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Brenda Smith v. Reliable Life Insurance Company

Decision date: March 22, 2021Injury #16-03553426 pages

Summary

The Labor and Industrial Relations Commission affirmed the Administrative Law Judge's award of 12% permanent partial disability for a lumbar spine injury sustained on May 17, 2016. The Second Injury Fund was found to have no liability because the employee failed to demonstrate preexisting disabilities meeting the statutory definitions required under § 287.220.3(2)(a).

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Caption

FINAL AWARD ALLOWING COMPENSATION (Affirming Award and Decision of Administrative Law Judge with Supplemental Opinion)
Employee:Brenda J. Smith
Employer:Reliable Life Insurance Company
Insurer:Travelers Indemnity Company of America
Additional Party:Treasurer of Missouri as Custodian of Second Injury Fund
This workers’ compensation case is submitted to the Labor and Industrial Relations Commission (Commission) for review as provided by § 287.480 RSMo. Having read the briefs, reviewed the evidence, and considered the whole record, we find that the award of the administrative law judge allowing compensation is supported by competent and substantial evidence and was made in accordance with the Missouri Workers’ Compensation Law. Pursuant to § 286.090 RSMo, we affirm the award and decision of the administrative law judge with this supplemental opinion.
Discussion
The administrative law judge considered, among other issues, whether the employer was liable for permanent partial versus permanent total disability and the Second Injury Fund’s liability for permanent total disability benefits.The administrative law judge found that the employee sustained permanent partial disability of 12% of the body as a whole referable to the lumbar spine as a result of her May 17, 2016, work injury. The administrative law judge correctly noted that the § 287.220.3.(2) as revised effective January 1, 2014, applied to employee’s Second Injury Fund claim. The administrative law judge determined that the Second Injury Fund had no liability because employee failed to demonstrate, as a threshold issue, any preexisting disabilities that meet the definitions of categories (i) or (iv) as set forth in § 287.220.3(2)(a).
Section 287.220.3. (2) provides, in pertinent part:
No claims for permanent partial disability occurring after January 1, 2014, shall be filed against the second injury fund. Claims for permanent total disability under section 287.200 against the second injury fund shall be compensable only when the following conditions are met:(a) a. An employee has a medically documented preexisting disability equaling a minimum of fifty weeks of permanent partial disability compensation according to the medical standards that are used in determining such compensation which is:
Employee:Brenda J. Smith
(i)A direct result of active military duty in any branch of the United States Armed Forces.
(ii)A direct result of a compensable injury as defined in section 287.020; or
(iii)Not a compensable injury, but such preexisting disability directly and significantly aggravates or accelerates the
(iv)subsequent work-related injury and shall not include unrelated preexisting injuries or conditions that do not aggravate or accelerate the subsequent work-related injury; or
(v)A preexisting permanent partial disability of an extremity, loss of eyesight in one eye, or loss of hearing in one ear, when there is a subsequent compensable work-related injury as set forth in subparagraph b of the opposite extremity, loss of eyesight in the other eye, or loss of hearing in the other ear; and
b.Such employee thereafter sustains a subsequent compensable work-related injury that, when combined with the preexisting disability, as set forth in items (i), (ii), (iii), or (iv) of subparagraph a. of this paragraph, results in a permanent total disability as defined under this chapter
.

Employee's application for review alleges that the administrative law judge erred as a matter of law "by not addressing whether Employee was permanently and totally disabled due to a combination of pre-existing injuries and [her] primary injury in a manner that does not fall within RSMO 287.220.3 (resulting in SIF liability) but would result in permanent total disability liability for Employer/Insurer". ${ }^{1}$ Employee argues that "the evidence in this case is substantial and overwhelming that Employee was rendered permanently and totally disabled following the May 17, 2016, injury" and because employee failed to establish Second Injury Fund liability pursuant to 287.220.3, employer/insurer is liable for employee's permanent and total disability, as proven by "substantial and irrefutable"2 evidence. We disagree.

In a letter dated July 22, 2016, Dr. Michael C. Chabot found that employee had reached maximum medical improvement regarding her back and neck strain injuries. He released employee from his care and stated, "She can return to full duty". ${ }^{3}$ After a reevaluation on May 21, 2018, Dr. Chabot opined that employee remained able to return to her prior employment as an insurance sales person. He observed, "[Employee's] high level of subjective complaint [sic] with opacity of objective physical findings, inconsistencies in ROM testing, giving way and inconsistencies on physical examination all suggest symptom embellishment or significant underlying psychological conditions playing a role in her present subjective complaints and physical examination today". ${ }^{4}$

[^0] [^0]: ${ }^{1} Application for Review, filed May 6, 2020, p.1. { }^{2} Id., p. 3. { }^{3} Transcript, p. 4047. { }^{4}$ Id., p. 4045

-3-

Injury No. 16-035534

On April 12, 2019, after a review of relevant medical evidence, vocational rehabilitation counselor Mr. Benjamin D. Hughes opined that employee was capable of work at the sedentary to light levels and returning to work as a social service director, even assuming the restrictions of employee's expert Dr. David T. Volarich. Mr. Hughes further identified a number of other matching vocations including alarm system monitor, security guard, and information clerk.

