Court Opinion

ID: 9806322
Source: CourtListenerOpinion
Date Created: 2023-08-31 18:55:30.322761+00
Date Added: 2024-06-11T11:03:00.071862
License: Public Domain

Robinson, J.,
¶ 38. concurring and dissenting. I note at the outset that this conversation necessarily takes place in something of a time warp. The majority’s opinion begins with the premise that a claim for permanent partial disability benefits is subject to its own statute of limitations, even if the claimant has initiated a claim for the underlying work-related injury within the applicable limitations period. As the majority acknowledges, ante, ¶ 28 n.7, the Legislature amended the law effective May 26, 2004, and made it clear that, while a claimant’s initiation of workers’ compensation proceedings is subject to the statute of limitations, specific claims for the various benefits to which an injured worker with a compensable injury is entitled — such as a claim for permanent partial disability benefits — are not each individually subject to a separate statute of limitations. See 21 V.S.A. § 660(a); 2003, No. 132 (Adj. Sess.), § 6 (shortening statute of limitations to three years and providing that section “shall not be construed to limit subsequent claims for benefits stemming from a timely filed work-related injury claim”). If claimant had been injured on May 27, 2004, and had duly filed a report of injury and generic claim for benefits at that time, the statute of limitations would have no bearing on the impact of a comparable delay in seeking permanent partial disability benefits.
¶ 39. I point this out not because the majority’s focus on pre-2004 law is inappropriate; it is not. Claimant here was injured in 1996. See Carter v. Fred’s Plumbing & Heating Inc., 174 Vt. 572, 574, 816 A.2d 490, 493 (2002) (mem.) (noting, in workers’ compensation case, that appropriate statute of limitations is one in effect when cause of action accrued). I emphasize the clear state of our current law on this point because the notion that a *547workers’ compensation case is open-ended, and that a claimant may not be statutorily barred from pursuing a claim for benefits years after an injury, and even years after the claim for benefits has arisen, is not particularly shocking or unusual. This is one of the most striking features distinguishing workers’ compensation from its tort-law cousin.
¶ 40. Even under the pre-2004 regime, when this Court construed the workers’ compensation laws to subject claims for permanent partial disability benefits to their own separate statute of limitations, the limitations clock did not begin ticking until the claimant reached a medical end result. Kraby v. Vt. Tel. Co., 2004 VT 120, ¶ 6, 177 Vt. 614, 868 A.2d 689 (mem.). A medical end result (also called an “end medical result” or “maximum medical improvement”) is “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 Vocational Rehabilitation Rule 51.1100, 3 Code of Vt. Rules 24 010 012-1, available at http:// www.lexisnexis.com/hottopics/codeofvtrules. This point may not arrive until years after the initial injury. See, e.g., Laumann v. Dep’t of Pub. Safety, 2004 VT 60, ¶ 2, 177 Vt. 52, 857 A.2d 309 (noting that worker “reached medical end result . . . more than three and a half years from the date of the incident”); E.H. v. Mack Molding Co., No. 14-09WC, 2009 WL 1648082, at *4 (Vt. Dep’t of Labor & Industry May 13, 2009) (commissioner accepted opinion testimony of claimant’s treating physician that it could take claimant “up to five years to reach end medical result”).
¶ 41. I also flag the 2004 amendment in order to emphasize the temporal limits of the majority’s critique of the requirement now reflected in Workers’ Compensation Rule 18.1100, 3 Code of Vt. Rules 24 010 003-4.9 That rule provides that once the injured worker reaches a medical end result, the employer or insurer must take action to determine whether the employee has any permanent impairment as a result of the work injury. The majority reasons that in Longe v. Boise Cascade Corp., 171 Vt. 214, 762 A.2d 1248 (2000), this Court found no statutory basis to support the argument that an employer’s failure to investigate whether the injured worker has a permanent impairment tolls the *548statute of limitations associated with that claim. Claimant here is arguing that employer’s failure to investigate whether claimant suffered a permanent partial disability (as required by Rule 18.1100) has tolled the applicable statute of limitations — the same argument presented in Longe. Because the Legislature has made no changes to the statute with respect to tolling, the majority argues, the Court’s decision in Longe applies with equal force here, and there is no tolling of the statute of limitations. The commissioner’s adoption of a rule suggesting otherwise does not affect the analysis since only the Legislature can change the law as it relates to tolling of the statute of limitations.
¶ 42. Putting aside the merits of this argument as it relates to this pre-2004 injury, the Legislature’s elimination of any distinct statute of limitations for permanent partial disability claims renders the majority’s appraisal of the former Rule 18(a) obsolete as it relates to injuries that arose on or after May 26, 2004. I digress to stress that the majority’s opinion is a limited response to a case that arose in the context of a since-abandoned statutory scheme.
¶ 43. Even in the context of the old framework, I find the analysis problematic because it relies on an after-the-fact assumption that the claimant reached a medical end at a specified time, such that the limitations clock started ticking, when there was no contemporaneous medical evidence to support the claim. This is contrary to the clear requirement in workers’ compensation law that once a claim is accepted or established, the burden of establishing that the claimant has reached a medical end point falls on the employer.
¶44. Bear in mind that “successful return to work” and “end medical result” are distinct concepts, with different ramifications. The former means that the claimant has demonstrated “the physical capacity and actual ability to perform the duties of the job, without disabling pain and/or imminent risk of re-injury.” Workers’ Compensation Rule 18.1410, 3 Code of Vt. Rules 24 010 003-14. The latter means that the claimant has “reached a substantial plateau in the medical recovery process, such that significant further improvement is not expected, regardless of treatment.” Workers’ Compensation Vocational Rehabilitation Rule 51.1100, 3 Code of Vt. Rules 24 010 012-1. A claimant who has reached a medical end — with his or her condition having improved as much as it is likely to — may or may not be able to return to work.
