BAPTIST HOSPITAL EAST V. AUGUST POSSANZA; HONORABLE GRANT S. ROARK
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2009-SC-000563-WC
BAPTIST HOSPITAL EAST
V.
APPELLANT
ON APPEAL FROM COURT OF APPEALS
CASE NO . 2009-CA-000082-WC
WORKERS' COMPENSATION BOARD NO . 07-79966
AUGUST POSSANZA ;
HONORABLE GRANT S. ROARK,
ADMINISTRATIVE LAW JUDGE ; AND
WORKERS' COMPENSATION BOARD
APPELLEES
OPINION OF THE COURT
AFFIRMING
An Administrative Law Judge (ALJ) dismissed the claimant's application
for benefits due to his misrepresentation of his physical condition when
applying for employment. The Workers' Compensation Board reversed, holding
that the ALJ misapplied KRS 342 .165(2) by relying on the fact that the
employer hired the claimant to show a causal relationship between his
misrepresentation and work-related injury . The Court of Appeals affirmed.
We affirm. We view whether exceeding the claimant's lumbar lifting
restriction helped to cause his neck injury to be a medical question .
medical evidence reveals no causal relationship.
The
The claimant sought workers' compensation benefits for a neck injury
that occurred on July 31, 2007, as he helped to lift a patient in the course of
his work as a psychiatric nurse at Baptist Hospital East. Medical evidence
submitted in the claim revealed a history of previous lumbar surgery and
related medical restrictions . The hospital did not dispute that the injury
occurred but contested the claim under KRS 342 .165(2), asserting that the
claimant misrepresented his physical condition and medical history on his
employment application . The hospital argued that he would not have been
hired had he revealed his restrictions . Thus, he would not have been lifting a
heavy patient, which exceeded his lifting restriction and caused his injury.
The claimant applied for work at the hospital's Behavioral Health Access
Center in April 2006. He was interviewed and provided a copy of the job
description, which indicated, among other things, that he must be able to stoop
and to push, pull, and lift up to 50 pounds occasionally . He also completed a
form entitled "Ability to Perform Duties" on which he responded "no" to a
question asking if he had any physical limitations that would prevent him from
performing the job outlined in the job description . He responded "yes" to a
question about whether he ever had a Workers' Compensation injury and
stated that he sustained a concussion and cervical strain in December 2004;
received a CT scan and pain medication ; was not currently under treatment for
the injury; and had no current work restrictions related to the injury .
The claimant testified subsequently that he underwent back surgeries in
December 1997 and July 2005 and did not work during the interval between
the latter surgery and his employment at Baptist Hospital East. He stated that
he discussed the back surgeries at the interview. He failed to list any physical
restrictions when completing the written form because he considered himself
able to perform the job and did not think that he was under any formal low
back restrictions . Moreover, he never saw the addendum to a March 22, 2006,
office note by his treating physician, Dr . Djurasovic, until after he filed his
claim. He stated that Dr. Djurasovic told him to let his symptoms be his guide
but never told him that he could not return to work as a nurse. He stated that
he received treatment in the emergency room for the 2004 cervical injury,
missed only two days' work, and required no further treatment for the injury.
The claimant testified that his work at Baptist Hospital East required
very little lifting because his patients were ambulatory and that nursing
assistants and transporters generally performed any necessary lifting . He
described the mechanism of the 2007 neck injury when deposed . He testified
that he, a medical assistant, and four transporters transferred an
overmedicated patient from a bed, onto a back board, and then onto a gurney .
While helping to lift the patient, he felt pain on the right side of his neck .
Dale Nolan interviewed the claimant for the job at Baptist East. She
testified that they discussed a previous neck strain that required him to miss
some work but that he never mentioned a pre-existing lumbar condition. She
also stated that she would not have hired the claimant had he disclosed the
restrictions that Dr. Djurasovic imposed on March 22, 2006, because they
would have prevented him from performing the essential functions of the job.
Medical evidence indicated that the claimant underwent lumbar surgery
in 1997 and that Dr. Djurasovic performed a fusion at the same level in 2005 .
Dr. Djurasovic's office note from March 22, 2006, indicated that the claimant
was doing well and was looking for a new nursing job that did not involve much
heavy lifting. An addendum to the note states as follows :
Of note, Mr. Possanza used to work in a psychiatry
unit as a nurse and this involved a lot of lifting, a lot of
physical restraint of patients . I do not think he should
get back to this kind of work, although he is doing very
well with his back now. If he goes back to a job that
involves a lot of manual lifting or heavy work with his
back, I think he would flare up his symptoms again. I
think he needs to look for a job that does not involve a
lot of heavy lifting, probably no greater than 20
pounds, and certainly not a job that would involve
altercations with patients. I think this would be the
best thing for him long term in terms of managing his
back symptoms.
In a letter to the claimant's attorney, dated March 25, 2008, Dr .
Djurasovic stated that the claimant's low back problem did not play a role in
his neck condition or disqualify him from working at Baptist East. Dr.
Djurasovic characterized the 20-pound lifting restriction as being "more of a
temporary suggestion ." He also stated that the claimant's back was solidly
healed ; that he was feeling well; and that he no longer had any specific back
restrictions . Finally, Dr. Djurasovic reiterated that the restrictions "only
applied to [the claimant's] lower back, not his neck."
