Hensley v. District of Columbia Department of Employment Services
2012 D.C. App. LEXIS 330
| D.C. | 2012Background
- Petitioner Horace Hensley has received total disability workers’ compensation since the late 1980s for ankylosing spondylitis (AS).
- He sought reimbursement for medical, assisted-living, transportation, home attendant, shaving, and other services claimed to relate to workplace aggravation of AS in 1986.
- Petitioner also sought a 20% penalty for employer’s alleged failure to timely pay COLAs from Feb 1990 through July 1997.
- An ALJ denied reimbursement but allowed the 20% penalty; the CRB upheld denial of reimbursement and reversed the penalty.
- The court affirms the reimbursement denial but reverses the CRB on the 20% penalty and remands for further proceedings.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Is there a causal connection between 1986 work injury and claimed medical expenses? | Hensley argues the prior OWC rulings bind causality. | Employer contends the expenses are not causally related to the 1986 work injury. | Affirmed: substantial evidence supports lack of causality for reimbursement. |
| Were the transportation, shaving, home-modification, and related expenses properly awarded for reimbursement? | Hensley asserts these expenses are compensable. | Employer argues insufficient medical evidence and documentation for relation to work injury. | Affirmed: substantial evidence supports ALJ finding against reimbursement for these items. |
| Whether the 20% penalty order was properly issued under § 32-1519(a) and timely appealed. | Hensley contends the ALJ awarded a penalty and the two-year default period should apply; CRB’s reversal was erroneous. | Employer argues the CRB correctly treated the relief as a default-order issue governed by § 32-1519(a). | Reversed: CRB’s construction of § 32-1519(a) was arbitrary; remand to address the proper interpretation. |
| Should res judicata or new arguments bar reconsideration of penalties? | Hensley contends prior DOClientes rulings bind the issue. | Employer cites res judicata and preclusion. | Rejected: remand for consistent application of law; not barred by preexisting informal-conference decisions. |
Key Cases Cited
- Muhammad v. District of Columbia Dep’t of Emp’t Servs., 34 A.3d 488 (D.C.2012) (de novo review of questions of law; defer to agency on statutory interpretation only for law not controlling)
- Marriott Int’l v. District of Columbia Dep’t of Emp’t Servs., 834 A.2d 882 (D.C.2003) (substantial evidence standard; cannot substitute CRB for ALJ absent error)
- Canlas v. District of Columbia Dep’t of Emp’t Servs., 723 A.2d 1210 (D.C.1999) (CRB cannot substitute its judgment for ALJ on factual findings)
- Hard Rock Cafe v. District of Columbia Dep’t of Emp't Servs., 911 A.2d 1217 (D.C.2006) (penalties for late payments; self-executing provision considerations)
- Snowden v. Dir., OWCP, 253 F.3d 725 (D.C.Cir.2001) (LHWCA analogy; penalties and default orders)
- Tidelands Marine Serv. v. Patterson, 719 F.2d 126 (5th Cir.1983) (substance of default/penalty orders)
- Joyner v. District of Columbia Dep’t of Emp’t Servs., 502 A.2d 1027 (D.C.1986) (guiding principles on precedents and statutory interpretation)
- Brown v. Davis Mem’l Goodwill Indus., unreporter (DC Wrk. Comp. LEXIS 378) (2007) (CRB practice and default/penalty distinctions (cited as guidance))