Opinion ID: 1881409
Heading Depth: 1
Heading Rank: 3

Heading: application of the whole man theory.

Text: There are four reasons why it was error to apply the whole man theory to this case: (1) ALJ King exceeded his authority by increasing the award in response to a petition for reconsideration; (2) the whole man theory applies only to independent injuries; (3) the whole man theory does not apply to awards apportioned under former KRS 342.120; and (4) ALJ Kerr's 1995 finding that 22% of Nye's disability from the 1994 injury was pre-existing and noncompensable is res judicata as to that issue.
KRS 342.281 provides that in considering a petition for reconsideration, [t]he administrative law judge shall be limited in the review to the correction of errors patently appearing upon the face of the award, order, or decision.... This language precludes an ALJ (or, formerly, the old Board) from reconsidering the case on the merits and/or changing the findings of fact. Wells v. Beth-Elkhom Coal Corp., Ky.App., 708 S.W.2d 104, 106 (1985); see also, Ford Furniture Co. v. Claywell, Ky., 473 S.W.2d 821, 823 (1971) (where record considered by old Board supported its decision, KRS 342.281 could not be used to reconsider case on the merits); Beth-Elkhorn Corp. v. Nash, Ky., 470 S.W.2d 329, 330 (1971) (after dismissing employee's claim, old Board exceeded its authority by awarding benefits on petition for reconsideration). Thus, ALJ King exceeded his authority by making additional findings and increasing the award in response to a petition for reconsideration.
The whole man theory is that [w]here [an employee] has had a compensable disability, received his compensation and returned to work and then receives a subsequent independent injury which incapacitates him, the prior injury should not be deducted. Cabe v. Skeens, Ky., 422 S.W.2d 884, 885 (1967) (emphasis added). In such instances, the key word is `independent.' Young v. Young, Ky., 460 S.W.2d 832, 835 (1970). The rule is applied when the disability caused by the second injury is unrelated to and unaffected by the disability caused by the previous injury. The two leading Kentucky cases applying the whole man theory, International Harvester Co. v. Poff, Ky., 331 S.W.2d 712 (1959) and Schneider v. Putnam, Ky., 579 S.W.2d 370 (1979), are perfect examples of independent injuries. In Poff , the case that first adopted the whole man theory in Kentucky, a worker who had lost an eye in a previous work-related accident had been compensated therefor and returned to work. He then suffered a second accident requiring the amputation of both legs. It was held that the whole man theory precluded deducting the disability caused by the lost eye from the award for the disability caused by the amputations. Id. at 714-15. The two injuries were unrelated and incapacitated the worker in different ways; obviously, the disability resulting from the amputations was not affected by the lost eye. In Schneider , the worker had been almost blind since early childhood but, nevertheless, was working full-time when he was disabled by a work-related injury to his back. It was held that the disability resulting from his visual impairment should not be deducted from the award for the disability resulting from his back injury. Id. at 372. Again, the disability resulting from the back injury was not affected by the pre-existing visual impairment, and the whole man theory applied. Id. at 371. In contrast, the whole man theory was not applied in Young v. Kentucky Baptist Hospital, Ky., 483 S.W.2d 148 (1972), where the employee, having lost one eye during childhood, lost his other eye in a work-related accident resulting in total disability. Since the work-related accident would not have caused total disability except for the pre-existing impairment, it was held that KRS 342.120 required an exclusion reflecting the pre-existing disability. Id. at 150. Both injuries affected the worker's vision rather than, e.g., one affecting his vision and the other his back; therefore, the whole man theory was not applicable. If there had been no preexisting disability, [the plaintiff] would have had a good left eye and would not have sustained total disability. Id. Here, both the 1990 accident and the 1994 accident injured Nye's back and shoulders (primarily cervical spine area), and all of his present disability stems from the injuries of that area of his body. Since he had a prior active disability in the same area of his present disability, the subsequent injury was not independent of the previous injury and the whole man theory does not apply.
