CITY OF HOPEWELL and Virginia Municipal Group Self-Insurance Association v. Michael W. TIRPAK.
Record No. 1369-97-2.
Court of Appeals of Virginia, Richmond.
July 28, 1998.
502 S.E.2d 161
ELDER, Judge.
Because appellee has not shown that he was materially prejudiced by appellant‘s failure to timely file the notice, appellee has not met the burden imposed on him by
The members of the bar may benefit from the issue addressed in this order. Therefore, we direct the Clerk to publish this order.
B. Mayes Marks, Jr. (B. Mayes Marks, Jr., P.C., on brief), Hopewell, for appellee.
Present: BENTON, ELDER and BUMGARDNER, JJ.
ELDER, Judge.
The City of Hopewell and Virginia Municipal Group Self-Insurance Association (collectively “employer“) appeal a decision of the Workers’ Compensation Commission (“commission“) awarding temporary total disability and medical benefits to Michael W. Tirpak (“claimant“), who is a police officer. Employer contends the commission erred when it (1) concluded it had subject matter jurisdiction over claims involving gradually incurred heart disease, (2) found that a diagnosis of claimant‘s heart disease was communicated to him on February 17, 1995, and (3) found that employer failed to rebut the statutory presumption contained in
I.
FACTS
Claimant has worked as a police officer for the City of Hopewell since 1973. On February 17, 1995, he was diagnosed with multi-vessel coronary artery disease by Dr. Ashok Kumar. Claimant underwent triple bypass surgery on February 21 and returned to work on May 22.
Claimant filed a claim with the commission seeking medical and temporary total disability benefits stemming from his heart disease. During a hearing on claimant‘s claim, both parties presented evidence regarding the causation of claimant‘s heart disease. Following the hearing, a deputy commissioner awarded claimant temporary total disability benefits from February 8, 1995, through May 21, 1995, and medical benefits from January 24, 1995, and continuing. Employer appealed, and the commission affirmed. The commission found that Dr. Kumar‘s diagnosis on February 17, 1995 informed claimant that his heart disease was an occupational disease. The commission also found that the evidence presented by employer failed to rebut the statutory presumption of
II.
COMMISSION‘S SUBJECT MATTER JURISDICTION OVER CLAIM REGARDING GRADUALLY INCURRED HEART DISEASE
Employer contends the commission lacked subject matter jurisdiction over claimant‘s claim. It argues that, in light of Jemmott and Allied Fibers v. Rhodes, 23 Va.App. 101, 474 S.E.2d 829 (1996), heart disease resulting from “cumulative exposure to causative factors” is no longer covered by the Workers’ Compensation Act (“Act“). As such, employer asserts the commission is without jurisdiction under
We hold that neither Jemmott nor Rhodes has stripped the commission of subject matter jurisdiction under
III.
COMMUNICATION DATE OF DIAGNOSIS
Employer contends the commission erred when it found that claimant received a diagnosis of an occupational disease on February 17, 1995. Because credible evidence in the record supports the commission‘s finding, we disagree with employer‘s contention.
An occupational disease is not compensable under the Act until a diagnosis of the occupational disease has been communicated to the employee. See Island Creek Coal Co. v. Breeding, 6 Va.App. 1, 9, 365 S.E.2d 782, 787 (1988);
IV.
LEGAL STANDARD APPLIED BY THE COMMISSION REGARDING THE REBUTTAL OF THE PRESUMPTION OF CODE § 65.2-402(B)
Both employer and claimant argue that Overbey and Bass rendered incorrect the legal standard applied by the commission and that this case should be remanded to the commission for factual findings based upon the correct legal standard. We agree.
The Act “currently provides coverage for impairments arising out of and in the course of employment that fall into one of two categories: (1) ‘injuries by accident’ and (2) ‘occupational disease.‘” A New Leaf, Inc., 26 Va.App. at 465, 495 S.E.2d at 513 (quoting
In Bass, this Court applied the holding of Overbey to a case in which one physician opined that the “probable cause” of the claimant‘s heart disease was “genetic and environmental.” Bass, 26 Va.App. at 134, 493 S.E.2d at 667. None of the doctors who expressed an opinion in Bass “opined to a reasonable degree of medical certainty that job stress was a causative factor in the disease [the] claimant suffered.” Id. at 135, 493 S.E.2d at 667. Based on the Supreme Court‘s holding in Overbey that the employer was not required to exclude the possibility that job stress may have contributed to the claimant‘s heart disease, we held that the commission erred when it found the employer had failed to rebut the causation presumption. Id. at 134, 493 S.E.2d at 667 (citing Overbey, 254 Va. at 527, 492 S.E.2d at 634).
In light of Bass and Overbey, we hold that the commission applied an incorrect legal standard in this case when it found that employer had failed to rebut the causation presumption. In its opinion, the commission stated that “[t]he employer fails to rebut the presumption [of
V.
