WCB App. Div. Rejects Bright Line Rule To Define “Significant” or Requirement EE Claim Pre-existing Condition When Applying Sec. 201(4)

Hopkins v. Sebasticook Family Health – Sebasticook conceded the employee sustained work-related injuries to his low back of January 13, 2016 and January 21, 2018 but argued the ALJ erred in granting the petitions for award because the employee failed to meet her burden under sec. 201(4) to show her employment made a significant contribution to the disability where the 312 IME opined that each injury contributed 12.5% to the disability. In Hopkins v. Sebasticook Family Health, Dec. No. 22-27, the employee had long standing pre-existing degenerative lumbar disc disease and was diagnosed with herniated disc at L4-5 resulting from the two injuries. The employer argued that as a matter of law 12.5% cannot be considered a significant contribution. It urged the panel to adopt a “bright line” rule that the employment contribution must exceed 50%. Finding no authority for this proposition the panel rejected the argument. There was competent evidence for the ALJ to find the employment contributed to the disability in a significant manner by causing persistent symptoms that required treatment, in addition to the 12.5% estimate provided by the 312 IME.

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Brown v. County of Cumberland – While at work on January 3, 2019 the employee slipped and fell on ice landing on his holstered firearm with his right hip. In Brown v. County of Cumberland, Dec. No. 22-28, the County argued the ALJ erred in awarding benefits based on a pre-existing condition under sec. 201(4) where the employee did not claim he had a pre-existing condition, offered no evidence of a pre-existing condition and denied knowledge of a pre-existing condition. The panel held it was appropriate for the ALJ to reject that testimony and accept medical evidence in the record that Brown had a right hip labral tear in 2013 with progressive arthritis. An ALJ has a responsibility to review the entire record to decide which facts to accept or reject. The panel also rejected the County’s argument that the ALJ erred by applying Bryant rather than sec. 201(4) when analyzing compensability of pre-existing conditions. When applying sec. 201(4) an ALJ must first determine whether a work related injury occurred, and if so, whether the employment contributed to disability in a significant manner. It was not error for the ALJ to apply Bryant when making the initial determination of whether a work-related injury occurred in the first place.

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Thomas Getchell
Daniel F. Gilligan