations period. The Workers' Compensation Board and the Court of Appeals affirmed . Appealing, the claimant maintains that the ALJ erred by misapplying Kentucky West Virginia Gas Co . v. Spurlockl and failing to find that he had reasonable grounds to believe that salary received after he exhausted his sick and vacation time was paid in lieu of workers' compensation benefits . 1 415 S .W.2d 849 (Ky . 1967) . We affirm . Voluntary payments toll the limitations period if the employer intends or the worker believes reasonably that they are made in lieu of workers' compensation benefits . Having reviewed the record, we have concluded that the ALJ did not misapply Spurlock and that the claimant's evidence did not compel a favorable decision . Knowledge. that a worker missed work due to a compensable injury does not, by itself, show that the employer intended salary paid during the worker's absence to be a substitute for income benefits . The claimant worked for the defendant-employer's lumber yard as a sales representative . He analyzed blueprints for residential contractors and sometimes made site visits in order to determine the materials required for construction . The claimant testified that he lost his balance while measuring for floorjoists at a construction site on October 18, 20052 and fell from a height of about 7 1/2 feet . He landed on his feet and went down to his knees, injuring his back . Filed on May 27, 2008, after the employer's carrier ceased paying medical expenses voluntarily, the claimant's application for benefits alleged that the work-related accident caused both a low back condition and inguinal hernia . Page two of the application indicated that he had filed previous workers' compensation claims for a 1986 hand injury and a 2002 groin injury . The employer raised a limitations defense, but the claimant asserted that salary his employer paid after he exhausted his vacation and sick time tolled 2 Inconsistencies appear in the opinions below, but the . claimant's application for benefits lists this date and the BRC memorandum states that the parties stipulated to this date. the limitations period. Thus, the ALJ bifurcated the claim in order to determine whether it was timely before proceeding to other issues . The claimant testified when deposed by counsel that he knew his injury was serious immediately. He began to experience low back pain on his way back to the office and his back had completely "locked up" by the time he arrived. He notified his supervisor and went home to rest . The claimant sought chiropractic treatment with Dr. Roberts on the following day and missed about a weeks' work before resuming his usualjob. He stated that Dr. Roberts saw him several times and ordered an MRI, after which his employer's workers' compensation carrier referred him for a bone scan and additional treatment with Dr. Cheng. He also saw Dr . Reddy for an evaluation in the fall of 2007 at the carrier's request. The claimant testified that his family doctor gave him a series of steroid shots to alleviate back pain and referred him to Dr . Guarnaschelli, who recommended surgery . He stated that he wished to undergo the procedure; that his health insurance carrier paid his medical expenses presently; and that he paid any deductibles and co-pays himself . The claimant testified that he underwent outpatient hernia surgery in 2002 . Contrary to the statement on page 2 of his application, he denied that the condition was work-related .3 He stated that he began to experience groin pain after the October 2005 injury and that Dr. Shively diagnosed a recurrent 3 The record indicates that the claimant had filed two previous workers' compensation claims, numbered 1986-32473 and 2002-89969. inguinal hernia, which he repaired surgically. The claimant testified that he missed two weeks' work after the surgery, but his employer paid him "just like I was working." He then returned to light duty for several weeks and continued to receive his salary although he worked only when he felt able . He stated that the employer's carrier refused to pay for the procedure and did not pay TTD benefits during his recovery .4 The claimant's testimony about his use of vacation and personal time due to the injury was unclear. He testified when deposed that he used vacation days when low back pain prevented him from working but that the employer continued to pay his salary after he exhausted his vacation days . When asked whether he lost any wages due to the October 2005 injury, he stated that he did not. He testified at the hearing that the employer did not count his absences due to the injury against either his vacation or personal days . He also testified that he missed a total of 25-30 days due to his back and his hernia but testified later that the October 2005 injury caused him to miss more than his three weeks of vacation time and six days of personal time annually in 2006, 2007, and 2008 . The lumber yard's manager, Chris Coyle, testified that the claimant was the business's top salesman and an excellent employee . He testified that he learned of the claimant's accident on the morning it occurred and directed him 4 Medical records indicate that the claimant began to complain of right groin pain on or about March 1, 2006 and underwent surgery on March 24, 2006. He reported to Dr . Shockey for the first time on April 26, 2006 that the groin pain began about three days after the October 2005 injury. The record indicates that the employer refused to pay for treating the condition because no medical evidence documented that it occurred on October 18, 2005. to seek medical attention. Coyle acknowledged that the business's attendance records attributed only an absence on November 4, 2005 to the claimant's back injury . Moreover, they failed to include all of the days that he missed due to back symptoms and related medical appointments . Coyle stated that the claimant also missed quite a bit of time after the hernia surgery. Yet, the attendance records listed him absent only on March 24, 2006 (the date of the surgery) and on April 14, 2006, and they attributed neither absence to a work- related injury .5 Coyle testified that he did not count days missed because of a work- related injury against the claimant's leave time and probably would have continued to pay the claimant's salary if the recurrent hernia resulted from a previous work-related injury. He explained that he paid the claimant's base salary when he missed work due to the back injury and hernia because "We try to take care of our employees ." He stated that the business never notified its worker's compensation carrier of the claimant's absences or sought or was reimbursed for a portion of his salary by the carrier . The ALJ dismissed the claim, having reviewed the evidence in light of Spurlock. The ALJ noted that the claimant offered no evidence that he thought his employer paid his salary in lieu of workers' compensation benefits . Nor did he show that the employer intended to pay his salary in lieu of workers' 5 Attendance records attached to Coyle's deposition indicated that the claimant missed 5 days after the injury in 2005 (3 vacation, 2 personal), 13 days in 2006 (12 vacation, 1 personal), 21 days in 2007 (15 vacation, 6 personal), and 15 1/2 days through July 2008 (9 1/2 vacation, 6 personal). 