LAUREL COOKIE FACTORY V. ANNA FORMAN ; HON . JOHN B. COLEMAN, ADMINISTRATIVE LAW JUDGE ; AND WORKERS' COMPENSATION BOARD
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IMPOR-IT'ANTNOTICE
NOT TO BEPUBLISHED OPINION
THIS OPINION IS DESIGNA TED "NOT TO BE
PUBLISHED." PURSUANT TO THE RULES OF
CIVIL PROCED URE PROMUL GA TED B Y THE
SUPREME COURT, CR 76.28 (4) (c), THIS OPINION
IS NOT TO BE PUBLISHED AND SHALL NOT BE
CITED OR USED AS A UTHORITY INANY OTHER
CASE INANY COUR T OF THIS STA TE.
MODIFIED : October 7, 2003
RENDERED : September 18, 2003
NOT TO BE PUBLISHED
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2002-SC-0867-WC
LAUREL COOKIE FACTORY
V.
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APPELLANT
APPEAL FROM COURT OF APPEALS
2002-CA-0608-WC
WORKERS' COMPENSATION BOARD NO. 00-69127
ANNA FORMAN ; HON . JOHN B. COLEMAN,
ADMINISTRATIVE LAW JUDGE ; AND
WORKERS' COMPENSATION BOARD
APPELLEES
MEMORANDUM OPINION OF THE COURT
AFFIRMING IN PART, REVERSING IN PART, AND REMANDING
Although the Court of Appeals and the Workers' Compensation Board (Board)
have affirmed the claimant's workers' compensation award, her employer continues to
challenge findings that on September 1, 2000, she sustained a work-related injury as
evidenced by objective medical findings ; that she was entitled to temporary total
disability (TTD) benefits until January 4, 2001 ; and that she had an 8% AMA impairment
and a permanent partial disability . Furthermore, the employer maintains that the
claimant is not entitled to a double income benefit under KRS 342 .730(1)(c)2 because
she has not worked since her injury . While we agree that the claimant is not entitled to
an enhanced award, we affirm in all other respects .
The claimant alleged that on Friday, September 1, 2000, near the end of her
shift, she slipped in some water on the break room floor and fell, landing on her right
knee and then her buttocks . She testified that she experienced immediate pain in her
right knee and lower back and that Tammy Jackson, a co-worker, helped her get up .
Although she worked on September 4 and 5, she sought medical treatment with Dr.
Lester on September 6, 2000, and did not attempt to return to her job or to find other
work thereafter . At the hearing, she testified that she continued to see Dr. Hoskins and
to experience muscle spasms in her legs, constant headaches, back pain, difficulty
sleeping due to pain, and an inability to care for her children due to her symptoms .
Tammy Jackson, a co-worker, testified that she did not see the claimant fall but
heard her hand slap the table . When she saw the claimant, she was in a squatting
position, tilted backwards . She did not think the claimant's bottom was on the floor and
indicated that neither she nor anyone else helped the claimant get up . When she asked
the claimant if she was alright, the claimant replied that her knee hurt and kept rubbing
her knee which looked red . She also testified that the claimant said that "she had hurt
her butt bone in the past and then it was bothering her or something . I'm not for sure ."
On re-direct, the claimant insisted that she fell to a sitting position on the floor
and that Jackson had helped her to get up. She also testified that her hand did not hit
the table as she fell. Finally, she asserted that she was wearing pants with tight legs
and could not have pulled up her pant leg to show her knee after the fall .
On September 13, 2000, the claimant gave Dr. Grentz a history of the incident at
work and the onset of back pain . On October 25, 2000, she continued to have pain that
was made worse by physical therapy. Low back and neck pain continued as of
December 4, 2000, at which point Dr. Grentz noted that the claimant would be off work
from December 4, 2000, through January 4, 2001 . Medical records also indicated that
Dr. Grentz had treated the claimant when she was hospitalized in September, 1997, for
abdominal pain with frequent vomiting and diarrhea and frequent back pain . Although
they attributed no particular cause to the back pain, they noted a history of previous
abdominal surgery and indicated that an ultrasound of the gallbladder was planned .
