Randall K. Shawver v. Quality Plus Auto Care, LLC
20-0301
| W. Va. | Jun 23, 2021Background
- Claimant Randall K. Shawver, a mechanic, injured his lower back at work on September 25, 2017; initial imaging showed an L4-5 disc bulge and suspected L5-S1 herniation. The claim was held compensable for lumbar sprain/strain and TTD was paid from 9/28/17–10/26/17.
- Treating records (PARS Neurosurgical Associates and others) document ongoing back/radicular pain, physical therapy with limited benefit, a June 19, 2018 discogram reported as not demonstrating discogenic pain, and consideration of surgery by some providers.
- Multiple independent medical evaluations: Dr. Prasadarao Mukkamala (Jan–Apr–July 2018) initially recommended additional PT and light-duty work, later opined L4-5 discectomy/decompression might be indicated but ultimately (July 2019) concluded symptoms were due to preexisting degenerative disease and that the compensable soft-tissue injury had reached MMI; Dr. David Soulsby (Sept. 20, 2018) found the sprain/strain resolved, the ongoing pain attributable to preexisting degenerative disc disease, and that claimant had reached MMI.
- The claims administrator closed temporary total disability (TTD) benefits on October 18, 2018. The Office of Judges affirmed that closure on October 1, 2019; the Board of Review affirmed on April 14, 2020.
- The Supreme Court of Appeals reviewed the administrative record and affirmed, holding the claim had reached maximum medical improvement (MMI) and TTD benefits were properly discontinued.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether the claim was properly closed for temporary total disability benefits | Shawver: ongoing symptoms and need for further treatment/surgery mean he had not reached MMI and TTD should continue | Employer: claimant reached MMI; compensable condition limited to sprain/strain; ongoing symptoms result from preexisting degenerative disease | Affirmed: MMI reached (by 9/20/2018) and TTD properly closed 10/18/2018 |
| Whether the compensable condition included a new disc injury requiring surgery | Shawver: work injury aggravated a disc herniation and may require surgical treatment | Employer/IMEs: no evidence compensable injury caused a specific disc injury or necessitated surgery; findings attributable to preexisting degeneration | Held: compensable condition limited to lumbar sprain/strain; no causal link to surgical-disc pathology established |
Key Cases Cited
- Hammons v. W. Va. Off. of Ins. Comm’r, 235 W. Va. 577, 775 S.E.2d 458 (2015) (explains standard of review and deference to Board of Review in workers’ compensation appeals)
- Justice v. W. Va. Office Ins. Comm’n, 230 W. Va. 80, 736 S.E.2d 80 (2012) (applies de novo review to legal questions from the Board)
- Davies v. W. Va. Off. of Ins. Comm’r, 227 W. Va. 330, 708 S.E.2d 524 (2011) (further explains standards for appellate review of workers’ compensation decisions)