Albright v. North Dakota Workforce Safety & Insurance
2013 ND 97
| N.D. | 2013Background
- Brenda Albright, a long‑time Smurfit‑Stone forklift operator with a documented history of multilevel degenerative cervical and lumbar disk disease, reported acute right‑side/back pain on June 8, 2010 after standing up from squatting; MRI showed an L1‑L2 herniation and she later had L1‑2 surgery.
- WSI initially accepted liability then denied the claim, concluding the incident merely triggered symptoms of a preexisting degenerative condition and did not substantially accelerate or worsen it.
- Treating providers (Dr. Marc Eichler, PA Heidi Olson‑Fitzgerald, and chiropractor Kevin Paape) submitted letters attributing the herniation or degenerative disease to work; WSI relied on an independent records reviewer (Dr. Charles Burton) who concluded the work event was the ‘‘straw that broke the camel’s back’’ and did not substantially accelerate the underlying disease.
- An ALJ credited Dr. Burton over the treating providers, finding the treating opinions inconsistent with the record and insufficiently supported; the ALJ denied benefits and reconsideration.
- The district court reversed the ALJ, awarded benefits, and granted attorney fees to Albright; WSI appealed to the North Dakota Supreme Court.
- The Supreme Court evaluated N.D.C.C. § 65‑05‑08.3 (treating doctor’s opinion statute), affirmed deference to the ALJ, held WSI satisfied the statute in rejecting treating opinions, reversed the district court, reinstated the ALJ order denying benefits, and vacated the attorney‑fee award.
Issues
| Issue | Albright's Argument | WSI's Argument | Held |
|---|---|---|---|
| Effect of N.D.C.C. § 65‑05‑08.3 (treating‑doctor weight) | Statute creates a presumption that treating doctors’ opinions get controlling weight unless WSI rebuts under listed factors. | Statute codifies existing caselaw: WSI may disregard treating opinions but must explain and apply factors when doing so. | Statute is ambiguous but legislative history shows it codifies caselaw requiring WSI to consider the whole record and adequately explain rejection using the listed tests/factors. |
| Whether WSI adequately rejected treating physicians’ opinions | Treating physicians’ letters showed causation; ALJ and district court should give them controlling or presumptively greater weight. | Treating opinions were inconsistent with substantial record evidence, weakly worded, not tested by testimony, and thus could be rejected under § 65‑05‑08.3 factors. | WSI met § 65‑05‑08.3: ALJ reasonably found treating opinions inconsistent with the record and gave persuasive reasons for crediting Dr. Burton. |
| Causation / compensability (substantial acceleration or worsening) | The June 8, 2010 work event and repetitive forklift duties substantially contributed to/worsened her degenerative disease and caused the L1‑2 herniation. | The event merely triggered symptoms of a longstanding multilevel degenerative condition; bending could have produced the herniation anywhere/anytime and did not substantially accelerate progression. | A reasoning mind could accept ALJ’s finding that the work incident did not substantially accelerate or worsen the preexisting disease; ALJ’s credibility and fact‑weighing were reasonable. |
| Attorney fees under N.D.C.C. § 28‑32‑50(1) | WSI acted without substantial justification in denying benefits, so fees and costs should be awarded. | WSI acted with substantial justification in disputing claim; fees not warranted. | Albright is not prevailing party; district court erred in awarding fees/costs. |
Key Cases Cited
- Mickelson v. N.D. Workforce Safety & Ins., 820 N.W.2d 333 (N.D. 2012) (standards for appellate review of agency decisions)
- Bruder v. N.D. Workforce Safety & Ins. Fund, 761 N.W.2d 588 (N.D. 2009) (agency must consider entire record and explain reasons for disregarding treating physician evidence)
- Swenson v. N.D. Workforce Safety & Ins. Fund, 738 N.W.2d 892 (N.D. 2007) (court has declined to give treating physician opinions an automatic presumption of controlling weight)
- Unser v. N.D. Workers Comp. Bureau, 598 N.W.2d 89 (N.D. 1999) (claimant bears burden to prove entitlement by preponderance)
- Manske v. Workforce Safety & Ins., 748 N.W.2d 394 (N.D. 2008) (causal connection requires employment to be a substantial contributing factor)
- Snyder v. N.D. Workers Comp. Bureau, 622 N.W.2d 712 (N.D. 2001) (district court’s analysis of agency decisions is entitled to respect)