Although the procedural law applicable to the motion to reopen is the law in effect at the time of reopening, Peabody Coal Co. v. Gossett, supra, at 36, the substantive law applicable to a reopened case is the law in effect at the time of the injury. Maggard v. Int'l Harvester Co., Ky., 508 S.W.2d 777, 783 (1974). Here, that includes the apportionment procedures mandated by former KRS 342.120(7), which provided, inter alia: The remaining compensation for which such resulting condition would entitle the employee, including any compensation for disability resulting from a dormant disease or condition aroused into disabling reality by the injury or occupational disease, but excluding all compensation which the provisions of this chapter would have afforded on account of prior disabling disease or injury had it been compensated thereunder, shall be paid out of the special fund.... (Emphasis added.) Thus, as recognized in Young v. Young, supra, at 835-36, if the case is practiced under KRS 342.120, i.e., if part of the award is to be apportioned against the Special Fund, exclusion for a prior disabling injury is required by the apportionment statute, [3] and the common law whole man theory simply does not apply. In fact, Poff, supra , distinguished two prior cases that had required an exclusion for a prior disability because those cases had been practiced under KRS 342.120 whereas Poff had not. Id. at 714. The reason an apportionment case is different is that only in KRS 342.120, the apportionment statute, does the law expressly require that a pre-existing disability be excluded (in the form of a deduction) from the benefits otherwise payable as the result of a compensable injury or disease. Schneider, supra, at 371. However, Schneider clarified that, even then, the exclusion is required only if, as here, the pre-existing condition is a contributing factor to the disability caused by the subsequent injury. Id. at 372. The employee's pre-existing visual impairment in Schneider was not a contributing factor, thus did not require an exclusion (even though causation of the claimant's work-related back injury in Schneider was apportioned between the employer and the Special Fund). Id. Here, both the 1990 and 1994 injuries affected the same bodily functions and the award was apportioned between the employer and the Special Fund under KRS 342.120. Thus, KRS 342.120(7) required that an exclusion for the pre-existing disability for which Nye had been previously compensated and precluded application of the whole man theory to this case.
A workers' compensation award can be reopened on grounds of (a) fraud, (b) newly discovered evidence, (c) mistake, and (d) change of disability. KRS 342.125(1). While KRS 342.125(7) provides that upon reopening of an award based upon an approved settlement agreement, [t]he parties may raise any issue upon reopening and review of this type of award which could have been considered upon an original application for benefits (emphasis added), the statute does not contain a similar provision with respect to reopening of awards adjudicated by an ALJ on the basis of the law and facts. Obviously, the intent of KRS 342.125(7) was to assure that the principle of res judicata would apply only to prior judicial determinations, not to cases that were settled between the parties. Thus, in American Standard, Inc. v. Stephen, Ky.App., 565 S.W.2d 158 (1978), it was held that KRS 342.125(2) [now KRS 342.125(7)] authorized joinder of the Special Fund upon reopening and apportionment of the new award despite the fact that the Special Fund had not been a party to the original settlement agreement. Id. at 161. However, once an ALJ-adjudicated award and order becomes final, the ALJ's determinations with respect to, e.g., causation, notice, apportionment, etc., cannot be readdressed under KRS 342.125 except upon an allegation of fraud, newly discovered evidence, or mistake, grounds that do not exist and are not asserted in this case. The reason, of course, is that revisiting issues previously decided is precluded by the principle of res judicata. The doctrine of res judicata applies to the rulings of a Workmen's Compensation Board the same as it does to the decisions of a court. Hysteam Coal Corp. v. Ingram, 283 Ky. 411, 141 S.W.2d 570, 572 (1940). See Keefe v. O.K. Precision Tool & Die Co., Ky.App., 566 S.W.2d 804, 809 (1978) (method of computing original award could not be changed on reopening for mistake to conform to Supreme Court's later interpretation of computation statute in Apache Coal Co. v. Fuller, Ky., 541 S.W.2d 933 (1976)); compare General Elec. Co. v. Morris, Ky., 670 S.W.2d 854, 856 (1984) (on reopening of prior settlement agreement because of change of condition, new award could be computed in accordance with Apache ); cf. Whittaker v. Cecil, Ky., 69 S.W.3d 69, 73 (2002) (employer precluded by res judicata from challenging ALJ's apportionment decision by way of 803 KAR 25:075 § 3, a regulation permitting an employer to challenge the Special Fund's calculation of the employer's credit for commuted attorney's fees); Whittaker v. Morgan, Ky., 52 S.W.3d 567, 569-70 (2001) (Special Fund's failure to appeal ALJ's manner of calculating credit would have resulted in that calculation becoming the law of the case). The disease condition had been recognized as contributing to disability and used as a factor for computation in the apportionment made in the 1961 back injury claim. Therefore, it could not be regarded as dormant or nondisabling prior to the 1968 injury. Neither the employer nor the Special Fund was liable for the percentage of the resulting disability attributed to the disease condition.... Young, supra, at 836. Likewise, the pre-existing active disability attributable to Nye's 1990 back injury, having been recognized by ALJ Kerr as contributing to Nye's disability in the 1995 award, could not be disregarded by ALJ King upon reopening the same award for increased disability caused by the same injury in 2001. Thus, while ALJ King had the authority under KRS 342.125(4) to increase Nye's award in accordance with his increased disability, he was without authority to change the apportionment of causation established in the original award and to require payment of more than 78% of maximum benefits. Nor did he have the authority, in response to a petition for reconsideration, to make new findings, apply a new theory, and increase the amount of benefits awarded. Accordingly, the opinion of the Court of Appeals is affirmed in part and reversed in part. The order entered on March 21, 2001, is vacated and the award and order entered on February 20, 2001, is reinstated. LAMBERT, C.J.; GRAVES, JOHNSTONE, and KELLER, JJ., concur. WINTERSHEIMER, J., dissents by separate opinion with STUMBO, J., joining that dissenting opinion.