eNotes: Workers’ Compensation – March 2024 – West Virginia

West Virginia Case Summary

Patton Bldg. Servs., Inc. v. Kaida
State of West Virginia Supreme Court of Appeals
No. 22-0177, 2024 W. Va. LEXIS 98

Decided February 26, 2024

There must be an actual medical diagnosis for a claim to be found compensable, not simply a description of symptoms.

Background

The Claimant, a janitor, filed a claim against the Employer alleging numerous symptoms including difficulty breathing, chest pain, coughing, eye swelling, nasal passage burning, etc., related to exposure to Quat disinfectant chemicals used for cleaning. The Employer denied the claim and the Claimant protested. The Employer’s medical expert opined that the Claimant’s medical records showed no physical exam findings consistent with Quat exposure. The Claimant’s treating physician, after reviewing Quat safety data sheet information, also opined that there was no indication that the Claimant’s chronic or cumulative symptoms resulted from Quat disinfectant exposure. Nonetheless, the Office of Judges reversed the claim denial and deemed the claim compensable, finding that the material safety data sheets for Quat chemicals reflect health exposure risks for at least some of the symptoms described by the Claimant. The Board of Review affirmed the Decision of the Office of Judges, adopting their findings.

Holding

The Supreme Court of Appeals reversed the opinion of the Board of Review and Decision of the Office of Judges, disagreeing with their reasoning. The Court cited to several prior opinions over time consistently holding that symptoms are not diagnoses and cannot be held compensable. The Court noted that there is no actual medical diagnosis in this case upon which to hold the claim compensable.

Takeaway

This case reemphasizes the Court’s consistent holding that there must be an actual medical diagnosis for a claim to be found compensable, not simply a description of symptoms. This concept is true for both musculoskeletal conditions as well as occupational diseases. In considering whether to accept or deny a claim or to add a particular condition to a recognized injury, one must pay careful attention to the actual diagnosis or diagnoses listed by the medical provider. If the diagnosis or diagnoses reflects symptoms (back pain, shoulder pain, etc.) rather than specific medical conditions, it is grounds for denial.

Questions about this case can be directed to Evan Jenkins at (412) 697-7403 or ejenkins@tthlaw.com.