T.E.C. v. M & G Polymerse USA, LLC, 20-0388

Claimant (T.E.C.) suffered severe work-related injuries on January 14, 2015 (multiple femur fractures, shoulder and other injuries) and underwent multiple surgeries; the claim was held compensable for orthopedic injuries.
Treating physician Mahija Kottapalli, M.D., reported that claimant developed depression, suicidal ideation, flashbacks, and anxiety immediately after the injury and requested adding recurrent severe major depressive disorder, post-traumatic stress disorder (PTSD), and generalized anxiety disorder to the claim.
Claims administrator denied the addition on November 28, 2016, and again on April 4, 2017; claimant appealed and the Office of Judges and Board of Review ultimately denied the requested additions.
Independent medical examiner Bobby Miller, M.D., and later evaluators (Drs. Abascal, Caveney, and Lillard) administered multiple psychological tests that showed marked symptom exaggeration/malingering; both concluded psychiatric diagnoses could not be reliably made due to feigning.
The Board and the Supreme Court found the Hale three-step procedure for adding psychiatric conditions was not followed (treating‑physician referral, psychiatrist’s detailed report per rule, claims-administrator determination) and that the preponderance of evidence (psychological testing) did not support adding the psychiatric diagnoses.

Issue	Plaintiff's Argument	Defendant's Argument	Held
Whether severe recurrent MDD, PTSD, and GAD should be added to the claim	Kottapalli diagnosed these conditions as beginning immediately after the injury and asserted they are compensable	Claims administrator and IMEs say evidence insufficient and tests show malingering; procedural defects in submission	Denied — claimant failed to prove conditions by preponderance; testing showed symptom fabrication
Whether the Hale procedure was satisfied for adding psychiatric conditions	Plaintiff relied on treating-physician diagnosis to support addition	Defendant noted Hale’s required referral/report steps were not followed and no adequate psychiatrist report was submitted	Hale steps not followed; procedural deficiency supports denial
Whether IME and subsequent psychiatric evaluations were reliable given early hospitalization and referrals	Plaintiff suggested Dr. Miller’s initial referral to hospital undermined reliance on his malingering finding	Defendant emphasized later addendum and independent testing confirming symptom feigning	Court credited Miller and later evaluators; their testing supported denial
Proper standard of review for Board/Office findings	Plaintiff sought reversal of Board’s affirmance	Employer urged deference to Board/Office findings under WV law	Court applied statutory deference and affirmed (no clear legal error)

Hammons v. W. Va. Off. of Ins. Comm’r, 235 W. Va. 577, 775 S.E.2d 458 (discussion of appellate standard of review and deference to Board)
Justice v. West Virginia Office Insurance Commission, 230 W. Va. 80, 736 S.E.2d 80 (de novo review applies to legal questions arising from Board decisions)
Davies v. W. Va. Off. of Ins. Comm’r, 227 W. Va. 330, 708 S.E.2d 524 (standard of review principles for workers’ compensation appeals)
Hale v. West Virginia Office of the Insurance Commissioner, 228 W. Va. 781, 228 S.E.2d 752 (establishes three-step procedure for adding psychiatric conditions to a workers’ compensation claim)