| S. F. Raymond Smith, Esq. Rundle & Rundle Pineville, West Virginia Attorney for Appellant Sandra L. Evans, Esq. |
Harold S. Albertson, Esq. Albertson & Jones Charleston, West Virginia Attorney for Appellee W-P Coal Company |
| |
1. 'The
Workmen's Compensation Law is remedial in its nature, and must be given a
liberal construction to accomplish the purpose intended.' Syl. pt. 3, McVey
v. Chesapeake & Potomac Telephone Co., 103 W. Va. 519, 138 S.E. 97
(1927) (citation omitted). Syl. pt. 1, Plummer v. Workers' Compensation
Division, ___ W. Va. ___, 551 S.E.2d 46 (2001).
2. '[The
Workers' Compensation Act] requir[es] the state compensation commissioner
in administering the workmen's compensation fund, to ascertain the substantial
rights of the claimants in such manner as will carry out justly and
liberally the spirit of the act unrestricted by technical and formal
rules of procedure . . . .' Syllabus, in part, Culurides v. Ott,
78 W. Va. 696, 90 S.E. 270 (1916) (citation omitted). Syl. pt. 2, Plummer
v. Workers' Compensation Division, ___ W. Va. ___, 551 S.E.2d 46 (2001).
3. Long
delay in processing claims for workmen's compensation is not consistent with
the declared policy of the Legislature to determine the rights of claimants
as speedily and expeditiously as possible. W. Va. Code, 23-5-3a. Syl.
pt.1, Workman v. Workmen's Compensation Comm'r, 160 W. Va. 656, 236
S.E.2d 236 (1977).
4. If
a claimant in a Workers' Compensation case to whom an award was made, dies while
appealing a subsequent adverse decision concerning that award, the appeal shall
proceed as if death had not occurred. Any unpaid compensation awarded as a result
of such an appeal, which would have been paid or payable to the claimant up
to the time of his or her death, shall not accrue to the estate of the claimant,
but shall be payable to the dependents of the deceased claimant, if there are
dependents at the time of death. Syl. pt. 3, Wingrove v. Workers' Compensation
Div., 208 W. Va. 80, 538 S.E.2d 378 (2000).
5. If
a claimant in a workers' compensation case dies during the pendency of the
claims process, the claim shall proceed as if death had not occurred. If the
claim ultimately prevails, all compensation that would have been awarded to
the claimant, had he or she lived, shall be paid to the dependents of the
deceased claimant. Any other claims any dependent might have as a result of
the claimant's death shall proceed unaffected. To the extent that this holding
conflicts with Wingrove v. Workers' Compensation Div., 208 W. Va. 80,
538 S.E.2d 378 (2000), or Hughes v. State Compensation Comm'r, 145
W. Va. 629, 116 S.E.2d 153 (1960), or its progeny, they are hereby overruled.
6. When
conflicting medical evidence is presented concerning the degree of impairment
in an occupational pneumoconiosis claim, that medical evidence indicating
the highest degree of impairment, which is not otherwise shown, through explicit
findings of fact by the Occupational Pneumoconiosis Board, to be unreliable, incorrect,
or clearly attributable to some other identifiable disease or illness, is
presumed to accurately represent the level of pulmonary impairment attributable
to occupational pneumoconiosis. Syl. pt. 1, Javins v. Workers' Compensation
Comm'r, 173 W. Va. 747, 320 S.E.2d 119 (1984).
7. If
the parties to a workers' compensation claim introduce reliable, conflicting
evidence about the existence of occupational pneumoconiosis, or reliable,
conflicting evidence about the degree of respiratory impairment caused by
or attributable to occupational pneumoconiosis, then the Division, the Office
of Judges and the Appeal Board must award the claimant benefits based upon
the reliable evidence that shows either the existence of occupational pneumoconiosis
or the highest degree of impairment. The claimant must be given the benefit
of all reasonable inferences the record will allow, and any conflicts in evidence
must be resolved in favor of the claimant.
McGraw, Chief Justice:
Mrs. Juanita Martin appeals
a decision of the Workers' Compensation Appeal Board that affirmed a denial
of her late husband's claim for a permanent total disability award. She was
substituted as a party to this action upon the death of her husband Dana Martin.
Because we find that Mr. Martin's death does not affect the outcome of his
appeal, and because we conclude that the Office of Judges and the Workers'
Compensation Appeal Board erred in not awarding permanent total disability
benefits, we reverse.