REBUTTING THE PRESUMPTION OF CODE § 65.2-402(B)
Employer makes additional legal arguments that are likely to arise on remand. First, it contends Overbey stands for the proposition that determining whether the causation presumption has been rebutted is based solely upon the evidence presented during the employer‘s rebuttal case.3 Along these lines, the concurring opinion contends the causation presumption shifts only the burden of production on the issue of causation to the employer and that the presumption disappears upon the introduction of contrary evidence by the employer. Second, employer argues that, under Overbey, all an employer must show to rebut the causation presumption is that the claimant‘s heart disease had at least one non-work-related cause.4 We address each issue in turn.
A.
EFFECT OF THE PRESUMPTION OF CODE § 65.2-402(B) ON THE BURDENS OF PRODUCTION AND PERSUASION
First, we consider the effect of the causation presumption when an employer offers evidence tending to show that a claimant‘s heart disease has a non-work-related cause. Because the Virginia Supreme Court stated in Fairfax County Fire and Rescue Services v. Newman, 222 Va. 535, 281 S.E.2d 897 (1981), that the causation presumptions now codified at
1.
Burden of Proof and Presumptions
In order to understand the Supreme Court‘s interpretation of the causation presumption in Newman, the law regarding the burden of proof and presumptions must be examined. In every judicial proceeding, the procedural mechanism known as the “burden of proof” is allocated.5 The phrase “burden of proof” refers to two related but distinct concepts: (1) the “burden of production,” which is the obligation to make a prima facie case, i.e., to introduce evidence
It is well established that the burden of production can shift from one party to the other during the course of a trial. See Redford v. Booker, 166 Va. 561, 569, 185 S.E. 879, 883 (1936) (citing Riggsby v. Tritton, 143 Va. 903, 918, 129 S.E. 493, 498 (1925)).8 Although the burden of persuasion “does not normally shift” during a trial, the burden of persuasion on a particular issue may be cast upon the defendant, particularly in cases involving certain kinds of presumptions.9 Although the burdens of production and persuasion are generally allocated to either the plaintiff, the party seeking to disturb the status quo, the party having peculiar knowledge of the matter, or according to the pleadings, there is no fixed rule for determining how these burdens should be allocated in every
A presumption is a procedural rule of law “directing that if a party proves certain facts (the ‘basic facts‘) at a trial or hearing, the factfinder must also accept an additional fact (the ‘presumed fact‘) as proven unless sufficient evidence is introduced tending to rebut the presumed fact.” 1 Jones on Evidence, supra, § 4:2 (emphasis in original); see also Martin v. Phillips, 235 Va. 523, 530, 369 S.E.2d 397, 401 (1988).11 Presumptions affect the evidentiary burdens of the parties with regard to particular factual issues.12 They are created for any of several reasons, including procedural fairness, procedural economy, the probability of the matter at issue, and the implementation of social policy.13
The actual effect of presumptions on the allocation of the burdens of production and persuasion is a hotly contested legal issue that “has literally plagued the courts and legal scholars” for decades.14 On one side of the issue is the
The competing school of thought, which is known as the “Morgan theory,” criticizes the “bursting bubble theory” for giving presumptions an effect that is too “slight and evanescent” when viewed in light of the policy reasons that justified their creation.17 Under the “Morgan theory,” a presumption should have the effect of shifting both the burden of production and the burden of persuasion on the factual issue in question to the party against whom the presumption operates.18 This effect ensures that a presumption, particularly
The law of presumptions in Virginia reflects both the Thayer theory and the Morgan theory. In an apparent Thayerian reference, the Virginia Supreme Court has stated that “[n]o presumption ... can operate to shift the ultimate burden of persuasion from the party upon whom it was originally cast,” Martin, 235 Va. at 526, 369 S.E.2d at 399, and there are numerous presumptions of the “bursting bubble” variety whose effect is merely to shift the burden of production on the factual issue in question.19 However, there are at least three “Morgan theory” presumptions in Virginia law that have the effect of shifting both the burdens of production and persuasion with regard to a particular factual issue: the presumption against suicide that arises in the context of claims under life insurance policies, the presumption of negligence arising in cases involving damaged goods delivered by a common carrier, and the presumption of legitimacy of a child born in wedlock.
