HUNTER EXCAVATING V GORDON BARTRUM ; HON . IRENE STEEN, ADMINISTRATIVE LAW JUDGE ; AND WORKERS' COMPENSATION BOARD
Annotate this Case
Download PDF
RENDERED : May 19, 2005
TO BE PUBLISHED
,*ixYrrxrt-r (110urf of ~*
2004-SC-0485-WC
[OA=r~
HUNTER EXCAVATING
V
APPEAL FROM COURT OF APPEALS
2003-CA-2305-WC
WORKERS' COMPENSATION BOARD NO . 02-1163
GORDON BARTRUM ; HON. IRENE STEEN,
ADMINISTRATIVE LAW JUDGE; AND
WORKERS' COMPENSATION BOARD
APPELLEES
OPINION OF THE COURT
AFFIRMING IN PART, REVERSING IN PART, AND REMANDING
As amended effective July 15, 2002, KRS 342.316(3) sets forth a two-step
"consensus" procedure for evaluating x-ray evidence of coal workers' pneumoconiosis .
KRS 342 .316(13) creates a presumption that a consensus x-ray classification is correct
absent clear and convincing evidence to the contrary . Appealing an order that denied
his application for benefits, the claimant asserted that KRS 342.316(3) and the
accompanying regulations deprived him of a meaningful opportunity to rebut the
consensus, thereby violating his right to due process under the constitutions of the
United States and Kentucky.
Considering the appeal en banc, a majority of the Court of Appeals determined
that the limit the statute and regulations place on the number of x-rays and x-ray reports
that may be submitted to rebut a consensus denies the parties' constitutional right to a
fair hearing . A minority was of the opinion that the statute is constitutional but that 803
KAR 25:009, § 3(1) exceeds its statutory authority by prohibiting additional x-rays and
reports from being submitted to rebut a consensus . We conclude that KRS 342 .316(3)
is constitutional but that 803 KAR 25:009, § 3(1) and (2) conflict with KRS 342 .316(13)
to the extent that they prohibit additional reports of the x-rays that were considered in
the consensus process . To that extent, they are void .
The claimant's last exposure to coal dust was on August 29, 1997. On August 5,
2002, he applied for benefits under the newly-enacted KRS 342 .792 . He filed with his
application an April 8, 2002, x-ray and Dr. Wicker's report that the x-ray was quality 1
and showed category 1 /0 pneumoconiosis . The employer then had him examined by
Dr. Broudy and filed an October 23, 2002, x-ray as well as a report that it was quality 1
and negative . Dr. Broudy's narrative report stated that there was no evidence of
pneumoconiosis or chronic lung disease due to inhaling coal dust .
The Commissioner of the Department of Workers' Claims determined that the
reports were not in consensus . The parties' x-rays were then forwarded to three other
"B" readers who were hired by the Department of Workers' Claims . Dr. Schulthesis
reported that x-ray "L," taken on October 23, 2002, was negative, and Dr. Coburn
reported that x-ray "C," taken on April 18, 2002, was negative for pneumoconiosis but
revealed osteophytes in the thoracic spine . Dr . Vuskovich interpreted x-ray "L" and
classified it as category 1/0. All rated the x-ray they read as being quality grade 1 .
The Commissioner certified that there was a consensus . Shortly thereafter, the
claimant filed a report from Dr. Patel, a "B" reader who interpreted a June 7, 2001, chest
x-ray as being quality 2 and revealing category 1/0 pneumoconiosis . He also filed a
July 16, 2001, report of a clinical evaluation by Dr. Rasmussen who appears to have
ordered the chest x-ray. Dr. Rasmussen agreed with the diagnosis and reported that
there was no evidence of significant lung impairment . The employer deposed Drs .
Coburn and Broudy who confirmed their previous findings .
When summarizing the claimant's evidence, the ALJ stated that the reports from
Drs . Rasmussen and Patel were not considered because "the statute does not allow the
filing of more than one x-ray by either party." Noting that the consensus classification
was negative and that no party had challenged it within 30 days after the
Commissioner's notice as permitted by 803 KAR 25:009, § 2(7), the ALJ determined
that the consensus was presumed to be correct and dismissed the claim .
KRS 342 .316 provides, in pertinent part, as follows :
(3) The procedure for filing occupational disease claims shall be as
follows:
(a) The application for resolution of claim shall set forth the
complete work history of the employee with a concise description of
injurious exposure to a specific occupational disease, together with
the name and addresses of the employer or employers with the
approximate dates of employment. The application shall also
include at least one (1) written medical report supporting his claim.'
This medical report shall be made on the basis of clinical or X-ray
examination performed in accordance with accepted medical
standards and shall contain full and complete statements of all
examinations performed and the results thereof. The report shall be
made by a duly-licensed physician . The commissioner shall
promulgate administrative regulations which prescribe the format of
the medical report required by this section and the manner in which
the report shall be completed .