Mr. Dana Martin worked for
approximately twenty years as a coal miner for W-P Coal Company in Southern
West Virginia. As is often the case, Mr. Martin contracted occupational pneumoconiosis
while working in the mines, for which he submitted a workers' compensation
claim in 1987. That 1987 filing resulted in a finding by the Workers' Compensation
Division that Mr. Martin suffered from a 50 percent permanent partial disability
due to occupational pneumoconiosis. Mr. Martin sought an increase in his award
by filing another claim application in 1994, which the Division numbered 94-37387.
Because Mr. Martin's injury
was occupational pneumoconiosis, the Occupational Pneumoconiosis Board had to
make a determination if he merited an additional award. On March 13, 1995,
the Occupational Pneumoconiosis Board ruled that Mr. Martin was not entitled
to any additional permanent partial disability award beyond the 50 percent award
he had already received. Mr. Martin appealed this decision to the Office of
Judges, which also ruled against him, issuing a decision on October 28, 1998.
Undeterred, Mr. Martin took
this decision of the Office of Judges to the next step in the lengthy process,
an appeal to the Workers' Compensation Appeal Board (the Appeal Board).
After several months, the Appeal Board also ruled against Mr. Martin, issuing
on March 31, 1999, an order affirming the prior decision of the Office of
Judges. Mr. Martin proceeded to the final step in the process, a petition
for appeal to this Court, which he filed by counsel on April 9, 1999.
Before this Court could
act on the petition, Mr. Martin died on November 13, 1999. This Court granted
his petition for appeal on November 16, 1999, and granted his wife's requested
to be substituted as appellant in this case on December 20, 2000.
If considering a question
of fact, [i]n most cases we show substantial deference to the factual
findings of the Workers' Compensation Appeal Board. Plummer v. Workers'
Compensation Division, ___ W. Va. ___, ___, 551 S.E.2d 46, 48 (2001).
Indeed, we have repeatedly held that: This Court will not reverse a
finding of fact made by the Workmen's Compensation Appeal Board unless it
appears from the proof upon which the appeal board acted that the finding
is plainly wrong. Syllabus, Dunlap v. State Workmen's Compensation
Commissioner, 152 W. Va. 359, 163 S.E.2d 605 (1968); Accord, Rushman
v. Lewis, 173 W. Va. 149, 313 S.E.2d 426 (1984); Conley v. Workers'
Compensation Div., 199 W. Va. 196, 483 S.E.2d 542 (1997).
However, when considering
a question of law, we have a different standard: [w]hile the findings
of fact of the appeal board are conclusive unless they are manifestly against
the weight of the evidence, the legal conclusions of the appeal board, based
upon such findings, are subject to review by the courts. Barnett
v. State Workmen's Compensation Com'r., 153 W. Va. 796, 812, 172 S.E.2d
698, 707 (1970) (quoting Emmel v. State Compensation Director, 150
W. Va. 277, 145 S.E.2d 29 (1965)).
Also, we note that: When
the Workers' Compensation Appeal Board reviews a ruling from the Workers' Compensation
Office of Judges it must do so under the standard of review set out in W. Va.
Code § 23-5-12(b) (1995), and failure to do so will be reversible error.
Syl. pt. 6, Conley v. Workers' Compensation Div., 199 W. Va. 196, 483
S.E.2d 542 (1997). That code section provides, in pertinent part:
[The WCAB] shall reverse, vacate or modify the order or decision of the
administrative law judge if the substantial rights of the petitioner or petitioners
have been prejudiced because the administrative law judge's findings are:
(1) In violation of statutory provisions; or
(2) In excess of the statutory authority or jurisdiction of the administrative law judge; or
(3) Made upon unlawful procedures; or
(4) Affected by other error of law; or
(5) Clearly wrong in view of the reliable, probative
and substantial evidence on the whole record; or
(6) Arbitrary or capricious or characterized by
abuse of discretion or clearly unwarranted exercise
of discretion.
W. Va. Code § 23-5-12(b) (1995). Bearing these various standards in mind,
we turn to the case before us.
The initial petition for
appeal in this case concerned only whether or not Mr. Martin was entitled
to an increase in his permanent partial disability award. We will discuss
that issue in this opinion, but before doing so, we must address another issue
raised by Mr. Martin's demise. Because Mr. Martin died before his claim could
reach a final resolution, we must examine how his death may have affected
the outcome of his claim.
Before proceeding, we reiterate
the principles that guide us when considering a workers' compensation issue.
'The Workmen's Compensation Law is remedial in its nature, and must
be given a liberal construction to accomplish the purpose intended.' Syl.
pt. 3, McVey v. Chesapeake & Potomac Telephone Co., 103 W. Va.
519, 138 S.E. 97 (1927) (citation omitted). Syl. pt. 1, Plummer v.
Workers' Compensation Division, ___ W. Va. ___, 551 S.E.2d 46 (2001).