We credit the opinions of Dr. Chabot and vocational expert Mr. Hughes. These expert opinions constitute competent and substantial evidence in the record. Based on this evidence, we find as a factual matter that the employee herein is not permanently and totally disabled, either due to disability related solely to her May 17, 2016, primary injury or as a result of disabilities related to her primary injury in combination with preexisting disabilities.

Because, as we have found, the employee is not permanently and totally disabled, we need not address the employee's argument, based on dicta included in a 2017 award issued by a Commission with a former Chairman and that lacked an employer representative, asserting that an employer must be liable for permanent total disability in the event an employee fails to establish liability against the Second Injury Fund pursuant to § 287.220.3.

**Conclusion**

We affirm and adopt the award of the administrative law judge as supplemented herein.

The award and decision of Administrative Law Judge Amy L. Young is attached hereto and incorporated herein to the extent not inconsistent with this decision and award.

Given at Jefferson City, State of Missouri, this _______ 22nd _______ day of March 2021.

LABOR AND INDUSTRIAL RELATIONS COMMISSION

Robert W. Cornejo, Chairman

Reid K. Forrester, Member

DISSENTING OPINION FILED

Shalonn K. Curls, Member

Attest:

Secretary

DISSENTING OPINION

The majority errs in finding that employee Brenda J. Smith is not permanently and totally disabled.

Section 287.020.6 defines total disability "as the ability to return to any employment and not merely the inability to return to the employment in which the employee was engaged at the time of the accident." The test for permanent and total disability is whether, given the employee's situation and condition, she is competent to compete in the open labor market. Reiner v. Treasurer of the State of Missouri, 837 S.W.2d 363,367. The most important question is whether an employer in the usual course of business would reasonably be expected to employ the employee in her present physical condition. Id. at 367. Additional factors such as work, experience, education, and age may be considered in determining employability. Reves v. Kindell's Merc. Co., Inc., 793 S.W.2d 917 (Mo. App. 1990).

The question of whether an employee is totally and permanently disabled is not exclusively a medical question and the Commission need not rely exclusively on the testimony of medical experts; rather, it may consider all the evidence and the reasonable inferences drawn from that evidence. Lewis v. Kansas Univ. Med. Ctr., 356 S.W.3d 796,802 (Mo. App. 2011). The Commission may even rely on testimony from the claimant herself. See Pavia v. Smitty's Supermarket, 118, S.W.3d 228, 234 (Mo. App. 2003).

The administrative law judge, while finding the employee to be a poor historian, specifically found that employee did not intentionally misrepresent facts but rather "appeared easily confused during both direct and cross-examination". ${ }^{1}$ She noted that employee alternated between standing and sitting several times during the hearing due to back discomfort and verbalized, "[O]uch". ${ }^{2}$ The administrative law judge's assessment of the employee's credibility, based on her personal observations at hearing, is at odds with Dr. Michael C. Chabot's disparagement of employee's moral character, upon which the majority relies. For this reason, Dr. David T. Volarich's expert opinion regarding the nature and extent of employee's permanent disability is entitled to greater weight.

Dr. Volarich opined that employee was permanently and totally disabled following her May 17, 2016, work injury. Dr. Stephen W. Nagy, employee's treating physician for over ten years, corroborated Dr. Volarich's opinion. In a letter dated March 21, 2017, Dr. Nagy stated, "[N]umerous symptoms and medication side effects make it impossible for [employee] to maintain any type of gainful employment." ${ }^{3}$ He further opined that employee's condition was likely to worsen over time. In that the administrative law judge found that employee's permanent and total disability was not due to the last

[^0]

[^0]: ${ }^{1} Award, p. 14.

{ }^{2} \mathrm{Id}.

{ }^{3}$ Transcript, p. 185.

injury, it is clear that employee's permanent and total disability is due to a combination of pre-existing injuries and her primary injury.

As previously stated by this Commission:

[It is] our view that the 2013 amendments [to § 287.220] are not unconstitutional, in that no rights were extinguished. This is because, "in the absence of an apportionment statute or second injury fund legislation, the employer is liable for the entire disability resulting from a compensable injury [.]"Fed. Mut. Ins. Co. v. Carpenter, 371 S.W.2d 955, 957 (Mo. 1963). In our view, the 2013 amendments to $\S 287.220$ work the effect that employers and their insurers are now liable for any enhanced permanent partial disability that results from the synergistic combination of preexisting disabilities and primary injuries occurring after January 1, 2014, as the legislature has clearly removed from employers the prior protections of the Second Injury Fund for these kind of synergistic injuries. By the same token, we believe an employer is liable for any claim of permanent total disability resulting from the combination of preexisting disability with a subsequent compensable primary injury, where the facts and circumstances of the claim do not satisfy the new and more rigorous standards set for the under $\S 287.220 .3(2)$ for proving a compensable claim of permanent total disability against the Second Injury Fund. Rather than extinguishing any rights or removing any existing remedy, the legislature in 2013 merely shifted back to employers and their insurers any liability that would have otherwise rested with the Second Injury Fund. ${ }^{4}$

The employee's credible testimony and the weight of the more credible expert testimony in the record supports a finding that employee is permanently and totally disa

Full decision text continues in the plain-text archive copy.

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