Source: https://www.seglawyersvermont.com/news/
Timestamp: 2018-02-20 01:47:47
Document Index: 616936567

Matched Legal Cases: ['§660', '§660', '§670', '§650', '§15', '§15', '§15', '§15', '§18', '§648', '§678', '§642', '§648', '§664', '§678', '§655', '§655', '§655', '§655', '§655', '§655', '§655', '§655', '§655', '§655', '§655', '§602', '§655', '§650', '§650', '§670', '§678', '§678', '§678', '§678', '§640', '§664', '§678', '§662', '§602', '§601']

Dislike Conflict? Learn How to Effectively Negotiate
Conflict Resolution: When Winning Isn’t Everything
10 Mar2017 Comments
Lesley Bienvenue v. Sandra Kuc d/b/a Vermonsters Daycare Center
Categories: Do not chooseAuthor: John Schraven
Opinion No. 23-15WC
State File No. CC-2661
Lesley Bienvenue, pro se
Is Claimant’s workers’ compensation claim time-barred under 21 V.S.A. §660(a)?
Defendant’s Exhibit A: Employer First Report of Injury (Form 1)
Defendant’s Exhibit B: Denial of Workers’ Compensation Benefits (Form 2)
Defendant’s Exhibit C: Letter from Anne Coutermarsh, November 18, 2011
Defendant’s Exhibit D: Letter from Tracy Downing, February 9, 2012
Defendant’s Exhibit E: Letter from Claimant, February 15, 2012
Defendant’s Exhibit F: Letter from Anne Coutermarsh, March 11, 2015
Considering the evidence in the light most favorable to Claimant as the non-moving
party, see, e.g., State v. Delaney, 157 Vt. 247, 252 (1991), I find the following:
At all times relevant to these proceedings, Claimant was an employee and
Defendant was her employer as those terms are defined in Vermont’s Workers’
Judicial notice is taken of all relevant forms contained in the Department’s file
relative to this claim.
On or about May 5, 2011 Claimant filed an Employer First Report of Injury
(Form 1) with the Department, in which she alleged that on March 21, 2011 she
had injured her lower back and left knee when a co-worker fell into her and
knocked her to the ground.1 Defendant’s Exhibit A.
On or about June 10, 2011 Defendant filed a Denial of Workers’ Compensation
Benefits (Form 2), Defendant’s Exhibit B, in which it asserted that there was no
causal relationship between Claimant’s injuries and her employment. In support
of its position, Defendant submitted email correspondence from Sandra Kuc, its
executive director, and Stacy Sturtevant, its assistant director, both of whom
challenged Claimant’s version of events. Specifically, Ms. Kuc and Ms.
Sturtevant denied that Claimant had ever informed them either of the incident or
of the injuries she alleged, nor had she ever appeared disabled to the extent she
Claimant appealed Defendant’s denial on or about June 20, 2011. On September
14, 2011 the parties participated in an informal conference with the Department’s
specialist. By this time, Defendant had produced additional statements from two
of Claimant’s co-employees, both of whom denied having witnessed the incident
she had alleged despite having worked with her on the day in question. Based on
this evidence, as well as her review of the contemporaneous medical records, on
November 18, 2011 the Department’s workers’ compensation specialist
determined that Defendant’s denial was reasonably supported and therefore
upheld it. Defendant’s Exhibit C.
By Notice and Application for Hearing (Form 6) dated December 7, 2011,
Claimant challenged the specialist’s determination and requested a formal
By letter dated February 9, 2012 the formal hearing docket administrator notified
the parties that Claimant’s claim had been referred to the formal hearing docket,
and that a telephone pretrial conference had been scheduled for March 12, 2012.
Defendant’s Exhibit D.
On February 15, 2012 Claimant addressed the following letter to the Department,
Defendant’s Exhibit E:
I have chosen to withdraw my request for a hearing. I am not able
to handle the stress associated with this case. I unfortunately, I
chose to wait and see if I would heal on my own before reporting
the incident to my Doctor and can’t undo that fact.
Upon receipt of Claimant’s letter, the specialist notified the parties that the
previously scheduled pretrial conference had been cancelled.
1 Claimant appears to have completed the First Report of Injury herself; it is in her handwriting, and neither
Defendant nor its representative signed it.
Defendant filed additional denials with the Department on February 21, 2013 and
May 1, 2013, pertaining to medical bills it had received from various providers
for treatment rendered to Claimant between January and March 2013. Claimant
did not immediately appeal either denial.
By correspondence dated February 27, 2015 (received by the Department on
March 4, 2015), Claimant sought to renew her appeal of Defendant’s claim
denial. By letter dated March 11, 2015 the Department’s specialist determined
that the evidence did not support her claim, and therefore declined to issue an
interim order for benefits. Defendant’s Exhibit F.
At Claimant’s request thereafter, the specialist referred the matter back to the
formal hearing docket. Defendant’s motion for summary judgment followed.
Claimant has not filed any response.
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).
Defendant here asserts that because Claimant previously withdrew her request for
a hearing on its denial of her claim for workers’ compensation benefits, the
applicable statute of limitations now precludes her from reviving it. As the
material facts are undisputed, summary judgment is an appropriate vehicle for
resolving this issue. Samplid Enterprises, Inc. v. First Vermont Bank, 165 Vt. 22,
25 (1996).
The statute of limitations for initiating a claim for workers’ compensation benefits
is three years from the date of injury. 21 V.S.A. §660(a). Having alleged an
injury date of March 21, 2011, Claimant here first initiated her claim on or about
May 5, 2011, which was well within the limitations period. Thereafter, however,
in February 2012 she withdrew her appeal of Defendant’s claim denial, and did
not seek to revive it until February 2015. The legal question posed by these
actions is whether the statute of limitations was tolled in the meantime, such that
her current appeal remains timely, or whether it has since expired, such that her
appeal is now time-barred.
So long as they do not defeat the informal nature of the dispute resolution process,
the Vermont Rules of Civil Procedure apply generally to workers’ compensation
proceedings. Workers’ Compensation Rule 7.1000.2 Vermont Rule of Civil
Procedure 41(a) governs voluntary dismissals. It allows for a plaintiff to dismiss
an action without a court order at any time before the adverse party files an
answer, V.R.C.P. 41(a)(1), and thereafter with the court’s approval, V.R.C.P.
I consider the actions taken in February 2012, when in response to Claimant’s
notice that she had chosen to “withdraw” her request for a hearing the
Department’s specialist cancelled the previously scheduled pretrial conference, to
be the equivalent of a voluntary dismissal of her appeal under V.R.C.P. 41(a)(2).
See Agency of Natural Resources v. Lyndonville Savings Bank & Trust Co., 174
Vt. 498 (2002) (equating “withdrawal” of action with voluntary dismissal in
context of V.R.C.P. 11 “safe harbor” provisions).
For statute of limitations purposes, the legal effect of Claimant having voluntarily
dismissed her appeal without pursuing a determination on the merits of
Defendant’s claim denial is the same as if she had never filed a claim for benefits
at all. Grant v. Cobbs Corner, Inc., Opinion No. 22A-02WC (July 25, 2002),
citing Demars v. Robinson King Floors, Inc., 256 N.W.2d 501, 505 (Minn. 1977).
Were the rule otherwise, a claimant might voluntarily dismiss and then renew his
or her claim “in perpetuity.” Grant, supra.
The time limits imposed by a statute of limitations “represent a balance, affording
the opportunity to plaintiffs to develop and present a claim while protecting the
legitimate interests of defendants in timely assertion of that claim.” U.S. v.
Kubrick, 444 U.S. 111, 117 (1979), cited with approval in Investment Properties,
Inc. v. Lyttle, 169 Vt. 487, 492 (1999). For both the parties and the fact-finder,
“the search for truth may be seriously impaired by the loss of evidence, whether
by death or disappearance of witnesses, fading memories, disappearance of
documents, or otherwise.” Id. These concerns are especially relevant in cases
where, as here, the most basic facts underlying a claimant’s claim for workers’
compensation benefits, including where and when the alleged injury occurred,
who witnessed it and what if any disability resulted, have been hotly contested
I conclude as a matter of law that the statute of limitations was not tolled when
Claimant voluntarily withdrew her appeal of Defendant’s claim denial in February
That being the case, she had three years from the date of her alleged March
21, 2011 injury, or until March 21, 2014, within which to reassert her claim for
worker’s compensation benefits. As she failed to do so, her claim is now timebarred.
2 Effective August 1, 2015 Workers’ Compensation Rule 7.1000 has been re-codified as Rule 17.1100.
Defendant’s Motion for Summary Judgment is hereby GRANTED. Claimant’s claim for
workers’ compensation benefits arising out of her alleged March 11, 2011 work-related
injury is hereby DISMISSED WITH PREJUDICE.
DATED at Montpelier, Vermont this _____ day of ____________, 2015.
Within 30 days after copies of this opinion have been mailed, either party may appeal
questions of fact or mixed questions of law and fact to a superior court or questions of
law to the Vermont Supreme Court. 21 V.S.A. §§670, 672.
01 Feb2017 Comments
Ryan Wetherby v. Donald P. Blake Jr. Opinion No. 02-16WC
Ryan Wetherby Opinion No. 02-16WC
Donald P. Blake, Jr.
State File No. EE-65426
RULING ON DEFENDANT’S MOTION FOR PARTIAL SUMMARY
Did Defendant’s calculation of Claimant’s average weekly wage and
compensation rate in accordance with Workers’ Compensation Rule 15.4240
violate the parameters of 21 V.S.A. §650(a)?
Claimant’s Exhibit 1: Wage Statement (Form 25)
Defendant’s Exhibit A: Wage Statement (Form 25)
Defendant’s Exhibit B: Proposed Workers’ Compensation Rules
Claimant filed the pending workers’ compensation claim alleging a lower back
injury arising out of a June 24, 2013 work-related accident.
Defendant’s workers’ compensation insurance carrier, Acadia Insurance
Company (“Acadia”), accepted the claim as compensable.
Karen Kendrick v. LSI Cleaning Service, Inc Opinion No. 07-16WC
Karen Kendrick Opinion No. 07-16WC
LSI Cleaning Service, Inc.
State File No. DD-51585
Hearing held in Montpelier on September 14, 2015
Record closed on October 30, 2015
Robert Mabey, Esq., for Claimant
Had Claimant reached an end medical result for her July 26, 2011 compensable
work injury as of September 26, 2014, the date on which Defendant discontinued
If not, on what later date did Claimant reach an end medical result for her July 26,
2011 compensable work injury?
What is the appropriate permanent impairment rating referable to Claimant’s July
26, 2011 compensable work injury?
Is Defendant responsible for paying the charges referable to Dr. Ensalada’s June
2, 2015 evaluation?
Claimant’s Exhibit 1: Curriculum vitae, Adam Pearson, M.D.
Claimant’s Exhibit 2: Curriculum vitae, Leon Ensalada, M.D.
Claimant’s Exhibit 3: Permanent impairment evaluation, June 2, 2015
Claimant’s Exhibit 4: Dr. Ensalada invoice, August 17, 2015
Claimant’s Exhibit 5: Agreement for Permanent Partial or Permanent Total
Disability Compensation (Form 22), 2/1/13
Defendant’s Exhibit A: Curriculum vitae, William Boucher, M.D.
Judicial notice is taken of all relevant forms and correspondence contained in the
Department’s file relating to this claim.
Claimant’s July 2011 Work Injury and Subsequent Medical Course
Claimant worked as a cleaner for Defendant’s cleaning service company. On July
26, 2011 she sought medical treatment for neck and left shoulder pain causally
related to wearing a vacuum pack and performing other heavy lifting activities
necessitated by her job duties. Defendant accepted her injury as compensable and
began paying workers’ compensation benefits accordingly.
Initially Claimant treated conservatively for her injury, which was diagnosed as
probable cervical radiculopathy. She began a course of physical therapy, but
could not tolerate it. Her symptoms at the time included left shoulder and neck
pain and paresthesias down her left arm and into her fingers.
Claimant failed to improve with conservative therapy. An October 2011 MRI
scan revealed a large, left-sided disc herniation at C6-7. As treatment, in
December 2011 she underwent fusion surgery with Dr. Pearson, a specialist in
Claimant enjoyed complete relief of her left upper extremity symptoms postsurgery,
but her neck pain continued. At a February 2012 independent medical
examination with Dr. Backus, an occupational medicine specialist, she reported
“significant complaints,” including constant aching pain in her neck, upper back
and shoulders. She reiterated these complaints to her treating provider in New
Mexico, where she had relocated, in April 2012. As treatment, the provider
strongly recommended physical therapy and progressive rehabilitation.
Claimant underwent a course of physical therapy (her second since her initial
injury) while in New Mexico – a total of nine visits between May 30th and
September 4th, 2012. At formal hearing, she described the treatment as “not at all
At Defendant’s request, in October 2012 Claimant underwent an independent
medical examination with Dr. Chen. She continued to report constant, aching
pain in her neck and shoulders, with general weakness in her left arm and
intermittent numbness and tingling radiating down into her fingers. Dr. Chen
anticipated that she would reach an end medical result one year post-surgery, or
December 2012, with an estimated 25 percent whole person permanent
Based on the extent to which Claimant’s activities of daily living were impacted
by the continued limitations she reported – difficulty sleeping, lifting more than
15 or 20 pounds or sitting or standing for extended periods, for example – Dr.
Backus rated a somewhat higher permanent impairment – 27 percent whole
person – than Dr. Chen had. With the Department’s approval, Defendant
compromised the two ratings, and paid permanent partial disability benefits in
accordance with a 26 percent whole person impairment rating.
Having returned from New Mexico, Claimant next sought treatment for her neck
pain and upper extremity paresthesias in July 2013, again with Dr. Pearson. At
Dr. Pearson’s referral, from mid-August through mid-September 2013 she
underwent a third course of physical therapy. Unlike the therapy she had
undergone in 2012, which consisted primarily of passive modalities, this course
was exercise-based. Unfortunately, however, this treatment as well failed to yield
significant improvement. In all, Claimant attended eight of fourteen scheduled
sessions, during which she reported increased symptoms.