Although the rules and regulations governing the workers' compensation system in this state are necessarily detailed and complex, we must be careful to prevent those deserving of compensation from being thwarted by technicalities or procedural niceties:
[The Workers' Compensation Act] requir[es] the state compensation commissioner
in administering the workmen's compensation fund, to ascertain the substantial
rights of the claimants in such manner as will carry out justly and liberally
the spirit of the act unrestricted by technical and formal rules of procedure
. . . . Syllabus, in part, Culurides v. Ott, 78 W. Va.
696, 90 S.E. 270 (1916) (citation omitted).
Syl. pt. 2, Plummer v. Workers' Compensation Division, ___ W. Va.
___, 551 S.E.2d 46 (2001). Finally, we note that the instant matter, as is
the case with many workers' compensation claims, has taken many years to reach
this Court. We have often held that such delay runs counter to the avowed
purpose of the system. Long delay in processing claims for workmen's
compensation is not consistent with the declared policy of the Legislature
to determine the rights of claimants as speedily and expeditiously as possible.
W. Va. Code, 23-5-3a. Syl. pt.1, Workman v. Workmen's Compensation
Comm'r, 160 W. Va. 656, 236 S.E.2d 236 (1977).
Appellee points out that
W. Va. Code § 23-4-6(g) bears on the outcome of this case. That section
of the statute reads in pertinent part:
(g) Should a claimant to whom has been made a permanent
partial award die from sickness or noncompensable injury, the unpaid balance
of such award shall be paid to claimant's dependents as defined in this chapter,
if any; such payment to be made in the same installments that would have been
paid to claimant if living: Provided, That no payment shall be made to any
surviving spouse of such claimant after his or her remarriage, and that this
liability shall not accrue to the estate of such claimant and shall not be
subject to any debts of, or charges against, such estate.
W. Va. Code § 23-4-6(g) (1999). The point made by appellee is that Mr.
Martin did not receive any favorable rulings along the way as his claim advanced
toward this Court, and that, at least on the basis of the 1994 claim (94-37387),
Mr. Martin cannot be said to be a claimant to whom has been made a permanent
partial award. Thus, goes the appellee's argument, because Mr. Martin
died before receiving any favorable decisions in the 1994 claim, his claim has
been extinguished.
We note that a long line
of authority stands between Mrs. Martin and any potential recovery of the
benefits sought by her late husband. First in that line is a case with facts
very similar to the instant case. In Hughes v. State Compensation Comm'r,
145 W. Va. 629, 116 S.E.2d 153 (1960), Mr. Hughes was a workers' compensation
claimant who had received a 50 percent permanent partial disability award,
but sought to reopen that claim so that he might receive an additional award.
At the first level of the process, the Division ruled he was not entitled
to any additional award. However, the Appeal Board
(See footnote 1) ruled on December 10, 1959,
that Mr. Hughes was entitled to an additional 10 percent disability award.
Unfortunately for all concerned, Mr. Hughes had died three weeks before, in
late November of that year.
This Court held that, because
the initially unfavorable decision remained in effect until overruled, and that
because Mr. Hughes died before the favorable decision was issued, the law would
not permit his widow to receive the additional award to which the Appeal Board
thought him entitled.
(See footnote 2)
[I]n the case now under consideration no award had been made at
the date of the death of the claimant. On that date there was in effect the
unreversed order of the commissioner denying further benefits. The claimant
was not one to whom, at the date of his death, had been made an award.
Hughes v. State Compensation Comm'r, 145 W. Va. 629,634, 116 S.E.2d
153, 156 (1960). In essence, because Mr. Hughes died holding a losing
decision, the later winning decision was of no help to his
widow.
In a case with an even more
Draconian holding, the Court denied relief to a widow whose husband died a
mere ten days too early. In Ferguson v. State Workmen's Compensation Commissioner, 152 W. Va. 366, 163 S.E.2d 465 (1968),
an injured Mr. Ferguson was examined by the then-called Silicosis Medical
Board, and found by the Board to be entitled to a 30 percent permanent partial
disability award. The Board forwarded this decision to the Commissioner, who
officially made the award on June 2, 1967. Unfortunately, Mr. Ferguson died
ten days before, on May 23, 1967. The Court explained its holding
(See footnote 3)
by stating:
Alleged rights and remedies, not provided by the workmen's compensation statutes,
can not be recognized or granted by the courts. As the statutory requirement
that a valid award of compensation must be made to the claimant while living
to entitle his widow to receive the unpaid balance of such award has not been
satisfied in this case, this Court is without power or authority to award
compensation benefits to the dependent widow of the deceased employee, Hercy
C. Ferguson, or to relieve her from the unfortunate situation which has resulted
from the untimely death of her husband.
