[Cite as Jones v. Catholic Healthcare Partners, Inc., 2012-Ohio-6269.]

STATE OF OHIO, MAHONING COUNTY 

IN THE COURT OF APPEALS 

SEVENTH DISTRICT 

CHRISTINE M. JONES ) CASE NO. 11 MA 23 

) 

APPELLEE ) 

) 

VS. ) OPINION 

) 

CATHOLIC HEALTHCARE ) 

PARTNERS, INC., et al. ) 

) 

APPELLANT ) 

CHARACTER OF PROCEEDINGS: Civil Appeal from the Court of Common 

Pleas of Mahoning County, Ohio 

Case No. 07CV4679 

JUDGMENT: Affirmed. 

APPEARANCES: 

For Appellee: Atty. Patrick E. Parry 

434 High Street 

P.O. Box 792 

Warren, Ohio 44482 

For Appellant: Atty. Thomas R. Wyatt 

Atty. Jerry P. Cline 

Andrews & Wyatt, LLC 

561 Boston Bills Road, Suite 700 

Hudson, Ohio 44236 

JUDGES: 

Hon. Cheryl L. Waite 

Hon. Gene Donofrio 

Hon. Joseph J. Vukovich 

Dated: December 31, 2012
[Cite as Jones v. Catholic Healthcare Partners, Inc., 2012-Ohio-6269.]

WAITE, P.J. 

{¶1} Appellant, Catholic Healthcare Partners, Inc., appeals the trial court’s 

decision to grant summary judgment in favor of Appellee, Christine M. Jones. The 

trial court’s judgment upheld a bureau of workers’ compensation decision to allow 

benefits for physical injuries and posttraumatic stress disorder (“PTSD”) resulting 

from a hostage incident. Appellant does not dispute Appellee’s right to recovery for 

the physical injury. However, Appellant argues that the award for PTSD was 

inappropriate. Appellant contends that there was insufficient evidence that 

Appellee’s PTSD was a covered condition under applicable law, and that the trial 

court should not have granted summary judgment affirming the bureau award and 

compensation. Appellant’s argument is without merit and is overruled. 

Factual and Procedural History

{¶2} Appellee’s initial application for workers’ compensation was based on 

the events of April 4, 2007. On that date, Appellee was employed at St. Elizabeth 

Medical Center in Youngstown, Ohio and working as a unit clerk and monitor 

technician. She and five others were taken hostage by an inmate who had been 

transported to the hospital for treatment. The group was held for approximately 

twenty-five minutes by the inmate, who then escaped. Appellee described portions of 

the incident to her evaluating physician as follows: 

He took a gun from a guard * * * the inmate “grabbed my left wrist. I 

yanked away from him. Then he grabbed my right wrist, and pulled it 

and banged it against a doorway and pressed it there—holding me. 
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That’s when he brought the gun up and said, ‘I’ll f*****g kill both of you.’ 

* * * ‘I kept telling him to calm down. He kept saying over and over that 

he would kill us—at least 15 times. He said he wouldn’t kill us if we did 

what he said until his brother got there. I told Francine (other hostage) 

that I wouldn’t let him hurt her.’ ” 

(3/28/08 Heltzel Depo., Exh. A, p. 2.) The examining physician noted that she 

described interacting extensively with the hostage-taker, including having been 

forced to assist him when he changed into the guard’s uniform, and that she was 

later able to alert hospital security. (3/28/08 Heltzel Depo., Exh. A, p. 2.) Although 

the hostage-taker escaped, he was subsequently apprehended in another state. 

Appellee’s wrist injury had not been fully diagnosed when she originally met with Dr. 

Heltzel, and the physician referred to the injury in his initial report but stated that at 

that time an assessment of the psychological aspect of her physical injury would be 

deferred. (3/28/08 Heltzel Depo., Exh. A, p. 3.) Dr. Heltzel later explained during two 

depositions that the assault and resulting physical injury to Appellee’s wrist as well as 

the continuing close physical proximity of the hostage-taker were contributing and 

perhaps aggravating factors in her resulting PTSD. 

{¶3} Appellee filed a workers’ compensation claim for the wrist injury and for 

PTSD resulting from the same incident. Initially, Appellee’s compensation claim for 

PTSD was denied by the bureau of workers’ compensation. Compensation was 

allowed for the physical injury to her wrist. Although the parties did not include the 

bureau file in the record on appeal, they appear to agree as to the proceedings below 
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and the actions taken by various levels within the bureau. According to Appellant’s 

notice of appeal, filed December 14, 2007, and Appellee’s “Complaint (Petition for 

Workers’ Compensation benefits)” filed December 31, 2007, Appellee appealed the 

initial denial of benefits for her PTSD. According to the same documents, Appellee’s 

administrative appeal of the denial of compensation was heard by a hearing officer 

on September 17, 2007 and the denial of coverage was reversed. After the 

September 2007, hearing, Appellee was awarded compensation for her PTSD by the 

bureau. 

