WILLIAM CRAIG COLEMAN V. EMILY ENTERPRISES, INC.; RICHARD H. CAMPBELL, JR., ADMINISTRATIVE LAW JUDGE; AND WORKERS' COMPENSATION BOARD
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WILLIAM CRAIG COLEMAN
V.
APPEAL FROM COURT OF APP&LS
NO. 1999-CA-2704-WC
WORKERS’ COMPENSATION BOARD NO. 98-92547
EMILY ENTERPRISES, INC.;
RICHARD H. CAMPBELL, JR.,
ADMINISTRATIVE LAW JUDGE; AND
WORKERS’ COMPENSATION BOARD
APPELLEES
OPINION OF THE COURT
REVERSING
Based upon a finding that the claimant’s anxiety and depression were associated
with his work-related back injury and his employer’s failure to promptly provide medical
care for the injury, an Administrative Law Judge (ALJ) determined that expenses
incurred for treating the anxiety and depression were compensable. Reversing a
decision of the Workers’ Compensation Board (Board) that had affirmed the award, the
Court of Appeals determined that the mental conditions were not a direct result of the
back injury and concluded that because they did not come within the definition of an
“injury,” they were not compensable. This appeal concerns whether the conditions
constituted an “injury” as that term is defined in the December 12, 1996, version of
KRS 342.001 l(1).
The claimant worked as a laborer and equipment operator in underground coal
mining. On February 18, 1998, the shuttle car that he was operating ran over a rock,
throwing him from the cab and injuring his back. Dr. Coleman, the claimant’s family
physician, diagnosed a muscular injury and prescribed physical therapy and work
hardening before eventually referring the claimant to Dr. Hylton, a neurosurgeon.
Dr. Hylton’s April, 1998, report indicates that he diagnosed an
acute structural
musculoligamentous injury and an acute right sacroiliac injury, both of which resulted
from the work-related incident. He recommended pelvic stabilization maneuvers which
he indicated could be helped by careful chiropractic treatment and should be
coordinated with a specific sacroiliac treatment program for which he referred the
claimant to Dr. Dubick at the Pain Clinic. He anticipated that treatment would take
about three months.
In May, 1998, Dr. Coleman noted that the claimant had been unable to obtain
the treatment which Dr. Hylton had recommended because the employer’s insurance
carrier had refused to pay for it. Noting that the claimant was in pain and that he had
also become anxious and depressed, Dr. Coleman indicated that the carrier’s actions
had interfered with the claimants medical care, prolonged the injury, and caused a
secondary problem with severe anxiety and depression because of his inability to work.
Dr. Coleman indicated that he had prescribed an antidepressant to alleviate the
symptoms, which he indicated were directly related to the injury, and that he had
suggested that the claimant seek legal counsel in order to be able to obtain proper
treatment.
A June, 1998 report from Dr. Harrison indicates that he provided chiropractic
treatment on referral from Dr. Hylton. His report indicates that he had tried repeatedly
to get approval and authorization for treatment from the insurance carrier but that it had
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refused to give any information or to authorize treatment. Nonetheless, the record
indicates that Dr. Harrison continued to provide treatment through September 23, 1998.
At the employer’s request, Dr. Schmitz evaluated the claimant in July, 1998.
Reviewing the medical treatment to date, Dr. Schmitz noted that Dr. Hylton had
recommended treatment by both a chiropractor and a pain specialist but that it had
been denied. He thought that the claimant had reached maximum medical
improvement but suggested a bone scan to rule out the possibility of a subtle pelvic
fracture or a sacroiliac joint injury. He also recommended treatment at a pain clinic as
the next therapy but indicated that the improvement might not be great.
In September, 1998, the employer had the claimant examined by Dr. Pursley, a
neurologist. He was not persuaded that the anxiety and depression were due to the
injury or that claimant’s injury was so significant that it would warrant a permanent
impairment rating. He also reported significant symptom magnification.
Dr. Rapier evaluated the claimant in October, 1998, and testified on his behalf.
He assigned a 5% functional impairment, all of which he attributed to the back injury.
He also assigned various restrictions and indicated that the claimant did not retain the
physical capacity to return to his pre-injury employment.