Ferguson v. State Workmen's Compensation Commissioner, 152 W. Va. 366,
371, 163 S.E.2d 465, 468 (1968). It seems that in this case, untimely
death was no mere platitude.
In the case of Hagy v.
State Workmen's Compensation Commissioner, 163 W. Va. 198, 255 S.E.2d
906 (1979), Mr. Hagy had lost several fingers from his left hand in an accident
in Virginia. He was later injured in West Virginia and received benefits for
temporary total disability while his hand healed. After reaching the maximum
degree of recovery from the accident, his doctor opined that he had a 50 percent
permanent partial disability. Before the Commissioner made a final decision
regarding the permanent partial disability award, Mr. Hagy died. The Commissioner
dismissed his claim, and his widow appealed.
Citing the forerunner to
W. Va. Code § 23-4-6(g), the Court ruled against the widow, explaining:
This statute predicates the right of the claimant's dependents to obtain
the benefits of the claimant on his initially having been given an award of
permanent partial disability. The phrase 'unpaid balance of such award' also
clearly indicates this construction. Hagy v. State Workmen's Compensation
Commissioner, 163 W. Va. 198, 201- 02, 255 S.E.2d 906, 908 (1979).
Citing the earlier Ferguson
case, the Court found that a claimant must have already won an award for a widow
(or widower) to recover: Ferguson requires that the Commissioner
shall have made an award of permanent partial disability before the claimant's
dependents are entitled to receive the benefits at his death under W. Va. Code,
23-4-6(g). The Court in Hagy finished: We conclude that under
Ferguson the claimant's widow is not entitled to permanent partial disability
benefits, since the claimant received no unscheduled permanent partial disability
award during his lifetime and died of causes unrelated to the injury.
Hagy v. State Workmen's Compensation Commissioner, 163 W. Va. 198, 203,
255 S.E.2d 906, 909 (1979).
However, Hagy did
discuss the difference between W. Va. Code § 23-4-6, subsection(g) and
W. Va. Code § 23-4-6, subsection (f), dealing with the loss of a body
part. Subsection (f) then read, in pertinent part:
Should a claimant sustain a compensable injury which results in the total
loss by severance of any of the bodily members named in this subdivision,
die from sickness or noncompensable injury before the commissioner makes the
proper award for such injury, the commissioner shall make such award to claimant's
dependents as defined in this chapter, if any; such payment to be made in
the same installments that would have been paid to the claimant if living:
Provided, that no payment shall be made to any widow of such claimant after
her remarriage, and that this liability shall not accrue to the estate of
such claimant and shall not be subject to any debts of, or charges against,
such estate.
W. Va. Code § 23-4-6 (f) (1978).
(See footnote 4) The Hagy Court explained
the different treatment dependents receive under the two subsections stems from
the need for further evidence:
The apparent rationale for this provision is that a severance of a bodily member
is subject to a specific scheduled award under W. Va. Code, 23-4-6(f). The Commissioner
can thus easily determine the award amount without the benefit of medical advice.
Consequently, there is no medical evaluation and claimant's death does not affect
the award process. His dependents, therefore, are entitled to the disability
benefits.
Hagy v. State Workmen's Compensation Commissioner, 163 W. Va. 198,
203, 255 S.E.2d 906, 909 (1979). As we discuss below, we feel the Hagy
Court was in error.
Perhaps because of the Draconian
holding in Ferguson, the Legislature made changes to the workers' compensation
law so that a determination of the Occupational Pneumoconiosis Board had the
same force and effect as a ruling by the Workers' Compensation Commissioner.
See, W. Va. Code § 23-4-6(h) (1999). Two widows were found
to be the beneficiaries of this change in the case of Charles v. State
Workmen's Comp. Comm'r, 161 W. Va. 285, 241 S.E.2d 816 (1978). The Charles
court noted: The obvious purpose of the amendment was to allow dependents
to receive a deceased employee's benefits where, as was often the case, the internal workmen's compensation
procedure was so burdened and lengthy that many claimants died before a final
Commissioner's award was made. Id., 161 W. Va. at 287, 241 S.E.2d
at 818 (footnote omitted).
While the Charles
court recognized the unfairness in awarding dependents benefits only when
the claimant managed to outlive the appeals process, the Court found it unnecessary
to reexamine any of the earlier cases because the change in the statute provided
the widows in that case with the relief they requested. But the Court made
one important observation. It noted that W. Va. Code § 23-4-6 provide[s]
for distribution of funds after death of the employee to [his or her] dependents.
