Court Opinion

ID: 9722240
Source: CourtListenerOpinion
Date Created: 2023-08-26 09:21:56.842431+00
Date Added: 2024-06-11T13:06:24.160423
License: Public Domain

COOPER, Justice,
dissenting.
The majority opinion has sua sponte created a new rule for “gradual injury” *280cases that inexplicably departs from the sound principles established in cases such as American Printing House for the Blind v. Brown, 142 S.W.3d 145 (Ky.2004), which was so recently decided that there were ink stains on my hands after reviewing it. Because this new rule undoubtedly will discourage voluntary payments and settlements of such cases and encourage insurers to avoid liability by canceling coverage, thereby encouraging employers to terminate partially disabled workers, I respectfully dissent.
The issue in this case, as it was in American Printing House, is which of two successive insurers of the same employer provided coverage for a work-related gradual injury, i.e., on what date did the injury legally occur? In Randall Co. v. Pendland, 770 S.W.2d 687 (Ky.App.1989), the Court of Appeals adopted a rule of discovery and held that the date of injury is “when the disabling reality of the injuries .becomes manifest,” id. at 688, i.e., when the worker experiences disabling symptoms of pain. In Alcan Foil Products v. Huff, 2 S.W.3d 96 (Ky.1999), we refined that rule by holding that the compensable injury manifests itself “where a worker discovers that a physically disabling injury has been sustained [and] knows it is caused by work,” regardless of whether the worker thereafter continues to work in the same employment. Id. at 101.
In American Printing House, the employer’s workers’ compensation insurer for the period prior to October 1, 2000, was Mutual Insurance Company of America (MICOA); its insurer on and after that date was KESA. The worker began to experience pain in her wrists on June 5, 2000, and immediately gave notice to her employer that she had sustained a work-related injury. On June 28, 2000, she complained to the company nurse of arm and shoulder pain. In November 2000, she informed her employer that her physician had diagnosed her condition as carpal tunnel syndrome. She continued to work until January 8, 2001. On January 11, 2001, she saw Dr. Roberts (not further identified), who diagnosed carpal tunnel syndrome and concluded that the condition was work-related. We held that June 5, 2000, was the date of the injury for coverage purposes, not November 2000 or January 11, 2001, even though the worker was not diagnosed with carpal tunnel syndrome and was not advised by a medical expert that' the condition was work-related until after the coverage changed on October 1, 2000:
It is undisputed that the claimant sustained work-related trauma and that harmful changes from the trauma were symptomatic on June 5, 2000. Therefore, she sustained an injury as defined by KRS 342.0011(1) although Chapter 342’s notice and limitations provisions were not triggered until she received a medical diagnosis in January, 2001.
Id. at 148. Thus, MICOA was the responsible insurer (and, incidentally, the employee received seven additional months of benefits). See also Special Fund v. Clark, 998 S.W.2d 487, 490 (Ky.1999) (holding that the “date of accident,” for statute of limitations purposes, in a gradual injury claim is the date the worker becomes aware of the existence of a disabling condition and the fact that it is caused by work).
In the case sub judice, the facts are virtually identical as those in American Printing House (even the dates roughly correspond). Kentucky Employers Mutual Insurance Co. (KEMI) was the workers’ compensation insurer for Southeastern Kentucky Rehabilitation Industries until it canceled its coverage effective May 1, 2000. Century Insurance Co. was Southeastern’s insurer after that date. Southeastern employed Appellant as an assem*281bly line worker from October 11, 1999 through December 11, 2000. The work required repetitive use of her arms and hands. In early April 2000, Appellant developed symptoms of what she believed to be tendonitis and purchased two arm braces at Wal-Mart, later explaining that she did so “[b]eeause other girls at work was, you know, wearing them and they told me that it helped a lot.” On April 17, 2000, Appellant sought treatment at White House Clinic in McKee, Kentucky, because:
I had went to work and my hands was hurting. And I asked her if there was something that she could give me or give me advice on my hands.
She was seen and treated by Jean L. Fee, a nurse practitioner, whose handwritten note in the clinic’s medical records reflects “problems with hands, swelling, fingers numb.” Fee diagnosed “[pjrobable repetitive motion syndrome of both upper extremities” and gave Appellant a new pair of wrist splints and some pain medication. Appellant testified that Fee told her on that date that her condition was work-related and that she should wear the splints when working and rest her hands as much as possible. Appellant notified Gretta Lawson, her personnel supervisor, of Fee’s advice and Lawson reassigned Appellant to a different assembly-line job.
On October 6, 2000, Appellant returned to White House Clinic and presented the same symptoms to Dr. Daniel Adkins, who diagnosed “probably early carpal tunnel syndrome” and tendonitis. Dr. Adkins prescribed a Colles’ splint and pain medication. Appellant returned on October 10, 2000, and told Dr. Adkins that she was unable to work and that she “wants to file a workman’s comp claim.” Dr. Adkins’ record for that date contains the following handwritten note: “has forms she wants filled out states DOI k!17/00.” (Emphasis added.) Dr. Adkins referred her to Dr. Paul Brooks for electromyography (EMG) testing. Dr. Brooks’s report, dated November 1, 2000, reflects a “conclusion” of “Electrodiagnostic evidence of bilateral mild median mononeuropathies at the wrist.” Appellant continued to work sporadically until December 11, 2000, when she finally quit. Thus, the facts of this case are virtually identical to those in American Printing House.
