Blue Flame Pipeline, LLC. v. James Thomas
20-0291
| W. Va. | Jun 23, 2021Background
- On July 12, 2018 James Thomas was struck on the head by falling equipment while on a Blue Flame jobsite; he suffered a concussion, laceration, loss of consciousness and later seizure activity.
- Thomas received immediate treatment at MedExpress and United Hospital Center; a WC‑1 (Employees’ and Physicians’ Report of Occupational Injury) was completed at MedExpress on July 12, 2018 and a second WC‑1 was completed October–December 2018.
- The carrier (Travelers) sent Thomas correspondence and a Claim ID card with a claim number in late July/early August 2018, and Thomas exchanged emails with a claims representative about treatment, medication costs, and settlement in spring 2019.
- The claims administrator issued an Order on May 30, 2019 rejecting the claim as not timely filed because the WC‑1 allegedly was not submitted within six months; Thomas protested and testified he believed the claim had been handled by employer/carrier.
- The Office of Judges affirmed the denial on September 18, 2019; the Board of Review reversed on April 14, 2020, finding employer and carrier had actual knowledge and the claim was timely; the Supreme Court of Appeals affirmed the Board.
Issues
| Issue | Plaintiff's Argument (Thomas) | Defendant's Argument (Blue Flame / Carrier) | Held |
|---|---|---|---|
| Timeliness of filing under six-month rule | Thomas completed WC‑1(s) within six months and reasonably believed employer/carrier submitted them | Thomas’s benefit application filed April 29, 2019 was untimely; WC‑1 not timely submitted | Claim held timely: employer and carrier had actual notice and communications that made further filings unnecessary |
| Validity of claims administrator’s May 30, 2019 rejection | Carrier had acknowledged claim, issued claim number, and communicated about claim matters | Rejection based on missing WC‑1 was proper after investigation | Rejection reversed; remanded to claims administrator to rule on compensability merits |
| Whether Office of Judges lacked jurisdiction to accept late filing | Thomas argued communications and carrier actions excused his failure to file directly | Office concluded carrier lacked jurisdiction to accept late application | Board and Court rejected Office’s conclusion; Court sided with Board finding timely notice to employer/carrier |
| Standard of review for Board reversal of Office of Judges | N/A (legal standard) | N/A | Court applies deference to Board per statute and case law; reversal of Board only if clearly wrong, but here Court affirmed Board |
Key Cases Cited
- Hammons v. W. Va. Office of Ins. Comm’r, 235 W. Va. 577, 775 S.E.2d 458 (2015) (explains standard of review and deference to the Board of Review in workers’ compensation appeals)
- Justice v. W. Va. Office of Ins. Comm’n, 230 W. Va. 80, 736 S.E.2d 80 (2012) (applies de novo review to legal questions arising from Board decisions)
- Davies v. W. Va. Office of Ins. Comm’r, 227 W. Va. 330, 708 S.E.2d 524 (2011) (addresses appellate review of workers’ compensation rulings)