Source: https://www.seglawyersvermont.com/marjorie-alden-v-fletcher-allen-health-care-august-21-2009/
Timestamp: 2019-04-23 14:33:23+00:00

Document:
1. Is Claimant’s current claim against Fletcher Allen Health Care (FAHC) time-barred under either 21 V.S.A. §656 or 21 V.S.A. §660(a)?
2. Is Defendant CNA Insurance Company (CNA) barred from asserting FAHC’s liability for Claimant’s current claim under either 21 V.S.A. §656, 21 V.S.A. §660(a) and/or the equitable doctrines of waiver, estoppel or laches?
3. Do genuine issues of material fact exist as to whether Claimant’s job responsibilities in 2000 and thereafter caused her to suffer an aggravation and/or new injury?
1. On January 30, 1992 Claimant sustained a work-related low back injury while employed by FAHC.
2. CNA was on the risk at that time and accepted the claim.
3. Claimant underwent L3-4 disc surgery in November 1992. After she reached an end medical result, Claimant and CNA entered into a Form 22 Agreement for Permanent Partial Disability Compensation, which the Department approved on November 3, 2003.
4. Claimant’s prior medical history includes L5-S1 disc surgery in 1970.
5. In July 1996 FAHC became self-insured for workers’ compensation purposes.
6. In or around September 2000 Claimant transferred from bedside nursing to the Dermatology Clinic. Claimant’s job responsibilities in this position required both sitting – while working on the computer, writing and/or talking on the telephone – and standing – while retrieving supplies, delivering paperwork and, once or twice a week, assisting in surgery.
7. At some point after her transfer Claimant began to experience increased low back and right leg pain. Claimant did not complete any injury or incident report relating to these increased symptoms, but she did inform her supervisor, Deb LeBlanc, that she planned to seek medical treatment. This she did, in February 2001, with Dr. Monsey, an orthopedic surgeon.
9. In November 2003 Dr. Monsey performed L4-5 disc surgery to address Claimant’s ongoing complaints.
10. On December 26, 2003 Attorney Chris McVeigh wrote to Claimant, advising that “Fletcher Allen Health Care/CNA Insurance Company has retained me to investigate your claim for workers’ compensation benefits.” Presumably this letter was prompted by the submission of the bills for Dr. Monsey’s November 2003 surgery for payment in conjunction with Claimant’s 1992 work injury.
Q: Okay. In your note of February 12, 2001, in the subjective portion of that note, it states quote: “Over the past year her work has changed such that she is spending the majority of her time now sitting, which has been associated with worsening symptoms.” Period. “The pain is clearly worse with prolonged sitting or driving.” Period. Close quote. Did I read that accurately?
Q: Is prolonged sitting a cause of increasing pain for an area that has epidural scarring?
A: For individuals who have back and leg pain related to neuro compression, sitting is a significant risk factor for both the development of those symptoms and the exacerbation of those type of symptoms.
A: The theory is that sitting increases the intradiscal pressure more than a variety of other maneuvers such as standing and walking.
Q: If someone is sitting over a prolonged period of time, can the increase in the intradiscal pressure on the nerve cause permanent increased symptoms?
A: The sitting, in and of itself, doesn’t cause permanent symptoms. Individuals who have prolonged neural compression are more likely to have ongoing residual symptoms even with decompression of that root. So the length of time of symptoms is a prognostic factor for resolution after decompression.
[Claimant] has right leg pain. These symptoms have been present since her injury in 1992 secondary to an injury while at work. The symptoms became progressively more severe necessitating her most recent surgical intervention. These current symptoms are an aggravation of an ongoing problem secondary to her injury at Fletcher Allen Health Care in 1992.
I have worked at FAHC for 30 years as a nurse, 27 of those as a bedside nurse. I have moved to the Dermatology Clinic because I felt that I could not do the heavy lifting and bending required to do bedside nursing . . .
I guess, not claiming all those years of treatments on the workers comp was my own stupidity or oversight but I guess I have no excuse. I do wish that you would review my case.
17. In a letter dated April 28, 2004 the Department advised both Claimant and Attorney McVeigh, whom it identified as “legal counsel for Fletcher Allen Health Care/CNA Insurance,” that it was considering Claimant’s April 20, 2004 letter as a request for hearing pursuant to Rule 4.1100.
19. On August 24, 2004 Claimant notified the Department that she was appealing CNA’s determination that her claim was time-barred. Once again, the Department treated this correspondence as a request for hearing. On October 21, 2004 it held an informal conference with both Claimant and Attorney McVeigh.