Dr. Grentz referred the claimant to Dr. Kiefer who saw her on September 27 and
October 11, 2000. She gave a history of the fall at work and complained of back pain
that radiated into her neck, headaches, bilateral thigh pain, and pain in the right knee.
X-rays and a lumbar CT scan revealed a small chip fracture at L4 . A bone scan was
normal, but an MRI revealed some minimal degenerative changes in the lumbar spine.
He concluded that the claimant sustained a diffuse soft tissue strain due to the fall and
reached maximum medical improvement (MMI) early in November, 2000, with no
permanent impairment . In his opinion, she retained the physical capacity to return to
the work she performed at the time of her injury without restrictions .
Dr. Snider examined the claimant in January, 2002, at which time he received a
history of the incident at work. She reported low back pain, headache, pain in the right
knee, and numbness in the right foot . X-rays that were taken at the time revealed only
slight straightening of the cervical curvature, and Dr. Snider reported evidence of
symptom magnification . He determined that the claimant's complaints were not related
to the incident at work, assigned a 0% impairment rating, and was of the opinion that no
work restrictions were warranted.
Dr. Nickerson examined the claimant in March, 2001, at the request of her
counsel . She gave a history of the incident at work and of the immediate onset of right
foot numbness and low back pain, and she complained of marked pain in several areas,
the most severe of which was in the low back . Dr. Nickerson examined her and
documented his observations and testing in the report he prepared . He also reviewed
the diagnostic studies and medical records from Drs . Lester, Grentz, and Kiefer. After
doing so, he diagnosed lumbosacral musculoskeletal ligamentous sprain/strain, right
knee contusion, and chronic pain syndrome, all of which he attributed to the incident at
work. Using the Fifth Edition of the AMA Guides, he assigned an 8% impairment under
DIRE category 2 . He based the rating upon the asymmetric loss of motion and
nonverifiable radicular complaints, noting that he placed her in the higher end of the
category due to the significant impact of her pain on the activities of daily living . In his
opinion, the entire impairment was due to the work-related injury and would result in
work restrictions. Although listing no specific restrictions, he stated :
At this time, I am hesitant to place permanent restrictions on
this patient as I do not believe that she is able to return to
gainful employment . It should also be noted that I do not
believe that the patient has reached full maximal medical
improvement as I would recommend that she be seen in a
chronic pain management clinic to determine if there are
other treatment options for her with regard to her pain
syndrome. I did go ahead and place a permanent partial
impairment as of today's date even though I realize that
other treatment options should be considered in this case .
Dr. Hoskins saw the claimant in May, 2001, at which time she gave a history of
slipping on a wet floor, twisting her right knee, falling on her buttocks, and jerking her
neck and back. At the time, she complained of neck, back, and right leg pain;
intermittent numbness in her hands ; numbness in the right leg ; muscle spasms
extending from the neck to the scalp; and frequent headaches . Dr. Hoskins
recommended an MRI of the neck and thoracic spine, would refer the claimant for
possible EMG studies, and felt that she should continue with Dr. Grentz for pain control .
Persuaded that the claimant did fall at work and that the fall constituted a
traumatic event, the ALJ noted that Dr. Hoskins observed a paraspinal muscle spasm,
and that Dr. Nickerson had made his diagnosis based upon a physical examination,
diagnostic studies, and the claimant's inability to perform toe raises. Although
4
recognizing that the objective medical findings were minimal, the ALJ was convinced
that they were sufficient to prove an injury as defined by KRS 342.0011(1) . The AU
relied upon Dr. Nickerson's testimony with respect to the claimant's AMA impairment
rating but was convinced by testimony from the other physicians that the claimant
retained the physical capacity to return to her job. The ALJ awarded TTD benefits from
September 7, 2000, until January 4, 2001, basing the termination date upon Dr.