Claimant returned to Dr. Pearson in October 2013. Electrodiagnostic studies
suggested longstanding radiculopathy in the C7 nerve root distribution, and an
MRI scan demonstrated adjacent segment degeneration at C5-6, the level above
the solid fusion at C6-7. Dr. Pearson recommended a second surgical fusion, this
time at C5-6, which Claimant underwent in November 2013. Defendant accepted
this procedure as causally related to her original injury, and paid benefits
Claimant continued to complain of persistent axial neck pain following her
second surgery. As treatment, Dr. Pearson again referred her for physical therapy
(her fourth course). Between March and April 2014 Claimant attended five of ten
scheduled sessions, during which she reported that the exercises exacerbated
rather than relieved her symptoms.
Claimant next saw Dr. Pearson in mid-May 2014. As before, she reported pain at
the base of her cervical spine, radiating into her trapezius muscles bilaterally. Dr.
Pearson prescribed Tramadol, a narcotic pain medication, and advised her to
return in six months for a follow-up visit.
Claimant credibly testified that during this period her symptoms significantly
limited her functional abilities. She stopped driving her car, because
manipulating the standard shift caused pain in her arm and shoulder, and the
limited range of motion in her neck made her feel unsafe. She was unable to
grocery shop, vacuum, perform yard work, carry laundry or pick up a gallon of
milk. She had difficulty washing her hair and could not tolerate working on a
computer for more than 30 minutes at a time. She did not go camping or fishing
during the summer, both recreational activities she had enjoyed previously.
At Defendant’s request, in August 2014 Claimant underwent an independent
medical examination with Dr. Boucher, an occupational medicine specialist.
Based on his physical examination and review of the pertinent medical records,
Dr. Boucher concluded that Claimant had reached an end medical result. In his
opinion, the treatment she had received to date had been reasonable, though he
voiced concern about the use of Tramadol for long-term relief of chronic pain.
Instead, he recommended a combination of non-steroidal anti-inflammatories and
As for permanency, Dr. Boucher rated Claimant with a 24 percent whole person
permanent impairment, the details of which are discussed infra, Conclusion of
Law Nos. 34-39. He described her overall prognosis as only “fair.”
Following Dr. Boucher’s examination, in September 2014 Claimant telephoned
Dr. Pearson’s office to request a follow-up visit, notwithstanding that she was still
two months shy of the six-month timeframe he had suggested at her last
appointment in mid-May. She acknowledged at formal hearing that she
understood the financial ramifications of Dr. Boucher’s end medical result
determination – specifically, that it likely would prompt Defendant to discontinue
her temporary disability benefits – but credibly denied that her motivation for
contacting Dr. Pearson was solely to preclude it from doing so. Rather, her
primary goal was to discuss her remaining treatment options, if any.
Dr. Pearson examined Claimant on September 30, 2014. Since his May
evaluation, her right-sided radicular symptoms had subsided, but she still
complained of significant axial neck pain radiating into her left trapezius, with
intermittent numbness into her left upper extremity. Dr. Pearson determined that
further surgery was not appropriate, and instead suggested non-surgical treatment
options – medial branch blocks, radiofrequency ablation or another course of
physical therapy. Claimant chose physical therapy, and Dr. Pearson made the
Unlike her four prior attempts at physical therapy, this time Claimant made
excellent progress. As of late December 2014 her therapist reported that she no
longer guarded her neck movements, demonstrated full active range of motion
(within the limits of her fusions) and showed good upper extremity strength. Dr.
Pearson confirmed these results in his January 2015 follow-up examination,
noting in particular a ten-degree improvement in neck extension, which is
As of December 26, 2014 Claimant’s physical therapist anticipated that she would
require only one to three additional sessions prior to discharge. Thereafter,
Claimant cancelled her next scheduled session on January 5, 2015, and did not
resume therapy until March 13, 2015. At hearing, she testified that she had been
ill during some of the intervening weeks, but otherwise did not offer any
After resuming therapy, Claimant underwent six additional sessions, and then was
discharged to a self-directed gym and/or home exercise program on April 30,
According to the physical therapist’s report, by that date she had “met and
surpassed” all therapy goals.
In her formal hearing testimony, Claimant credibly described the manner in which
her most recent course of physical therapy differed from those she had attempted
in the past. Beginning with massages and light exercises and then progressing to
more strenuous work in the gym allowed her gradually to build strength and
improve her range of motion without also increasing her pain. As a consequence,
her function improved as well. Over time, she regained the ability to lift a gallon
of milk, go grocery shopping, perform normal household chores, wash her own
hair, sit for longer periods at her computer and turn her head enough to drive
safely. She also reduced her use of Tramadol. In all, to her the program seemed
more attuned to her abilities than the previous ones had.
Claimant credibly testified that although she has lost some of the gains she
realized while actively engaged in physical therapy, her functional abilities today
remain much improved over what they were a year ago. She has been unable to
maintain a gym membership, as both Dr. Pearson and the physical therapist
recommended, but continues to do her home exercises on a daily basis. With
better range of motion in her neck, she is still able to drive safely, grocery shop
and perform most activities of daily living.
Expert End Medical Result Opinions
With Dr. Boucher’s end medical result opinion as support, Finding of Fact No. 15
supra, Defendant discontinued Claimant’s temporary total disability benefits
effective September 26, 2014.
At formal hearing, Dr. Boucher testified that Dr. Pearson’s subsequent referral for
an additional course of physical therapy did not alter his August 2014 end medical
result determination in any respect. Based on his review of Claimant’s medical
records, her cervical condition had already stabilized, such that additional therapy
likely would not have resulted in substantial improvement. To his eye,
furthermore, the increased range of motion in her neck was relatively
insignificant, and with home exercise the functional gains she reported could just
as easily have been realized a year earlier.
Dr. Boucher acknowledged that he did not question Claimant closely during his
examination about her functional abilities, and also that he did not review the
records relating to her final course of physical therapy in any detail. I find that
these omissions significantly weaken his conclusions as to end medical result.
(b) Dr. Pearson
On the basis of his September 30, 2014 physical therapy referral, Finding of Fact
No. 18 supra, and contrary to Dr. Boucher’s opinion on the issue, Dr. Pearson
concluded that Claimant had not yet reached a plateau in her recovery process by
that date, and therefore that she was not yet at an end medical result for her work
injury. Noting that at the time of Dr. Boucher’s evaluation she was only nine
months post-surgery, in his opinion any end medical result determination was on
its face premature. In his experience, the standard is at least one year postsurgery,
particularly in cases involving fusions, because it takes that long to
ensure that the vertebrae have solidly fused.
Of greater import, Dr. Pearson believed that with additional physical therapy
Claimant still might realize decreased neck pain, increased cervical range of
motion and upper extremity strength, and improved function overall. It is not
uncommon for a patient to respond positively to physical therapy even after
having failed to do so previously, as Claimant had. Different therapists employ
different techniques, and patients often tolerate different modalities in different
ways at different times. Thus, while Dr. Pearson admitted that his physical
therapy referral would not “cure” Claimant’s chronic neck pain, he fully expected
that it would result in substantial improvement. That according to both his
clinical examination and Claimant’s subjective report this is in fact what occurred
corroborates his opinion, which I find credible in all respects.
As for Dr. Boucher’s characterization of the cervical range of motion gains Dr.
Pearson measured in January 2015 as insignificant, again Dr. Pearson disagreed.
Range of motion measurements suffer from very poor inter-rater reliability,
meaning that two doctors examining the same patient are unlikely to record the
same measurements. Thus, to the extent that Dr. Boucher based his conclusions
on a comparison between Dr. Pearson’s measurements and his own, this was a
Dr. Pearson credibly testified that Claimant’s recovery process had not yet
plateaued as of the last time he examined her, January 7, 2015, because her
cervical condition was still improving and in his opinion probably would continue
to do so. He acknowledged that without personally evaluating her, he could not
determine at what point she likely reached an end medical result.
At her attorney’s referral, in June 2015 Claimant underwent an independent
medical examination with Dr. Ensalada. Dr. Ensalada is board certified in both
pain management and as an independent medical examiner. The primary purpose
of his evaluation was to rate the extent of the permanent impairment referable to
Claimant’s work injury in accordance with the American Medical Association
Guides to the Evaluation of Permanent Impairment (5th ed.) (“AMA Guides”).
The AMA Guides require that a patient must first have reached an end medical
result before his or her permanency can be rated, and for that reason Dr. Ensalada
addressed that issue as well in his subsequent report.
As Dr. Pearson had, Dr. Ensalada disputed Dr. Boucher’s August 2014 end
medical result determination. In his opinion, it was appropriate for Dr. Pearson to
recommend additional physical therapy in September 2014, and in fact, the
treatment resulted in further improvement in her condition, thus negating any
finding that her recovery process had plateaued. For that reason, in Dr. Ensalada’s
opinion Claimant did not reach an end medical result until the date she was
discharged from physical therapy, April 30, 2015.
In support of his opinion, Dr. Ensalada referenced the Occupational Disability
Guidelines (“ODG”), a publication of evidence-based treatment protocols for
various injuries and conditions arising in the workers’ compensation context.
According to the ODG, and specifically with regard to cervical spine fusion
surgeries, the evidence supports as many as 24 physical therapy sessions, spread
over 16 weeks after graft maturity, as reasonable and necessary. In comparison,
for a soft tissue sprain or strain, the ODG recommends only ten sessions, spread
over eight weeks. But in Claimant’s case, following her November 2013 fusion
surgery she had been able to tolerate just five sessions, in March and April 2014.
Viewed from this perspective, Dr. Pearson’s September 2014 referral for an
additional course of therapy fit well within the ODG guidelines and was therefore
entirely appropriate. I find this analysis credible.
Expert Permanent Impairment Ratings
With reference to the AMA Guides, Dr. Boucher rated Claimant with a 24 percent
whole person impairment referable to her work injury. In cases such as
Claimant’s, where the patient has undergone surgeries at different levels in the
same spinal region, the AMA Guides (§15.2 at pp. 379-380) require that the range
of motion model be used to calculate impairment. Under that model, the
evaluator must assess three separate elements: (1) the impaired spinal region’s
range of motion; (2) the accompanying diagnosis; and (3) any spinal nerve deficit.
AMA Guides §15.8 at p. 398.
In Claimant’s case, Dr. Boucher assessed eleven percent impairment on account
of cervical range of motion deficits, thirteen percent impairment for the diagnostic
component and zero percent for nerve deficits. From this, he derived a total
whole person impairment rating of 24 percent.
The methodology Dr. Boucher used to calculate Claimant’s range of motionrelated
impairment deviated in significant respects from that required by the AMA
Guides. Specifically:
 The AMA Guides require that the impairment rating for cervical
flexion/extension, lateral bending and rotation be based on “a valid set of
three consecutive measurements,” AMA Guides §15.11 at pp. 417-420.
Dr. Boucher took only two measurements in each plane.
 The AMA Guides require use of the two-inclinometer technique for
flexion/extension and lateral bending measurements, id. Dr. Boucher
used only a single inclinometer.
 To measure cervical rotation, the AMA Guides require use of an
inclinometer while the patient is in a supine position on the examining
table, id. Dr. Boucher used a goniometer instead, and took his
measurements while Claimant was seated rather than lying down on her
 The AMA Guides require that the range of motion impairments for each
plane (flexion/extension, lateral bending and rotation) be added together
to derive the total cervical range of motion impairment, id. §15.8d at p.
403 and Figure 15-18 at p. 422, and then combined (using the Combined
Values chart, id. at pp. 604-605) with the diagnosis and nerve deficit
impairments to determine a single whole person impairment referable to
the cervical spine, id. at p. 403. Dr. Boucher combined all of his ratings,
including not only the 13-percent diagnosis-based rating but also the
range of motion measurements for each individual plane. Had he
followed the Guides’ procedure correctly, the result would have been 23
percent whole person impairment, not 24 percent.
Dr. Boucher offered various justifications for deviating from the AMA Guides’
methodology. These ranged from asserting that his examination methods
produced equally valid results to theorizing that the Guides’ instructions with
respect to adding versus combining impairment ratings were erroneous and likely
had been misprinted. None of these explanations was even remotely credible.
Dr. Boucher acknowledged that his final impairment rating – 24 percent – was
less than either of the two impairment ratings Claimant had obtained following
her first fusion surgery in December 2011, see Finding of Fact Nos. 8 and 9
supra. He agreed that this was an unfair result, given that Claimant has now
undergone a second fusion surgery. The first rating was derived under the
diagnosis-related estimate method, however, which does not always correlate
exactly to one based on the range of motion method. I find this analysis credible.
Dr. Boucher did not assess any additional permanent impairment on account of
pain in formulating his rating. The AMA Guides allow an evaluator to rate as
much as three percent additional impairment when a person with a verifiable
medical condition experiences pain in excess of what the primary impairment
rating already has captured. AMA Guides §18.3 at p. 570. Phrased alternatively,
the Guides allow for an additional rating in situations “in which the pain itself is a
major cause of suffering, dysfunction or medical intervention,” id. at p. 566.
Here, Dr. Boucher concluded that the range of motion impairments incorporated
into his 24 percent whole person rating adequately reflected Claimant’s pain
experience; therefore, no additional impairment was justified. I find this analysis
In Dr. Ensalada’s opinion, Claimant has suffered a 30 percent whole person
permanent impairment referable to her work injury – eighteen percent on account
of cervical range of motion deficits, twelve percent for the diagnostic component,
zero percent for nerve deficits and three percent for pain.
Dr. Ensalada adhered scrupulously to the AMA Guides’ methodology to calculate
his cervical range of motion-related impairment. He took at least three
measurements in each plane. To do so, he used an inclinometer, because it
measures smaller angles of the spine with greater accuracy than a goniometer.