20. On June 20, 2005 Claimant’s attorney entered his appearance on Claimant’s behalf.
[Dr. Monsey’s] surgery addressed a site that had not previously been operated on. The precise date of the injury is unclear. However, a record from Fletcher Allen’s Work Enhancement and Rehabilitation Center relates that, in September 2000, [Claimant] experienced exacerbated low back and right leg pain coinciding with her having begun a new job, suggesting that something may have happened then.
In any event, it is clear that this is a new injury and that a claim was asserted in a timely fashion.
I am writing to inform you that it appears that Liberty Mutual, who was Fletcher Allen Health Care’s insurer in all of 2000, should be put on notice regarding this claim.1 This action involves [Claimant’s] claim that she experienced an aggravation of her low back condition in 2000 while working at Fletcher Allen Health Care.
It is my understanding that CNA Insurance Company’s coverage for Fletcher Allen Health Care ended in 1996.
24. In response to Attorney McVeigh’s letter, the Specialist indicated that the file contained no evidence upon which to base an aggravation claim and that therefore she could not take the action he requested. In response to that, Attorney McVeigh forwarded copies of documents that he asserted indicated that Claimant’s condition worsened as a result of her job change, specifically (a) Dr. Monsey’s February 12, 2001 office note (referenced and quoted in paragraph 13 above); and (b) excerpts from Claimant’s December 2006 deposition transcript. With that information in hand, in June 2007 the Specialist put FAHC on notice of its potential responsibility for Claimant’s current claim.
1. Claimant’s current claim for workers’ compensation benefits posits that the low back and right leg pain that necessitated her 2003 surgery resulted either from the compensable work injury she sustained in 1992 or from the change in her work environment and job responsibilities that occurred when she transferred to the Dermatology Clinic in 2000. If the former, then her condition represents a recurrence, for which CNA is liable. If the latter, then her condition is indicative of an aggravation or new injury, for which FAHC, in its capacity as a self-insured employer, ordinarily would be responsible.
1 Attorney McVeigh was mistaken as to FAHC’s workers’ compensation insurance coverage. As of July 1996 FAHC was self-insured.
2. FAHC moves to dismiss and/or for summary judgment on three alternative grounds. First, it asserts that any aggravation or new injury claim made by Claimant is time-barred under either 21 V.S.A. §656 and/or 21 V.S.A. §660(a). Alternatively, it asserts that any attempt by CNA to pass responsibility onto it under an aggravation or new injury theory is barred, either under those same statutory provisions and/or under the equitable doctrines of waiver, estoppel and laches. Last, it asserts that the undisputed medical evidence conclusively establishes that Claimant’s job transfer in 2000 caused neither an aggravation nor a new injury and that therefore it is entitled to judgment in its favor as a matter of law.
3. Summary judgment is proper when “there is no genuine issue of material fact and the moving party is entitled to a judgment as a matter of law, after giving the benefit of all reasonable doubts and inferences to the opposing party.” State v. Delaney, 157 Vt. 247, 252 (1991). To prevail on a motion for summary judgment, the facts must be “clear, undisputed or unrefuted.” State v. Heritage Realty of Vermont, 137 Vt. 425 (1979); A.M. v. Laraway Youth and Family Services, Opinion No. 43-08WC (October 30, 2008).
4. As against Claimant, FAHC asserts that her claim is barred because she failed to comply with either the notice provisions of 21 V.S.A. §656 or the statute of limitations provided in 21 V.S.A. §660(a). According to FAHC’s characterization of the evidence, Claimant has admitted that she knew shortly after transferring to the Dermatology Clinic in September 2000 that her new job responsibilities were causing new and/or aggravated symptoms in her low back. Therefore, FAHC argues, under §656 Claimant was obligated to put it on notice of any claim for compensation within six months of that date, or by March 2001, and under §660(a) she should have initiated her claim for benefits within six years, or by September 2006.
(b) The date of injury . . . shall be the point in time when the injury . . . and its relationship to the employment is reasonably discoverable and apparent.
7. Notably, these statutory provisions require only that an injured worker notify his or her employer, not that he or she also discern the employer’s workers’ compensation insurance status and notify the appropriate adjuster or third party administrator as well. This is, obviously, as it should be. That information is readily available to the employer, but rarely so to its employees.