*549¶ 45. Similarly, a successful return to work does not imply that a claimant has reached a medical end point; often a claimant is able to perform the duties of his or her job well before his or her condition improves to its maximum extent. In fact, when a claimant’s temporary disability benefits end on account of a return to work, that claimant is entitled to resume temporary total disability benefits upon notice to the carrier that his or her return to work has proven unsuccessful, despite reasonable good-faith efforts — unless the employer or insurer has filed a Form 27 (Notice of Intention to Discontinue Payments) based on claimant’s reaching of an end medical result. Workers’ Compensation Rules 18.1200-.1420, 3 Code of Vt. Rules 24 010 003-14 to -15. In this case, even though claimant had successfully returned to work, employer’s exposure to continuing temporary total disability benefits, or to temporary partial disability benefits, continued indefinitely because employer never,filed a Form 27. Had claimant’s return to work failed at some point, employer would have been presumptively back on the hook for temporary total or temporary partial disability benefits unless and until it filed a Form 27 discontinuance. A discontinuance, in turn, must be filed with “adequate, written medical documentation” in order to be effective. Id. 18.1200, 3 Code of Vt. Rules 24 010 003-14.
¶46. In short, wholly apart from the requirements of Rule 18 concerning the employer’s obligation to investigate permanent partial disability, the statutory and regulatory scheme assigned to the employer the burden of demonstrating medical end point. Wood v. Fletcher Allen Health Care, 169 Vt. 419, 422-23, 739 A.2d 1201, 1204-05 (1999) (citing Merrill v. Univ. of Vt., 133 Vt. 101, 105, 329 A.2d 635, 637 (1974)); see also Peabody v. Home Ins. Co., No. 69-98WC, 1998 WL 940287, at *4 (Vt. Dep’t of Labor & Industry Dec. 23, 1998) (“The burden is on the employer to demonstrate that the claimant has reached a medical end result.”). The medical end point was, in turn, the starting point for the six-year limitations period for filing a claim for permanent disability benefits under the old framework.
¶ 47. With that in mind, I consider the summary judgment record here.10 There is no dispute that the last medical record *550concerning claimant’s condition prior to his 2010 impairment rating was from Dr. Thatcher on July 8, 1996. There can be no dispute that Dr. Thatcher did not conclude that claimant had reached a medical end result at that time. Instead, Dr. Thatcher noted that he offered claimant physical therapy, but claimant was not interested. He wrote, “If he does not improve over the next several months, which I think he will, then he will get in touch with us for some PT. In general, it takes a year to completely recover from such an injury.” Claimant saw Dr. Thatcher approximately six months after his injury.
¶ 48. There can be no doubt, as a matter of law, that if employer had filed a Form 27 discontinuance, asserting that claimant had reached a medical end and attaching this record, it would have been rejected. The doctor’s clear statement that he expected claimant to improve over the next several months, and that the typical time to fully recover from such an injury was a year, flies in the face of the suggestion, adopted by the commissioner, that claimant reached a medical end on July 8, 1996. Likewise, if employer had filed a Form 27 six months later, with no new medical evidence, and no affirmation that claimant’s condition had improved and then plateaued as expected, it would not have met the requirements of Rule 18.1200.
¶ 49. I have no reason to think that claimant did not reach a medical end result at some point along the way — whether in a month, six months, a year, or more. But we also have no basis for ascertaining when that happened. Instead, here we are a decade and a half later, retroactively reconstructing the record and making what is, at best, an educated guess. And we are doing that despite the fact that throughout the entire period, employer bore the burden of providing evidence to support discontinuing benefits on the ground that claimant had reached a medical end result. Of course, employer had no pressing incentive to do so, because claimant had returned to work. Although the potential for pay*551ment of additional temporary disability benefits remained, employer here did not have the same incentive to expeditiously secure a determination of medical end result that employers have in cases in which the claimant does not return to work. In fact, its incentives may have pointed the other way: further evaluation could well have exposed employer to further liability for medical care, temporary disability benefits, or permanent disability benefits. But, incentive or not, in the framework of the workers’ compensation system, if employer wanted to claim the benefits of claimant’s “medical end” status, it had the burden of taking the necessary steps to establish the status.
¶ 50. That brings me to a second major distinction between the workers’ compensation process and ordinary personal-injury tort cases. In workers’ compensation cases, the employer has a tremendous amount of power to direct the claimant to see providers of the employer’s choosing from time to time. Workers’ Compensation Rule 13.0000, 3 Code of Vt. Rules 24 010 003-9. Employer not only had the duty to establish when claimant reached a medical end result, if it intended to rely on that determination, but it had the ability to do so easily — in fact, more easily than a claimant who is unfamiliar with the exact questions to ask, and the process for securing such opinions.11
¶ 51. Under these circumstances, I .do not see how employer can invoke the statute of limitations that applied to claimant’s permanent partial disability claim. I am not resting my analysis primarily on employer’s failure to secure an impairment rating — although as a practical matter the determination of medical end and impairment evaluation are often (though not always) part of the same medical assessment. And I am not arguing that employer’s failure in this regard tolled the statute of limitations. I am *552arguing that the clock never started running in the first place, because the power and the responsibility to establish a condition precedent to the ticking of the clock — claimant’s medical end status — fell to employer. Because employer failed to act, the clock never started ticking. No assessment by a medical expert more than a decade later can retroactively change that history.
¶ 52. For that reason, I respectfully dissent. Although I concur in the majority’s judgment as to the first certified question, and concur in its conclusion that Workers’ Compensation Rule 18(a) applies to injuries sustained prior to the effective date of the rule, I would answer the second certified question in the negative and conclude that the statute of limitations does not bar claimant’s claim for permanent partial disability benefits.12