Last, he appropriately added the individual range of motion ratings, and then
combined the result with the other component ratings to derive the final whole
person impairment rating. I find that his close attention to the procedures
articulated in the Guides adds significant credibility to his calculations.
Although grounded in the same section of the AMA Guides (Table 15-7 at p. 404)
that Dr. Boucher had utilized, Dr. Ensalada’s interpretation yielded a slightly
lower diagnosis-related impairment – twelve percent, as opposed to Dr. Boucher’s
thirteen percent. Neither evaluator specifically addressed the discrepancy in their
formal hearing testimony. Again, given Dr. Ensalada’s demonstrated familiarity
with, and close adherence to, the Guides’ rating system, I find his application of
Table 15-7 is likely more accurate than Dr. Boucher’s.
As noted above, Conclusion of Law No. 39 supra, the AMA Guides permit an
evaluator to assess an additional pain-related impairment if he or she determines
that the body system impairment already rated has failed to adequately
incorporate it. Dr. Ensalada acknowledged that the impairment he derived under
the Guides’ range of motion methodology included some consideration of
Claimant’s pain. Nevertheless, in his view she still deserved the maximum
allowable pain-related rating, three percent.
As support for his opinion, Dr. Ensalada referenced various pain-related
limitations on daily living activities that Claimant had reported to her physical
therapist on April 23, 2014. As documented in the therapist’s report, Claimant
rated her pain at that time as “6-7/10 constantly.” By the time of Dr. Ensalada’s
examination, however, and with the benefit of the physical therapy she had
undergone more recently, Conclusion of Law Nos. 19-23 supra, Claimant was
reporting both significantly decreased pain levels – ranging from three to six out
of ten – and an increased ability to perform daily living activities. Indeed, it was
exactly because of the gains she realized with this latest round of physical therapy
that Dr. Ensalada characterized the sessions as both medically appropriate and
successful, see Conclusion of Law No. 32 supra. With that in mind, I find it
difficult to accept his opinion that Claimant’s current condition merits the
maximum allowable pain-related impairment rating.
Dr. Ensalada billed a total of $1,750.00 for the time spent interviewing and
examining Claimant, reviewing her medical records and preparing his
independent medical examination report.
In workers’ compensation cases, the claimant has the burden of establishing all
facts essential to the rights asserted. King v. Snide, 144 Vt. 395, 399 (1984). He
or she must establish by sufficient credible evidence the character and extent of
the injury as well as the causal connection between the injury and the
employment. Egbert v. The Book Press, 144 Vt. 367 (1984). There must be
created in the mind of the trier of fact something more than a possibility,
suspicion or surmise that the incidents complained of were the cause of the injury
and the resulting disability, and the inference from the facts proved must be the
more probable hypothesis. Burton v. Holden Lumber Co., 112 Vt. 17 (1941);
The primary disputed issues here revolve around end medical result and
permanency. Claimant asserts that the physical therapy she underwent from
October 2014 until April 2015 substantially improved her condition, and thus
negated Dr. Boucher’s previous end medical result determination. She further
contends that Dr. Ensalada’s permanency opinion, which includes an additional
rating for pain-related impairment, more accurately reflects her current condition
than Dr. Boucher’s does.
Vermont’s workers’ compensation rules define end medical result as “the point at
which a person has reached a substantial plateau in the medical recovery process,
such that significant further improvement is not expected, regardless of
treatment.” Workers’ Compensation Rule 2.2000. The date of end medical result
marks an important turning point in an injured worker’s progress, both medically
and legally. Medically, it signals a shift in treatment from curative interventions,
the goal of which is to “diagnose, heal or permanently alleviate or eliminate a
medical condition,” to palliative ones, which aim instead to “reduce or moderate
temporarily the intensity of an otherwise stable medical condition.” Workers’
Compensation Rule 2.3400.
Legally, because temporary disability benefits are only payable “for so long as the
medical recovery process is ongoing,” once an injured worker reaches an end
medical result his or her entitlement to temporary indemnity benefits ends, and
the focus shifts instead to consideration of permanent disability. Bishop v. Town
of Barre, 140 Vt. 564, 571 (1982).
The Vermont Supreme Court has defined the proper test for determining end
medical result as “whether the treatment contemplated at the time it was given
was reasonably expected to bring about significant medical improvement.” Brace
Vergennes Auto, Inc., 2009 VT 49 at ¶11, citing Coburn v. Frank Dodge &
Sons, 165 Vt. 529, 533 (1996). In Brace, the Court approved the trial court’s
determination that the claimant had not yet reached an end medical result because
her referral to a rehabilitation and pain management clinic had the potential to
improve her overall function, and in fact did so, in terms of both range of motion
and ability to engage in activities and tasks. Id. at ¶13.
In cases decided since Brace, the Commissioner has ruled that a defined course of
treatment that (a) offers long-term symptom relief rather than just a temporary
reprieve; and (b) is reasonably expected to provide significant functional
improvement can, in appropriate circumstances, negate a finding of end medical
result. Marsh v. Koffee Kup Bakery, Inc., Opinion No. 15-15WC (July 6, 2015)
(pain management treatment); Luff v. Rent Way, Opinion No. 07-10WC (February
16, 2010) (trial implantation of spinal cord stimulator); Cochran v. Northeast
Kingdom Human Services, Opinion No. 31-09WC (August 12, 2009)
(participation in functional restoration program). Interpreting the concept of the
“medical recovery process,” Bishop, supra, in this way is in keeping with the
benevolent objectives and remedial nature of Vermont’s workers’ compensation
law. Luff, supra, citing Montgomery v. Brinver Corp., 142 Vt. 461, 463 (1983).
The parties here proffered conflicting expert testimony regarding whether
Claimant’s most recent course of physical therapy could reasonably have been
expected to significantly improve her condition. In such cases, the Commissioner
persuasive: (1) the nature of treatment and the length of time there has been a
patient-provider relationship; (2) whether the expert examined all pertinent
records; (3) the clarity, thoroughness and objective support underlying the
opinion; (4) the comprehensiveness of the evaluation; and (5) the qualifications of
the experts, including training and experience. Geiger v. Hawk Mountain Inn,
Opinion No. 37-03WC (September 17, 2003).
I conclude here that the opinions offered by Drs. Pearson and Ensalada are the
most credible. As the treating physician, Dr. Pearson was best positioned to
compare Claimant’s condition both before and after her most recent course of
physical therapy. His clinical observations and range of motion measurements
documented significant improvement, and thus provided objective support for his
conclusion that at least as of the last time he examined her, January 7, 2015, she
had not yet reached an end medical result. In addition, his clinical experience
with patients like Claimant, who showed significant improvement despite having
failed at previous attempts, and also with physical therapists that employ different
techniques to achieve successful rehabilitation, was compelling.
Dr. Ensalada provided further support for Dr. Pearson’s opinion. His reliance on
the Occupational Disability Guidelines, which established that an additional
course of physical therapy fit well within the treatment parameters for a patient
with Claimant’s medical history, was persuasive.
In contrast, Dr. Boucher’s end medical result opinion was premised primarily on
his assertion that Claimant’s cervical condition had already stabilized, and that
whatever further gains she realized thereafter were insignificant. As noted above,
however, Finding of Fact No. 29 supra, his comparison of Dr. Pearson’s range of
motion measurements with his own was faulty. He was unfamiliar with the
Occupational Disability Guidelines, and offered no objective support for his
claim that Claimant could have achieved the same results with a home exercise
program that she did with a final course of physical therapy. Last, he admitted
that he neither questioned Claimant closely about her functional abilities, nor
reviewed her physical therapy records in any detail, Finding of Fact No. 26 supra.
Considered together, these omissions render his opinion unpersuasive.
I conclude from Dr. Pearson’s credible testimony that Claimant had not yet
reached an end medical result for her July 26, 2011 compensable work injury as
of September 26, 2014, the date on which Defendant discontinued her temporary
disability benefits. I further conclude from Dr. Ensalada’s credible testimony that
she did not do so until April 30, 2015, the date on which she was discharged from
her final course of physical therapy.
Although Claimant is thus owed additional temporary total disability benefits, she
has failed to establish her entitlement for the period from January 5, 2015 to
March 13, 2015. Her hiatus from therapy during this time was largely
unexplained, Finding of Fact No. 20 supra. Had it not occurred, presumably
treatment would have concluded sooner and she would have reached an end
medical result earlier. Claimant offered no credible justification for the delay, and
for that reason I cannot require Defendant to pay disability benefits while it
I conclude that Claimant is owed temporary total disability benefits for the
periods from September 26, 2014 through January 5, 2015 and from March 13,
2015 through April 30, 2015.
As for the extent of Claimant’s permanent partial impairment, again, the parties
offered conflicting expert medical evidence. As noted above, Finding of Fact No.
36 supra, the methods Dr. Boucher used to calculate permanency deviated from
the AMA Guides’ requirements in important respects, whereas Dr. Ensalada’s
rating complied in every detail.
The primary purpose of the AMA Guides is to provide a “standardized, objective
approach to evaluating medical impairments,” id. at p. 1, quoted in Brown v. W.T.
Martin Plumbing & Heating, Inc., 2013 VT 38, ¶16. It is with that in mind that
Vermont’s workers’ compensation statute directs that the Guides are
determinative with respect to “the existence and degree of permanent partial
impairment” associated with a work injury. Id. at ¶21.
I conclude that Dr. Boucher’s failure to adhere to the AMA Guides’ procedures for
determining permanent impairment renders his rating unpersuasive.
While I accept Dr. Ensalada’s 28 percent range of motion-determined rating as
consistent with the AMA Guides and therefore credible, I cannot accept the basis
for his pain-related impairment. Claimant’s credible testimony itself belies his
assertion that her functional abilities remain impaired to such an extent as to merit
the maximum three percent additional impairment for pain. For that reason, I
must reject this component of his permanency rating.
I conclude from the credible expert evidence that Claimant has suffered a 28
percent whole person permanent impairment referable to her July 26, 2011
compensable work injury. Having already been paid permanency benefits for a
26 percent whole person impairment in 2013, Finding of Fact No. 9 supra, she is
now owed benefits for an additional two percent whole person impairment,
pursuant to 21 V.S.A. §648(d).
As Claimant has substantially prevailed on her claim for benefits, she is entitled to
an award of costs1 and attorney fees. In accordance with 21 V.S.A. §678(e),
Claimant shall have 30 days from the date of this opinion within which to submit
her itemized claim.
Based on the foregoing findings of fact and conclusions of law, Defendant is hereby
ORDERED to pay:
Temporary total disability benefits from September 26, 2014 through January
5, 2015 and from March 13, 2015 through April 30, 2015, in accordance with
21 V.S.A. §642, with interest as calculated in accordance with 21 V.S.A.
Permanent partial disability benefits in accordance with a two percent whole
person impairment referable to the spine, a total of eleven weeks commencing
on May 1, 2015, as calculated in accordance with 21 V.S.A. §648, with
interest as calculated in accordance with 21 V.S.A. §664; and
Costs and attorney fees in amounts to be determined, in accordance with 21
V.S.A. §678.
DATED at Montpelier, Vermont this _____ day of ______________, 2016.
1 Claimant having substantially prevailed, the cost of Dr. Ensalada’s independent medical examination and
permanent impairment rating is recoverable as a litigation expense. Therefore, I need not address the
extent to which it would have qualified in any event as a permanent impairment rating “from a physician of
[Claimant’s] choosing,” which Defendant would have been obligated to pay for under Workers’
Compensation Rule 10.1210.
Sue Ann Goodrich v. Fletcher Allen Health Care Opinion No. 06-16WC
Sue Ann Goodrich Opinion No. 06-16WC
By: Jane Woodruff, Esq.
State File No. DD-60132
RULING ON DEFENDANT’S MOTION TO ENFORCE CLAIMANT’S
STATUTORY OBLIGATION TO SUBMIT TO NEUROLOGICAL
TESTING AND, IN THE ALTERNATIVE, MOTION IN LIMINE
Do the terms of 21 V.S.A. §655 apply to independent neuropsychological
Does Claimant’s right to make a video recording of Defendant’s
independent neuropsychological examination impermissibly deny
Defendant’s right to an examination?
Did Claimant give proper notice of her intent to make a video recording of
Defendant’s independent neuropsychological examination under Workers’
Compensation Rule 6.1410?
If Claimant failed to give proper notice, should she be held financially
responsible for the charges Defendant incurred as a consequence?
Should Claimant’s right to prosecute her claim be suspended on the
grounds that she has refused to attend a properly noticed independent
Claimant’s Exhibit 1: Federal Rule of Civil Procedure 6
Claimant’s Exhibit 2: American Psychological Association, Statement on Third
Party Observers in Psychological Testing and Assessment:
A Framework for Decision Making, 2007
Claimant’s Exhibit 3: Zabkowicz v. The West Bend Co., et al., 585 F. Supp. 635
(E.D. Wis. 1984)
Defendant’s Exhibit A: Letter from Attorney Moore to Claimant, December 11,
Defendant’s Exhibit B: Affidavit of Sarah Spicer, January 26, 2016
Defendant’s Exhibit C: Emails between Attorney Talbott and Attorney Moore,
Defendant’s Exhibit D: Dr. Postal’s fee schedule
Defendant’s Exhibit E: Lewandowski, et al., Policy Statement of the American
Board of Professional Neuropsychology regarding third
party observation and the recording of psychological test
administration in neurological evaluations, http://abnboard.
com/?s=ABN+White+paper
Defendant’s Exhibit F: Policy Statement on the Presence of Third Party Observers
in Neuropsychological Assessments, The Clinical
Neuropsychologist, 2001, Vol. 15 No. 4, pp. 433-439
Defendant’s Exhibit G: Affidavit of thirty-three Illinois psychologists opposed to
the presence of third party observers during
neuropsychological and psychological assessments, June
Defendant’s Exhibit H: Legal policies regarding the reproduction and
dissemination of Pearson Test Materials, January 1, 2014
On February 12, 2012, Claimant sustained a low back injury while lifting a heavy trash
bag in the course of her employment for Defendant. Defendant accepted the injury as
compensable and paid benefits accordingly. On December 10, 2014 Claimant filed a
Notice and Application for Hearing (Form 6), in which she asserted a claim for
permanent total disability benefits. Specifically, she claims that she is unable to return to
gainful employment because her learning disability prevents her from learning a new
trade that does not exceed her work capacity.
