Court Opinion

ID: 9962165
Source: CourtListenerOpinion
Date Created: 2024-04-22 20:24:46.259235+00
Date Added: 2024-06-11T08:19:57.301323
License: Public Domain

IN THE INTERMEDIATE COURT OF APPEALS OF WEST VIRGINIA

CAROL L. HOOSIER, DEPENDENT OF RONNIE G. HOOSIER (DECEASED),
Claimant Below, Petitioner
                                                                           FILED
v.) No. 23-ICA-495           (JCN: 770050419)
                                                                        April 22, 2024
                                                                     ASHLEY N. DEEM, DEPUTY CLERK
APOGEE COAL COMPANY,                                                INTERMEDIATE COURT OF APPEALS
Employer Below, Respondent                                                 OF WEST VIRGINIA

and

OFFICES OF THE INSURANCE COMMISSIONER OF WEST VIRGINIA IN
ITS OFFICIAL CAPACITY AS THE ADMINISTRATOR OF THE OLD FUND,
Respondent

                              MEMORANDUM DECISION

       Petitioner Carol L. Hoosier, Dependent of Ronnie G. Hoosier (Deceased), appeals
the October 12, 2023, order of the Workers’ Compensation Board of Review (“Board”).
Respondent Offices of the Insurance Commissioner in its capacity as administrator of the
Old Fund (“Old Fund”) filed a response.1 Ms. Hoosier did not reply. The issue on appeal
is whether the Board erred in affirming the claim administrator’s order, which rejected the
claimant’s application for fatal dependents’ benefits.

       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 Board’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 Board’s decision is reversed, in part, and vacated and
remanded, in part, for further proceedings consistent with this decision.

       The decedent, Ronnie G. Hoosier, was employed by Apogee Coal Company from
1973 until 1977. Mr. Hoosier had two workers’ compensation claims during his lifetime,
one for a leg injury and the other for occupational pneumoconiosis (“OP”). Mr. Hoosier
was granted permanent total disability (“PTD”) benefits as a result of these claims. In 2016,

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       Ms. Hoosier is represented by Donald C. Wandling, Esq. Old Fund is represented
by James W. Heslep, Esq. Apogee Coal Company did not appear.

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Mr. Hoosier was diagnosed with invasive adenocarcinoma of the lung. In 2018, Mr.
Hoosier underwent a U.S. Department of Labor Medical History and Examination for Coal
Mine Workers’ Pneumoconiosis completed by J. Randolph Forehand, M.D. Dr. Forehand
diagnosed Mr. Hoosier with obstructive lung disease and pneumoconiosis and noted a
history of lung cancer, pneumonia, and pleurisy.

        On November 12, 2019, Mr. Hoosier underwent a CT scan, revealing bilateral
ground glass pulmonary opacities. On December 5, 2019, Mr. Hoosier was seen by Phillip
Cox, M.D. Dr. Cox noted that Mr. Hoosier was on continuous oxygen and complained of
shortness of breath, cough, chest pain, chest tightness, and weakness. Dr. Phillips assessed
chronic obstructive pulmonary disease (“COPD”), coronary artery disease, congestive
heart failure, cough, diabetes mellitus, exertional dyspnea, history of deep vein thrombosis,
history of pulmonary embolism, lung nodule, malignant neoplasm of lower lobe of right
lung, pleural effusion, restrictive lung disease, tobacco abuse in remission, chronic
respiratory failure with hypoxia, and coal workers’ pneumoconiosis.

       Mr. Hoosier died on February 3, 2020. Fahad F. Bafakih, M.D., authored a
pathology report dated February 4, 2020. The report indicated diagnoses of simple coal
workers’ pneumoconiosis, bilateral pulmonary embolism involving the distal vasculature,
moderately differentiated tumor deposits involving the right lung lower lobe, and clinical
history of invasive lung adenocarcinoma in the right lower lobe. Dr. Bafakih opined that
these diagnoses contributed to Mr. Hoosier’s death. Mr. Hoosier’s death certificate dated
February 25, 2020, indicated that the causes of death were adenocarcinoma of the lung,
COPD, and atherosclerotic cardiovascular disease.

