NCCI Court Case Update

Iowa, Entitlement to Death Benefits

On October 30, 2024, the Iowa Court of Appeals, in Linnhaven Inc. v. Blasdell, affirmed an award of workers compensation (WC) death benefits to the spouse of a totally disabled employee who died from a prescription drug overdose.

An employee who developed depression after suffering a compensable workplace injury died from a prescription drug overdose. The employee's spouse filed a claim for WC death benefits. The employer denied liability, asserting that the employee died by suicide, which pursuant to Iowa statute 85.16, bars recovery of WC benefits for willfully self-inflicted injuries. The Workers' Compensation Commissioner (WCC) concluded that although there was some evidence that could have pointed to a suicide, other evidence supported a finding of an accidental overdose.

On appeal, the court of appeals explained that the WCC is vested with discretion to make factual determinations in cases such as this. Moreover, the court noted, the WCC's determinations must be accepted when supported by substantial evidence, regardless of whether other evidence in the record makes it possible to arrive at the opposite result. In this case, the court concluded that the WCC's finding that the employee's death was caused by an accidental overdose was supported by substantial evidence and upheld the award of death benefits.

Kentucky, COVID-19 Compensability

On November 8, 2024, the Court of Appeals of Kentucky, in Norton Healthcare v. Murphy, held that a nurse was not entitled to workers compensation (WC) benefits as she failed to meet her burden of proof that her contraction of COVID-19 was work related.

In this case, a nurse filed an injury claim seeking WC benefits for her alleged contraction of COVID-19 at work. The administrative law judge (ALJ) concluded that the nurse failed to present clear evidence of actual exposure at work. The Workers' Compensation Board reversed the ALJ's determination concluding that, as an occupational disease claim, the employee only had to show that the workplace conditions "could have caused" the disease.

On appeal, the court of appeals disagreed with the Board's finding, reasoning that the Board had applied the occupational disease standard to an injury claim based upon exposure to a communicable disease. The court noted that, according to Kentucky statute 342.0011, communicable diseases can be compensable as injuries when the claimant establishes that the risk of contracting the disease is increased by the nature of the employment. Turning to the facts of the case, the court found that while there was some evidence of potential exposure at work, the nurse failed to present any clear evidence of actual work exposure. Moreover, the court added, the record contained substantial evidence that the nurse could have contracted the illness while engaging in activities outside of work.​

With this decision, the court reversed the Workers' Compensation Board's findings, concluding that the ALJ applied the correct standard as to the question of whether the nurse was actually exposed to COVID-19 during the course and scope of employment.

Maine, Accrual of Interest on Benefits

On November 5, 2024, the Supreme Judicial Court of Maine, in Michaud v. Caribou Ford-Mercury, Inc., considered for the first time when specific loss benefits for the loss of an eye become due to a claimant.

In 2014, a claimant suffered a traumatic injury to the left eye, which immediately resulted in a loss of more than 80% of vision in that eye. In 2021, the claimant petitioned for specific loss benefits, which are designed to compensate injured employees for the actual loss of a body part. A physician determined that the claimant was at maximum medical improvement (MMI) and that at that point in time, the claimant had a 94% loss of vision in the affected eye.

The court determined that per Maine statute 212, the claimant was entitled to specific loss benefits as he had sustained 80% loss of vision. Turning to the issue of when the benefits became due, the court reasoned that even though the determination of when benefits become due cannot be made until after MMI has been reached, the date that specific-loss benefits become due is retrospective, potentially to the date of injury. The analysis would require looking backward to determine when the eye injury damaged the employee's vision to the threshold of 80% vision loss, whether treatment later restored the employee's vision, and the extent of any restoration.

Based on the facts of this case, the court concluded that the employee suffered actual loss of his left eye on the date of his injury and there was never an assessment that his vision loss was restored to a point below the 80% threshold after that. Therefore, the court held, the employee became entitled to specific-loss benefits on the date of his injury and the employer owed interest on the award accruing from that date.

For more information on other cases monitored by NCCI's Legal Division, visit previous Court Case Updates and Court Case Insights under the Legal section of INSIGHTS on ncci.com.

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