{¶4} Appellant challenged the compensation award by filing an 

administrative appeal of the hearing officer’s decision with the Industrial Commission 

of Ohio. The commission refused to hear Appellant’s appeal. Apparently after 

exhausting the administrative remedies, Appellant appealed both the decision 

allowing compensation for Appellee’s PTSD and the denial of an administrative 

appeal of the award to the common pleas court. Although Appellant identified both 

the award of compensation for PTSD and the denial of review by the commission as 

the grounds for review in the trial court, subsequent trial proceedings dealt only with 

whether PTSD was a covered condition. In the proceedings before the trial court 

there was no dispute between the parties concerning the factual events that caused 

the wrist fracture and PTSD. 

{¶5} When asked by counsel for Appellant whether the hostage incident 

alone, rather than in combination with the assault and physical injury to Appellee’s 

wrist, was the cause of her PTSD during the March 28, 2008 deposition, Dr. Heltzel 
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explained “--he grabbed her. She was hurt. I think that does become an additional 

factor.” (3/28/08 Heltzel Depo., p. 16.) The doctor concluded: 

Again, I have to be very careful, because the fact that he grabbed her, I 

mean, that does contribute to trauma, if you can imagine. 

It’s not like he was well across the room threatening her. He was in 

close contact with her and he physically grabbed her. I think that that 

aspect of it, you know, is a part of it for her and I just don’t believe that 

the wrist injury per se can explain the Post-Traumatic Stress Disorder. 

(3/28/08 Heltzel Depo., p. 23.) According to the doctor’s testimony during the 

deposition, the anxiety and constant state of hyper-vigilance Appellee was 

experiencing due to her disorder was interfering with her interpersonal 

communication, her ability to concentrate and sustain focus, and the resulting level of 

suffering and distress prevented her from working. (3/28/08 Heltzel Depo., p. 23.) 

{¶6} Dr. Heltzel was deposed for a second time by Appellant on August 9, 

2010. During that deposition, unlike the March 28, 2008 deposition, the doctor was 

questioned by both counsel for Appellee and for Appellant. During the second 

deposition, the doctor further explained the steps he took in diagnosing Appellee’s 

PTSD, and responded to additional questions concerning the definition of PTSD and 

the role of physical injury in the development of the disorder. Dr. Heltzel summarized 

the definition of the disorder as follows: 

I’ll need to scan my -- the definition because it’s quite lengthy. The 

essential aspect of post-traumatic stress disorder is an experience of an 
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event that involves actual or threatened death or serious injury or other 

threat to one’s physical integrity; so that the concept of the physical 

injury is incorporated into that initial definition. 

Further on the definition states that the disorder may be especially 

severe and long-lasting when the stresser [sic] is of human design, 

such as torture or rape. The likelihood of developing this disorder may 

increase as the intensity of the physical proximity to the stresser [sic] 

increase. 

(8/9/10 Heltzel Depo., p. 15.) Dr. Heltzel expressed his opinion that the proximity of 

the stressor to the victim was a significant factor in the trauma, and explained that the 

primary causes of the disorder are the perception of danger to one’s well-being 

coupled wit the possibility of death. The doctor emphasized that there is not a single 

trigger and what is referred to as the “traumatic event” is not a single moment, but 

may “encompass many different facets.” (8/9/10 Heltzel Depo., pp. 16-17.) He 

explained that “the direct threat with a weapon and the verbal threat by the inmate, 

as well as the physical assault on Ms. Jones, which conveys a dominance over a 

person, increase the sense of helplessness” and that these aspects contributed to 

Appellee’s disorder. (8/9/10 Heltzel Depo., p. 17.) Dr. Heltzel concluded by saying 

that the physical attack and fracture of Appellee’s wrist, which occurred during the 

hostage incident, were “a definite contributing factor as one important feature of an 

overall traumatic event” resulting in a clinical diagnosis of post-traumatic stress 

disorder. (8/9/10 Heltzel Depo., p. 20.) 
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{¶7} The depositions of Dr. Heltzel, and his report, diagnosis and 

conclusions concerning Appellee’s condition are the only medical evidence in the 

record. No alternate expert or contradictory evidence has been offered by Appellant. 