On December 11, 2015, Defendant provided notice to Claimant and her counsel,
Attorney Talbott, that it had scheduled her to attend a neuropsychological examination on
Thursday, January 7, 2016 at 9:00 AM with Dr. Karen Postal, Ph.D. On Monday,
January 4, 2016 Sarah Spicer, a paralegal employed by Attorney Moore (Defendant’s
counsel), telephoned Attorney Talbott between 3:01 PM and 3:10 PM to confirm that
Claimant would be attending the examination as scheduled. Attorney Talbott indicated
that Claimant would attend. In addition, he requested that Ms. Spicer inform Attorney
Moore that Claimant intended to exercise her right, under 21 V.S.A. §655, to make a
video recording of the examination.
Shortly thereafter, at 3:39 PM Attorney Moore emailed Attorney Talbott to advise that
Dr. Postal would allow Claimant to make a video recording of the interview portion of
the examination, but objected to any video record of the testing itself.
Attorney Talbott responded to Attorney Moore’s email at 4:34 PM. In it, he asserted that
Claimant had the right to videotape the entire evaluation. At 4:38 PM Attorney Moore
replied, and again asserted her position that Claimant would not be permitted to make a
video recording of the actual testing portion of the examination. More specifically, she
advised that Dr. Postal was unwilling to conduct the examination if it was to be
videotaped, due to her concern that a third party observer would render the test results
unreliable. Thus, Attorney Moore asserted, if Claimant insisted on doing so the ultimate
result would be to deprive Defendant of its right to the evaluation altogether. In addition,
Attorney Moore questioned whether Attorney Talbott had given the requisite three
business days’ notice of Claimant’s intent to videotape the examination, as mandated by
Workers’ Compensation Rule 6.1410.
On January 5, 2016 Attorney Moore sought guidance from the administrative law judge
on the issues she had raised in the previous day’s email to Attorney Talbott. As to the
question whether Claimant should be allowed to videotape the testing portion of Dr.
Postal’s examination, Attorney Moore asserted that doing so would be improper because
(a) the presence of a third party observer (in this case, the videographer) would invalidate
the test results; and (b) videotaping would compromise the proprietary nature of the
written test materials.
At a telephone status conference that same afternoon, the administrative law judge
preliminarily ruled that the statute granted Claimant an absolute right to make a video
recording of the examination, and that Dr. Postal’s concerns could be adequately
addressed by crafting an order to protect the proprietary nature of the test materials. She
also ruled preliminarily that Claimant had in fact given adequate notice of her intent to
videotape. She then allowed the parties additional time in which to more fully brief their
respective positions on these issues.
As a consequence of the administrative law judge’s preliminary rulings, Defendant
canceled Dr. Postal’s scheduled examination. However, because it failed to do so at least
48 hours beforehand, Dr. Postal imposed a late cancellation charge of $1,600.00, in
accordance with her established fee schedule. Now, in addition to a final ruling on the
issues discussed above, Defendant also requests an order that Claimant be held
responsible for the cancellation charge, on the grounds that but for her improper request
to videotape the examination it would have occurred as scheduled.
Application of 21 V.S.A. §655 to Independent Neuropsychological Examinations
I consider first Defendant’s argument that the statute pertaining to independent
medical examinations, 21 V.S.A. §655, does not apply to neuropsychological
examinations. The specific statutory language reads:
After an injury and during the period of disability, if so requested
by his or her employer, . . . the employee shall submit to
examination . . . by a duly licensed physician or surgeon
designated and paid by the employer.
Workers’ Compensation Rule 6.0000 refers to the examinations that §655
mandates by their more common descriptor, “independent medical examinations.”
Defendant asserts that a neuropsychological examination is not a “medical”
examination, and therefore that the rights granted Claimant by both statute and
rule with respect to videotaping examinations do not apply here. Unlike a
neuropsychological examination, it argues, a “medical” examination does not
involve “testing;” thus, Claimant’s right to make a video recording should not
extend to the actual test portion of Dr. Postal’s exam.
The short answer to Defendant’s argument is that if a neuropsychological
examination is not covered by §655, then Defendant has no right to require
Claimant to submit to it in the first instance.
Beyond that, I reject Defendant’s premise that a neuropsychological examination
is not properly characterized as a “medical” procedure. “Neuropsychology” is
defined as “a science concerned with the integration of psychological
observations on behavior and the mind with neurological observations on
the brain and nervous system.” http://www.merriamwebster.
com/dictionary/ neuropsychology. “Medical” is defined as “of or
relating to the treatment of diseases and injuries: of or relating to
medicine.” http://www.merriam-webster.com/dictionary/medical. The
brain and the nervous system are organs of the human body and are
treated for diseases and injuries. Considering these definitions together, I
conclude that it is reasonable to characterize neuropsychology as a wellrecognized
subset of medicine.
The employer’s statutory right to independent medical examinations has
long been interpreted to include both psychological and
neuropsychological evaluations. I see no basis for interpreting the
statutory language as narrowly as Defendant suggests. I conclude that the
parties’ rights and responsibilities with respect to Dr. Postal’s evaluation
are squarely covered by §655 and Rule 6.0000.
Claimant’s Right to Make Video Recording versus Employer’s Right to
Workers’ compensation-related independent medical examinations are governed
by statute, 21 V.S.A. §655. Particularly with respect to video- and audiotaping,
the statute safeguards both parties’ rights as follows:
The employee may make a video or audio recording of any
examination performed by the insurer’s physician or surgeon or
have a licensed health care provider designated and paid by the
employee present at the examination. The employer may make an
audio recording of the examination. . . . If an employee refuses to
submit to or in any way obstructs the examination, the employee’s
right to prosecute any proceeding under the provisions of this
chapter shall be suspended until the refusal or obstruction ceases,
and compensation shall not be payable for the period during which
the refusal or obstruction continues.
Defendant contends that, under the circumstances of this case, Claimant’s
insistence on videotaping Dr. Postal’s neuropsychological examination is
tantamount to denying its right to conduct the examination itself, in violation of
the language of §655 quoted in Paragraph 1 above. It argues that ethical
considerations preclude Dr. Postal from allowing a third party observer to be
present while the necessary tests are administered. As support, Defendant cites to
two journal articles purporting to explain the positions of the American Board of
Professional Neuropsychology (the “Board”) and the American Academy of
Clinical Neuropsychology (the “Academy”) on this issue, see Defendant’s
Exhibits E and F.
Both the Board and the Academy state the same reasons for their policies: (1)
because test results are measured against normalized standards that do not account
for third party observers, validating tests conducted with an observer present is
impossible; and (2) because testing materials are proprietary in nature, the
presence of a third party observer will compromise their integrity and jeopardize
As Claimant correctly observes, see Claimant’s Exhibit 2, the American
Psychological Association (the “Association”) has advocated an alternative
position, one that recognizes the necessity of third party observers in certain
situations, for example, where testing occurs in the context of criminal
proceedings against the examinee. The Association has provided a framework
under which an examination can proceed without compromising either test
validity or security.
As to test validity, the concern raised by both the Board and the Academy is the
risk that a third party observer will distort the testing environment, distract the
examinee and damage the examiner’s ability to establish rapport, all of which will
adversely affect the examinee’s performance and skew test results. To minimize
these risks, the Association has suggested various solutions, such as positioning
the observer behind the examinee (with strict instructions to remain silent
throughout) or recording the examination through a one-way mirror. Though
perhaps not perfect, these steps represent an effective compromise between the
examinee’s rights and the examiner’s need for valid test results.
In this case, both Claimant’s right to have a third party videographer present at
Dr. Postal’s examination and Defendant’s right to the examination itself derive
from the same statute, 21 V.S.A. §655. As to the right to make a video recording,
the statute grants permission for “any examination” to be videotaped. I can accept
the need to impose whatever safeguards are reasonably necessary to address an
examiner’s valid concerns. However, having in mind the remedial purposes of
the workers’ compensation act, Grather v. Gables Inn, Ltd., 170 Vt. 377, 382
(2000), I cannot countenance restrictions that are unduly limiting.
I conclude here that Claimant has the right to make a video recording of Dr.
Postal’s neuropsychological examination, including not only the interview portion
of the exam but also the actual testing portion. Among the safeguards that are
reasonable to impose are those discussed in Paragraph 4 above. In addition, in
order to protect the proprietary nature of the test materials, I conclude that it is
reasonable to prohibit Claimant from disclosing the video recording to anyone
(including her attorney) other than directly to another qualified expert
In reaching this conclusion and imposing these safeguards, I acknowledge the
very real possibility that Dr. Postal will refuse to conduct the examination. That
is her right. I am reasonably confident that if this occurs, Defendant will be able
to identify another equally competent neuropsychologist who is willing to
proceed. If travel beyond the statutory two-hour driving limitation becomes
necessary, I expect it will be within the proper exercise of the discretion granted
me by §655 to allow the examination to take place nevertheless.
Notice of Intent to Make Video Recording
Workers’ Compensation Rule 6.1400 reiterates the Claimant’s statutory right to
videotape an independent medical examination, see Paragraph 6 supra, but adds a
notice requirement, as follows:
6.1410 At least three business days prior to the scheduled
examination date, the injured worker shall give notice of his or her
intention to make a video or audio recording of the examination to
the employer or insurance carrier, who shall in turn notify the
Defendant argues that Claimant did not comply with the requirements of Rule
6.1410 because she did not give three full business days’ notice of her intent to
video record the examination. Claimant contends that she complied with the plain
meaning of the Rule in providing her notice.
The Vermont Rules of Civil Procedure apply in workers’ compensation
proceedings to the extent that they do not defeat the informal nature of the
hearings. 21 V.S.A. §§602, 604; Workers’ Compensation Rule 17.1100.
Specifically with respect to determining timeliness, Workers’ Compensation Rule
3.3000 incorporates the provisions of Vermont Rule of Civil Procedure 6(a). That
rule states, in pertinent part, that when computing time, “the day of the act, event,
or default from which the designated period of time begins to run shall not be
included.” The last day of the period is included, however, unless it falls on a
weekend or holiday.
There is an important distinction between the time computations encompassed by
the Rules of Civil Procedure and the one at issue here. Counting the last day of a
period as a full day of notice makes sense when the action to be taken involves
serving documents on a party or filing papers with the court, because acts such as
this are not scheduled to occur at any particular hour of the day. However, when
the notice concerns a scheduled medical appointment, time of day matters. And
with its specific reference to “business days,” Workers’ Compensation Rule
6.1410 reflects that.
In the instant case, the three-day notice period began to run on Tuesday, January
5, 2016, the day after Attorney Talbott first gave notice of Claimant’s intent to
videotape Dr. Postal’s exam. Wednesday, January 6th was the second day.
Thursday, January 7th – the day of Dr. Postal’s exam – would have been the third
day. Had the exam been scheduled for later in the afternoon, perhaps it would
have been fair to count it as a notice day. As it was, the exam was scheduled for
9:00 AM, the very start of the business day, however. Under that circumstance, to
count January 7th as the third day would be manifestly unfair.
I conclude that Claimant failed to give adequate notice of her intent to videotape
Dr. Postal’s independent medical examination, as required by Workers’
Compensation Rule 6.1410. Because her failure to do so led directly to the
appointment’s late cancellation, I further conclude that she is liable for the
$1,600.00 cancellation fee that Dr. Postal imposed.
Defendant’s Motion in Limine in the Alternative
I reject Defendant’s contention that Claimant should be sanctioned under §655 for
“refusing to attend” Dr. Postal’s examination, however. Although she failed to
give adequate notice of her intention to videotape the exam, I do not interpret her
actions as amounting to a refusal to attend. For that reason, I conclude that it
would be improper to allow Defendant to suspend benefits on those grounds.
Based on the foregoing, Defendant’s Motion to Enforce Claimant’s Statutory Obligation
to Submit to Neuropsychological Testing and Motion in Limine in the Alternative are
hereby DENIED. Defendant’s request for reimbursement is hereby GRANTED.
Ryan Wetherby v. Donald P. Blake, Jr. Opinion No. 02-16WC
RULING ON CLAIMANT’S MOTION FOR FINAL JUDGMENT
This claim came before the Commissioner on Defendant’s Motion for Partial
Summary Judgment. The sole issue in dispute was whether Defendant’s
calculation of Claimant’s average weekly wage and compensation rate in
accordance with Workers’ Compensation Rule 15.4240 violated the parameters of
21 V.S.A. §650(a).
By Order dated January 25, 2016, the Commissioner concluded as a matter of law
that Rule 15.4240 was consistent with the statute, rationally based and validly
promulgated, and therefore that it was appropriate for Defendant to have calculated
Claimant’s average weekly wage in accordance with its terms. On those grounds,
the Commissioner granted Defendant’s Motion for Partial Summary Judgment.
Wetherby v. Donald P. Blake, Jr., Opinion No. 02-16WC (January 25, 2016).
Claimant’s underlying workers’ compensation claim remains open. There are
currently no claim disputes pending in which the Commissioner is actively
involved, nor any anticipated that might trigger additional scrutiny of the specific
legal issues already determined by the Commissioner’s January 25, 2016 Order.
Final resolution of these issues will determine whether Claimant is appropriately
compensated for past and/or future periods of indemnity causally related to his June
24, 2013 compensable work injury. With that consideration in mind, I conclude
that there is no just reason for delaying entry of final judgment. See V.R.C.P.
54(b). To the contrary, there is every reason to expedite it.