Id. 161 W. Va. at 289, 241 S.E.2d at 819.
A case that anticipated
the problem we face today is that of Cole v. State Workmen's Compensation
Comm'r, 166 W. Va. 294, 273 S.E.2d 586 (1980). Although Cole dealt
with the effect subsequent statutory enactments would have upon a worker's
previously filed claim, the opinion discussed the very question we now consider.
In explaining that West Virginia focused on whether a claimant had died before
the end of the appeals process, the Court suggested that this was perhaps
not the best approach:
[T]he rule often revolves around the question of whether the deceased employee
received an award, or the equivalent, before his death. While
the outcome of such an inquiry frequently turns on statutory variables, most
jurisdictions hold that if a claim has been filed, but no award is made at the time of death,
the death will not abate the claim. 2 Larson, Workmen's Compensation Law,
§ 58.40 (1976). While West Virginia seems, at this juncture, to require
that an award be made pursuant to W. Va. Code § 23-4-6(a)
before dependents may recover, see e.g., Hagy v. State Workmen's
Compensation Commissioner, W. Va., 255 S.E.2d 906 (1979); Richmond
v. State Compensation Commissioner, 136 W. Va. 234, 67 S.E.2d 39 (1951),
other courts
(See footnote 5) have criticized this view as unfairly providing
the employer with a windfall because of the death of the employee before a
formal award.
Cole v. State Workmen's Compensation Comm'r, 166 W. Va. 294, 298-99,
273 S.E.2d 586, 589 (1980) (footnote added) (citations omitted). The Court
went on to note that, even if the death of the claimant caused some difficulty
in ascertaining the proper amount of an award, death should not bar an otherwise
valid award:
The question of when death precludes derivative benefits is often addressed
in the context of determinations on permanent partial disability awards. According
to Professor Larson, the death of the claimant before an award is made does
not make the disability impossible to prove and should not result in defeating
an award. Rather, the better approach is to make the best possible medical
estimate of the probable residual disability that would have remained if the
employee had lived to complete his healing period.
Id. (See
footnote 6)
Although the Cole
opinion does not attempt to overrule this line of cases, it clearly did cast
some doubt upon them. [W]e today question, in light of Professor Larson's
admonition, 2 Larson, § 58.40 (1976), the rather draconian and technical
approach laid down in Hagy, supra, that an award must
be made prior to death[.] Id., 161 W. Va. at 301, 273 S.E.2d
at 591.
We recently dealt with a similar issue in the case of Wingrove v. Workers' Compensation Div., 208 W. Va. 80, 538 S.E.2d 378 (2000). In Wingrove, another coal miner, Mr. Wingrove, had filed a workers' compensation claim, but died before the claim reached a final decision before this Court. However, Mr. Wingrove had received an initially favorable ruling from the Division, which gave him a permanent total disability award. Later, the Appeal Board stripped Mr. Wingrove of that award, so he appealed to this Court. Unfortunately, Mr. Wingrove died after his appeal was granted, but before this Court could rule on his case.
As in the instant case, Wingrove
presented the question of how the death of a claimant during the pendency of
his appeal would affect the outcome of his workers' compensation claim. We ruled
in Wingrove that the statute does not require a claimant to have received
a final award before death in order for his family to be eligible
for receipt of any unpaid benefits. Specifically, we held:
If a claimant in a Workers' Compensation case to whom an award was made, dies
while appealing a subsequent adverse decision concerning that award, the appeal
shall proceed as if death had not occurred. Any unpaid compensation awarded
as a result of such an appeal, which would have been paid or payable to the
claimant up to the time of his or her death, shall not accrue to the estate
of the claimant, but shall be payable to the dependents of the deceased claimant,
if there are dependents at the time of death.
Syl. pt. 3, Wingrove v. Workers' Compensation Div., 208 W. Va. 80,
538 S.E.2d 378 (2000).
In Wingrove, we recognized
that Mr. Wingrove had faced long delays in the adjudication of his claim,
and stated:
By not requiring a final award, the effect of delays in the adjudicatory process
is minimized. In this case, there were long delays in the adjudicatory process;
a review by the Office of Judges took almost four years. To require a final
award would not further justice (Click, id.) because
it would reward a system that did not determine the rights of claimants
as speedily and expeditiously as possible. Workman, supra.
Wingrove v. Workers' Compensation Div., 208 W. Va. 80, 85, 538 S.E.2d
378, 383 (2000). The instant case presents us with a similar problem, and
again highlights the perverse and pernicious incentive this Court's prior interpretation of the law has created
for those opposing the claim of an injured worker.
Although surely not the
intent of the Court or the Legislature, this interpretation of law has created
an incentive for delay for those who oppose a workers' compensation award.