The Supreme Court expressly considered the issue of the effect of the presumption against suicide on the burden of proof in Life & Cas. Ins. Co. of Tenn. v. Daniel, 209 Va. 332, 340-42, 163 S.E.2d 577, 583-86 (1968). Under this presumption; “when death by external and violent means is proven, a presumption arises in favor of the beneficiary that the death was accidental....” Id. at 335, 163 S.E.2d at 580. Addressing the effect of this presumption on the burden of proof, the Virginia Supreme Court held that, once the presumption arises, the burden of persuasion on the issue of whether the
Evidence to overcome [the presumption against suicide] must be clear and satisfactory and to the exclusion of any reasonable hypothesis consistent with death from natural or accidental causes. The presumption remains throughout the trial unless the evidence of suicide is so conclusive that only one reasonable deduction can be drawn therefrom, and it becomes a question of law for the court to decide. The jurors will weigh the evidence and test the persuasiveness of the facts proved on the issue of suicide, in the light of human experience, and the truth gained from it, that under most circumstances a human being will not deliberately and intentionally destroy himself.
Id. at 341-42, 163 S.E.2d at 584-85 (emphasis added).20 In concluding that the presumption against suicide shifted the burden of persuasion on the issue to the insurer, the Supreme Court relied on Morgan-like reasoning:
If the presumption disappeared once evidence to the contrary appeared, there would be nothing for that evidence to controvert. The presumption should stand in the face of such evidence and be given weight in determining the fact question. When positive evidence appears to indicate suicide it stands on one side, and the evidence of the plaintiff-beneficiary, together with the presumption, on the other, and the trier of fact must weigh them both in determining the question.
Id. at 340, 163 S.E.2d at 583.
Regarding the presumption of negligence that arises in cases where damaged goods are delivered by a common carrier, the Supreme Court has held that “[w]hen the plaintiff
such severity as may inhere in the rule seems necessary to the security of property, and the protection of commerce; it is founded on the great principle of public policy, has been approved by many generations of wise men; and if the courts were now at liberty to make instead of declaring the law, it may well be questioned whether they could devise a system which on the whole would operate more beneficially.
Id. (citation omitted) (emphasis added).
Turning to the presumption of legitimacy, the Supreme Court indicated as early as 1888 that this presumption has the effect of shifting the burden of persuasion on the issue of the child‘s legitimacy to the party claiming illegitimacy. See Scott v. Hillenberg, 85 Va. 245, 7 S.E. 377 (1888). In Scott, the Court stated:
Throughout the investigation, the presumption in favor of legitimacy is to have its weight and influence; and the evidence against it ought to be strong, distinct, satisfactory and conclusive.... The duty of the jury is to weigh the evidence against the presumption (of legitimacy,) and to decide according to the preponderance.
We conclude from the co-existence of “Thayer theory” presumptions and “Morgan theory” presumptions in Virginia law that, in practice, the Supreme Court follows the approach advocated by commentators on the common law rules of evidence: there is no single rule governing the effect of all presumptions; instead, the effect of a particular presumption on the burdens of production and persuasion depends upon the purposes underlying the creation of the presumption.22
2.
Newman and the Effect of the Presumptions of Code § 65.2-402
In Newman, the Supreme Court indicated that the presumptions included in Virginia‘s heart and lung statute, then codified at
The legislature was making a public policy judgment in its allocation of the burden of proof the ultimate risk of nonpersuasion in these cases. The fact that it chose to cast that burden upon the employer infringes no constitutional right.
Newman, 222 Va. at 541, 281 S.E.2d at 901. It is fundamental and well settled that the “risk of nonpersuasion” is a direct reference to the burden of persuasion. See Darden v. Murphy, 176 Va. 511, 518, 11 S.E.2d 579, 580 (1940) (stating that “the burden of proof in the sense of the risk of nonpersuasion” is distinguishable from “the burden of going forward with the evidence“).23
The Supreme Court also indicated in Newman that the causation presumption regarding respiratory diseases shifts both the burdens of production and persuasion to the employer by comparing it to the presumption against suicide. Citing Daniel, the Court stated that this causation presumption operates like the presumption against suicide:
Such burden on the employer is similar, we believe to the burden upon an insurance carrier who relies upon suicide as a defense to an accident policy where the insurer has the burden of proving suicide. . . .
Newman, 222 Va. at 541, 281 S.E.2d at 901. Thus, according to the Supreme Court‘s reasoning, the causation presumption “does not just disappear when evidence is offered in opposition thereto,” Daniel, 209 Va. at 340, 163 S.E.2d at 583, and, like the presumption against suicide, it has the effect of shifting both the burden of production and the burden of persuasion on the issue of causation to the employer.
Although, in Newman, the Supreme Court considered the General Assembly‘s intended effect of the causation presump-
Concluding that the causation presumption is a “bursting bubble” presumption would defeat the General Assembly‘s intent. Given the division in the medical community regarding the causative link between occupational stress and heart disease and the abundance of “risk factors” for heart disease that occur in everyday life, it is not difficult to imagine that, in cases where the presumption arises, an employer will be able to introduce evidence that a police officer‘s or firefighter‘s heart disease was caused solely by non-work-related factors. In such cases, under the “bursting bubble” theory,
This interpretation of
We note that, in Overbey, the Supreme Court arguably contradicted its earlier statements in Newman regarding the shifting from the claimant to the employer of the burden of persuasion on the issue of causation. The Court stated:
Because we conclude that the employer introduced sufficient evidence to rebut the presumption, [the claimant] had the burden of “establishing by clear and convincing evidence, to a reasonable medical certainty,” that his heart disease arose out of and in the course of his employment.
