New Psychological Reports Merit 2nd Look at Worker’s PTD Request

Case File

Because a worker presented evidence that his psychological condition had worsened, the Ohio Supreme Court determine that an SHO too hastily turned away his request for PTD benefits. Simply Research subscribers have access to the full text of the decision.

Case

State ex. rel. Prinkley v. Emerine's Towing, Inc., No. 2024-Ohio-5713 (Ohio 12/09/24).

What Happened

A worker for a towing company was injured while working. His workers' compensation claim was allowed for myocardial infarction and substantial aggravation of preexisting coronary artery disease as well as major depressive disorder, single episode.

More than four years later, the worker filed an application for permanent total disability compensation, with a physician opining that the worker was "permanently and totally disabled from any and all sustained, gainful, and remunerative employment."

The worker's psychologist opined that the worker's psychiatric condition constituted approximately 25% disability, but the commission's psychologist opined that the worker had a 3% whole-person impairment and was "capable of working."

A state hearing officer found that the worker's nonmedical disability factors favored reemployment.

Later, the worker filed a subsequent application for PTD compensation. The medical doctors did not deviate from the previous assessments of the worker's physical conditions, but two new psychologists opined that he was incapable work and put the whole-person impairment caused his psychological condition at 30% to 35%.

Regarding the subsequent application, an SHO found that, based on a change in law, the worker was required to present evidence of new and changed circumstances on the new request for PTD compensation.

The case went to court, where the SHO's order was deemed not to satisfy precedent case law in Ohio.

Eventually, a magistrate recommended returning the matter to the commission, which appealed to Ohio's Supreme Court.

Rule of Law

Because the worker was seeking a writ of mandamus, which is granted in Ohio when there is a legal basis to compel the commission to perform its duties under the law or when the commission has abused its discretion in carrying out its duties, the Ohio Supreme Court would leave the decision alone if the order was adequately explained and based on "some evidence."

Under State ex. rel. Noll v. Indus. Comm., 57 Ohio St.3d 203 (1991), in any order of the commission granting or denying benefits to a claimant, the commission must specifically state what evidence has been relied upon and briefly explain the reasoning for its decision.

What the Ohio Supreme Court Said

The Ohio Supreme Court upheld the lower court ruling, agreeing that the SHO's order did not satisfy the requirements of the Noll case. According to the court, the SHO failed to cite the evidence on which it relied in reaching its decision and instead just mentioned all the evidence it considered.

In particular the court pointed out that the worker presented evidence of the worsening of his existing medical condition, which "often serves as evidence of new and changed circumstances justifying the exercise of continuing jurisdiction to modify a previous order" per State ex. rel. Bing v. Indus. Comm., 61 Ohio St.3d 424 (1991).

"Given that the psychologists’ reports in the claim file document a worsening of [the worker]’s allowed conditions, the SHO could not have relied on the entire claim file in concluding that [the worker] failed to present any evidence of new and changed circumstances," the court concluded.

Takeaway

Evidence that an existing medical condition has worsened may be the kind of evidence Ohio requires to justify modifying a workers' compensation award.

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