While we impute no evil intentions to the employer in this case, allowing
the death of the claimant to extinguish the claim sets up a unavoidable conflict.
For the purely rational economic actor, it is advantageous to extend
litigation in the hope that the claimant will die before ever receiving a
favorable decision.
This was also true in Mr.
Wingrove's case, but because of the particular history of Mr. Wingrove's claim,
we did not have to face head-on the problems created by this old line of cases.
Indeed, we even adopted that logic as our own in examining W. Va. Code § 23-4-6(g).
(See footnote 7)
However, upon further examination, we must conclude that we were in error.
We now believe that the theory espoused by this entire line of cases is fundamentally
flawed.
Subsection (g) of W. Va. Code
§ 23-4-6 says nothing about extinguishing a claim upon the death of a claimant.
Subsection (g) merely describes how one should distribute the unpaid balance
of an award if the claimant dies. As noted above, subsection (g) merely
provide[s] for distribution of funds after death of the employee to [his
or her] dependents. Charles v. State Workmen's Comp. Comm'r, 161
W. Va. 285, 289, 241 S.E.2d 816, 819 (1978). Quite logically, one cannot distribute
an award unless that award, in fact, exists. Thus subsection (g) describes how
an award, once it exists, should be distributed if the claimant dies. The section
is entirely silent as to how one should proceed in the circumstance where a
claimant dies before receiving a favorable ruling.
Also, we note that other portions of our workers' compensation law contain contingencies for dealing with a claim after the claimant has died. For example, the section dealing with examinations by the Occupational Pneumoconiosis Board establishes examination requirements for living claimants, and also states If the employee be dead, the notice of the board shall further require that the claimant produce necessary consents and permits so that an autopsy may be performed, if the board shall so direct. W. Va. Code § 23-4-8b (1971). If our law permits the Occupational Pneumoconiosis Board to examine deceased employees to gather evidence of a compensable injury, it surely permits the appellate organs of the workers' compensation scheme to continue processing a claim if a claimant dies before the procedure has run its course.
Two other provisions support
our contention, one of which we have noted previously:
Should a claimant sustain a compensable injury which
results in the total loss by severance of any of the bodily members named in
this subdivision, die from sickness or noncompensable injury before the division
makes the proper award for such injury, the division shall make such award to
claimant's dependents as defined in this chapter, if any; such payment to be
made in the same installments that would have been paid to claimant if living:
Provided, That no payment shall be made to any surviving spouse of such claimant
after his or her remarriage, and that this liability shall not accrue to the
estate of such claimant and shall not be subject to any debts of, or charges
against, such estate.
W. Va. Code § 23-4-6(f) (1999) (emphasis added). And several sections
later, the Code provides:
Compensation, either temporary total or permanent partial, under this section
shall be payable only to the injured employee and the right thereto shall
not vest in his or her estate, except that any unpaid compensation which
would have been paid or payable to the employee up to the time of his or her
death, if he or she had lived, shall be paid to the dependents of such
injured employee if there be such dependents at the time of death.
W. Va. Code § 23-4-6(l) (1999) (emphasis added). As we have stated on numerous occasions, [s]tatutes in pari materia, must be construed together and the legislative intention, as gathered from the whole of the enactments, must be given effect. Syl. pt. 3, State ex rel. Graney v. Sims, 144 W. Va. 72, 105 S.E.2d 886 (1958). We are also mindful that:
Given the statutory basis of workers' compensation rights and resultant remedies,
the primary method of ascertaining the availability and scope of such benefits
is to look to the plain meaning of the applicable statutes and to ascertain
the Legislature's intent in enacting the provisions at issue. The primary
object in construing a statute is to ascertain and give effect to the intent
of the Legislature. Syl. pt. 1, Smith v. State Workmen's Compensation
Comm'r, 159 W. Va. 108, 219 S.E.2d 361 (1975). Accord West Virginia
Health Care Cost Review Auth. v. Boone Memorial Hosp., 196 W. Va. 326, 336,
472 S.E.2d 411, 421 (1996).
State ex rel. ACF Industries, Inc. v. Vieweg, 204 W. Va. 525, 537,
514 S.E.2d 176, 188 (1999).
Looking at these provisions
together, the common thread running through all is that the Legislature intended
that in the event a workers' compensation claimant died, the dependents,
and not the estate, should receive the claimant's compensation. The Legislature
is demonstrating its desire, as it has done in the realm of wrongful death
cases (See
footnote 8) , that dependents in need of support receive compensation, and that the compensation
does not end up in the hands of any creditors that may have claims upon the
decedent's estate.