Overbey, 254 Va. at 527, 492 S.E.2d at 634. However, the only issue expressly addressed by the Court in Overbey was whether the employer is required to exclude every hypothetical possibility that the claimant‘s heart disease was work-related in order to rebut the presumption. See id. at 526, 492 S.E.2d at 633. Because the effect of the causation presumption on the burdens of production and persuasion was not the issue
B.
EXTENT OF NON-WORK-RELATED CAUSATION NECESSARY TO REBUT THE PRESUMPTION OF CODE § 65.2-402(B)
We next consider employer‘s contention that the causation presumption is always rebutted when the employer offers evidence that the claimant‘s heart disease had at least one non-work-related cause. We hold that, because the causation presumption shifts both the burdens of production and persuasion to the employer, whether proof of a non-work-related cause is sufficient to rebut the presumption depends upon how the commission weighs the evidence presented by the parties.
As the Supreme Court held in Overbey, an employer is never required to exclude the “possibility” that particular conditions of a claimant‘s employment caused his or
However, a claimant who proves that the causation presumption applies to his or her claim is entitled to full benefits if there is affirmative evidence deemed persuasive by the commission that the employment was a contributing cause of the claimant‘s heart disease.28 Thus, if the preponderance of the evidence indicates to the commission that the claimant‘s heart disease had multiple causes, at least one of which is related to the employment, then the presumption that the heart disease was “suffered in the line of duty” is not rebutted.29
Even assuming that the language of
As previously discussed, the General Assembly‘s purpose when enacting
Finally, we would be exceeding the scope of our judicial function were we to alter the General Assembly‘s intended application of
For the foregoing reasons, we affirm the commission‘s conclusion that it had subject matter jurisdiction over claimant‘s claim and its finding that the communication date of claimant‘s diagnosis was February 17, 1995. We vacate the commission‘s finding that employer failed to rebut the presumption of
Affirmed in part, vacated in part and remanded.
BUMGARDNER, Judge, concurring.
I concur in the decision to remand the case for further proceedings in light of Augusta County Sheriff‘s Dep‘t v.
In this case, Michael Tirpak had the burden of producing evidence that his heart disease was caused by his employment.
In Overbey, the employer presented evidence to rebut the presumed fact, causation by employment. The claimant failed to present evidence that established causation once the benefit of the presumption disappeared. Overbey had no evidence on the issue of causation, and the employer prevailed as a matter of law because it rebutted the presumption.
In the instant case, the employer presented evidence to rebut the presumed fact. Under Overbey the presumption was rebutted. However, the claimant presented other evidence that could establish causation. He did not rely solely on the presumption as Overbey did. This case must be remanded for the commission, acting as trier of fact, to evaluate
On remand the majority directs the commission to weigh the evidence of both parties to see if the employer presented sufficient evidence to rebut the presumed fact. I do not believe that is the correct procedure, but in this case it is not necessary to decide the correct practice for handling presumptions. Overbey establishes that the employer in this case has presented sufficient evidence to rebut the presumption. Because Tirpak, unlike Overbey, has some evidence to prove causation independent of the presumption, he may prevail if the commission finds that he met the burden of “‘establishing by clear and convincing evidence, to a reasonable medical certainty,’ that his heart disease arose out of and in the course of his employment.” Overbey, 254 Va. at 527, 492 S.E.2d at 634 (quoting
I would remand to the commission for it to evaluate the evidence from both sides to see if the claimant has met this burden. The issue of whether the burden of persuasion shifts to the employer should not be addressed at this time. It did not arise as the case was presented to the commission. The issue was never raised, briefed or argued.
502 S.E.2d 176
FAIRFAX COUNTY SCHOOL BOARD, Appellant,
v.
Ellen M. ROSE, Appellee.
Court of Appeals of Virginia.
July 28, 1998.
Notes
It is of no constitutional significance that the present state of medical science and the healing arts places a greater burden on the employer. . . . As long as an employer may introduce evidence in rebuttal of the presumption, the employer‘s constitutional rights of due process have been protected. The absence of evidence is a problem of proof and does not automatically make the presumption irrebuttable.
Virginia Dep‘t of State Police v. Talbert, 1 Va. App. 250, 254, 337 S.E.2d 307, 309 (1985). The factual findings of the commission are binding on appeal if they are supported by credible evidence in the record. Seethe weight to be given the evidence, the credibility of witnesses, and the resolution of conflicting opinions of expert medical testimony are matters solely . . . decided by the Commission.