Grentz's records . For permanent partial disability beginning on January 5, 2001, the
AU awarded an income benefit under KRS 342 .730(1)(b). Furthermore, based upon a
finding that the claimant had not returned to work at an average weekly wage that
equaled or exceeded her wage at the time of the injury, the AU doubled the benefit
under KRS 342.730(1)(c)2 . After its petition for reconsideration was overruled, the
employer appealed .
As the Court of Appeals pointed out, the AU is the fact-finder in a workers'
compensation proceeding and, in that capacity, has the sole discretion to determine the
credibility of witnesses and the quality, character, and substance of evidence . When
doing so, the AU may reject any testimony and believe or disbelieve any part of the
evidence, including testimony from the same witness . KRS 342.285; Whittaker v.
Rowland , Ky., 998 S.W .2d 479, 481 (1999) . Although the testimony of an interested
witness is not binding on the fact-finder, it is of some probative value and may be relied
upon if it is found to be credible . Caudill v. Maloney's Discount Stores , Ky ., 560 S.W.2d
15 (1977) ; Grider Hill Dock v. Sloan , Ky., 448 S.W.2d 373 (1969) . Findings that favor
the party with the burden of proof may not be reversed on appeal if they are supported
by substantial evidence in the record and, therefore, are reasonable . Special Fund v.
Francis , Ky., 708 S .W.2d 641, 643 (1986) . Thus, the mere existence of evidence from
which a different finding could have been made, would not compel a different result .
Whittaker v. Rowland, supra, at 482.
Contrary to the employer's assertions, we are persuaded that the findings in the
claimant's favor were reasonable under the evidence and were properly affirmed on
appeal . Although there were discrepancies between the claimant's testimony and that
of Tammy Johnson, the fact remains that because the ALJ found the claimant to be
credible, her testimony constituted substantial evidence of the traumatic event of
September 1, 2000 . Likewise, although Dr. Snider was not convinced that the
claimant's symptoms were due to the incident at work, records from Drs. Hoskins and
Nickerson contained objective medical findings as defined in Staples, Inc . v. Konvelski ,
Ky., 56 S .W .3d 412 (2001), and those findings supported the conclusion that she
suffered a harmful change from the fall at work.
It is undisputed that the extent of a permanent impairment cannot be determined
until after an injured worker reaches MMI . Pointing to Dr. Nickerson's belief that the
claimant's condition might continue to improve when he assigned an 8% impairment,
the employer maintains that the impairment rating is invalid. It does not challenge the
method by which the rating was reached but asserts that the rating was premature on
the ground that the claimant had not reached MMI . Yet, Dr. Kiefer clearly testified that
the claimant reached MMI and retained no permanent impairment as of November,
2000, and it was on that basis that the employer discontinued voluntary TTD benefits .
Furthermore, Dr. Snider assigned a 0% impairment in January, 2001, implying a belief
that the claimant had reached MMI at that time. Thus, there was substantial evidence
from which the ALJ could determine that the claimant reached MMI well before Dr.
Nickerson assessed the extent of his impairment in March, 2001 .
With regard to the duration of TTD, it is undisputed that Dr. Grentz kept the
claimant off work until January 4, 2001 . Thus, despite Dr . Kiefer's testimony that the
claimant reached MMI in November, 2000, and despite Dr. Nickerson's testimony that
the claimant remained unable to work in March, 2001, there was substantial evidence
from which the ALJ could reasonably conclude that the claimant was entitled to TTD
benefits through January 4, 2001, and to benefits for permanent partial disability
thereafter.
Based upon the fact that the claimant had not returned to work at a wage that
equaled or exceeded her wage at the time of her injury, the AU awarded a double
benefit under KRS 342.730(1)(c)2 . The employer maintains, however, that because the
claimant did not return to work, her employment at a wage that equaled or exceeded
her wage at the time of the injury did not cease and, therefore, her award should not
have been doubled under KRS 342 .730(1)(c)2 . We agree.
