eNotes: Workers’ Compensation – February 2022 – West Virginia

SIGNIFICANT CASE SUMMARIES

WV CASE SUMMARY

Blue Flame Pipeline, LLC v. James Thomas
State of West Virginia, Supreme Court of Appeals
No. 20-0291 (Memorandum Decision)

Decided: June 23, 2021

Even though the claims administrator never received a WC-1 Report of Injury, notice was sufficient under WV Code §23-4-15(a) because the claims administrator had actual notice of the injury in a timely fashion

Background

The Claimant sustained a head injury/concussion in a fall at work on July 12, 2018. The Claimant was taken to an urgent care facility, where both the Claimant and a physician filled out the WC-1. The Claimant was then transported to a hospital for evaluation of a possible concussion. Shortly thereafter, the Claimant received several documents from the claims administrator including acknowledgement of the reporting of the injury, claim forms, and ID card. The WC-1 was never submitted to the claims administrator.

The Claimant had a number of follow up visits to the hospital for a myriad of symptoms, most notably seizures, and was diagnosed with seizure disorder related to the aforementioned head injury. Both the Claimant and hospital completed a second WC-1, which was again never submitted to the claims administrator. On May 30, 2019 (outside of the six-month statute of limitations), the claims administrator issued a claim decision denying the claim due to failure of the claimant to provide timely statutory notice by virtue of submission of the WC-1, to which the Claimant filed a protest. In testimony, the claims administrator acknowledged that they were aware of the injury within the limitations time frame and did not mention to the claimant the WC-1 requirement. The Office of Judges issued a Decision affirming the claim decision, but the Board of Review reversed and found the claim to be timely filed. The employer appealed.

Holding

The WV Supreme Court of Appeals affirmed the Board of Review’s Decision and upheld its ruling that the claim was timely filed. The Supreme Court held that the purpose of the WC-1 is to provide notice to the employer and insurance company that a work injury has, in fact, taken place and that the employee will require insurance coverage by virtue of payment of necessary benefits. The Court ruled that both the employer and insurance carrier had “actual notice” of the work injury, leading the Claimant to believe that he had an established claim and entitlement to benefits.

Takeaway

This case represents final clarification that timely submission of the WC-1 form is no longer an absolute requirement for notice of a work injury, even if a claimant has not been misled by the employer relative to its submission. The WC-1 is now simply another option for an employee to show notice of a work injury. Timely notice of a work injury can be provided through any means of communication between employee and employer and is to be assessed on a case-by-case basis.

Questions about this case can be directed to Evan Jenkins at ejenkins@tthlaw.com or (412) 926-1419.