After the initial deposition, but before the second, Appellant sought summary 

judgment. Appellant argued that the testimony of Dr. Heltzel failed to establish that 

the allowable injury to Appellee’s wrist was the sole proximate cause of her PTSD. 

Appellant argued that absent direct causation, PTSD is not a covered injury. 

Appellant’s motion was initially denied, although the decision was vacated by the 

court to allow Appellant to file objections to the magistrate’s decision. After 

considering Appellant’s objections, on March 5, 2009 the trial court issued a final 

decision denying the motion. The initial magistrate’s decision and subsequent trial 

court decision adopting it noted that “[w]hen multiple factors contribute to produce 

injury or illness, each is proximate cause.” (12/31/08 J.E.) The trial court concluded 

that Appellant had failed to demonstrate that Appellee’s “physical injury sustained in 

the assault was not the proximate cause of her psychiatric condition.” (3/5/09 J.E.) 

{¶8} The matter was unsuccessfully referred to mediation. Various 

subsequent filings continued through 2009 and into 2010, when Dr. Heltzel was 

deposed for a second time and trial was scheduled. Although three notices of 

deposition indicate Appellant’s intent to depose Appellee and one indicates an intent 

by Appellant to depose her husband, no transcript of deposition of Appellee or her 

husband appears in the record. On August 6, 2010, Appellee sought leave to file a 

motion for summary judgment. Leave was granted and the motion was ultimately 
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filed instanter on November 29, 2010. What appears to be a complete transcript of 

the August 9, 2010 deposition of Dr. Heltzel is attached to Appellee’s motion for 

summary judgment as Exhibit B. Appellee cites to and incorporates by reference the 

transcript of the deposition in the motion for summary judgment, however, no 

separate complete copy was filed, and no notice of filing of deposition is entered in 

the record with regard to the August 9, 2010 deposition. Appellant did not object to 

the form or use of the deposition transcript in support of Appellee’s summary 

judgment motion, and in fact, also cites to portions of this deposition in a January 5, 

2011 motion in opposition to Appellee’s motion for summary judgment. 

{¶9} The trial court granted Appellee’s motion for summary judgment on 

January 14, 2011. The trial court referred to Dr. Heltzel’s testimony in the August 9, 

2010 deposition and noted that “Dr. Heltzel consistently testified during both 

depositions that the physical injury was a cause of Ms. Jones’[sic] PTSD, albeit not 

the sole cause.” (1/14/11 J.E., p. 1.) The trial court concluded that under the 

applicable law, because it was undisputed that Appellee suffered both a covered 

physical injury and PTSD resulting from events that occurred during the course of her 

employment, Appellee’s PTSD “arose from and was accompanied by the allowed 

injury.” (1/14/11 J.E., p. 3.) The court ordered that Appellee was to participate in the 

workers’ compensation fund “by reason of the injury and condition post traumatic 

stress disorder.” (1/14/11 J.E., p. 3.) Appellant filed a timely appeal from this 

judgment. 

Argument and Law
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ASSIGNMENT OF ERROR

The trial court erred as a matter of law in finding that there is no 

genuine issue of material fact to be litigated and Plaintiff is entitled to 

summary judgment as a matter of law. 

{¶10} Although Appellant mentions both the trial court’s decision to grant 

summary judgment in favor of Appellee and the commission’s decision not to hear an 

appeal of the bureau hearing officer’s decision, the appellate brief focuses solely on 

the decision to grant summary judgment. No record of proceedings in the bureau or 

before the commission was included in the record on appeal. For these reasons, the 

only issue before us is whether the trial court properly granted summary judgment in 

favor of Appellee. Appellant posits that Appellee should be required to show that a 

compensable physical injury was the sole cause of her PTSD before she can receive 

compensation for her condition. The trial court, however, applied the same proximate 

cause standard generally applied in tort and adopted by the Supreme Court for use in 

workers’ compensation cases in Murphy v. Carrollton Co., 61 Ohio St.3d 585, 575 

N.E.2d 828 (1991). 

{¶11} Under Civ.R. 56(C), summary judgment is proper “if the pleadings, 

depositions, answers to interrogatories, written admissions, affidavits, transcripts of 

evidence, and written stipulations of fact, if any, timely filed in the action, show that 

there is no genuine issue as to any material fact and that the moving party is entitled 

to judgment as a matter of law.” Civ.R. 56(C). The party seeking summary judgment 

“bears the initial burden of demonstrating that there are no genuine issues of material 
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fact concerning an essential element of the opponent’s case.” (Emphasis sic.) 