Claimant’s Motion for Final Judgment is hereby GRANTED. Consistent with the
Commissioner’s January 25, 2016 Ruling on Defendant’s Motion for Partial
Summary Judgment, and in accordance with V.R.C.P. 54(b), final judgment in
Defendant’s favor on the question whether Claimant’s average weekly wage has
been appropriately calculated in accordance with Workers’ Compensation Rule
15.4240 and 21 V.S.A. §650(a) is hereby ENTERED.
DATED at Montpelier, Vermont this ____ day of _____________, 2016.
Within 30 days after copies of this opinion have been mailed, either party may
appeal questions of fact or mixed questions of law and fact to a superior court or
questions of law to the Vermont Supreme Court. 21 V.S.A. §§670, 672.
Thomas Kibbie v. Killington, Ltd Opinion No. 05A-16WC
Thomas Kibbie v. Killington, Ltd. Opinion No. 05A-16WC
State File No. Z-58225
RULING ON CLAIMANT’S PETITION FOR AWARD OF ATTORNEY FEES AND
The Commissioner previously decided this claim on February 23, 2016. Two disputed
issues were presented: (1) whether ongoing treatment for Claimant’s neck pain was within the
terms of the medical benefits foreclosed by the parties’ Modified Form 15 Settlement Agreement;
and (2) to what other medical benefits, if any, was Claimant entitled.
The Commissioner ruled in Claimant’s favor as to Defendant’s responsibility to pay for
treatment referable to his vision deficits, dental injuries, headaches and psychological condition.
She ruled against him on his claim that the Settlement Agreement did not foreclose treatment for
his cervical injury, and also on his claim for mileage reimbursement.
In accordance with 21 V.S.A. §678(e), Claimant now submits his petition for costs
totaling $719.00 and attorney fees totaling $14,752.00.
According to 21 V.S.A. §678(a), when a claimant prevails after formal hearing necessary
litigation costs “shall be assessed” against the employer. The commissioner has discretion to
award attorney fees to a prevailing claimant as well.
The Supreme Court has held that a claimant does not automatically forfeit entitlement to
costs and fees under §678(a) merely because he or she did not prevail as to every issue litigated
at formal hearing. Hodgeman v. Jard, 157 Vt. 461, 465 (1991). With that in mind, where the
claimant only partially prevails, the commissioner typically endeavors to award only those costs
that relate directly to the successful claims. See, e.g., Hatin v. Our Lady of Providence, Opinion
No. 21S-03 (October 22, 2003).
It is not always possible to separate out the costs that are attributable to a successful claim
as opposed to an unsuccessful one, however. Here, for example, all of the costs Claimant
incurred were for Dr. Miller’s expert witness deposition. Although some portion of this
deposition was devoted to issues mpensation Rule 10.1210,1 I consider the
total amount of his fee request to be $9,352.50.
The issues upon which both parties concentrated most of their efforts were Claimant’s
entitlement to treatment for his cervical injuries, which he lost, and Defendant’s responsibility to
pay for his vision deficits, dental injuries, headaches and psychological treatment, which he won.
In monetary terms, the treatment for Claimant’s dental injuries alone are quite substantial.
Combining that treatment with ongoing treatment for his headaches, vision deficits and
psychological treatment may well exceed the costs for the cervical treatment that he also sought,
but did not prevail on.
Weighing all of these considerations, and acknowledging that the exercise of discretion in
these matters is at best an imperfect science, I find it appropriate to award Claimant one-half of
the hours he sought, or 32.25 hours. At the appropriate reimbursement rate of $145.00 per hour,
this yields a total award of $4,676.25.
Given the particular circumstances of this case, I therefore conclude that it is a proper
exercise of the discretion granted by §678(a) to apportion Claimant’s entitlement to attorney fees
with reference to the extent of his success on the various claims he litigated.
1 Rule 10.1210 is now re-codified as Rule 20.1310.
Costs totaling $719.00; and
Attorney fees totaling $4,676.25.
DATED at Montpelier, Vermont this 24th day of May 2016.
Thomas Kibbie v. Killington, Ltd. Opinion No. 05-16WC
Thomas Kibbie v.Killington, Ltd. Opinion No. 05-16WC
For: Anne Noonan
Hearing held in Montpelier, Vermont on December 29, 2014
Record closed on August 21, 2015
Is ongoing treatment for Claimant’s neck pain within the terms of the medical
benefits foreclosed by the parties’ Modified Form 15 Settlement Agreement?
To what other medical benefits is Claimant entitled?
Claimant’s Exhibit 1: Modified Form 15 Settlement Agreement, August 18, 2010
Claimant’s Exhibit 2: Addendum to Modified Form 15 Settlement Agreement,
Claimant’s Exhibit 3: Letter from Dr. Miller to Attorney Mabie, May 15, 2012
Claimant’s Exhibit 4: Letter from Dr. Miller to Barbara Hewes, May 29, 2012
Claimant’s Exhibit 5: Letter from Dr. Miller to Attorney Bixby, February 24,
Claimant’s Exhibit 6: Letter from Attorney Mabie to Director Monahan, August
Claimant’s Exhibit 7: Letter from Attorney Mabie to Ms. Bard, March 3, 2011
Claimant’s Exhibit 8: Letter from Attorney Mabie to Attorney Valente, April 23,
Claimant’s Exhibit 9: Letter from Attorney Mabie to Department specialist, June
Claimant’s Exhibit 10: Two prescription co-payments
Claimant’s Exhibit 11: Mileage reimbursement request
Claimant’s Exhibit 12: Saint Francis Hospital bill
Claimant’s Exhibit 13: Multiple health insurance claim forms
Claimant’s Exhibit 14: Saint Francis bills, November and December 2010
Claimant’s Exhibit 15: Physical therapy itinerary, November and December 2010
Claimant’s Exhibit 16: TENS unit denial letter, May 13, 2011
Claimant’s Exhibit 17: Mount Sinai Hospital collection letter, January 18, 2011
Claimant’s Exhibit 18: Dentist bill, May 7, 2008
Claimant’s Exhibit 18A: Letter from dentist office to Attorney Bixby, December 19,
Claimant’s Exhibit 19: Insurance payment history, September 16, 2011
Claimant’s Exhibit 20: Summary of unpaid medical bills
Claimant’s Exhibit 21: Pharmacy printout for 2010 and 2011
Claimant’s Exhibit 22: Expired prescription card
Claimant’s Exhibit 23: Physical therapy prescriptions from Dr. Miller, November
Defendant’s Exhibit A: Approved Modified Form 15 Settlement Agreement,
Defendant’s Exhibit B: Email from Attorney Mabie to Attorney Valente with
marked up Form 15 Settlement Agreement, August 10,
Ruling on Defendant’s Motion to Exclude Evidence
During the formal hearing, Claimant proffered testimony from his former attorney, John
Mabie, Esq., who had represented him at the time that the Modified Form 15 Settlement
Agreement at issue in this case was negotiated. Attorney Mabie sought to testify
regarding the intended scope of the settlement agreement, specifically, which ongoing
medical treatments the parties meant to foreclose thereby. Defendant moved to exclude
the testimony on the grounds that the parol evidence rule rendered it inadmissible. The
administrative law judge reserved ruling on the motion pending further briefing by the
The parol evidence rule is well settled in Vermont. When contracting parties embody
their agreement in writing, the rule prohibits the admissibility of “evidence of a prior or
contemporaneous oral agreement . . . to vary or contradict the written agreement.” Big G
Corporation v. Henry, 148 Vt. 589, 591 (1987) (internal quotations omitted).
The purpose of the parol evidence rule is to prevent fraud and eliminate confusion in the
making of written agreements. Id. at 594. The law presumes that a written contract
contains the parties’ entire agreement. Economou v. Vermont Electric Coop., 131 Vt.
636, 638 (1973) (internal citations omitted). Contract terms that are unambiguous on
their face cannot be modified by extrinsic evidence. Hall v. State, 2012 VT 43, ¶21.
As will be seen infra, Conclusion of Law Nos. 4-16, because I have concluded in this
case that the parties’ Modified Form 15 Settlement Agreement was unambiguous on its
face, I presume that its terms fully embody the parties’ intent. For that reason, I conclude
that Attorney Mabie’s proffered testimony is inadmissible.
Defendant’s Motion to Exclude Evidence is hereby GRANTED.
Defendant was his employer as those terms are defined in Vermont’s Workers’
Claimant was a volunteer ski ambassador for Defendant, a position he had held
for ten years prior to the 2008 winter season. His duties included helping other
skiers, putting their equipment back on if they fell and generally being pleasant to
the paying customers.
Claimant resides in Vernon, Connecticut. On weekends during the ski season, he
traveled to Defendant’s ski area to perform his ambassador duties. He did not
introduce any evidence to establish either where he stayed while in Vermont or
what his regular commute distance to and from work was.
Claimant’s January 2008 Work Injury
At the end of the day on January 12, 2008, Claimant was conducting a final trail
sweep as part of his ambassador duties. His son was accompanying him. During
the run, Claimant fell and hit his head so hard that it cracked his ski helmet. He
credibly testified that he has no real memory of the fall or its immediate
Claimant’s son called for emergency assistance. Claimant went by ambulance to
Dartmouth-Hitchcock Medical Center, where he was later admitted. A CT scan
revealed a very small hemorrhage in his right temporal lobe, but no skull fracture.
Claimant was discharged home four days later. While he could not specifically
recall at formal hearing what his injuries were upon discharge, he credibly
testified that he remembered not being able to see very well, having a difficult
time walking due to right ankle pain, having pain in his right arm, and just
wanting to get home.
Defendant accepted Claimant’s injury, which it initially described as
“head/face/concussion,” as compensable, and began paying workers’
Claimant’s Course of Treatment from March 2008 through August 2010
(a) Traumatic brain injury, occipital neuralgia, headaches and neck pain (Dr.
In March 2008, Claimant entered the traumatic brain injury program at Mount
Sinai Rehabilitation Hospital under the care of Dr. Miller, a board certified
physiatrist with a subspecialty in brain injuries. Dr. Miller diagnosed a traumatic
brain injury with occipital neuralgia, that is, an injury to or inflammation of the
occipital nerves. Dr. Miller also diagnosed a cervical whiplash injury and vision
problems, all causally related to Claimant’s January 2008 work injury.
Claimant has treated with Dr. Miller continuously from March 2008 to the
present. His initial complaints included headaches, neck pain, loss of taste and
smell, loss of concentration, attention and memory, vision problems and mood
For Claimant’s whiplash injury, Dr. Miller initially prescribed a muscle relaxant
and administered a cervical injection, which provided only short-term relief. To
address his ankle injury, Dr. Miller referred him to physical therapy. Claimant
also underwent both occupational and speech therapy. For his chronic headaches
and neck pain, Dr. Miller prescribed oxycodone, which Claimant continues to this
day to take for this purpose.
In April 2008 Claimant underwent a cervical spine MRI in an attempt to identify
the source of significant pain complaints between his right shoulder and the back
part of his head. The results were negative for any pathology. Thereafter, Dr.
Miller administered a series of occipital nerve blocks to address both occipital
neuralgia and neck pain, but these provided only short-term symptom relief.
During the ensuing months, Dr. Miller continued to administer nerve blocks for
short-term relief of Claimant’s pain. Unfortunately, none of the treatments
provided long-term pain relief. Thereafter, he referred Claimant for craniosacral
therapy. This is a subset of physical therapy that uses gentle hands-on
manipulation of the head and neck to relieve pain.
Claimant saw Dr. Miller on a monthly basis throughout 2009. He continued to
complain of headaches, neck pain, difficulty processing his thoughts, vision
problems and drastic mood swings. Dr. Miller strongly recommended that
Claimant undergo a neuropsychological evaluation with counseling thereafter.
Defendant approved one counseling session, but none after that until its own
expert, Dr. Drukteinis, recommended psychological counseling in July 2012, see
Finding of Fact No. 58, infra. The evidence does not reflect any basis for
Defendant’s refusal to pay. Claimant also continued to engage in craniosacral
therapy during this time, which provided him with some measure of pain relief.
(b) Fractured teeth and dental work (Dr. Shlafstein)
Claimant credibly testified that prior to his January 2008 work injury, his teeth
were “perfect.”
The work injury caused damage to seven teeth. Specifically, in March 2008
Claimant’s treating dentist, Dr. Shlafstein, diagnosed fractures to tooth numbers
25, 26 and 30, and chips and possible fractures to tooth numbers 7, 8, 9 and 10, all
causally related to the January 2008 work injury.
Dr. Shlafstein repaired the fractures to tooth numbers 25 and 26 in March 2008.
To repair the other injured teeth, he determined that Claimant would require full
coverage crowns. Otherwise, he risks further damage to the roots, which might
necessitate root canals and/or excision. I find this analysis credible.
Defendant accepted the repairs to tooth numbers 25 and 26 as causally related to
the work injury and paid the associated dental bills accordingly. As for the
repairs to tooth numbers 7, 8, 9, 10 and 30, it is unclear from the record at what
point Claimant first sought coverage from Defendant for this treatment and was
denied. He has yet to undergo the repairs to these teeth. It is unclear whether he
has suffered the additional damage Dr. Shlafstein feared would occur were
treatment delayed.
(c) Vision deficits (Dr. Danberg)
Claimant first reported vision problems to Dr. Miller in March 2008. He began
treating with Dr. Danberg, a behavioral optometrist, in October 2008.
Dr. Danberg administered several tests to measure Claimant’s visual and
perceptual deficiencies. Based on the results, she diagnosed convergence
insufficiency and ocular motor deficiency. Dr. Danberg causally related both
conditions to Claimant’s January 2008 work injury. I find her opinion on this
issue credible.
Dr. Danberg treated Claimant’s visual deficiencies with Optometric Visual
Rehabilitation Therapy (OVRT). The purpose of this therapy was to address
some of the functional difficulties Claimant had encountered – skipping words
and transposing letters while reading, veering out of his lane while driving and
seeing double, for example. She also prescribed glasses with prism, which are
designed to correct double vision and convergence difficulties.
Claimant underwent three OVRT sessions from February through April 2009.