An ALJ awarded a 5.625% permanent, partial disability and medical treatment
for the effects of the back injury. Petitioning for reconsideration, the claimant pointed
out that he had received prescriptions from Dr. Coleman for the psychiatric effects of
his injury and that the employer’s insurance carrier had refused to pay for
recommended medical treatment. He requested that the employer be ordered to pay
the existing and outstanding expenses for those psychiatric medications. The ALJ
sustained the petition and stated as follows:
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Although Dr. Pursley did not consider plaintiffs psychological/psychiatric
symptoms work-related, the proof from Dr. Coleman, one of plaintiff’s
treating physicians, established that such symptoms indeed were
associated with the February 18, 1998, work injury and the defendantemployer’s failure to promptly provide medical care; therefore, while the
record otherwise lacks proof that the anxiety and depression [have]
produced permanent impairment or disability, an award of medical
benefits therefor is warranted.
Appealing, the employer asserted that the mental conditions were not a direct result of
the back injury and, therefore, were not compensable. The Board rejected the
argument, explaining that had the claimant not sustained the work-related back injury
and required medical treatment, the employer’s subsequent denial of that treatment
would not have resulted in anxiety and depression. The Board concluded that although
the evidence did not compel such a finding, the ALJ had acted within his authority when
concluding that the need for psychiatric treatment was “reasonable and a proximate
result of his work-related injury.”
Reversing the Board, the Court of Appeals explained that KRS 342.001 l(1)
requires that a mental condition be a “direct result” of the physical injury in order for it to
be compensable. It determined that the terms “proximate cause” and “direct result”
referred to different types of causation and that the claimant’s mental injury was “the
sort of condition that the legislature intended to exclude from its definition of ‘injury’
when it amended KRS 342.0011 (l).” Concluding that the Board had misconstrued the
provision, the Court of Appeals reversed and remanded for further proceedings.
As effective December 12, 1996, KRS 342.001 l(1) provides, in pertinent part, as
follows:
“Injury” means any work-related traumatic event or series of traumatic
events, including cumulative trauma, arising out of and in the course of
employment which is the proximate cause producing a harmful change in
the human organism evidenced by objective medical findings. . . . “Injury”
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. . . shall not include a psychological, psychiatric, or stress-related change
in the human organism, unless it is the direct result of a physical injury.
It is apparent from the foregoing that since December 12, 1996, the term “injury”
refers to the traumatic event or series of events that causes a harmful change rather
than to the harmful change, itself. We conclude, therefore, that for the purposes of the
1996 version of KRS 342.001 l(l), a “physical injury” is an event that involves physical
trauma and proximately causes a harmful change in the human organism that is
evidenced by objective medical findings. Furthermore, an event that involves physical
trauma may be viewed as a “physical injury” without regard to whether the harmful
change that directly results is physical, psychological, psychiatric, stress-related, or a
combination thereof. But in instances where the harmful change is psychological,
psychiatric, or stress-related, it must directly result from a physically traumatic event.
As applied to the present facts, the question then becomes whether a psychiatric
condition that a physician associates with a work-related physical injury and with a
refusal of the employer’s insurance carrier to pay for recommended medical treatment
for that injury may be viewed as a “direct result” of the underlying physical injury. Unlike
the Court of Appeals, we conclude that it may. Although the legislature has used the
terms “proximately causes” and “direct result” in KRS 342.0011 (I), we are persuaded
that those terms do not denote different types of causal relationships because the
terms “proximate cause” and “direct cause” are synonymous. See Dunn v. Central
State Hospital, 197 Ky. 807, 813, 248 S.W. 216, 218 (1923); Bryan A. Garner,
A Dictionary of Modern Leaal Usaae (2d ed.’ 1995); and Black’s Law Dictionary
(5th ed. 1979). We conclude, instead, that the legislature’s intent was to require
that a mental injury be directly and, therefore, proximately caused by physical rather
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than mental trauma.
Causation is a matter to be decided by the fact-finder. The general rule is that all
of the injurious consequences that flow from a work-related physical injury and that are
not attributable to an unrelated cause are compensable. Beech Creek Coal Co. v.
Cox, Ky., 237 S.W.2d 56 (1951). Furthermore, anxiety over a workers’ compensation
claim is not an unrecognized phenomenon. See Holland v. Childers Coal Co., KY., 384
S.W.2d 293 (1964). In the instant case, there was substantial evidence that the
claimant’s anxiety and depression were due to the work-related back injury and,
therefore, that they directly resulted from the physically traumatic accident at work.