Dresher v. Burt, 75 Ohio St.3d 280, 292, 662 N.E.2d 264 (1996). “[S]ummary 

judgment shall not be rendered unless it appears from the evidence or stipulation * * 

* that reasonable minds can come to but one conclusion and that conclusion is 

adverse to the party against whom the motion for summary judgment is made, that 

party being entitled to have the evidence or stipulation construed most strongly in the 

party’s favor.” Civ.R. 56(C). “When a motion for summary judgment is made and 

supported as provided in this rule, an adverse party may not rest upon the mere 

allegations or denials of the party’s pleadings, but the party’s response * * * must set 

forth specific facts showing that there is a genuine issue for trial.” Civ.R. 56(E). A 

reviewing court has a “complete and independent power of review as to all questions 

of law.” Grafton v. Ohio Edison Co., 77 Ohio St.3d 102, 105, 671 N.E.2d 241 (1996). 

A trial court’s decision to grant summary judgment is a question of law and we review 

this discretion de novo. Id. 

{¶12} On appeal, Appellant challenges the trial court’s decision characterizing 

Dr. Heltzel’s testimony as consistent. Appellant rejects the court’s acceptance of the 

doctor’s statement that the injury to Appellee’s wrist was “a cause,” “albeit not the 

sole cause” was sufficient to support the conclusion that Appellee is entitled to 

compensation for PTSD under R.C. 4123.01 as a matter of law. Appellant urges us 

to adopt an interpretation of R.C. 4123.01 that would limit recovery for psychiatric 

conditions arising out of employment, where occupational disease is not a factor, to 

situations where a claimant can identify a physical injury as the sole cause of the 
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psychiatric disorder. Adoption of the interpretation advocated by Appellant would 

result in denial of Appellee’s compensation for PTSD awarded by the bureau’s 

hearing officer. Appellant’s interpretation of this section would similarly bar any 

claimant seeking compensation for PTSD after a hostage-taking or other traumatic 

incident, regardless of whether a compensable physical harm was concurrently 

suffered by the claimant. 

{¶13} When considering “the issue of proximate cause in the workers’ 

compensation context, * * * the definition of and principles governing * * * the 

determination of ‘proximate cause’ in the field of torts are applicable.” Murphy v. 

Carrollton Mfg. Co., 61 Ohio St.3d 585, 587, 575 N.E.2d 828 (1991) citing Oswald v. 

Connor, 16 Ohio St.3d 38, 42 476 N.E.2d 658 (1985). “It is a well-established 

principle of tort law that an injury may have more than one proximate cause.” Murphy 

at 587. In “Ohio, when two factors combine to produce damage or illness, each is a 

proximate cause.” Id. at 588 quoting Norris v. Babcock & Wilcox Co., 48 Ohio 

App.3d 66, 67, 548 N.E.2d 304, 305 (1988). 

{¶14} The language of R.C. 4123.01 in effect at the time of Appellee’s original 

claim provides: 

(C) “Injury” includes any injury, whether caused by external accidental 

means or accidental in character and result, received in the course of, 

and arising out of, the injured employee’s employment. “Injury” does 

not include: 
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(1) Psychiatric conditions except where the claimant’s psychiatric 

conditions have arisen from an injury or occupational disease sustained 

by that claimant or where the claimant’s psychiatric conditions have 

arisen from sexual conduct in which the claimant was forced by threat 

of physical harm to engage or participate; 

When applying the definitions of R.C. 4123.01 to a specific claim, the legislature has 

also charged that the provisions “shall be liberally construed in favor of employees 

and the dependents of deceased employees.” R.C. 4123.95. 

{¶15} The definition of injury pursuant to R.C. 4123.01(C) was last altered in 

1986 when the limiting language concerning psychiatric conditions was introduced. 

Am.Sub.S.B. No. 307, 141 Ohio Laws, Part I, 718. Prior to the 1986 amendment, 

injury was defined broadly: “ ‘Injury’ includes any injury, whether caused by external 

accidental means or accidental in character and result, received in the course of, and 

arising out of, the injured employee’s employment.” (Emphasis sic.) Am.Sub.H.B. 

No. 470, 128 Ohio Laws 743, 745, effective November 2, 1959 as quoted in McCrone 

v. Bank One Corp., 107 Ohio St.3d 272, 275, 2005-Ohio-6505, 839 N.E.2d 1, ¶12. 

The exception to the definition of injury found in R.C. 4123.01(C)(1), which denies 

recovery for psychiatric conditions except in limited circumstances, was altered twice 

in 2006. (Alterations effective June 30, 2006). The first 2006 amendment to R.C. 