So, while we have utmost
respect for our predecessors on this Court, and some chagrin over our recent
statements in Wingrove, we feel that the earlier line of cases that
saw subsection(g) (or its forerunners) as a device to limit the recovery of
widows and orphans was simply wrong.
At the time Mr. Martin petitioned
the Court in this case, before his death, the disputed issue was whether Mr.
Martin was owed additional compensation for his occupational pneumoconiosis
impairment. Had he not died, and had this Court found in his favor, the Workers'
Compensation Division would have owed Mr. Martin two things: a back pay award
for the period of time from the onset date of his disability to the date of
his favorable decision, and ongoing payments from the date of the decision until
Mr. Martin's condition changed or until he died.
But, though Mr. Martin's death obviously impacts any future payments a still- living Mr. Martin might have received, we cannot see why his death should have any impact whatsoever on the question of what sort of award he was entitled to for the time he was still alive, i.e., the back pay award. Either the evidence shows he deserved it, or shows he did not. His death has no bearing on that question. (See footnote 9)
Thus we hold that, if a claimant
in a workers' compensation case dies during the pendency of the claims process,
the claim shall proceed as if death had not occurred. If the claim ultimately
prevails, all compensation that would have been awarded to the claimant, had
he or she lived, shall be paid to the dependents of the deceased claimant. Any
other claims any dependent might have as a result of the claimant's death shall
proceed unaffected. To the extent that this holding conflicts with Wingrove
v. Workers' Compensation Div., 208 W. Va. 80, 538 S.E.2d 378 (2000), or
Hughes v. State Compensation Comm'r, 145 W. Va. 629, 116 S.E.2d 153 (1960),
or its progeny, they are hereby overruled.
(See footnote 10)
As is required, the Occupational
Pneumoconiosis Board also examined Mr. Martin, and after that examination,
the Occupational Pneumoconiosis Board concluded that: [We] find sufficient
evidence to justify a diagnosis of occupational pneumoconiosis with no
more than the 50% pulmonary functional impairment attributable
to this disease previously found in [Mr. Martin's 1987 claim]. The Occupational
Pneumoconiosis Board went on to state what evidence supported its finding:
The evidence upon which we base our findings is a history that this 56
year old COAL MINER has been exposed to a dust hazard for 27
years with sufficient exposure to have caused occupational pneumoconiosis
or to have perceptible aggravated a pre-existing occupational pneumoconiosis.
The further evidence upon which we base our finding is physical examination
of the [sic] by the members of the Board, pulmonary function studies
made for the Board and now a part of this record, and x-rays of the chest
made by a member of the Board.
While this is all well and good,
nowhere does the Occupational Pneumoconiosis Board discuss the evidence presented
by Mr. Martin that showed him to be permanently and totally disabled. Our law
on this issue has been clear for some time:
When conflicting medical evidence is presented concerning the degree of impairment
in an occupational pneumoconiosis claim, that medical evidence indicating the
highest degree of impairment, which is not otherwise shown, through explicit
findings of fact by the Occupational Pneumoconiosis Board, to be unreliable,
incorrect, or clearly attributable to some other identifiable disease or illness,
is presumed to accurately represent the level of pulmonary impairment attributable
to occupational pneumoconiosis.
Syl. pt. 1, Javins v. Workers' Compensation Comm'r, 173 W. Va. 747,
320 S.E.2d 119 (1984). We have declared that the Occupational Pneumoconiosis
Board must examine the claimant's evidence, and cannot simply ignore it because
it does not precisely match the evidence produced by the Occupational Pneumoconiosis
Board:
[O]n the one side we have a high regard for the Occupational Pneumoconiosis
Board's professional competence in evaluating expert testimony, yet on the
other side we have a rule of law, namely the liberality rule, which mandates
that reputable evidence favorable to the claimant be considered and the claimant
treated as generously as any reasonable view of the evidence would justify.
In this regard the Occupational Pneumoconiosis Board, the Commissioner, and
the Workmen's Compensation Appeal Board as finders of fact are in a different
position from either a jury or a trial chancellor; they are not quite entitled
to disbelieve evidence based exclusively upon their own subjective evaluation
of the credibility of the witnesses.
Persiani v. State Workmen's Compensation Commissioner, 162 W. Va. 230,
236, 248 S.E.2d 844, 848 (1978). Justice Starcher elaborated on this point in
a recent concurrence:
In Persiani v. SWCC, 162 W. Va. 230, 248 S.E.2d
844 (1978) we specified that the rule of liberally interpreting evidence in
favor of the claimant is to be applied in occupational pneumoconiosis claims.