8. Here, Claimant has testified by affidavit that at least by the time she began treating with Dr. Monsey in February 2001 her supervisor knew that she was experiencing increased low back pain possibly related to having transferred from bedside nursing to the Dermatology Clinic at some point in September 2000. There also is evidence that FAHC arranged for a work site assessment in March 2001 and thereafter implemented the recommendations suggested as a result. At a minimum, this evidence is sufficient to raise genuine questions of material fact as to whether FAHC had timely “notice of the injury” under §656(a), and/or whether it had “knowledge of the accident” under §660(a). Until those factual issues are resolved, summary judgment against Claimant is inappropriate.
9. The evidence also establishes that Claimant “initiated a claim for benefits” as early as December 2003, when the medical bills relating to her November 2003 surgery were submitted for payment as work-related. Even assuming that Claimant’s injury occurred immediately after her job transfer in September 2000, this still was well within the six-year limitations period mandated by §660(a).
10. FAHC makes much of the fact that Claimant’s claim for benefits arising out of her November 2003 surgery initially was directed to CNA, its insurer at the time of Claimant’s 1992 injury, and that neither Claimant nor CNA made any claim specifically against it, in its status as self-insured employer, until June 2007, after the statute of limitations for a September 2000 date of injury would have passed. It is not necessary at this juncture to reach the legal merits of FAHC’s argument. For now, it is enough to note the factual questions germane to it that remain unresolved – to what extent Claimant’s supervisor was aware of Claimant’s increased symptoms and their possible connection to her new job, why no new incident or injury report was filed in conjunction with the medical treatment Claimant sought in February 2001, how the medical bills for Claimant’s November 2003 surgery found their way to CNA. These are genuine issues of material fact that cannot be resolved in the context of a motion for summary judgment.
2 In 2004 the limitations period for initiating a new injury claim was reduced from six to three years. The current claim arises under the old statute of limitations.
11. Because genuine issues of material fact exist as to FAHC’s claimed defenses under either §656 or §660(a), its motion to dismiss and/or for summary judgment against Claimant must fail.
12. As against CNA, FAHC argues that it is entitled to summary judgment because CNA’s attempt to shift responsibility for Claimant’s workers’ compensation benefits is time barred, either under the statutory provisions cited above or under the equitable doctrines of waiver, estoppel and/or laches.
13. I cannot discern from the language of §656 any legislative intention to apply the six-month notice requirement to actions between insurance carriers (or in this case, between a carrier and a self-insured employer) in the same manner as it applies as between an injured worker and his or her employer. In fact, the statutory references to “claimant” and “employee” strongly suggest otherwise.
14. As applied to the facts of this claim, furthermore, the six-year statute of limitations provided for in §660 could not have begun to run against CNA at least until late 2003, when it first received notice of Claimant’s claim for workers’ compensation benefits related to her November 2003 surgery. That defense is unavailing to FAHC as well, therefore.
15. What remains are FAHC’s equitable arguments against CNA – waiver, estoppel and laches. FAHC asserts that these defenses are available to it as a result of Attorney McVeigh’s acts and omissions, most notably his failure to notify FAHC of its own potential exposure for Claimant’s claim, separate and apart from CNA’s exposure, in a more timely fashion than he did.
16. These defenses might well prove successful in a third-party action against CNA. Under the circumstances, however, I cannot grant them in this forum. Should the evidence ultimately establish that Claimant did in fact suffer an aggravation or new injury causally related to her job transfer in 2000, under our workers’ compensation law her right to recover will be against FAHC, not CNA. To dismiss FAHC from the claim for reasons that have nothing at all to do with Claimant’s actions would leave her with an entitlement to workers’ compensation benefits, but no responsible employer or carrier from which to collect them. This would be manifestly unfair and I cannot allow it.
17. I conclude, therefore, that there is no statutory basis upon which to grant FAHC summary judgment against CNA. Nor do the circumstances of this claim permit me to do so on equitable grounds.
19. Questions of recurrence, aggravation, flare-up or new injury are inherently fact-specific. Expert testimony on the issue is often complex, contradictory and confusing. Such is the case here. While Dr. Monsey did indicate in the context of his deposition that prolonged sitting alone did not cause an aggravation, in his January 19, 2004 “To Whom It May Concern” letter (referred to in Finding of Fact No. 14 above), he stated that the symptoms that necessitated his November 2003 surgery were “an aggravation of an ongoing problem” secondary to her 1992 work injury. Taken together, Dr. Monsey’s statements do not make a conclusive case either for or against aggravation. Summary judgment is, therefore, improper.
For the foregoing reasons, Defendant FAHC’s Motion to Dismiss and/or for Summary Judgment is DENIED, both as to Claimant and as to Defendant CNA.
DATED at Montpelier, Vermont this 21st day of August 2009.

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