Alabama Workers Comp Blawg

Fish Nelson :: Attorneys at Law

Friday, March 25, 2011

Alabama Court of Civil Appeals Affirms Retaliatory Discharge Verdict in favor of Employee

Black Creek , Inc. v. Woods

The Alabama Court of Civil Appeals affirmed the Etowah County Circuit Court’s ruling in a retaliatory discharge lawsuit with no opinion in Black Creek Inc v. Wood. The Trial Court awarded $50,000.00 to the employee based on his discharge being deemed solely the result of his filing a workers’ compensation claim. $30,000.00 of the award was allocated for mental anguish and $20,000.00 was for lost wages. Judge Moore concurred in the result, with writing.

In support of the mental anguish award, Judge Moore pointed to the plaintiff’s testimony that he suffered serious financial problems, sought psychiatric care, obtained medication for depression and suffered marital strife leading to a divorce. Judge Moore cited Montgomery Coca-Cola Bottling Co. V. Golson as support that the plaintiff’s testimony provided sufficient evidence that he suffered from mental anguish as a result of his termination.

In regards to the lost wages award, the employer argued that, by receiving Social Security Disability benefits, the employee was estopped from asserting that he was able to work. The employer cited the case of Bleir v. Wellington Sears Co. which held that if an employee is discharged as the result of a workers’ compensation claim but is unable to return to work, he cannot recover lost wages. The employer acknowledged that it did not affirmatively plead estoppel as a defense and that, if not plead, the defense would be waived. However, it alleged that the pleadings should be amended pursuant to Rule 15 (b) of the Alabama Rules of Civil Procedure to conform to the evidence presented at trial. The employer argued that the Social Security Disability evidence would be relevant toward proving the defense of estoppel and it was tried without objection at trial. Judge Moore stated that this evidence also went to prove whether or not any lost wages should be offset by the Social Security Disability award. Therefore, because the employee would not have known that he was trying the estoppel issue, Rule 15 (b)@was not triggered.

Judge Moore also stated that the lost wages were from the date of termination until the plant closed in late 2001 or early 2002 and the Social Security Disability did not begin until October 2003, which would date it back to October 2002 pursuant to 42 U.S.C § 423 (b) and 20 C.F.R. § 404.621. Although it is true that the employee cannot receive workers’ compensation benefits for lost wages due to an inability to work and compensatory damages for lost wages in a retaliatory discharge claim, the burden is on the employer to prove overlapping compensation. In this case, the employer did not present any evidence as to what portion of the $20,000.00 lost wages award, if any, was related to the period that the employee received Social Security Disability benefits. Therefore, no evidence was presented to support estoppel or an off set of the lost wages award.

MY TWO CENTS:

The affirmative defense of Estoppel should always be plead in all retaliatory discharge claims where lost wages are claimed and the employee has received workers’ compensation or Social Security Disability benefits.

Released 03/25/2011

Thursday, March 24, 2011

Physical Injury to Other Body Parts not Necessary to Remove from Schedule

The Alabama Supreme Court released its opinion in Ex parte Thomas Hayes (In re: Vintage Pharmaceuticals, LLC v. Thomas Hayes) on March 18, 2011, holding that an injured worker will not be limited to the schedule when the effects of an injury extend to and interfere with the effective functioning of the remainder of the injured worker’s body.

The employee’s initial claimed injury was to his right heel. At trial, the evidence showed that he suffered a calcaneal fracture, and that a subsequent infection caused skin loss, severe pain, and loss of feeling in his heel. The employee alleged that he was permanently and totally disabled and testified that, as a result of the injury, he had to keep his right leg elevated the majority of the time, had to wear a calf-high hard brace on his right foot at all times, and experienced severe pain that was debilitating. He also presented evidence that he had a congenital birth defect in his left uninjured foot and that, due to the right foot injury, he was unable to compensate for the left foot. As a result, he suffered from poor balance and stability. Finally, he offered the testimony of a vocational expert who testified that, due to his severely altered gait, the fact that he had to use a cane to walk, and his obvious appearance of having a substantial physical disability, the employee was permanently and totally disabled. The employer argued that the employee was limited to recovery under the schedule as set forth in Alabama Code § 25-5-57(a)(3)(a).