Since the inception of the Act, income benefits have been awarded on the basis
of occupational disability. In Osborne v. Johnson , Ky ., 432 S.W.2d 800 (1968), the
Court defined occupational disability, taking into account various factors that result in a
loss of wage-earning capacity following an injury. That definition was later codified in
KRS 342.0011 (11), and KRS 342.730(1) authorized income benefits based upon the
percentage of occupational disability.
In 1996, KRS 342.0011 (11) was amended as part of a major revision of the Act.
At the same time, KRS 342 .0011(34), (35), and (36) were enacted, and KRS
342.730(1)(b) and (c) were amended . As a result, partial disability was re-defined to
require both a permanent disability rating and an ability to work. A table found in
KRS 342.730(1)(b) listed a factor for various ranges of AMA impairment, with the factor
increasing as the corresponding range of impairments increased . As set forth in KRS
342 .0011(36), the worker's percent of impairment and the corresponding factor were
multiplied to arrive at a disability rating from which the income benefit was determined .
KRS 342.730(1)(c)1 provided for a 50% increase in the benefit of an individual who did
not retain the physical capacity to return to the previous type of work, and KRS
342.730(1)(c)2 provided for a 50% reduction in the benefit of a worker who returned to
work at a wage that equaled or exceeded the wage when injured . Thus, the benefit of
an individual who retained the physical capacity to return to the previous type of work
but failed to do so was calculated under KRS 342 .730(1)(b) and was neither enhanced
nor reduced .
Effective July 14, 2000, the method for awarding permanent partial disability
benefits was amended again . The factors contained in KRS 342.730(1)(b) were
decreased . KRS 342.730(1)(c)1 was amended to provide for a triple benefit if the
worker did not retain the physical capacity to return to the previous work, with KRS
342.730(1)(c)3 providing additional multipliers based upon age and education . KRS
342.730(1)(c)2 was amended to provide :
2 . If an employee returns to work at a weekly wage equal to
or greater than the average weekly wage at the time of
injury, the weekly benefit for permanent partial disability shall
be determined under paragraph (b) of this subsection for
each week during which that employment is sustained .
During any period of cessation of that employment,
temporary or permanent, for any reason, with or without
cause, payment of weekly benefits for permanent partial
disability during the period of cessation shall be two (2)
times the amount otherwise payable under paragraph (b) of
this subsection . This provision shall not be construed so as
to extend the duration of payments .
The question presented by this appeal is how the legislature intended for permanent
partial disability benefits to be calculated when a worker retains the physical capacity to
return to their previous work but fails to do so.
As under the 1996 amendments, KRS 342 .730(1)(b) and (c) provide a system for
calculating partial disability benefits . KRS 342 .730(1)(b) continues to provide for a basic
partial disability benefit, but because the factors are smaller than under the 1996 Act,
the benefit is smaller. Under KRS 342 .730(1)(c)1 and 3, an individual who does not
retain the physical capacity to return to the previous type of work receives triple the
basic benefit and may be entitled to additional multipliers based upon age and
education . Whereas, under KRS 342 .730(1)(c)2, an individual who returns to work
earning the same or greater wage receives the basic benefit but is entitled to a double
benefit for any period that the employment ceases, regardless of the reason .