Defendant paid for these sessions, but then refused to authorize any more. The
record does not indicate the basis for its denial. Similarly, Defendant paid for
Claimant’s first pair of glasses with prism, but when his prescription changed in
October 2009, it refused to cover the cost of a new pair.
The September 2010 Modified Form 15 Settlement Agreement
In January 2009, Claimant retained Attorney John Mabie to represent him in his
claim for workers’ compensation benefits causally related to his January 2008
On August 18, 2010 Claimant executed a Modified Form 15 Settlement
Agreement (the “Agreement”) that Attorney Mabie had negotiated on his behalf.
In pertinent part, the Agreement, which included handwritten language that
Attorney Mabie had inserted (shown in bold), stated:
This is an agreement in which the Claimant agrees to accept
$50,000.00, in full and final settlement of all claims for: All claims
occurring as a result of the work incident including but not limited
to right ankle, head/TBI1 and right elbow/biceps, however as noted
in the addendum attached the carrier will continue to furnish all
reasonable and related future medical treatment pursuant to the
Rules necessary for the treatment of his cognitive or other head
injury including neurological, psychological, ophthalmological,
TBI care and treatment; and prior care for his covered injuries
sustained as a result of the accident referred to above, including his
claim for past, present and future compensation for temporary total
disability, temporary partial disability, permanent partial disability
or permanent total disability, dependency benefits, medical,
hospital, surgical and nursing expenses, and vocational
The Agreement incorporated by reference a typewritten Addendum. Paragraph 2
of the Addendum, which again included handwritten language that Attorney
Mabie had inserted (shown in bold), stated:
As part of this agreement the carrier agrees it will continue to
furnish all reasonable and related future medical treatment
pursuant to the Rules, necessary to [sic] for the treatment of his
cognitive or other head injury, including neurological,
1 The acronym “TBI” stands for “traumatic brain injury.”
psychological, ophthalmological, TBI care and treatment; and
to pay for care for his covered injuries prior to the time of
The Agreement and Addendum thus purported to settle, on a full and final basis,
all claims for future indemnity and vocational rehabilitation benefits causally
related to any of the injuries Claimant suffered as a consequence of his January
2008 accident.
As for medical benefits, however, the settlement terms sought to differentiate
between Claimant’s “cognitive or other head injury” and all of his other injuries.
As to medical treatment for the former, which specifically included “neurological,
psychological, ophthalmological, TBI care and treatment,” Defendant would
continue to bear responsibility into the future. As to treatment for the latter, it
would no longer be responsible.
After both parties had executed the settlement documents, on August 27, 2010
Attorney Mabie submitted them to the Department for its review, along with the
explanatory letter required by Workers’ Compensation Rule 17.0000.2 The letter
described the settlement terms as follows:
[T]he parties are desirous of resolving their dispute with respect to
indemnity benefits and certain medical benefits insofar as the
claimant’s right ankle and right elbow/bicep are concerned.
Medical benefits will continue to be paid by the carrier/employer
for head injuries and TBI care and treatment, including but not
limited to cognitive, neurological, psychological and
ophthalmological care. The head injuries are significant and will
require on-going assessment and care.
The settlement letter, which was copied to Defendant’s attorney, but neither
reviewed beforehand nor signed by him,3 also referenced the settlement
documents themselves, stating:
The terms of the settlement agreement are fully set forth in the
settlement documents to be submitted to the Department under
separate cover by [Defendant], including the Settlement
Agreement (DOL Form 15) and Addendum to Modified Form 15
Settlement Agreement, both of which will have been duly executed
2 Effective August 1, 2015, the pertinent subsections of Rule 17.0000 have been re-codified as Rule
13.1600.
3 Claimant acknowledged in the Rule 17.0000 letter that Defendant’s attorney “has been away this week
and has not approved this letter, but he did draft the settlement documents and agreed they could be
submitted in his absence.”
The Department approved the parties’ proposed settlement on September 2, 2010.
Claimant credibly testified that he had ample opportunity to review the settlement
documents with Attorney Mabie, and to ask questions if he so chose, before he
signed them. He further testified that he believed the settlement meant that
Defendant would continue to be responsible for medical treatment “for everything
from the shoulders up.” I do not doubt that Claimant was sincere in this belief.
Claimant’s Course of Treatment from September 2010 Forward
Claimant underwent ongoing treatment with Dr. Miller in 2010 for his traumatic
brain injury, occipital neuralgia, persistent headaches and neck pain. The latter
two conditions he continued to manage with oxycodone.
As treatment for Claimant’s ongoing headaches and cervical symptoms, in
November 2010 Dr. Miller prescribed physical therapy, with both mechanical
traction and deep tissue mobilization. Claimant attended seven sessions during
November and December 2010.
Defendant denied payment for the November and December 2010 physical
therapy sessions, which totaled $1,364.94, on the grounds that the terms of the
parties’ approved settlement agreement now excused it from doing so.
Specifically, it asserted that Claimant’s headaches were causally related to his
cervical injury, that the cervical injury was not subsumed under the category of
either “cognitive or other head injury” or “traumatic brain injury,” and that
therefore its ongoing responsibility had ended. Thereafter, Dr. Miller prescribed
additional sessions, but because Defendant continued to deny payment Claimant
was unable to continue them.
Defendant also denied payment of several of Dr. Miller’s bills. Nine of the
unpaid bills Claimant submitted at hearing covered treatments rendered between
November 8, 2010 and April 5, 2011. The diagnosis noted on eight bills is
“cervicalgia;” the ninth bill, for services rendered on November 8, 2010, indicates
treatment for “brain injury.” From reviewing the medical records corresponding
to the eight “cervicalgia” bills, I find that the treatments rendered were in fact
related to Claimant’s cervical injury. Similarly, the medical record corresponding
to the November 8, 2010 bill reflected treatment for his brain injury.
Defendant also denied payment for treatment rendered by Dr. Miller on March 15,
From my review of the corresponding office note, I find that Dr. Miller’s
treatment on that date involved ongoing evaluation of both Claimant’s cervical
pain, for which he administered a cervical injection, and his traumatic brain
In February 2014 Dr. Miller became increasingly concerned that Claimant was
not receiving any treatment for depression. In his opinion, Claimant’s
psychological condition is causally related to his traumatic brain injury. As noted
above, Finding of Fact No. 13 supra, until July 2012 Defendant had denied
responsibility for all but one counseling session. The record does not establish
any basis for its denial of psychological treatment. According to Dr. Miller, all of
Claimant’s physical injuries have been exacerbated as a consequence of his
inability to access mental health services. I find this analysis credible.
Claimant continued to treat with Dr. Miller at least through June 2015. Currently
he continues to suffer from chronic neck pain, headaches, visual problems and
difficulty sleeping. Defendant having denied payment for additional physical
therapy, Dr. Miller’s treatment has consisted of medications: oxycodone for pain
management, zolpidem tartrate for sleep disturbance and paroxetine for
depression. Defendant has denied payment for all of these; again, however, the
record does not clearly establish any basis for its denials.
Dr. Miller also recommended that Claimant obtain a TENS unit, a device that
sends electrical impulses along the skin surface and nerve strand to relieve pain.
Defendant refused payment for the device, on the grounds that its purpose was to
treat Claimant’s neck pain, for which it was no longer responsible under the terms
of the parties’ approved settlement. Claimant has since purchased one on his
own, and credibly testified that it has helped to alleviate his neck pain.
Claimant also has paid for at least some of the medications Dr. Miller has
prescribed from his own funds. He introduced evidence of payments totaling
$719.99 for prescriptions of oxycodone, zolpidem tartrate and paroxetine that he
filled between January 2011 and January 2013.
Claimant also paid $157.37 for a prescription for Catapres-TTS, a blood pressure
medication, in September 2010. The medical evidence does not address whether
his need for this medication is causally related in any way to his January 2008
(b) Dental work (Dr. Shlafstein)
As noted above, Finding of Fact No. 17 supra, Claimant has yet to undergo the
remaining dental work that Dr. Shlafstein recommended in March 2008.
Defendant has refused payment on the grounds that under the terms of the parties’
approved settlement agreement, it is no longer covered.
(c) Visual deficits (Dr. Danberg)
Claimant continues to suffer from various visual deficiencies, including difficulty
tracking and focusing and eye-teaming deficits. Functionally, he continues to
skip letters and read words out of sequence.
In May 2012 Claimant returned to Dr. Danberg to assess whether he might still
benefit from additional OVRT treatment. Dr. Danberg credibly concluded that he
As noted above, Finding of Fact No. 21 supra, since at least October 2009
Claimant has required new glasses with prism, as his prescription has changed.
Defendant has denied payment, for reasons that are unclear from the record.
The parties introduced conflicting expert medical evidence regarding the causal
relationship between the various treatments at issue in this claim and the injuries
for which Defendant remains responsible in accordance with the September 2010
(a) Dr. Miller
As noted above, Finding of Fact No. 8 supra, Dr. Miller diagnosed Claimant with
a traumatic brain injury with occipital neuralgia, cervical pain from a whiplash
injury and vision problems, all causally related to his January 2008 work accident.
Dr. Miller had difficulty separating out which of the medical treatments he
prescribed were referable specifically to Claimant’s head and/or traumatic brain
injury and their associated sequelae (neurological, psychological and/or
ophthalmological), and which were referable to his neck injury. I acknowledge
his credible opinion that all of Claimant’s head and neck symptoms were causally
related to the work injury, but standing alone, this opinion is not responsive to the
question whether, under the terms of the parties’ settlement, Defendant remains
responsible for specific treatments or not.
Dr. Miller credibly concluded that Claimant’s trigger point injections, occipital
nerve blocks, craniosacral therapy, physical therapy with traction, TENS unit, and
vision treatment were all medically necessary and causally related to his work
injuries. Of these, he acknowledged that the trigger point injections, physical
therapy with traction and use of a TENS unit were treatments specifically
prescribed to treat Claimant’s cervical pain, and not his traumatic brain injury.
According to Dr. Miller, the occipital nerve blocks, craniosacral therapy and
vision treatments were causally related to the latter condition. I find this analysis
As for prescription medications, as noted above, Finding of Fact No. 37 supra,
Dr. Miller prescribed oxycodone for Claimant’s persistent headaches and chronic
neck pain, zolpidem tartrate for his sleep disturbance and paroxetine for
depression. Although Claimant’s chronic neck pain very well may have
contributed to all three of these conditions, according to Dr. Miller they are
common sequelae of traumatic brain injury as well. I accept as credible his
opinion that all three medications are necessitated at least in part by Claimant’s
traumatic brain injury, therefore.
(b) Dr. Conway
At Defendant’s request, in September 2013 Claimant underwent an independent
medical examination with Dr. Conway, a board certified neurologist. Dr. Conway
also reviewed Claimant’s relevant medical records.
Dr. Conway diagnosed Claimant with a closed head injury, causally related to his
January 2008 accident, which has affected his cognition, impaired his memory
and processing ability, triggered concussive headaches and made him frustrated
and psychologically distressed. I find this analysis credible.
As for which of Dr. Miller’s prescribed treatments were necessitated by
Claimant’s cervical injury as opposed to his cognitive and other head injuries, Dr.
Conway concluded that the physical therapy with traction that Claimant
underwent in November and December 2010, Finding of Fact No. 32 supra, was
directed at the former, while the craniosacral therapy he underwent in 2008 and
2009, Finding of Fact Nos. 12 and 13, supra, was focused on the latter. In this he
concurred with Dr. Miller, see Finding of Fact No. 48 supra.
Dr. Conway disputed the necessity for occipital nerve blocks as causally related to
Claimant’s traumatic brain injury, however. Unlike Dr. Miller, in Dr. Conway’s
opinion Claimant did not suffer from occipital neuralgia. For that reason, after
the first, diagnostic, nerve block he concluded that further blocks were neither
causally related to the brain injury nor medically necessary.
Consistent with Dr. Miller’s emphatic recommendation, Finding of Fact No. 36
supra, Dr. Conway also concluded that Claimant was in need of psychological
counseling causally related to his traumatic brain injury.
Dr. Conway disagreed with Dr. Danberg regarding the causal relationship
between Claimant’s vision deficits and his work injuries. In his opinion, the
problems Claimant was experiencing were simply due to the natural aging
process, and not to any injury. Given Dr. Conway’s lack of expertise in this field,
I do not find his opinion on this issue convincing.
At Defendant’s request, in July 2012 Claimant underwent an independent
psychiatric examination with Dr. Drukteinis, a board certified psychiatrist. Dr.
Drukteinis also reviewed Claimant’s relevant medical records.
Dr. Drukteinis diagnosed Claimant with a residual traumatic brain injury, a
cognitive disorder and a pain disorder. He also found that Claimant exhibited
clear signs of a depressive disorder. In Dr. Drukteinis’ credible opinion, all of
these conditions are causally related to Claimant’s January 2008 work accident.
As treatment for Claimant’s psychological disorders, Dr. Drukteinis
recommended both psychological counseling and anti-depressant medication.
According to his analysis, Claimant’s depression is an impediment to his
recovery. Therefore, the recommended treatments are medically necessary and
causally related. I find Dr. Drukteinis credible in all respects.
Claimant introduced a mileage log documenting his travel for injury-related
medical treatment with Drs. Danberg, Drukteinis, Shlafstein and Miller on various
dates between November 2011 and January 2014. In all, he calculated a total of
660 round-trip miles traveled to and from his home in Connecticut. I find that
none of these miles were incurred solely to obtain treatment for his cervical
condition; to the contrary, all were necessitated at least in part by his dental
injuries and/or traumatic brain injury and psychological sequelae. Claimant also
calculated a total of 1,068 round-trip miles traveled to and from a pharmacy for
the purpose of obtaining prescription medications.
The Scope of the Parties’ Approved Settlement Agreement
Claimant here seeks to hold Defendant responsible for various medical treatments
that he contends remain open under the terms of the parties’ approved settlement.
To resolve this issue, it is necessary to determine the scope of that agreement as it
relates to treatment for the specific conditions from which he still suffers.