The trial court agreed with the employee and treated his injury as to the body as a whole rather than as a scheduled member, and awarded permanent and total disability benefits. The employer appealed and the Alabama Court of Civil Appeals reversed, holding that the employee’s injury was limited to the schedule, relying on its previous ruling in Boise Cascade Corp. v. Jackson, 997 So. 2d 1026, 1036 (Ala. Civ. App. 2007). In the previous case of Ex parte Drummond Co., 837 So. 2d 831 (Ala. 2002), the Alabama Supreme Court held that, in order for an injury to a scheduled member to be compensated outside the schedule, there must be substantial evidence that the effects of the injury extend to other parts of the body and affect their efficiency. However, in Boise Cascade, the Alabama Civil Court of Appeals held that an employee who had sustained a foot injury could not recover non-scheduled disability benefits on the basis of back pain absent a showing that the foot injury caused a permanent physical injury to his back.

In its analysis, the Court of Appeals stated that the trial court erred by awarding compensation outside of the schedule because, although the employee showed that the effects of his injury extended to other parts of his body and affected their efficiency by affecting his balance and stability, he failed to show that his right foot injury actually caused an injury to any particular non-scheduled part of his body. However, after the Court of Appeals issued its opinion in Vintage Pharmaceuticals, LLC v. Hayes, the Supreme Court reversed the lower court’s decision in Boise Cascade. In Ex parte Jackson, 997 So. 2d 1038 (Ala. 2007), the Supreme Court explained that the test in Drummond does not require damage to the physical structure of other parts of the body in order to take an injury out of the schedule. The Supreme Court also pointed out that the facts of Hayes were substantially different from those in Drummond. It noted that in Drummond, the employee did not establish that the effects of his injury extended to other parts of the body based on testimony that his knee only swelled occasionally, the employee was assigned a 1% impairment, and had returned to work for almost a year after his knee surgery. It further noted that the employee’s injury had severely limited his ability to walk, and that he had been able to work prior to his injury, despite the congenital defect in his left foot. It also distinguished the two cases by noting that the employee had to use a cane or walker at all times, had fallen frequently, and had to sit or lie down frequently throughout the day with his foot elevated. By applying the facts of Hayes to the test set out in Drummond, the Supreme Court reversed the Court of Civil Appeals, holding that the effects of the employee’s foot injury extended to other parts of his body and affected their efficiency, and he was therefore entitled to compensation outside of the schedule.

Wednesday, March 02, 2011

Employer Ordered to Continue to Pay Medical Benefits Despite Settlement of Same Where CMS Declines to Accept Proposed MSA Trust Allocation

ArvinMeritor, Inc. v. Clifton Johnson:

On February 25, 2011, the Alabama Court of Civil Appeals released an opinion concerning the responsibilities of an employer when CMS fails to accept a proposed Medicare Set Aide (MSA) trust allocation. Initially, the matter proceeded to trial and the employee was held to be permanently and totally disabled as the result of an occupational disease. The employee later entered into a confidential settlement against a third party tortfeasor for an amount that significantly surpassed the employer’s financial obligations as a result of the P&T verdict. As a result, the employer asserted its rights under Section 25-5-11(a) which gives an employer the right to credit any third party proceeds against its liability for workers’ compensation (WC) benefits and the right to subrogation as to the employee’s recovery of medical expenses from a third party. The employer and employee later entered into a settlement of his WC benefits. In the settlement agreement it was noted that the employer would pay up to $65k to fund an MSA trust the remainder of which was to be paid by the employee. The agreement also noted that the trust would require funding of $83,936.17.
 
The Center for Medicare and Medicaid Services (CMS) later determined that additional sums would be required to fund the MSA trust and both parties looked to the other for the additional contribution. The Alabama Court of Civil Appeals held that neither party was required by the terms of the settlement to pay additional sums but that the employer would have to continue to pay for medical treatment until either an MSA trust was established or until the employer requested a hearing in the third party matter and seek a judicial determination as to how much of the confidential settlement was allocated for the payment of medical expenses. Once that amount was determined, then the employer would be relieved of paying medical expenses until the amount allocated in the third party case was exhausted.
 
My Two Cents: It is clear from this case that you should not enter into a settlement based on a proposed allocation unless you either first seek the approval of CMS or you include a contingency plan in the agreement that considers the possibility that CMS will either increase or decrease the amount necessary to satisfy its interests.