 The commissioner adopted this rule in 2001. It is the successor to Rule 18(a), discussed in the majority opinion.

 The majority states that the commissioner “found” that claimant reached a medical end point on July 8, 1996. Ante, ¶ 2. Insofar as the commissioner decided this case on summary judgment, without an evidentiary hearing, I treat the *550commissioner’s determination on this point as a legal conclusion based on the summary judgment record rather than as a finding of fact. Consistent with this posture, our review of the commissioner’s determination of law should be deferential. Cyr v. McDermott’s, Inc., 2010 VT 19, ¶ 14, 187 Vt. 392, 996 A.2d 709 (“[WJhile we require the Commissioner’s conclusions to reflect the correct interpretation of the law, we will uphold the Commissioner’s construction of the workers’ compensation statutes absent a compelling indication of error.” (alteration and quotation marks omitted)).

 For this reason, I don’t accept the majority opinion’s narrative that only claimant knew whether his condition had stabilized and that there was no way for employer to know he had a lingering disability. See ante, ¶ 34. In workers’ compensation cases, claims adjusters closely monitor, and in some cases effectively manage, the course of a claimant’s medical treatment. Those adjusters are intimately familiar with the applicable laws and medical concepts, and are quite experienced in setting up evaluations for a determination of medical end point, as well as for impairment ratings. The suggestion that claimant hid the ball here, and that employer bears no responsibility for creating the situation giving rise to this ease ignores the reality that employer had both the duty and the power to close the deal and for whatever reason — perhaps neglect, perhaps a strategic calculation — failed to do so.

 I would not reach the question of whether the employer’s failure to secure an impairment rating for the claimant tolled the statute of limitations because I conclude that the limitations period never began running due to the employer’s failure to file a discontinuance documenting claimant’s medical end.