When determining that KRS 342 .730(1)(c)2 authorized a double benefit on these
facts, the decisions below failed to address the implications of the finding that the
claimant retained the physical capacity to return to her previous work and the fact that
she failed to attempt any type of work after her injury. As stated in KRS 342 .710(1), one
of the primary goals of Chapter 342 is to encourage injured workers to return to work,
preferably with the same employer and to the same or similar work. In the past, a
means for doing so was to limit income benefits for partial disability to two-thirds of the
worker's average weekly wage, up to a maximum of 75% of the state's average weekly
wage, so that it was less profitable to be disabled than to be employed . Although the
1996 and 2000 versions of KRS 342.730(1)(b) and (c) retain the same maximums, they
also provide a financial incentive for partially disabled workers who retain the physical
capacity to return to the type of work they performed until the injury to do so. Consistent
with the policy of awarding benefits in proportion to occupational disability, they provide
the greatest benefits to those workers who do not retain the physical capacity to do so,
for those are the workers who would be expected to suffer the greatest wage loss due to
their injuries.
The 1996 version of KRS 342 .730(1)(b) and (c) provided a basic benefit for those
who retained the physical capacity to return to the previous type of work and provided
and enhanced benefit to those who lacked the physical capacity to return to their
previous work. Furthermore, because individuals who returned to work at the same or
greater wage were permitted to receive a partial income benefit in addition to their postinjury earnings, the statute provided a financial incentive for workers who retained the
physical capacity to return to their previous work to do so . The apparent goal of the
2000 amendments was to provide an even greater incentive for that group of workers to
return to their previous type of work and, presumably, to earn the same or a greater
wage than when injured . Thus, those who fail to do so are limited to the basic benefit
under KRS 342 .730(1)(b), with the benefit based upon a lower statutory factor than
under the 1996 Act. In contrast, those who return to work at the same or a greater wage
are permitted to receive the basic income benefit in addition to their earnings .
Furthermore, they are assured a double benefit during periods that the employment is
not sustained, regardless of the reason. Thus, workers who retain the physical capacity
to perform their previous work are rewarded for attempting to do so even if the attempt
later proves to be unsuccessful .
After reviewing the lay and medical evidence, the ALJ determined that the
claimant retained the physical capacity to return to her previous work. Whereas, the
claimant maintained she was unable to work and made no attempt to do so. Under
10
those circumstances, she was entitled to receive only the basic income benefit that is
provided in KRS 342.730(1)(b).
The decision of the Court of Appeals is affirmed in part and reversed in part, and
the claim is remanded to the ALJ for the entry of an award of income benefits under
KRS 342 .730(1)(b) .
Lambert, C .J., and Graves, Johnstone, Keller, Stumbo, and Wintersheimer, JJ.,
concur. Cooper, J ., disagrees with the construction of KRS 342.730(1)(c) as per his
dissenting opinion in Fawbush v. Gwinn , Ky., 103 S.W.3d 5, 13 (2003), and, therefore,
concurs in result only.
COUNSEL FOR APPELLANT :
Bradford L. Breeding
Farmer & Farmer
P .O. Box 490
London, KY 40743
COUNSEL FOR APPELLEE :
Timothy J. Wilson
Wilson, Sowards, Polites & McQueen
Goodwin Square
444 E . Main Street, Ste. 201
Lexington, KY 40507
RENDERED : September 18, 2003
NOT TO BE PUBLISHED
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2002-SC-0867-WC
LAUREL COOKIE FACTORY
V
APPELLANT
APPEAL FROM COURT OF APPEALS
2002-CA-0608-WC
WORKERS' COMPENSATION BOARD NO . 00-69127
ANNA FORMAN ; HON . JOHN B . COLEMAN,
ADMINISTRATIVE LAW JUDGE ; AND
WORKERS' COMPENSATION BOARD
APPELLEES
ORDER MODIFYING OPINION ON THE COURT'S OWN MOTION
On the Court's own motion, the Opinion of the Court rendered on September 18,
2003, is modified by the substitution of a new page nine and new page ten, hereto
attached, in lieu of pages nine and ten of the Opinion as originally rendered . Said
modification does not affect the holding of the Opinion, but is made only to correct
typographical errors on pages nine and ten (page nine : "triple" to "double" ; page ten :
omit the word "twice") .
ENTERED : October 7, 2003.
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