The Court of Appeals' majority was concerned that because KRS 342.316(3)(a) states
at least one" medical report, it might imply that a worker could submit more than one xray report but that the employer was limited by KRS 342.316(3)(b)4 .d . to one such
report. A more reasonable interpretation is that at least an x-ray report is required but
that the report of a clinical evaluation with spirometry may also be submitted if
pulmonary impairment is alleged . See KRS 342.316(3)(a)1 ., which permits spirometric
tests to be filed when pulmonary impairment is alleged ; see also KRS 342.316(3)(b)4 .d .,
which directs the employer to include spirometry in its examination if pulmonary
impairment is alleged . The two types of evaluations commonly are performed by
different physicians and reported separately .
3
1 . For coal-related occupational pneumoconiosis claims, each
clinical examination shall include a chest X-ray interpretation by
a National Institute of Occupational Safety and Health (NIOSH)
certified "B" reader. The chest X-ray upon which the report is
made shall be filed with the application as well as spirometric
tests when pulmonary dysfunction is alleged .
(b) To be admissible, medical evidence offered in any proceeding
under this chapter for determining a claim for occupational
pneumoconiosis resulting from exposure to coal dust shall comply
with accepted medical standards as follows :
1 . Chest X-rays shall be of acceptable quality with respect to
exposure and development and shall be indelibly labeled with
the date of the X-ray and the name and Social Security number
of the claimant . Physicians' reports of X-ray interpretations shall :
identify the claimant by name and Social Security number;
include the date of the X-ray and the date of the report ; classify
the X-ray interpretation using the latest ILO Classification and
be accompanied by a completed copy of the latest ILO
Classification report. Only interpretations by National Institute of
Occupational Safety and Health (NIOSH) certified "B" readers
shall be admissible.
3 . The commissioner shall promulgate administrative
regulations pursuant to KRS Chapter 13A as necessary to
effectuate the purposes of this section. . . .
4 . The procedure for determination of occupational disease
claims shall be as follows :
a . Immediately upon receipt of an application for resolution
of claim, the commissioner shall notify the responsible
employer and all other interested parties and shall furnish
them with a full and complete copy of the application .
b . The commissioner shall assign the claim to an
administrative law judge . . . .
d . Within forty-five (45) days of assignment of a coal workers'
pneumoconiosis claim to an administrative law judge, the
employer shall cause the employee to be examined by a
physician of the employer's choice and shall provide to all
other parties and file with the commissioner the X-ray
4
interpretation by a "B" reader. . . . The commissioner shall
determine whether the X-ray interpretations filed by the
parties are in consensus .
e . If the readings are not in consensus, the commissioner
shall forward both films, masking information identifying the
facility where the X-ray was obtained and the referring
physician, consecutively to three (3) "B" readers selected
randomly from a list maintained by the commissioner for
interpretation . Each "B" reader shall select the highest
quality film and report only the interpretation of that film. The
commissioner shall determine if two (2) of the X-ray
interpretations filed by the three (3) "B" readers selected
randomly are in consensus . If consensus is reached, the
commissioner shall forward copies of the report to all parties
as well as notice of the consensus reading which shall be
considered as evidence . If consensus is not reached, the
administrative law judge shall decide the claim on the
evidence submitted . (emphasis added) .
f. "Consensus" is reached between two (2) chest X-ray
interpreters when their classifications meet one (1) of the
following criteria : each finds either category A, B, or C
progressive massive fibrosis ; or findings with regard to
simple pneumoconiosis are both in the same major category
and within one (1) minor category (ILO category twelve (12)
point scale) of each other.
g. The administrative law judge shall conduct such
proceedings as are necessary to resolve the claim and shall
have authority to grant or deny any relief, including
interlocutory relief, to order additional proof, to conduct a
benefit review conference, or to take such other action as
may be appropriate to resolve the claim . (emphasis added).
(13) . . . . The consensus classification shall be presumed to be the
correct classification of the employee's condition unless overcome
by clear and convincing evidence . If an administrative law judge
finds that the presumption of correctness of the consensus reading
has been overcome, the reasons shall be specially stated in the
administrative law judge's order.
X-rays and x-ray reports must comply with KRS 342.316(3)(b)1 . in order to be
admissible as evidence . Furthermore, KRS 342.316(3)(a)1 . and KRS 342.316(3)(b)4 .d.
require that parties' x-ray interpretations be performed by a "B" reader, a term that is
defined in KRS 342.794(3). KRS 342 .794(1) provides for a list of qualified "B" readers
who agree to be hired by the Department under KRS 342 .316(3)(b)4 .e. to interpret
chest x-rays when the parties' reports are not in consensus . Parties commonly refer to
the three randomly-selected "B" readers who consider the x-rays in a given claim as a
consensus panel.
