Court Opinion

ID: 9353267
Source: CourtListenerOpinion
Date Created: 2023-01-11 16:11:35.537635+00
Date Added: 2024-06-11T17:06:07.406551
License: Public Domain

IN THE INTERMEDIATE COURT OF APPEALS OF WEST VIRGINIA

                                                                             FILED
SAHAJ MORGANTOWN LLC,
Employer Below, Petitioner                                               January 10, 2023
                                                                         EDYTHE NASH GAISER, CLERK
                                                                       INTERMEDIATE COURT OF APPEALS
vs.)   No. 22-ICA-93        (BOR Appeal No.: 2058170)                        OF WEST VIRGINIA

                            (JCN: 2021008467)

TARA SAPP,
Claimant Below, Respondent

                             MEMORANDUM DECISION

       Petitioner Sahaj Morgantown LLC (“employer”) appeals the July 25, 2020, order of
the West Virginia Workers’ Compensation Board of Review (“Board”). Respondent Tara
Sapp (“claimant”) filed a timely response. 1 The employer did not file a reply brief. The
issue on appeal is whether the Board erred in affirming the decision of the Office of Judges
(“OOJ”), which held the claimant had timely submitted her claim.

       This Court has jurisdiction over this appeal pursuant to West Virginia Code § 51-
11-4 (2022). After considering the parties’ arguments, the record on appeal, and the
applicable law, this Court finds that there is error in the lower tribunal’s decision but no
substantial question of law. This case satisfies the “limited circumstances” requirement of
Rule 21(d) of the Rules of Appellate Procedure for reversal in a memorandum decision.
For the reasons set forth below, the lower tribunal’s decision is reversed and remanded for
entry of an order denying the claim as untimely filed.

        The claimant was employed by Sahaj Morgantown, LLC, as a housekeeper. On
November 13, 2019, the claimant sustained a workplace injury to her nose when she fell
while ascending stairs in the normal course of her duties. The claimant submitted her
completed Employees’ and Physicians’ Report of Occupational Injury or Disease (“WC-
1”) to her employer on May 13, 2020, seeking workers’ compensation benefits for her
injury. This was the final day the claimant could apply for workers’ compensation benefits
under the six-month statute of limitations imposed by West Virginia Code § 23-4-15(a)
(2010). 2 The matter laid dormant until the claimant’s counsel sent letters to the employer

       1
         The employer is represented by Daniel G. Murdock, Esq. The claimant is
represented by Christopher J. Wallace, Esq.

       West Virginia Code § 23-4-15(a) requires, in part that “the application for
       2

compensation shall be made . . . and filed with the Insurance Commissioner, private carrier
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on July 2, 2020, and July 15, 2020, advising that he had been retained as counsel regarding
this November 13, 2019, workplace injury. In those letters it was requested that the
claimant’s WC-1 be forwarded to the employer’s current workers’ compensation insurance
carrier, but if the claimant received no response from the employer, it would be assumed
the employer no longer possessed current workers’ compensation coverage and the matter
would be referred to the West Virginia Office of the Insurance Commissioner. These letters
further advised that based on counsel’s research it appeared the employer’s most recent
workers’ compensation carrier on record was East Guard Insurance Company (“East
Guard”). After the employer did not respond, claimant’s counsel submitted a letter to the
West Virginia Office of the Insurance Commissioner’s Uninsured Employer Fund on
November 17, 2020, regarding the claim. On November 20, 2020, the claimant’s counsel
was advised by the Office of the Insurance Commissioner, that the employer still had an
active workers’ compensation policy with East Guard. On January 4, 2021, the claimant’s
counsel sent a letter with the WC-1 to East Guard asking it to recognize the claim and pay
the benefits due. By order dated March 22, 2021, the claim administrator rejected the claim.
The claimant timely filed a written protest to the claim administrator’s decision with the
OOJ.

       The main issues raised before the OOJ were the compensability of the claim and
whether the claim was timely filed within six months of the date of injury “with the
Insurance Commissioner, private carrier or self-insured employer, whichever is
applicable,” under West Virginia Code § 23-4-15(a). 3 The claimant argued that the WC-1
was timely filed with her employer in compliance with the statute. Conversely, the
employer argued that because the claimant did not file her claim with the employer’s
private insurance carrier, East Guard, within six months as required by law, it was time
barred. On November 1, 2021, the OOJ issued a written decision reversing the claim
administrator and finding the claim compensable. On December 1, 2021, the employer
filed a motion asking the OOJ to reconsider its order because it did not address the
employer’s argument regarding the timeliness of the claimant’s WC-1. The motion was
granted and on March 11, 2022, the OOJ issued a new written decision finding by a
preponderance of the evidence that the claim was both compensable and timely filed. In
concluding the WC-1 was timely filed under West Virginia Code § 23-4-15(a), the OOJ

or self-insured employer, whichever is applicable, within six months from and after the
injury[.]”
       3
         The employer also raised issues related to the physician’s portion of the WC-1 and
the veracity of the handwritten statement of a purported witness who saw the claimant
submit the WC-1 to her employer on May 13, 2020. However, because we have accepted
May 13, 2020, as the date of submission to the employer, we dispose of this appeal on the
issue of timeliness under West Virginia Code § 23-4-15(a). Therefore, the Court will not
address the employer’s remaining arguments regarding the additional factual findings by
the OOJ herein.
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found that the claimant could not be held responsible for submitting her form to her
employer instead of East Guard because the multiple letters from the claimant’s counsel to
various parties showed that the claimant had no knowledge of East Guard as the employer’s
workers’ compensation carrier, and that the employer failed to contact or identify the
carrier for the claimant in advance of the May 13, 2020, deadline to file her claim.