4123.01(C)(1) limits compensation for psychiatric conditions arising from an injury to 

those instances in which both the injury and psychiatric condition are suffered by the 

same person. This amendment was intended to correct the outcome reached in 
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Bailey v. Republic Engineered Steels, Inc., 5th Dist. No. 1999CA00084, 1999 WL 

1072194 (November 1, 1999), affirmed by Bailey v. Republic Engineered Steels, Inc., 

91 Ohio St.3d 38, 741 N.E.2d 121 (2001), in which compensation was allowed in an 

employee’s claim for “severe depression” resulting from witnessing the death of 

another employee in an industrial accident that the claimant unintentionally caused. 

(Id. at *1.) 

{¶16} The second 2006 amendment to R.C. 4123.01(C)(1) expanded covered 

conditions to include those resulting from coerced sexual conduct. This amendment 

addresses the outcome in Connors v. Sterling Milk Co., 98 Ohio App.3d 711, 649 

N.E.2d 856 (3rd Dist.1993) in which the claimant was denied compensation for PTSD 

and depression resulting from an assault by a masked assailant who forced the 

claimant at gunpoint to leave her place of work, enter an alley, and then told her to 

perform a sex act or die, because the claimant did not sustain a physical injury during 

the incident. At the time Connors was decided, a similarly situated employee 

subjected to sexual misconduct and sexual battery in the workplace was relegated to 

civil tort actions as a remedy. See e.g. Kearns v. Porter Paint Co., 61 Ohio St.3d 

486, 575 N.E.2d 428 (1991), inter alia. 

{¶17} In contrast to the 2006 amendments requiring that the injury and 

psychiatric condition both be suffered by the same claimant and allowing coverage of 

psychiatric conditions resulting from sexual assault suffered in the workplace, the 

legislature has declined to modify the statute to specifically include or exclude the 

Ohio Supreme Court’s 1984 expansive interpretation of R.C. 4123.01 “injury” to 
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include conditions that develop gradually over time as a result of the performance of 

an injured worker’s job-related duties. Village v. General Motors Corp., G.M.A.D., 15 

Ohio St.3d 129, 472 N.E.2d 1079 (1984) (prior to the Village decision the Court read 

the definition narrowly to cover only spontaneous, accidental, injuries; occupational 

diseases are defined separately under the statutory scheme.). 

{¶18} The history of revision, expansion, and inaction surrounding R.C. 

4123.01 over the last thirty years reflects an evolving area of law and highlights the 

need to adhere to “clear legislative intent” as expressed in the language of the statute 

itself. Rambaldo v. Accurate Die Casting, 65 Ohio St.3d 281, 285, 603 N.E.2d 975 

(1992) (citing the Minnesota Supreme Court in Lockwood v. Independent School Dist. 

No. 877 (Minn.1981), 312 N.W.2d 924, 927). When considering the meaning and 

application of R.C. 4123.01 we must consider the context of the amendments, 

“because ‘a legislative body in enacting amendments is presumed to have in mind 

prior judicial constructions of the section.’ ” Rambaldo at 286, citing State ex rel. 

Huron Cty. Bd. of Edn. v. Howard, 167 Ohio St. 93, 96, 146 N.E.2d 604 (1957). “We 

also presume that the General Assembly had in mind prior administrative 

constructions of the statutory sections.” Id. 

{¶19} Two Ohio Supreme Court cases on this subject are instructive: State 

ex rel. Clark v. Industrial Commission, 92 Ohio St.3d 455, 751 N.E.2d 967 (2001); 

and McCrone v. Bank One Corp., 107 Ohio St.3d 272, 2005-Ohio-6505, 839 N.E.2d 

1. In Clark, the earlier of the two cases, the Supreme Court decided whether hostage 

leave pay, which was paid pursuant to the terms of a collective bargaining 
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agreement, must be setoff against temporary total disability benefits awarded for the 

injuries and PTSD resulting from a hostage-taking incident. The claimant in Clark

was a corrections officer working in the Southern Ohio Correctional Facility and was 

taken hostage during an inmate riot. 

{¶20} Clark was held by the inmates from April 11, 1993 until April 15, 1993, 

and suffered multiple physical injuries including abrasions on his wrists, a laceration 

on his forearm, an abrasion on his face, dehydration, and malnutrition. According to 

the Supreme Court, “Clark suffered severe stress and anxiety as a direct result of 

being held hostage as well as having been beaten.” Clark, p. 456. Thirteen days 

after his release, Clark filed a claim with the Ohio Bureau of Workers’ Compensation 

for his injuries. Initially the bureau allowed a claim for “dehydration; malnourishment; 

abrasions bilateral wrists and face; laceration right upper arm; [and] atrial fibrillation.” 