Under those circumstances, the ALJ’s finding was properly affirmed by the Board and
was erroneously reversed by the Court of Appeals.
The decision of the Court of Appeals is reversed, and the award of medical
benefits for anxiety and depression is reinstated.
Lambert, C.J.; and Johnstone, Keller, Stumbo, and Wintersheimer, JJ., concur.
Cooper, J., dissents by separate opinion in which Graves, J., concurs.
COUNSEL FOR APPELLANT:
Miller Kent Carter
Branham & Carter, PSC
P.O. Box 1499
Pikeville, KY 41502
COUNSEL FOR APPELLEE
EMILY ENTERPRISES, INC.:
David B. Sloan
Raymond H. Decker, Jr.
O’Hara, Ruberg, Taylor, Sloan & Sergent
209-C Thomas More Park
P.O. Box 17411
Covington, KY 4117-0411
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RENDERED: OCTOBER 252001
TO BE PUBLISHED
WILLIAM CRAIG COLEMAN
V.
APPELLANT
APPEAL FROM COURT OF APPEALS
NO. 1999-CA-002704-WC
WORKERS’ COMPENSATION BOARD NO. 98-92547
EMILY ENTERPRISES, INC.;
RICHARD H. CAMPBELL, JR.,
Administrative Law Judge; and
WORKERS’ COMPENSATION BOARD
APPELLEES
DISSENTING OPINION BY JUSTICE COOPER
“Injury” means any work-related traumatic event or series of traumatic
events, including cumulative trauma, arising out of and in the course of
employment which is the proximate cause producing a harmful change in
the human organism evidenced by objective medical findings. . . . “Injury”
when used generally . . . shall not include a psychological, psychiatric, or
stress-related change in the human organism, unless it is a direct result of
a physical injury.
KRS 342.001 l(1) [I996 Ky. Acts (Ex.Sess.), ch. 1, 5 I] (emphasis added). Thus, all
harmful changes “proximately caused” by a work-related injury are compensable,
except that a psychological, psychiatric, or stress-related condition is compensable only
if it is a “direct result of a physical injury.” Since the legislature used the terms
“proximate cause” and “direct result” in the same
statute to define two different results,
it is reasonable to assume that the terms were intended to mean two different things.
Remarkably, the majority of this Court concludes that, as used in this statute, “direct
result” and “proximate cause” mean the same thing. If so, it would have been a simple
matter for the legislature to have said, in the exclusionary portion of the statute, that the
definition of “[iInjury . . . shall not include a psychological, psychiatric, or stress-related
change in the human organism, unless it is oroximatelv caused by a physical injury.”
The distinction between a “proximate cause” and a “direct cause” has often been
recognized in our jurisprudence, usually in the context of a claim that a particular result
was caused, as here, by an independent, intervening cause.
To constitute a “proximate cause” of an injury, the negligence
complained of need not be the direct or immediate cause, but it must do
more, unless the injurious result is foreseeable, than merely furnish the
condition or give rise to the occasion by which the injury was made
possible. If it is not the immediate or direct cause but requires the
intervention of an immediate or direct cause to brina about the result, it is
regarded as a “concurring proximate cause” imposing liability upon those
responsible for it only when the intervention of the immediate cause and
the resulting injury could or should have been foreseen in the light of the
circumstances.
Dixon v. Kentuckv Util. Co., 295 Ky. 32, 174 S.W.2d 19, 21 (1943) (emphasis added).
Thus, a direct (immediate) cause will always be a proximate cause of injury, but a
proximate cause need not be the direct (immediate) cause of injury. By specifically
excluding compensation for psychological, psychiatric, or stress-related harmful
changes unless they are the “direct result” of a work-related injury, the legislature
obviously intended to exclude them from the broader coverage encompassed within the
concept of “proximate cause,” and, thereby, render so-called “compensation neurosis”
claims noncompensable under the Kentucky Workers’ Compensation Act. While
Coleman’s work-related injury may have been a proximate cause of his neurosis
(absent the injury, he would not have been entitled to any compensation), it is
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uncontested that the direct cause of his neurosis was not the injury, but the insurance
company’s refusal to pay for certain specialized treatment prescribed by his family
physician, Dr. Larry Coleman.
Accordingly, I dissent.
Graves, J., joins this dissenting opinion.
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