       The employer appealed this decision to the Board. On July 25, 2022, the Board
entered an order adopting the findings of fact and conclusions of law of the OOJ and
affirming the decision below. It is from this July 25, 2022, decision that the employer now
appeals.

        The employer appeals the Board’s ruling to this Court. 4 Our standard of review is
set forth in West Virginia Code § 23-5-12a(b) (2022), in part, as follows:

       The Intermediate Court of Appeals may affirm the order or decision of the
       Workers’ Compensation Board of Review or remand the case for further
       proceedings. It shall reverse, vacate, or modify the order or decision of the
       Workers’ Compensation Board of Review, if the substantial rights of the
       petitioner or petitioners have been prejudiced because the Board of Review’s
       findings are:
       (1) In violation of statutory provisions;
       (2) In excess of the statutory authority or jurisdiction of the Board of Review;
       (3) Made upon unlawful procedures;
       (4) Affected by other error of law;
       (5) Clearly wrong in view of the reliable, probative, and substantial evidence
       on the whole record; or
       (6) Arbitrary or capricious or characterized by abuse of discretion or clearly
       unwarranted exercise of discretion.

       On appeal, the employer argues the Board erred by affirming the OOJ’s
determination that the claimant’s WC-1 was timely filed. Specifically, the employer avers
the claimant was required to submit her WC-1 to the employer’s private workers’
compensation insurance carrier, East Guard, by May 13, 2020, but failed to do so, rendering
her application for benefits time barred. After review, we agree.

       West Virginia Code § 23-4-15(a) directs that,

       4
         The employer’s brief omits an assignment of error section, which is required by
Rules 10(c)(3) and 12(e) of the West Virginia Rules of Appellate Procedure. Counsel is
directed to comply with the requirements of our Rules of Appellate Procedure in all future
filings with this Court.
                                              3
       the application for compensation shall be made . . . and filed with the
       Insurance Commissioner, private carrier or self-insured employer, whichever
       is applicable, within six months from and after the injury. . . and unless filed
       within the six months period, the right to compensation under this chapter is
       forever barred, such time limitation being hereby declared to be a condition
       of the right and hence jurisdictional[.]

In this regard, our state’s highest court has expressly held that “the six-month time
limitation in West Virginia Code § 23-4-15(a) is jurisdictional and a condition of the right
to compensation under the Workers’ Compensation Act.” Sheena H. ex rel. Russell H. v.
Amfire, LLC., 235 W. Va. 132, 138, 772 S.E.2d 317, 323 (2015). Further, it is the duty of
a claimant to timely file his or her workers’ compensation application. Young v. State
Comp. Comm’r, 121 W. Va. 126, 132, 3 S.E.2d 517, 520 (1939). “[T]he failure of an
employer or a claims administrator to provide information on how to file a worker’s
compensation claim, by itself, is not an excuse for an employee’s failure to timely apply
for workers’ compensation benefits.” Baker v. Ctr. Foundry Mach. Co., 2018 WL 2261275,
at *5 (W. Va. May 17, 2018).

        In finding the claim was timely filed, the OOJ and Board were persuaded by the
letters from claimant’s counsel to the employer, Insurance Commissioner, and claim
administrator. In the OOJ and Board’s opinion, the letters established that the claimant had
no knowledge of the identity of the employer’s private insurance carrier due to the
employer’s lack of cooperation, and thus turning the WC-1 into the employer complied
with the statute. We disagree.

        While it was recognized in France v. Workmens’ Compensation Appeal Board, 117
W. Va. 612, 186 S.E. 601 (1936), that a claimant’s failure to timely file a WC-1 may be
excused when the failure was caused by misleading or deceitful actions of an employer or
its insurance carrier, the claimant here does not raise that issue and offered no evidence to
support such a conclusion. Not only were the letters dated months after the timeframe set
forth in West Virginia Code § 23-4-15(a) had expired, but more critically, the letters failed
to allege any misleading or deceitful conduct by the employer or East Guard to substantiate
the OOJ and Board’s conclusion that the claim was timely filed. Therefore, we find that
pursuant to West Virginia Code § 23-4-15(a), the claimant was required to submit her WC-
1 to East Guard, not her employer, by May 13, 2020.

       The claimant having failed to do so, we conclude that the WC-1 application was
time barred and that the OOJ’s findings regarding the timeliness of the claimant’s WC-1
application were clearly wrong in view of the reliable, probative, and substantial evidence
on the whole record. Because we find the claimant’s WC-1 was time barred, we are further
compelled to conclude that the Board was without jurisdiction to consider the matter and
exceeded its statutory authority by finding the claim was timely filed.
                                              4
       The Court recognizes that since the initial rulings in this case, the review process
for workers’ compensation claims has changed. West Virginia Code § 23-5-8a(a) (2022)
provides that,

       [t]he Workers’ Compensation Office of Administrative Law Judges, referred
       to as the Office of Judges, shall terminate on or before October 1, 2022, as
       provided in §23-5-8b of this code. All powers and duties of the Office of
       Judges to review objections, protests, or any other matter authorized by this
       chapter, shall be transferred to the Workers’ Compensation Board of Review
       on July 1, 2022: Provided, That any objection or other matter filed pursuant
       to this chapter and pending before the Office of Judges upon its termination,
       in which a final decision has not been issued, shall also be transferred to the
       Workers’ Compensation Board of Review as provided in §23-5-8b of this
       code.

        Accordingly, we reverse and remand this matter to the Board of Review for entry
of an order denying claimant’s workers’ compensation application as untimely, consistent
with this opinion.

                                                  Reversed and Remanded with Directions.

ISSUED: January 10, 2023

CONCURRED IN BY:

Chief Judge Daniel W. Greear
Judge Thomas E. Scarr
Judge Charles O. Lorensen

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