On her Application for Resolution of Injury Claim, Appellant stated that the date of her injury was April 17, 2000 (the date she learned that her disabling condition was work-related). She later amended her application to allege an alternate date of injury of October 6, 2000, the date Dr. Adkins diagnosed her disabling condition as “probably carpal tunnel syndrome” and tendonitis. The Administrative Law Judge (ALJ) made a finding of fact that Appellant became awai’e of both her disabling condition and that it was caused by her work on April 17, 2000, and the ALJ concluded from that finding that the date of injury and the relevant date for determining which insurer provided coverage for the claim was April 17, 2000. The ALJ also found that “[t]his is not a case in which the worker’s symptoms improved, and a ‘new injury’ became manifest at a later date.” Brummitt v. Southeastern Ky. Rehab. Indus., Inc., No. 00-66642, slip op. at 8 (Ky. Dep’t of Workers’ Claims Oct. 28, 2002). In other words, there was only one injury, not two separate injuries occurring on both April 17, 2000, and October 6, 2000. Appellant has never contested that finding and does not claim on appeal that she sustained more than one injury. That theory is promulgated for the first time in today’s majority opinion.
The Workers’ Compensation Board unanimously affirmed, noting that the ALJ’s findings of fact were supported by *282“substantial evidence” and that her conclusions were “not wholly unreasonable as a matter of law.”
As aptly pointed out by the ALJ, this claim involves neither notice or [sic] statute of limitations; however, both Brummitt and South Eastern [sic] concede the respective rights and obligations of the parties become fixed on the date of manifestation of disability. This manifestation of disability date is a fact intensive determination by the fact finder based upon the particular circumstances in each case.... [A]n ALJ is authorized to conclude, if supported by evidence of record, that a disability could manifest on the date the claimant seeks treatment and is -informed on that occasion that her condition is related to her work.
Brummitt v. Southeastern Ky. Rehab. Indus., Inc., No. 00-66642, slip op. at 4-5 (Ky. Workers’ Comp. Bd. Apr. 23, 2003).
The Court of Appeals also unanimously affirmed, noting that the standard of review is “to correct the Board only where it has overlooked or misconstrued controlling statutes or precedent, or committed an error in assessing the evidence so flagrant as to cause injustice.” Brummitt v. Southeastern Ky. Rehab. Indus., Inc., No. 2003-CA-001055, slip op. at 6-7, 2003 WL 22417228 (Ky.App. Oct. 24, 2003) (citing W. Baptist Hosp. v. Kelly, 827 S.W.2d 685, 687-88 (Ky.1992)). Both the Board and the Court of Appeals noted that our cases do not require that the worker be aware of the precise diagnosis of the disabling condition, so long as the worker is aware of the existence of the condition and the fact that it is work related. That principle was most recently reiterated in American Printing House, 142 S.W.3d at 148-49, in which we held that the date of injury was June 5, 2000, when the worker gave her employer notice of her work-related gradual injury, even though the medical diagnosis of work-related carpal tunnel syndrome was not made until January 11, 2001. Thus, the date of injury in this case does not turn on whether the swelling of Appellant’s hands and the numbness in her fingers were caused by tendonitis (Appellant), repetitive motion syndrome (Jean Fee), carpal tunnel syndrome and tendonitis (Dr. Adkins), or bilateral mild median mononeuropathies (Dr. Brooks). Appellant admitted that she was aware of the swelling and numbness prior to April 17, 2000, and that she learned on that date that the swelling and numbness were caused by her work. She gave notice to her employer on that same date.
The ALJ’s finding that a new injury did not occur on October 6, 2000, is also supported by substantial evidence and, thus, is binding on appeal. KRS 342.285(1). The White House Clinic records for October 6, 2000, reflect that Appellant “had the same symptoms six months ago.” Nor did Appellant testify that her .symptoms were different on October 6, 2000. But even if she had, “[o]nce a worker is aware of the existence of a disabling condition and the fact that it is caused by work, the worker would also be aware that continuing to perform the same or similar duties was likely to cause additional injury.” Special Fund v. Clark, 998 S.W.2d at 490. Appellant has never claimed that she sustained more than one gradual injury. She only claims that the injury did not manifest itself until it was specifically diagnosed as carpal tunnel syndrome on October 6, 2000, the very same argument that we rejected in American Printing House.
The majority opinion’s sua sponte holding that a gradual injury claim can be divided into a series of mini-injury claims to be separately litigated against an employer’s subsequent insurers is simply unworkable. Insurers like KEMI will at*283tempt to reduce their own liability by proving that the worker’s gradual injury worsened during a subsequent period when the employer was covered by a different insurer. That is especially true here, where KEMI cancelled its coverage only fourteen days after Appellant’s manifestation of injury but Appellant continued to work for more than seven months thereafter. Based upon today’s holding, we should have held in American Printing House that MICOA, the insurer providing coverage on June 5, 2000, was liable only for benefits that accrued prior to October 1, 2000, and that KESA, the subsequent insurer, was hable for benefits accruing thereafter. It is no answer to say that the issue was not raised in American Printing House — -for neither was it raised here.
Today’s holding will also encourage insurers to cut their losses by canceling coverage for employers who retain gradually injured workers with only partial disabilities on them employment rolls, and it will discourage potential subsequent insurers from accepting coverage and, thus, assuming liability for payments to previously injured workers. This, in turn, could encourage employers to terminate gradually injured workers, who otherwise might remain gainfully employed, in order to obtain new coverage at a reasonable premium. This holding will also inhibit voluntary payments and settlements of gradual injury claims if an otherwise liable insurer believes it can reduce or avoid future payments by canceling coverage. Would KEMI have settled with Appellant if it had known that its liability for benefits expired fourteen days after the date of injury? I hope we have not made this unfortunate change in the law solely because Appellant did, in fact, settle her claim against KEMI and, thus, could recover additional benefits only against Century. However, I am aware of no fact, other than the claimant’s settlement with the otherwise responsible insurer, that distinguishes this case from American Printing House.
Accordingly, I dissent.
GRAVES, J., joins this dissenting opinion.