5 compensation rather than out of consideration for a valued employee . The ALJ was not convinced that the employer's knowledge of the reason he missed work, by itself, showed the intent to pay his salary in lieu of income benefits . The claimant asserts that the ALJ erred. He doesnot argue that the limitations period should be tolled because his absence of more than seven consecutive days after the hernia surgery entitled him to TTD benefits and, thus, to notice under KRS 342 .038(1) and KRS 342 .040(1) of his right to file a claim and of the applicable limitations period. In fact, he complains that the Board and the Court of Appeals "missed the primary issue" when they "veered off into issues regarding notice and the beginning date for the obligation to pay TTD benefits." His sole argument is that the employer tolled the limitations period by paying his salary for all of the days he missed work, even after he exhausted his leave time. An injured worker has the burden to prove every element of his claim, including that it is timely .6 Having failed to meet that burden, the worker must prove on appeal that the favorable evidence was so overwhelming as to compel a favorable decision.? We conclude that the evidence did not compel a decision in the claimant's favor under a correct interpretation of Spurlock. American Radiator 8a Standard Sanitary Corp . v. Crawford8 is an early example of a case in which the court affirmed a finding that income benefits 6 Snawder v. Stice, 576 S.W.2d 276 (Ky. App . 1979) . 7 Special Fund v. Francis, 708 S.W.2d 641, 643 (Ky. 1986) . 8 221 S.W.2d 684 (Ky. 1949) . paid in lieu of compensation toll the limitations period. Unable to work due to silicosis, Crawford sought workers' compensation benefits from his employer . The employer did not acknowledge its liability for compensation but paid him the exact amount he would have received each week as compensation, stating that the payments were gifts. The employer discontinued the payments when Crawford requested a lump-sum settlement after the limitations period expired, and it raised a limitations defense to his subsequent claim. Crawford testified that he considered the payments to be compensation and inquired when he realized that the employer was calling them gifts. He stated that the employer's personnel director told him the payments were compensation no matter what they were called . The employer's manager testified, however, that the payments were gifts from the company's welfare fund . The fact-finder determined that the payments were compensation and tolled the limitations period, decrying the notion that the Workers' Compensation Act permitted an employer to "string the [injured worker] along" by paying voluntary benefits until the limitations period expired and then prevail on a limitations defense. Holding that substantial evidence supported the decision, the court affirmed . Spurlock describes the type of voluntary payments that toll the limitations period as being those that the carrier intends or the worker has reasonable ground to believe are made in lieu of income benefits .9 At issue in 9 See also Louisville Safety Council, Inc. v. Hack, 414 S.W.2d 877 (Ky. 1966) (evidence compelled tolling where worker received assurance from employer that salary paid after injury was to be considered compensation and where all medical bills were 7 Spurlock was the effect of a provision in the parties' employment contract that required the employer to pay the worker's regular salary for up to one year after a compensable injury and allowed the employer to cash the disability checks received from its workers' compensation carrier. The court held that the wages tolled the limitations period because the terms of the contract led the worker to believe reasonably that a portion of his wages represented compensation . The court reiterated subsequently in a case involving different facts that an employer's payment of voluntary income benefits for disability resulting from a work-related injury tolls the limitations period because such payments tend to lull an injured worker into a false sense of security, which may cause the worker to fail to file a timely claim.' 0 The evidence clearly does not compel a decision for the claimant. Nothing indicates that this case involves an employer's attempt to lull a worker into failing to file a timely claim; an employer's assurances that continued salary payments were compensation ; a contractual provision indicating that a portion of the post-injury wages represented income benefits ; or a carrier's reimbursement of a portion of post-injury wages. The employer's carrier asserted in the present case that the recurrent hernia was unrelated to the paid without question) . Compare Moore v. Seagraves Coal Co., 441 S.W.2d 771, 772 (Ky. 1969) (evidence did not compel findings that employer made payments in lieu of compensation or fraudulently concealed facts concerning worker's rights where employer supplemented carrier's workers' compensation checks to "unusually conscientious and capable employee" so that combined checks equaled pre-injury wage ; where carrier later discontinued compensation and employer made up the difference ; but where employer advised worker to confer with carrier regarding compensation claim) . 10 City ofFrankfort v. Rogers, 765 S.W.2d 579 (Ky. App. 1988). 8 October 2005 injury and refused to pay for the surgery, which should have alerted a worker who was not unacquainted with the need to file a claim that he must do so. Although the claimant testified that he continued to receive his base salary of more than $700 per week during his absences, he submitted no evidence that he thought his salary represented compensation for his injury." Moreover, his supervisor denied that the employer viewed salary paid after the claimant's injury as being compensation . The decision of the Court of Appeals is affirmed . All sitting. All concur. COUNSEL FOR APPELLANT, KENDALL BURRESS : Ben Thomas Haydon, Jr. 118 East Broadway P.O. Box 1155 Bardstown, KY 40004 COUNSEL FOR APPELLEE, DON'S LUMBER : Sherri Porter Brown Ferreri 8s Fogle 300 East Main Street Suite 400 Lexington, KY 40507 il KRS 342.730(1)(a) provides TTD benefits equal to 66 2/3 of an injured worker's average weekly wage up to 100% of the state's average weekly wage, which was $607.23 for injuries that occurred in 2005 . KRS 342.730(1)(b) limits permanent partial disability benefits to 75% of the state's average weekly wage . 9