Id. The bureau later allowed compensation for his claim of “post-traumatic stress 

disorder” and his temporary total disability payments began on July 11, 1993. Id. 

{¶21} After his release by the inmates but apparently prior to filing his 

workers’ compensation claim, Clark also applied for and was granted hostage leave 

pay by the Ohio Department of Rehabilitation and Corrections pursuant to the 

collective bargaining agreement between the department and the Ohio Civil Services 

Employees Association. According to the Court, Clark received hostage leave 

payable at his regular rate beginning on April 18, 1993 and continuing until July 10, 

1993. Subsequently, Clark filed a workers’ compensation claim for temporary total 

disability benefits covering the period from April 12, 1993 through July 10, 1993, 
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which overlapped the dates on which he received hostage leave pay. The 

application for overlapping payment was denied by the bureau. The bureau decided 

that any hostage leave paid during that period was required to be deducted from the 

compensation award to avoid an overlap of benefits. Various levels of administrative 

appeal affirmed the denial but a subsequent mandamus action in the court of appeals 

resulted in an order granting compensation with no setoff for hostage pay. 

{¶22} The Ohio Supreme Court reviewed the appellate court decision and 

examined the purposes of both workers’ compensation and the setoff provision 

contained in R.C. 4123.56(A), which allows any “nonoccupational” benefit primarily 

paid for by the employer to reduce the amount of compensation paid over the same 

period. The Court concluded that the hostage leave payments were not a 

nonoccupational benefit, and therefore, setoff was not required. The Court explained 

that the hostage pay was intended to address a risk that corrections officers face 

every day as a result of a job that requires “daily intimate contact with convicted 

criminals, some of whom have violent propensities,” explaining that the “emotional 

and physical pressures of extended incarceration can erupt into violence, rioting, and 

prison takeovers, as in this case, which often involve hostage-taking of prison 

employees.” Id. at 458. “Thus, this benefit is designed to address a risk that is 

occupational, i.e., one that is clearly connected to the nature of the work.” Id. at 458-

459. 

{¶23} The Court emphasized that “[i]n order to qualify for hostage leave, Clark 

was not required to have suffered any physical injury; he was required to show only 
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that he suffered from stress associated with being held hostage.” Id. at 459. This, 

according to the Court, meant that the contractual benefit would protect employees 

who, “without a corresponding physical injury,” would not receive compensation 

under the workers’ compensation system. Id. (paraphrasing Bunger v. Lawson Co., 

82 Ohio St.3d 463, 464, 696 N.E.2d 1029, 1031 (1998) “A psychological injury 

without a corresponding physical injury is not compensable under the workers’ 

compensation system.”). The Court compared the hostage pay benefit to the civil 

action remedy for claims concerning sexual assault that were not then covered under 

the compensation statute, and were therefore not precluded by the section of the 

statute limiting recovery to the benefits allowed by statute, identified in Kearns v. 

Porter Paint Co., 61 Ohio St.3d, 575 N.E.2d 428 (1991). While Clark primarily dealt 

with the idea of benefit setoffs, not at issue in the matter before us, a few principles 

important to our understanding of our issue underlie the Clark court’s decision: (1) 

workers’ compensation is designed to compensate employees for harms that occur 

due to employment that would otherwise prevent the employee from earning wages; 

(2) workers’ compensation excludes psychiatric injuries that have no 

“contemporaneous” or “corresponding” compensable physical injury, but would allow 

compensation for psychiatric conditions that do correspond to a physical injury. 

{¶24} Officer Clark suffered a variety of physical injuries, both when he was 

taken hostage (lacerations, abrasions) and due to being held (dehydration, 

malnutrition, wrist abrasions). The Court’s description of Clark’s covered injuries 

reflects multiple stressors that contributed to the covered psychiatric condition: “[i]n 
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addition to his physical injuries, Clark suffered severe stress and anxiety as a direct 

result of being held hostage as well as having been beaten.” Clark at 456. Officer 

Clark’s ability to recover for PTSD when he had suffered a corresponding physical 

injury was a not ever at issue. There is no discussion of the nature of the injuries or 

the specific connection between the injuries and the psychiatric condition and there 

was no separate appeal of those issues in Clark. The fact that Clark’s PTSD was 

suffered as a result of both physical and non-physical trauma did not alter his 

eligibility for workers’ compensation. 