Relying on its statutory authority to regulate the practices and procedures for
processing workers' compensation claims, the Department promulgated 803 KAR
25 :009 on December 18, 2002 . 803 KAR 25 :009, § 4(5) provides that if a party
challenges a consensus, the ALJ "may allow timely cross-examination of a medical
evaluator that participated in the consensus process at the expense of the participating
party." This appeal concerns the validity of 803 KAR 25:009, §3(1), which prohibits the
parties from submitting any x-ray readings in addition to those submitted with the initial
application and response, and 803 KAR 25 :009, §3(2), which prohibits an ALJ from
considering any x-ray readings but those initially submitted by the parties and the
readings of the three neutral experts.
Like the university evaluator procedure that was at issue in Magic Coal Co . v.
Fox, 19 S.W.3d 88 (Ky. 2000), the apparent purpose of KRS 342 .794(1) and the second
level of the consensus procedure set forth in KRS 342.316(3)(b)4 .e. is to provide the
ALJ with additional evidence from three "B" readers who are unbiased . Like KRS
342 .315(2), KRS 342 .316(13) provides a rebuttable presumption that the unbiased
medical opinion is correct, but it adopts the more stringent "clear and convincing
evidence" standard for rebuttal . Due process requires a meaningful opportunity to
present such evidence . Matthews v. Eldridge , 424 U.S. 319, 47 L.Ed .2d 18, 96 S .Ct.
893 (1976); Jenkins v. McKeithen , 395 U.S . 411, 23 L .Ed .2d 404, 89 S .Ct. 1843 (1969) ;
Harlan Bell Coal Co . v. Lemar, 904 F .2d 1042 (6t" Cir. 1990) ; Commonwealth v. Raines,
847 S.W.2d 724 (Ky. 1993), overruled on other grounds in Commonwealth v. Howard,
969 S.W.2d 700 (Ky. 1998) . It does not require the opportunity to be unlimited .
Evidentiary restrictions may be imposed if they are reasonably calculated to advance a
legitimate interest of the tribunal and do not unduly burden the interests of the parties .
Matthews v. Eldridge , supra ; Jenkins v. McKeithen , supra . Consistent with its statutory
authority, the Department of Workers' Claims has a legitimate interest in the orderly and
efficient processing of claims and in limiting the introduction of evidence that is no more
than cumulative.
KRS 342.316 and KRS 342 .732 require the presence of coal workers'
pneumoconiosis to be proven with x-ray evidence . At the first level of the consensus
process, each party submits evidence of the worker's condition in the form of a chest x
ray and a report stating what it reveals. Only the x-rays submitted at the first level of the
process are considered by the panel at the second level . A consensus panel's charge
under KRS 342 .316(3)(b)4 .e . is to review the x-rays in evidence, to choose the highest
quality x-ray, and to interpret it . Stated otherwise, the question before the panel is:
"What does the highest quality x-ray in evidence show?" For that reason, additional
reports addressing the x-rays the panel considered could rebut a consensus
classification if sufficiently persuasive, but reports of additional x-rays the panel did not
consider could not.
We are aware of nothing in KRS 342 .316(3) that prevents a party from
introducing the type of evidence that will rebut a consensus classification . In fact, KRS
342 .316(3)(b)4 .g. gives an ALJ broad discretion "to order additional proof . . . or to take
such other action as may be appropriate to resolve (a] claim." We conclude, therefore,
that KRS 342 .316(3) does not deny parties a meaningful opportunity to rebut a
consensus and that it is constitutional. In contrast, 803 KAR 25:009, § 3(1) and (2)
defeat the purpose of KRS 342 .316(13) and KRS 342 .316(3)(b)4 .g . by prohibiting a
party from submitting additional reports of the x-rays the panel evaluated and prohibiting
an ALJ from considering such reports . Therefore, they exceed the Department's
authority to promulgate regulations and are invalid . United Sign, Ltd . v. Commonwealth,
Transportation Cabinet, Dept. of Highways, 44 S .W .3d 794, 798 (Ky. App. 2000);
Kentucky Alcoholic Beverage Control Board v. Anheuser-Busch, Inc . , 574 S .W.2d 344,
345 (Ky. App . 1978) .
The decision of the Court of Appeals is affirmed in part and reversed in part, and
the claim is hereby remanded to an ALJ for further proceedings that are consistent with
this opinion .
All concur.
COUNSEL FOR APPELLANT :
Paul E. Jones
Terri Smith Walters
Jones, Walters, Turner & Shelton, PLLC
P .O. Box 1167
Pikeville, KY 41502
COUNSEL FOR APPELLEE :
Thomas W . Moak
Stumbo, Moak & Nunnery
P.O . Box 511
Prestonsburg, KY 41653
Some case metadata and case summaries were written with the help of AI, which can produce inaccuracies. You should read the full case before relying on it for legal research purposes.
This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.