       Carol Hoosier filed an Application for Fatal Dependents’ Benefits dated December
31, 2021. Ms. Hoosier alleges that the application she filed did not contain a claim number,
but that she indicated that the basis of the claim was that OP was a contributing factor in
Mr. Hoosier’s death. Ms. Hoosier further alleges that the claim administrator arbitrarily
assigned the application to Mr. Hoosier’s leg injury claim rather than the OP claim.

       On February 7, 2022, Akshay Sood, M.D., authored a report in which he opined that
Mr. Hoosier’s coal workers’ pneumoconiosis was a substantial contributing factor to his
death. George Zaldivar, M.D., drafted a report dated April 29, 2023. Dr. Zaldivar opined
that Mr. Hoosiers’ death was due to pulmonary emboli and cancer, not OP.

       By order dated August 4, 2023, the Board noted that the “evidence submitted by the
parties does not address the issue of whether the leg fracture contributed to Mr. Hoosier’s
death.” The Board also noted that the parties’ evidence addressed whether OP contributed
to Mr. Hoosier’s death, yet the claim administrator’s order denying dependent benefits
indicated that Mr. Hoosier’s death was not related to the compensable leg fracture. The
Board cited West Virginia Code § 23-4-8c (2009), which provides:

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       The Occupational Pneumoconiosis Board . . . . shall make its written report .
       . . . of its findings and conclusions on every medical question in controversy
       and the board shall send one copy of the report to the employee or claimant
       and one copy to the employer. The board shall also return to and file . . . . all
       the evidence as well as all statements under oath, if any, of the persons who
       appeared before it on behalf of the employee or claimant, or employer, and
       also all medical reports and X-ray examinations produced by or on behalf of
       the employee or claimant, or employer.

The Board noted that it appeared the matter needed to be scheduled for a hearing before
the OP Board. However, the Board ordered the parties to provide it with position statements
addressing this issue within twenty days from the date of the order. In response, Ms.
Hoosier filed a position statement on August 17, 2023, in which she noted that the evidence
submitted concerned whether OP was a material contributing factor to her husband’s death.
Further, she noted that pursuant to West Virginia Code § 23-4-8c and the Supreme Court
of Appeals of West Virginia’s ruling in Parker v. WCC, 174 W.Va. 181, 324 S.E.142 (W.
Va. Dec. 14, 1984), where a claim for dependents’ benefits is filed by a dependent of a
deceased employee with an OP claim, it must be referred to the OP Board if the exposure
requirements have been met. Ms. Hoosier concluded that the matter must be referred to the
OP Board for its review and opinion before the Board may issue its decision.

       On October 12, 2023, the Board affirmed the claim administrator’s order rejecting
Ms. Hoosier’s application for fatal dependents’ benefits, finding that the claim was filed
under a prior leg injury claim and the leg injury did not materially contribute to Mr.
Hoosier’s death. The Board made a finding that the claim administrator’s order of May 11,
2022, indicated that Ms. Hoosier filed for benefits in Mr. Hoosier’s claim for a leg injury.
However, the Board noted in its Findings of Fact that the application for fatal dependents’
benefits was not of record. Ms. Hoosier now appeals the Board’s order.

        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;

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       (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.

Duff v. Kanawha Cnty. Comm’n, 247 W. Va. 550, 555, 882 S.E.2d 916, 921 (Ct. App.
2022).

       On appeal, Ms. Hoosier argues that the application for dependents’ benefits did not
contain a reference to a claim number, but the claim was clearly based on OP being a
contributing factor to the cause of death and the claim administrator arbitrarily assigned
the application for benefits to a leg injury claim rather than the appropriate OP claim. We
agree.