{¶25} The Court subsequently cited Clark in support of the proposition that 

covered “[c]onditions suffered by the claimant could be mental disorders, provided 

that they arose from a physical injury.” McCrone, supra, ¶16. In McCrone, the Ohio 

Supreme Court determined that the exclusion of benefits for psychiatric conditions 

that do not arise from a compensable physical injury or occupational disease does 

not rise to the level of a violation of the equal protection clauses of the Ohio and 

United States Constitutions. In McCrone, the claimant filed for PTSD but had 

suffered no physical injury during two armed robberies at the bank where she 

worked. The claimant was diagnosed with PTSD as a result of having witnessing the 

first robbery and then being the teller robbed during the second. The claimant 

argued that a workers’ compensation scheme that denies compensation for 

psychiatric harm except where such harm is accompanied or evidenced by a physical 

injury violates the equal protection clauses of the United States and the Ohio 

Constitutions. The Fifth District Court of Appeals found the statute unconstitutional, 
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and certified a conflict on appeal from its ruling. The Ohio Supreme Court’s review of 

the issue was limited to the issue of equal protection because due process and article 

two violations were not raised in the proposition of law or certified conflict. The 

certified question before the Court asked “[w]hether R.C. 4123.01(C)(1) violates the 

Equal Protection Clauses of the United States and Ohio Constitutions, where it 

excludes from Workers’ Compensation coverage psychological or psychiatric 

conditions occurring in the course of and arising out of the claimant’s employment, 

but [which] do not arise from or occur contemporaneously with a compensable 

physical injury.” Id. at ¶5. 

{¶26} The Court began its evaluation of the question by discussing the history 

of the definition and the treatment of covered injuries by the courts and by the Ohio 

Bureau of Workers’ Compensation. The Court noted that “courts have held that 

compensable injuries under the workers’ compensation system require a physical 

component suffered by the claimant” both before and after amendments to the 

definition of injury that explicitly excluded psychiatric conditions in the absence of 

physical harm. Id. ¶16. Similarly, the Ohio Bureau of Workers’ Compensation itself 

“has required a physical injury to the claimant before granting compensation for a 

psychiatric condition both before and after the 1986 amendments.” Id. at ¶17. The 

Court concluded: “Because the General Assembly has classified mental conditions 

as compensable under workers’ compensation laws only when they are accompanied 

by physical injury,” “psychological or psychiatric conditions that do not arise from a 

compensable physical injury or occupational disease are excluded from the definition 
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of ‘injury’ under R.C. 4123.01(C)(1).” Id. ¶18-19. The Court decided that 

psychological or psychiatric conditions, in the absence of a physical injury, could be 

excluded from coverage without violating the equal protection clause. Id. ¶38. In the 

Court’s formulation, the phrases “accompanied by” and “arise from” are 

interchangeable. 

{¶27} None of the various appellate court cases cited by Appellant in an 

attempt to support the enhanced standard Appellant would have us adopt involve the 

denial of coverage to a claimant suffering both a covered physical injury and a 

psychiatric condition resulting from the same work-place incident. The cases cited by 

Appellant generally involve a denial of coverage to a claimant suffering from a workrelated psychiatric condition who has not suffered a concurrent physical injury. (E.g.

Bunger, supra (no physical injury); Rambaldo, supra (no physical injury, denied claim 

by an employee who charged that he suffered from major depression and mixed 

personality disorder because his employer required him to do things which were 

dishonest or somewhat unethical); Banks v. LTV Steel Co., 100 Ohio App.3d 585 

(1995) (recovery is allowed to claimant who was diagnosed with PTSD in addition to 

the chest, spinal, arm and leg injuries she suffered in an industrial accident); 

Karavolos v. Brown Derby, Inc. 99 Ohio App.3d 548 (1994) (remanded for trial to 

determine whether there exists a connection between employee’s back injury and 

various mental conditions including drug addiction); Wood v. Ohio State Hwy. Patrol, 

156 Ohio App.3d 725, 2004-Ohio-1765 (5th Dist.) (no physical injury); Ireland v. S. 

Ohio Corr. Facility, 2006-Ohio-3519 (5th Dist.) (no physical injury). Appellant also 
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brings to our attention Dunn v. Mayfield, 66 Ohio App. 3d 336, 584 N.E.2d 37 (4th 