As I already have found, Finding of Fact No. 26 supra, with respect to medical
benefits, the settlement agreement established two distinct categories of injuries.
For treatment of Claimant’s “cognitive or other head injury,” including
“neurological, psychological, ophthalmological and TBI,” by the terms of the
settlement agreement Defendant would remain liable into the future. For all other
injuries, the agreement relieved Defendant from future responsibility.
(a) Treatment Directed at Neck Pain and Headaches
The most hotly contested area of disagreement between the parties concerns
Defendant’s post-settlement responsibility for treatments directed at Claimant’s
ongoing neck pain and headaches. As noted above, Finding of Fact No. 30 supra,
Claimant credibly testified as to his understanding that even after the settlement
Defendant would remain liable “for everything from the shoulders up.”
Defendant consistently has denied responsibility for any cervical-related
treatment, however, on the grounds that it is not subsumed under the category of
“other head injury” and therefore is no longer covered.
The term “head” is defined as “the upper part of the human body . . . typically
separated from the rest of the body by a neck, and containing the brain, mouth and
sense organs.” Oxford Dictionaries,
www.oxforddictionaries.com/definition/english/head; see also, Merriam-Webster
Dictionary, www.merriam-webster.com/dictionary/head (defining “head” as “the
part of the body containing the brain, eyes, ears, nose and mouth”); Merriam-
Webster Medical Dictionary; www.merriam-webster.com/medical/head (defining
“head” as “the division of the human body that contains the brain, the eyes, the
ears, the nose and the mouth”).
The term “neck” is defined as “the part of a person’s . . . body connecting the
head to the rest of the body.” Oxford Dictionaries,
www.oxforddictionaries.com/definition/english/neck; see also, Merriam-Webster
Dictionary, www.merriam-webster.com/dictionary/neck (defining “neck” as “the
part of the body between the head and the shoulders”); Merriam-Webster Medical
Dictionary, www.merriam-webster.com/medical/neck (defining “neck” as “the
usually narrowed part of an animal that connects the head with the body,
specifically, the cervical region of a vertebrate” (emphasis in original)).
As these definitions establish, in both their common and their medical usages the
terms “head” and “neck” each connote separate and distinct body parts.
Notwithstanding their anatomical connection, the neck is no more a part of the
head than the leg is a part of the hip, or the hand a part of the forearm.
Claimant argues that by referencing only his “head injury,” but not his “neck
injury” in either inclusionary or exclusionary language, the settlement agreement
created sufficient ambiguity as to negate any “meeting of the minds” between the
parties. Therefore, he asserts, the agreement must either be voided, or else
enforced as if the two terms were synonymous. See, e.g., Evarts v. Forte, 135 Vt.
306, 310 (1977) (real estate contract voided where property description was too
vague to establish parties’ mutual agreement as to what was being conveyed).
I cannot accept this analysis. As the above definitions establish, there is no
ambiguity in the term “head” injury. Reasonable people would not disagree that
its plain meaning signifies something other than an injury to the “neck,” see
Isbrandtsen v. North Branch Corp., 150 Vt. 575, 578 (1988) (internal citations
Claimant asks a legitimate question, however. If his neck injury, which
Defendant has never disputed is causally related to the January 2008 work
accident, does not qualify as a “head injury,” where in the settlement agreement
Again, the agreement’s plain language provides the answer. It defines the general
scope of the injuries to be covered by the settlement as “including but not limited
to right ankle, head/TBI and right elbow/biceps,” and the subcategory of those for
which Defendant will be liable only for “prior care” as “his covered injuries
sustained as a result of the [January 2008] accident (emphasis supplied).” There
being no question but that the neck injury is causally related and compensable, it
thus fits under both the “including but not limited to” and the “covered injuries”
descriptors. Though admittedly less specific than the “cognitive or other head
injury” category descriptors, I cannot conclude that these phrases are themselves
ambiguous, in either meaning or application.
I acknowledge the fact that, in describing the terms of the parties’ settlement in
his Rule 17.0000 letter to the Department, Claimant omitted any reference to his
cervical injury, either as one of the injuries for which medical benefits were to be
closed out, or as one of those for which medical benefits were to continue, see
Finding of Fact No. 27 supra. Claimant argues that the reason for this omission
was that it was “clear as day” that the parties’ intended for the “head” to include
the “neck.” See Claimant’s Findings of Fact and Memorandum of Law at p. 22.
I disagree. Had the matter been as clear as Claimant asserts, Defendant would not
have begun denying coverage for treatment of his neck pain almost immediately
after the settlement was approved, a position it has maintained ever since, and one
which I already have concluded is consistent with the agreement’s plain language,
see Conclusion of Law No. 9 supra. And while the Rule 17.0000 letter did not
contain the same inclusive category descriptors (“including but not limited to”
and “covered injuries,” see Conclusion of Law No. 11 supra), it specifically
deferred to the settlement documents themselves for a more complete description
of the agreement’s terms, Finding of Fact No. 28 supra. Notably, furthermore,
Defendant neither reviewed the Rule 17.0000 letter before its submission nor
I conclude that the Rule 17.0000 letter neither created nor resolved any ambiguity
in the settlement agreement’s terms. Instead, at best it signified a unilateral
mistake on Claimant’s part. A misunderstanding of this type does not preclude
contract rescission in all cases. Town of Lyndon v. Burnett’s Contracting Co.,
Inc., 138 Vt. 102, 107 (1980). However, “if the mistake has resulted solely from
the negligence or inattention of the party seeking relief, and the other party is
without fault, relief will not be granted absent unusual circumstances that would
make enforcement of the agreement manifestly unjust.” Id. at 108.
Claimant’s mistake here occurred solely as a result of his “erroneous assumption,”
Burnett, supra at 108, that an injury to the “neck” was equivalent to an injury to
the “head.” The evidence does not suggest that Defendant was in any way to
blame for this misunderstanding. Nor does it suggest any unusual circumstances
sufficient to render enforcement of the parties’ agreement “manifestly unjust.”
The facts necessary to justify rescission do not exist.
I do not dispute that the settlement agreement Claimant executed may not have
said what he wanted it to say. I cannot conclude that this was a consequence of
ambiguous or inadequately defined terms, however. Merely because the
agreement’s plain language led to an unfavorable outcome for him is not an
appropriate basis for finding ambiguity. Brault v. Welch, 2014 VT 44, ¶13. Nor
does his unilateral misunderstanding of the agreement’s scope provide sufficient
grounds for rescission. Absent a mutual mistake of fact, “one of the parties can
no more rescind the contract without the other’s express or implied assent, than he
alone could have made it.” Maglin v. Tschannerl¸174 Vt. 39, 45 (2002) (quoting
Enequist v. Bemis, 115 Vt. 209, 212 (1947). I am bound to enforce it according to
its terms, therefore.
I thus conclude that the parties’ approved settlement agreement does not obligate
Defendant to provide ongoing medical coverage for Claimant’s neck injury.
I turn now to the specific treatments at issue for that condition. The parties
presented conflicting expert medical opinions regarding the causal relationship
and/or medical necessity of at least some of these treatments, which is the
standard for determining an employer’s liability under the statute, 21 V.S.A.
640(a). See, e.g., MacAskill v. Kelly Services, Opinion No. 04-09WC (January
30, 2009). In such cases, the commissioner traditionally uses a five-part test to
determine which expert’s opinion is the most persuasive: (1) the nature of
whether the expert examined all pertinent records; (3) the clarity, thoroughness
and objective support underlying the opinion; (4) the comprehensiveness of the
evaluation; and (5) the qualifications of the experts, including training and
experience. Geiger v. Hawk Mountain Inn, Opinion No. 37-03WC (September 17,
As to the trigger point injections, physical therapy with traction and the use of a
TENS unit, both Dr. Miller, Claimant’s treating physician, and Dr. Conway,
Defendant’s medical expert, agreed that these treatments were necessitated by
Claimant’s neck injury, and not by his traumatic brain injury. Therefore, under
the terms of the parties’ approved settlement agreement, after September 2, 2010
Defendant was no longer obligated to pay for them.
Similarly, I conclude that Defendant is not obligated to pay for the treatments
reflected on the eight “cervicalgia” bills referenced in Finding of Fact No. 34
supra. Dr. Miller’s corresponding office notes reflect treatment for Claimant’s
cervical injury on the dates covered by those bills, and therefore Defendant is not
I conclude that Defendant is responsible, however, for the ninth bill referenced in
Finding of Fact No. 34 supra, as the treatment Dr. Miller rendered on that date
(November 8, 2010) was directed at Claimant’s traumatic brain injury, not his
cervical condition.
I conclude that Defendant is also liable for the office evaluation portion of Dr.
Miller’s March 15, 2012 bill, as it concerned at least in part Claimant’s traumatic
brain injury. However, Defendant is not responsible for the charges incurred for
administering a cervical injection on that date, as Dr. Miller himself conceded that
such therapy was causally related to Claimant’s neck injury, not his traumatic
The experts agreed as to the post-concussive nature of Claimant’s headaches, and
therefore I conclude that under the terms of the approved settlement agreement
reasonable treatment for that condition remains Defendant’s responsibility.
Based on Dr. Miller’s credible testimony, and with no countervailing expert
testimony to negate it, I conclude that the medications Dr. Miller prescribed,
specifically oxycodone for pain, zolpidem tartrate for sleep disturbance and
paroxetine for depression, are all causally related at least in part to his cognitive
or other head injury rather than exclusively to his cervical condition. Under the
specific terms of the parties’ approved settlement agreement, these medications
are all still covered and Defendant is obligated to pay for them, therefore.
I conclude that Defendant is responsible for medically necessary treatment of
Claimant’s occipital neuralgia, including the occipital nerve blocks that Dr. Miller
administered in 2008 and 2009. In reaching this conclusion, I accept Dr. Miller’s
diagnosis as more credible than Dr. Conway’s.
Last, I conclude that Claimant has failed to sustain his burden of proving any
causal relationship between his need for Catapres-TTS, a blood pressure
medication, and any of the injuries or conditions for which Defendant is still
responsible. For that reason, he is not entitled to reimbursement.
(b) Treatment for Dental Injuries
Claimant introduced credible medical evidence from his treating dentist, Dr.
Shlafstein, that as a direct result of the January 2008 work injury he now requires
full coverage crowns on tooth numbers 7, 8, 9, 10 and 30. Defendant failed to
offer any expert medical opinion to contradict the medical necessity of these
treatments. I therefore accept Dr. Shlafstein’s opinion on this issue as persuasive.
As noted above, Conclusion of Law No. 5 supra, in both its common usage and
its medical usage, the term “head” includes the mouth, and therefore the teeth as
well. I thus conclude that the dental treatments at issue are causally related to
Claimant’s head injury. Under the terms of the parties’ approved settlement
agreement, Defendant remains responsible for them, therefore.
(c) Treatment for Visual Deficits
The parties presented conflicting expert medical opinions regarding whether
ongoing treatment for Claimant’s visual deficits is causally related to his head
injury, as Dr. Danberg asserted, or is simply a consequence of the natural aging
process, as Dr. Conway concluded.
Considering the factors listed in Conclusion of Law No. 18 supra, I conclude that
Dr. Danberg’s opinion is the most credible. As a behavioral optometrist, Dr.
Danberg has specialized training and expertise in this area, which Dr. Conway
does not share. Having tested and treated Claimant in the past, she is best
positioned to evaluate his current and future needs, and also to determine their
relationship back to his work injury. Her opinion thus merits greater weight than
Dr. Conway’s.
I therefore conclude that Dr. Danberg’s ongoing treatment, including but not
limited to resumed sessions of optometric visual rehabilitation therapy, is both
causally related to Claimant’s work injury and medically necessary. Under the
terms of the parties’ approved settlement agreement, which specifically included
“ophthalmological” treatment as one of the enumerated medical services
associated with Claimant’s head injury, I conclude that Defendant remains
obligated to pay for it. Similarly, I conclude that Defendant is responsible for
providing Claimant with replacement glasses with prism, in order to
accommodate periodic changes in his prescription.
(d) Psychological Treatment
Defendant proffered no explanation to account for its continued denial of
coverage for Claimant’s antidepressant medications and other psychological
treatment. Its own medical expert, Dr. Drukteinis, confirmed Claimant’s pressing
need for treatment and its causal relationship to the January 2008 work accident.
Psychological treatment was another of the specifically enumerated medical
services associated with Claimant’s head injury for which Defendant remains
responsible under the terms of the approved settlement agreement, furthermore. I
conclude that Defendant is obligated to pay for both mental health services and
medications, therefore.
As a final matter, Claimant seeks reimbursement for 660 miles traveled to and
from medical appointments necessitated by his work injuries, and 1,068 miles
traveled to and from a pharmacy for the purpose of obtaining prescription
According to Workers’ Compensation Rule 12.2100,4 an injured worker who is
“required to travel for treatment, or to attend an employer’s independent medical
examination,” is entitled to reimbursement for mileage “beyond the distance
normally traveled to the workplace.” The purpose of the rule is to make the
worker whole, by providing compensation for expenses that he or she would not
have incurred but for the work injury. At the same time, the rule is phrased so as
to deny reimbursement for regular commuting expenses that presumably the
worker would have had to bear even had there been no injury. Fosher v. FAHC,
Opinion No. 11-11WC (May 6, 2011).
Claimant here failed to introduce any evidence from which I might calculate his
regular commute distance to and from work while he was in Vermont engaging in
his ambassador duties for Defendant. On that basis alone, it is impossible to
determine the amount due him in mileage reimbursement.
The language of Rule 12.2100 has never been interpreted to cover travel to and
from a pharmacy. Dain v. AIHRS, Opinion No. 85-95WC (November 17, 1995).
Presumably, most injured workers have access to a local pharmacy that is at least
within their commuting distance to and from work, and if not, mail order likely
presents a viable alternative, see Workers’ Compensation Rule 26.3000.5 I thus
conclude that Claimant is not entitled to reimbursement for the 1,068 miles
claimed for that purpose.