        Here, the Board analyzed Ms. Hoosier’s eligibility for fatal dependents’ benefits
under Mr. Hoosier’s leg injury claim and found that his leg injury did not materially
contribute to his death. Thus, the Board affirmed the rejection of Ms. Hoosier’s application
for fatal dependents’ benefits.

       Upon review, we find that the Board was clearly wrong in analyzing this claim under
Mr. Hoosier’s leg injury claim, rather than the OP claim. We find that the record clearly
shows that Ms. Hoosier did not add a claim number to her application for benefits and the
application was then arbitrarily assigned to a leg injury claim rather than the appropriate
OP claim. We note that Old Fund failed to refute that assertion.

       Further, regardless of the issue of the claim number on the application, we find that
the Board’s affirmation of the rejection of Ms. Hoosier’s claim for fatal dependents’
benefits amounts to a denial of benefits on a technicality. We find that there is enough
evidence indicating that Ms. Hoosier intended to file her application for fatal dependents
benefits under Mr. Hoosier’s OP claim. We note that Old Fund’s main argument in front
of the Board was that OP did not materially contribute to Mr. Hoosier’s death rather than
arguing that this claim for fatal dependents benefits was inappropriately filed under a leg
injury claim. The record indicates that both parties thought the application for benefits was
appropriately filed under Mr. Hoosier’s OP claim prior to the Board finding otherwise.

        West Virginia Code § 23-5-13a (2021) provides, “It is also the policy of this chapter
to prohibit the denial of just claims of injured or deceased workers or their dependents on
technicalities.” Further, the Supreme Court of Appeals of West Virginia has noted that,
“[a]lthough the rules and regulations governing the workers’ compensation system in this
state are necessarily detailed and complex, we must be careful to prevent those deserving
of compensation from being thwarted by technicalities or procedural niceties...” Martin v.
Workers’ Comp. Div., 210 W. Va. 270, 275, 557 S.E.2d 324, 329 (2001).

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       Thus, we vacate the Board’s order insofar as it affirms the rejection of Ms. Hoosier’s
application for fatal dependent’s benefits and remand the case to the Board with directions
to issue an order making appropriate findings of fact and conclusions of law as to the non-
medical issue of Ms. Hoosier’s eligibility for fatal dependents benefits under Mr. Hoosier’s
OP claim. If it is not possible to do so based upon the record, the Board may hold a new
hearing and allow the parties to submit additional evidence.

West Virginia Code § 23-4-10(e) (2010) provides:

        If a person receiving permanent total disability benefits dies from a cause
       other than a disabling injury leaving any dependents as defined in subdivision
       (d) of this section, an award shall be made to the dependents in an amount
       equal to one hundred four times the weekly benefit the worker was receiving
       at the time of his or her death and be paid either as a lump sum or in periodic
       payments, at the option of the dependent or dependents.

This Court noted in W. Va. Offices of the Ins. Comm’r, in its Capacity as Administrator of
the Old Fund v. Jarrell, No. 23-ICA-168, 2023 WL 7203360 (Ct. App. Nov. 1, 2023), that
dependents are automatically entitled to benefits under West Virginia Code 23-4-10(e).

        The Board’s order does not specifically address Ms. Hoosier’s application for 104
weeks benefits, and it is unclear from the record whether that application was rejected.
However, we find that Ms. Hoosier is entitled to 104 weeks of dependents benefits under
West Virginia Code § 23-4-10(e). Thus, we reverse the Board’s order insofar as it affirms
the rejection of Ms. Hoosier’s application for 104 weeks benefits.

       Accordingly, we reverse, in part, and vacate and remand, in part the Board’s October
12, 2023, order, for further proceedings consistent with this decision.

                                                                     Reversed, in part, and
                                                            Vacated and Remanded, in part.

ISSUED: April 22, 2024

CONCURRED IN BY:

Judge Charles O. Lorensen
Judge Daniel W. Greear

Chief Judge Thomas E. Scarr, not participating
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