Dist.1990). In Dunn, the employee filed a workers’ compensation claim requesting 

relief for acute anxiety and PTSD. The claim was left open for claimant to provide 

additional evidence of a physical injury. Claimant failed to meet the deadline to 

supplement and appealed the resulting denial of compensation. The appellate court 

reversed summary judgment against the claimant and, using proximate cause 

language, remanded the matter to the trial court for further proceedings, placing the 

burden on the claimant to show a connection between any physical injuries and the 

diagnosis of PTSD. Dunn actually appears to support the current matter in that 

Appellee could receive benefits for her PTSD so long as it can be said to be 

proximately caused by the physical injury. Nothing in Dunn requires physical injury to 

be the single or only cause of the psychiatric disorder. This Court has not considered 

the specific issue now before us, but we have previously denied coverage for PTSD 

in the absence of any physical injury. Fields v. City of Youngstown, 7th Dist. No. 88 

CA 89, 1989 WL 59014 *2 (May 30, 1989) (claimant specifically stated “I did not have 

or get any physical injury”). 

{¶28} Although no Ohio court has ruled on the precise issue raised by 

Appellant, the Second District Court of Appeals has affirmed a trial court decision that 

denied recovery for PTSD where the claimant also sustained physical injuries as a 

result of employment. However, the court did not apply the “sole cause” formulation 

advocated by Appellant. Armstrong v. Jurgenson Co., 2nd Dist. No. 2011-CA-6, 

2011-Ohio-6708. The 2011 decision affirmed the trial court’s finding that the physical 
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injuries suffered by a teamster, who was the victim of a rear-end crash while working, 

were not the cause of his PTSD. At trial, there was conflicting testimony on the 

central issue of causation. The claimant’s examining physician originally diagnosed 

the teamster with PTSD and referred to his physical injuries in the report relied on by 

the Industrial Commission to grant this PTSD benefits. The treating physician also 

testified at trial that the physical injuries contributed to and were causal factors in the 

claimant’s PTSD. Id. at ¶15. 

{¶29} At trial, the parties stipulated that the accident was work-related; that 

claimant suffered a variety of physical injuries due to the accident; and that claimant 

was suffering from PTSD due to the accident. However, the employer presented a 

contradicting expert witness who concluded that although the claimant was suffering 

from PTSD, the cause of the disorder was the act of witnessing the collision and 

resulting harm to the other driver (who died), and was not related in any way to the 

claimant’s own back and shoulder injuries. 

{¶30} The reviewing court’s majority opinion agreed with the trial court’s 

reading of the statute’s limitation on coverage to those psychiatric conditions that 

“have arisen from an injury or occupational disease sustained by that claimant.” The 

court held that in order to be compensable, psychiatric conditions must be “started by 

and therefore result[ing] from a physical injury or occupational disease the claimant 

suffered.” Id. at ¶35. Both the trial court and the reviewing court relied on the 

testimony of the employer’s expert who testified that there was no causal link 

between the physical injuries and PTSD, rather than the testimony of the treating 
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physician who identified the injuries as a contributing cause. This matter appears to 

rest entirely on a credibility determination; the trial court found the claimant’s 

physicians were not credible and the employer’s expert was credible. Hence, this 

credibility determination would be upheld on review. 

{¶31} The matter before us does not involve conflicting testimony. It does 

involve a claim for both physical injury and psychiatric condition resulting from a 

single hostage-taking incident. The two depositions of Appellee’s treating physician 

provide consistent testimony that the physical injury to Appellee is a proximate cause 

of her PTSD, although concededly not the sole proximate cause. She also suffers 

from the stress of being taken hostage. Both factors contributed to and resulted in 

her PTSD. In this instance, Appellee is most similarly situated to the claimant in 

Clark, who was similarly held hostage and was physically injured by his assailant. 

Without evidence ruling out her physical injury as one cause of PTSD, it appears that, 

were we to reverse the bureau’s decision granting compensation and the trial court’s 

decision allowing recovery, we must interpret the statute more narrowly than does the 

Ohio Supreme Court. This would result in the imposition of an evidentiary standard 

on claimants suffering from multiple work-related harms that ignores the principles of 

causation applicable to workers’ compensation. This is not reflective of controlling 

precedent. Accordingly, applying the principles of causation prescribed by the Ohio 

Supreme Court in Murphy and its progeny, the judgment of the trial court is affirmed. 

Conclusion
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{¶32} Appellee’s uncontradicted evidence of both a compensable physical 

and concurrent psychiatric condition was sufficient to support the trial court’s 

conclusion that there was no genuine issue of material fact to be litigated. Appellee 

was entitled to judgment as a matter of law. Appellant’s sole assignment of error is 

without merit and is overruled. The judgment of the trial court is affirmed in full. 

Donofrio, J., concurs. 

Vukovich, J., concurs.