I conclude that Claimant has failed to sustain his burden of proving any
entitlement to mileage reimbursement in the amounts claimed.
4 Effective August 1, 2015 Rule 12.2100 has been re-codified as Rule 4.1300.
5 Effective August 1, 2015 Rule 26.3000 has been re-codified as Rule 3.2510.
As Claimant has only partially prevailed, he is entitled to an award of only those
costs that relate directly to the claims he successfully litigated. Hatin v. Our Lady
of Providence, Opinion No. 21S-03 (October 22, 2003), citing Brown v. Whiting,
Opinion No. 7-97WC (June 13, 1997). As for attorney fees, in cases where a
claimant has only partially prevailed, the Commissioner typically exercises her
discretion to award fees commensurate with the extent of the claimant’s success.
Subject to these limitations, Claimant shall have 30 days from the date of this
opinion to submit evidence of his allowable costs and attorney fees.
Based on the foregoing findings of fact and conclusions of law, Claimant’s claim for
medical benefits covering the following medical services and supplies is hereby
Physical therapy services rendered on November 19 and 22, 2010 and
December 1, 2, 6, 8, and 13, 2010;
Evaluation and treatment of Claimant’s cervical condition by Dr. Miller as
reflected on the eight “cervicalgia” bills described in Finding of Fact No.
34 supra;
Trigger point and other cervical injections, including those reflected on
Dr. Miller’s March 15, 2012 billing, as described in Finding of Fact No.
35 supra;
TENS unit and associated supplies;
Catapres-TTS or other prescription blood pressure medications; and
Defendant is hereby ORDERED to pay medical benefits covering the following medical
services and supplies, in accordance with 21 V.S.A. §640(a):
Evaluation and treatment of Claimant’s cognitive or other head injury,
occipital neuralgia and concussive headaches, including evaluation and
treatment rendered by Dr. Miller on November 8, 2010 and March 15,
2012, as described in Finding of Fact Nos. 34 and 35 supra, and occipital
Reimbursement to Claimant for prescription medication costs (oxycodone,
zolpidem tartrate and paroxetine) totaling $719.99, with interest from the
date of purchase in accordance with 21 V.S.A. §664;
Prescription medications, including oxycodone, zolpidem tartrate and
paroxetine, or other medications prescribed for pain control, sleep
disturbance and/or depression, all as causally related to Claimant’s
cognitive or other head injury;
Ongoing treatment for visual deficits, including specifically optometric
visual rehabilitation therapy and glasses with prism;
Full coverage crowns and other dental treatment necessary to repair
accident-related damage to tooth numbers 7, 8, 9, 10 and 30;
Mental health counseling and anti-depressant medications, all as causally
related to Claimant’s cognitive or other head injury; and
Costs and attorney fees in amounts to be determined, in accordance with
21 V.S.A. §678.
Joseph Quinones v. State of Vermont Opinion No. 04-16WC
Joseph Quinones v.State of Vermont Opinion No. 04-16WC
State File No. FF-59764
Carey Rose, Esq., for Claimant
As a matter of law, is Defendant bound by the terms of an Agreement for
Permanent Partial or Permanent Total Disability Compensation (Form 22) that
was signed by the parties but not approved by the Commissioner prior to its
purported rescission?
Defendant’s Exhibit A: Psychology initial assessment (Joann Joy, Ph.D.),
Defendant’s Exhibit B: Independent behavioral medicine and pain experience
evaluation (Dr. Mann), October 20, 2014
Defendant’s Exhibit C: Independent medical evaluation supplemental report (Dr.
Backus), November 17, 2014
Defendant’s Exhibit D: Email from Lori Clark, November 13, 2014
On February 4, 2014 Claimant injured his right wrist in the course and scope of
his employment as a corrections officer for Defendant.
Defendant accepted Claimant’s right wrist strain/hyperextension injury as
compensable and paid all associated medical benefits.
Claimant never presented a formal written “claim” for a psychological injury.
However, the medical complaints associated with his compensable injury evolved
to the point where he was exhibiting psychological complaints. Specifically, on
July 30, 2014 Dr. Joann Joy offered an opinion that Claimant was suffering from
depression and anxiety regarding the pain issues referable to his February 2014
work injury. Defendant’s Exhibit A. I find that this reasonably can be construed
as notice of a claimed psychological injury.
At Defendant’s request, on October 10, 2014 Claimant underwent an independent
medical evaluation with Dr. Backus. Claimant was not represented by an attorney
In his October 10, 2014 report, Dr. Backus concluded that Claimant had sustained
a work-related wrist injury, which warranted an eight percent whole person
permanent impairment rating. Dr. Backus further stated that the exact cause of
Claimant’s chronic pain was medically unknown, “but it did start with the work
injury and remains related at this time to a reasonable degree of medical
At Defendant’s request, on October 20, 2014 Claimant underwent an independent
psychological evaluation with Stephen Mann, Ph.D. In his report, Dr. Mann
concluded that Claimant had not experienced a psychological injury causally
related to his February 2014 compensable wrist injury. Instead, in his opinion
Claimant suffers from somatoform disorder, which he stated “is based on a longterm,
chronic pattern of somatization arising from ingrained personality traits, not
causally related to a specific physical disorder.” Defendant’s Exhibit B.
Sometime before November 10, 2014 Defendant drafted an Agreement for
Permanent Partial or Permanent Total Disability Compensation (Form 22) and
sent it to Claimant to sign and return. The terms of the agreement called for
Defendant to pay permanent partial disability benefits in accordance with Dr.
Backus’ October 10, 2014 eight percent impairment rating.
Claimant, who was still pro se at the time, signed Defendant’s proposed Form 22
Agreement on November 10, 2014.
On November 12, 2014 Defendant’s workers’ compensation insurance adjuster
signed the proposed Form 22 Agreement and submitted the document, now fully
executed, to the Commissioner for approval.
On November 13, 2014 Defendant’s adjuster, Lori Clark, sent the following email
message to the Department’s workers’ compensation specialist:
I hereby rescind my previously expressed consent to the Form 22
based on Dr. Mann’s report dated 10/20/14. Please immediately
purge this agreement from the Department of Labor’s file.
At Defendant’s request, on November 17, 2014 Dr. Backus drafted a
“supplemental report,” in which he retracted his eight percent permanent
impairment rating on the basis of Dr. Mann’s reported psychological findings and
conclusions. Specifically, Dr. Backus determined that the history Claimant
previously had reported to him was unreliable, and that he likely had not suffered
any physical injury at all. In Dr. Backus’ opinion, a more likely alternative
explanation for the symptoms Claimant reported was “as part of his somatization
unrelated to the work injury.” Dr. Backus thus concluded that Claimant had
suffered a zero percent permanent impairment related to his “alleged” work
injury. Defendant’s Exhibit C.
On November 17, 2014 Ms. Clark again corresponded via email with the
Department’s workers’ compensation specialist, as follows:
Hello, I am writing in follow [sic] to my request to rescind the
previously issued Form 22. I attach for further support of my
request a supplemental report from Dr. Backus. Can you please
confirm and respond on my formal request for rescinding the Form
22? Thank you.
The Commissioner never approved the fully executed Form 22 Agreement.
Claimant did not agree to a rescission and instead hired legal counsel to enforce
the Form 22 Agreement.
There are no allegations of fraud or mutual mistake of fact in this claim.
In order to prevail on a motion for summary judgment, the moving party must
show that there exist no genuine issues of material fact, such that it is entitled to a
judgment in its favor as a matter of law. Samplid Enterprises, Inc. v. First
Vermont Bank, 165 Vt. 22, 25 (1996). In ruling on such a motion, the nonmoving
party is entitled to the benefit of all reasonable doubts and inferences.
State v. Delaney, 157 Vt. 247, 252 (1991); Toys, Inc. v. F.M. Burlington Co., 155
Vt. 44 (1990). Summary judgment is appropriate only when the facts in question
are clear, undisputed or unrefuted. State v. Heritage Realty of Vermont, 137 Vt.
425 (1979). It is unwarranted where the evidence is subject to conflicting
interpretations, regardless of the comparative plausibility of facts offered by either
party or the likelihood that one party or another might prevail at trial. Provost v.
Fletcher Allen Health Care, Inc., 2005 VT 115, ¶15.
The legal question presented here is whether Defendant can be bound to the terms
of an Agreement for Permanent Partial or Permanent Total Disability
Compensation (Form 22) that was signed by the parties but not approved by the
Commissioner prior to its purported rescission. As the facts are not disputed, the
issue is appropriate for resolution on summary judgment.
Vermont’s workers’ compensation statute, 21 V.S.A. §662(a), requires that the
parties to a compensation agreement must file “a memorandum thereof” with the
commissioner for review and approval. Approval is conditioned on a
determination that the agreement’s terms “conform to the provisions” of the
Workers’ Compensation Act. Id. “If approved by the commissioner, such
agreement shall be enforceable” and thereafter will be subject to modification
only in limited circumstances. Id.
Workers’ Compensation Rule 17.00001 identifies the forms, among them the
Agreement for Permanent Partial or Permanent Total Disability Compensation
(Form 22), that satisfy the statute’s “memorandum” requirement. It also reiterates
the requirement for, and effect of, approval, as follows:
Once executed by the parties and approved by the [Workers’
Compensation] Division,2 these forms shall become binding
agreements and absent evidence of fraud or material mistake of
fact the parties shall be deemed to have waived their right to
contest the material portions thereof.
Both statute and rule thus clarify the conditions precedent for even a fully
executed compensation agreement to become a binding and enforceable contract –
first, it must be reviewed by the commissioner for compliance with the statute;
second it must be approved; and third, it must not have been induced by fraud or
otherwise invalidated by the parties’ material mistake of fact.
The commissioner’s responsibility to review and approve compensation
agreements is more than just a formality. It is a necessary component of the
statutory obligation to facilitate the proper administration of the workers’
compensation law, see 21 V.S.A. §602. The review process encompasses all of a
compensation agreement’s material elements, from correctly calculating the
injured worker’s average weekly wage and compensation rate to appropriately
documenting the extent of his or her medical disability and permanent
impairment. See Workers’ Compensation Rule 17.0000. The statute does not
exempt any agreements from the review and approval process; even compromise
1 Effective August 1, 2015, Rule 17.0000 has been re-codified as Rule 10.1820.
2 Pursuant to 21 V.S.A. §601(20), the commissioner is empowered to delegate statutory authority to the
Workers’ Compensation Division as designee.
agreements negotiated in disputed cases are subject to it.3 It is by any measuring
stick one of the commissioner’s critical functions.
The parties here both acknowledge that the commissioner has neither reviewed
nor approved their signed compensation agreement. They further acknowledge
that neither of them was induced to execute the agreement by fraudulent means or
as a result of mutual mistake. True, both parties signed it, but none of the
conditions necessary for its enforcement exist. It is not a binding contract under
either statute or rule, therefore.
Claimant raises equitable arguments in support of his position that Defendant
should be precluded from rescinding the Form 22 Agreement nevertheless. I
acknowledge that rescission is often described as an equitable remedy, and that it
should not be granted unless it is possible “to restore both parties to their
condition before the contract.” Smith v. Munro, 134 Vt. 417, 420 (1976)
(citations omitted); see also, Paradise Restaurant, Inc. v. Somerset Enterprises,
Inc., 164 Vt. 405, 411 (1995) (rescission impractical due to difficulties inherent in
attempting to put parties in status quo ante); Caledonia Sand & Gravel Co. v.
Joseph A. Bass Co., 121 Vt. 161, 164 (1995) (party seeking to rescind release
contract must first restore the status quo).
Restoring the parties to the position they were in prior to executing the Form 22
Agreement is exactly what Defendant seeks to do here, and I cannot discern that
any inequities will result if it is allowed to do so. Rescinding the agreement will
leave each party free either to submit a negotiated permanency agreement for the
commissioner’s review and approval or to litigate the extent, if any, of Claimant’s
permanent impairment at formal hearing. Claimant will not be bound to a zero
percent impairment rating any more than Defendant will be bound to an eight
percent rating. Regardless of how the parties ultimately arrive at a determination
of the benefits to be paid, in either case the commissioner’s review and approval
will be necessary, in accordance with both statute and rule.
I note in this case the very brief timeframe – a span of only one day – that existed
between the time when Defendant submitted the parties’ executed agreement for
the commissioner’s approval and the time when it first sought to rescind it. Were
the timeframe a matter of weeks or months rather than days, restoring the status
quo might be more difficult to accomplish, such that the equities between the
parties might weigh differently. Even in that situation, however, I would be hard
pressed to enforce an agreement absent the commissioner’s prior review and
approval. To allow one party to bind another to an agreement that had not been
3 Section 662(a) allows the commissioner to approve a compromise agreement only “when he or she is
clearly of the opinion that the best interests of [the injured] employee or [his or her] dependents will be
served thereby.” Workers’ Compensation Rule 17.6000 (recently re-codified as Rules 13.1500 and
13.1600) reiterates the review requirement and details the supporting documentation necessary for
subjected to the scrutiny mandated by statute would impermissibly undermine the
commissioner’s essential role in the process.
I conclude as a matter of law that because the commissioner has neither reviewed
nor approved the parties’ previously submitted compensation agreement, it is not
a binding and enforceable contract. I further conclude that rescinding the
agreement will restore the parties to the position they occupied prior to its
execution. I thus conclude as a matter of law that Defendant is entitled to
Claimant’s Motion for Summary Judgment is hereby DENIED. Defendant’s Motion for
Summary Judgment is hereby GRANTED. The parties’ previously executed Agreement
for Permanent Partial or Permanent Total Disability Compensation (Form 22) is
rescinded. The extent, if any, of the permanent impairment referable to Claimant’s
February 4, 2014 compensable work injury remains to be determined, whether by a
properly reviewed and approved agreement or by formal hearing.
DATED at Montpelier, Vermont this _____ day of _______________, 2016.