When deposed by the employer, Dr . Djurasovic testified that he would
have discussed the restrictions with the claimant when releasing him from care
for the lumbar condition on March 22, 2006 . He explained that he generally
warned patients who were doing well after surgery that their symptoms might
flare up if they performed repetitive or occasional lifting, bending, twisting, or
stooping, but he often failed to impose restrictions . Dr. Djurasovic viewed the
existence of the March 22, 2006, addendum as an indication that he provided
restrictions in response to a question from the claimant about whether he
could return to work. When asked about his letter of March 25, 2008, Dr.
Djurasovic stated that it was written with the benefit of hindsight rather than
based on what he thought in 2006.
Dr. Harpring began treating the claimant's neck injury in October 2007
on referral from Dr . Djurasovic . He recommended surgery. Dr. Harpring
stated in March 2008 that the neck injury was unrelated to the claimant's
previous lumbar problems .
The ALJ dismissed the claim under KRS 342 .165(2) . Having reviewed
the evidence, the ALJ found Dr. Djurasovic to be more persuasive than the
claimant concerning the March 22, 2006, office visit. Convinced that the
claimant knew of his restrictions, the ALJ determined that he knowingly
misrepresented his physical condition by failing to disclose them on the
employment application. The ALJ accepted Ms. Nolan's testimony that she
would not have hired the claimant had she known of his restrictions . Finding
a causal connection between his failure to disclose the restrictions and his
injury, the ALJ reasoned that "if he had not been hired, he would not have
been placed in the job that required him to assist moving heavy patients and,
as such, he would not have been injured on July 31, 2007 ."
KRS 342 .165(2) provides as follows :
No compensation shall be payable for work-related
injuries if the employee at the time of entering the
employment of the employer by whom compensation
would otherwise be payable falsely represents, in
writing, his physical condition or medical history, if all
of the following factors are present:
(a) The employee has knowingly and willfully made a
false representation as to his physical condition or
medical history;
(b) The employer has relied upon the false
representation, and this reliance was a substantial
factor in the hiring; and
(c) There is a causal connection between the false
representation and the injury for which compensation
has been claimed .
Enacted in 1994, KRS 342 .165(2) was a legislative response to cases in
which an injured worker misrepresented his physical condition to the employer
in the process of obtaining employment and later received an injury that was
causally related to the misrepresentation.' KRS 342 .165(2) codified a
1 See Honaker v . Duro Bag Manufacturing Co. , 851 S.W.2d 481 (Ky. 1993) (worker
who had his brother take pre-employment physical failed to comply with condition
precedent to valid employment) ; Divita v. Hopple Plastics, 858 S.W.2d 214 (Ky. App .
1993) (remand appropriate to determine the role of previous injuries in workers'
compensation injury) .
judicially-adopted test that prohibits compensation if all of the three listed
factors are present. 2
The hospital asserts that the ALJ interpreted and applied KRS
342 .165(2) properly, arguing that its reliance on the claimant's
misrepresentation was not used to satisfy both the second and third prongs of
the test set forth in KRS 342 .165(2) . Instead, the ALJ based the finding of a
causal connection on the fact that the claimant would not have been hired if he
had told the truth and, thus, would not have performed work that exceeded his
lifting restriction and been injured . The hospital concludes that a neck injury
due to a slip and fall or reaching for a chart would have-been compensable, but
a neck injury due to exceeding the lifting restriction was not.
We presume that by listing three separate factors and by stating that all
must be present, the legislature intended for KRS 342 .165(2) to create three
distinct requirements . 3 If subsection (c) requires only proof that the injury
would not have occurred because the worker would not have been hired, an
employer will always win simply by showing that it relied on a
misrepresentation and would not have hired the worker had it known the
truth. KRS 342 .165(2)(c) requires "a causal connection between the false
representation and the injury for which compensation has been claimed ." The
hospital states correctly that the claimant failed to disclose his lifting
restriction ; that he exceeded the restriction by lifting a heavy patient; and that
2 Divita v. Hopple Plastics , 858 S .W .2d at 215-16 .
3 See Grieb v. National Bond and Investment Company, 264 Ky. 289, 94 S .W.2d 612
(1936) .
he injured his neck as a consequence of lifting the patient. We do not agree
that these facts supported a finding under KRS 342 .165(2)(c) because we view
whether exceeding the lumbar lifting restriction helped to cause the claimant's
neck injury to be a medical question.
This is not a case in which lumbar weakness or symptoms contributed to
the mechanism of the injury. Nor is it a case in which the claimant's lumbar
condition increased his susceptibility to the type of harm that occurred . Both
Dr. Djurasovic and Dr. Harpring stated that the claimant's lumbar and neck
conditions were unrelated . Dr. Djurasovic based the claimant's lifting
restriction on the previous lumbar surgeries . Although the claimant sought
compensation for a neck injury incurred while exceeding the restriction, no
medical evidence indicated that prior lumbar surgeries or exceeding a lumbar
lifting restriction would cause a neck injury . We conclude, therefore, that the
ALJ erred by finding for the hospital under subsection (c) and by dismissing
the claim without further consideration . The ALJ must consider the remaining
issues on remand.
The decision of the Court of Appeals is affirmed and this claim is
remanded for consideration of the remaining contested issues.
All sitting. All concur.
COUNSEL FOR APPELLANT,
BAPTIST HOSPITAL EAST:
Douglas Anthony U'Sellis
U'Sellis 8s Kitchen, PSC
600 East Main Street
Suite 100
Louisville, KY 40202
COUNSEL FOR APPELLEE,
AUGUST POSSANZA :
Mark Clark Webster
Karl Truman Law Office, LLC
420 Wall Street
Jeffersonville, IN 47130
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