We described the liberality rule as one which mandates that reputable
evidence favorable to the claimant be considered and the claimant treated as
generously as any reasonable view of the evidence would justify. 162 W.
Va. at 236, 248 S.E.2d at 848 (1978).
Persiani presented the Court with the question
of how the rule of liberality should be applied when the claimant introduces
expert testimony on disability to the Occupational Pneumoconiosis Board who,
as experts themselves, disbelieve the claimant's evidence and find the evidence
of the employer's examining experts more credible[.] The question raised
in Persiani is nearly identical to the issue in this case, where the
OP Board similarly concluded that the employer's pulmonary function tests,
which indicated that the appellant had no respiratory impairment, were more
reliable than the OP Board's test results indicating a 15% impairment.
This approach used by the OP Board in Persiani
for interpreting evidence in pneumoconiosis claims was specifically rejected
by this Court. We specified that the Division may not accept the OP Board's
recommendation to arbitrarily choose to disbelieve any competent medical
testimony in its entirety or to exclude it from consideration altogether,
absent credible evidence in the record that the suspect testimony is unreliable.
Syllabus, Persiani.
Thacker v. Workers' Compensation Div., 207 W. Va. 241, 245, 531 S.E.2d
66, 70 (1999) (per curiam)(footnote omitted).
We
interpret the rule set forth in Persiani and Javins to be quite
simple: if the parties to a workers' compensation claim introduce reliable,
conflicting evidence about the existence of occupational pneumoconiosis, or
reliable, conflicting evidence about the degree of respiratory impairment caused
by or attributable to occupational pneumoconiosis, then the Division, the Office
of Judges and the Appeal Board must award the claimant benefits based upon the
reliable evidence that shows either the existence of occupational pneumoconiosis
or the highest degree of impairment. The claimant must be given the benefit
of all reasonable inferences the record will allow, and any conflicts in evidence
must be resolved in favor of the claimant.
See, Thacker v. Workers' Compensation Div., 207 W. Va. at 250,
531 S.E.2d at 75 (Starcher, C.J., concurring). In Javins and Persiani,
we expressly made clear that the Division, the Office of Judges and the Appeal
Board may only disregard evidence that is unreliable. Whether
evidence is unreliable is a legal determination to be made by the finder of
fact, i.e., the Division or the Office of Judges. In a workers' compensation
claim, whether the evidence of a party is unreliable is a determination that
must be made by an affirmative showing by the parties in the record, and such
an affirmative showing can include the opinions of the members of the Occupational
Pneumoconiosis Board.
Furthermore, the finder of fact
may not rely upon only probable or conjectural reasons or causes
as a basis for disregarding a party's evidence. Pripich v. State Compensation
Comm'r, 112 W. Va. 540, 543, 166 S.E. 4, 5 (1932). In other words, the unsubstantiated
opinion of an expert, including the members of the Occupational Pneumoconiosis
Board, that a particular piece of evidence is unreliable is itself
unacceptable. The expert opinion must be accompanied by specific, credible evidence
or testimony that the suspect test result is unreliable.
In
the instant case, we find no evidence in the record -- from either the Occupational
Pneumoconiosis Board or any other expert witness -- to suggest that the claimant's
medical report from Dr. Ranavaya was unreliable. Dr. Ranavaya's opinion was
that the claimant was permanently, totally disabled as a result of his occupational
pneumoconiosis. The Occupational Pneumoconiosis Board's opinion was that the
claimant had only 50% permanent partial disability attributable to his occupational
pneumoconiosis.
The parties introduced reliable,
conflicting evidence about the degree of respiratory impairment caused by or
attributable to occupational pneumoconiosis, and the Division, the Office of
Judges and the Appeal Board should have awarded the claimant benefits based
upon the reliable evidence that showed the highest degree of impairment.
For the reasons stated,
the decision of the Workers' Compensation Appeal Board is reversed. This claim
is remanded for entry of a permanent total disability award with an onset
date of August 4, 1994, and for the payment to Mr. Martin's dependants of
any resultant benefits Mr. Martin would have received up to the date of his
death.
IV.
CONCLUSION
A claimant who dies from sickness or noncompensable injury pending his appeal
to the Workmen's Compensation Appeal Board from an order of the State Compensation
Commissioner denying further benefits to him is not, at the time of his death,
a claimant to whom an award has been made as contemplated by Code,
23-4-6(e) as amended.
Syl. pt. 2, Hughes v. State Compensation Comm'r, 145 W. Va. 629, 116 S.E.2d 153 (1960).
To entitle the dependent widow of a claimant, who dies from sickness or
a noncompensable injury, to payment of the unpaid balance of a permanent partial
disability award of compensation under Section 6(e), Article 4, Chapter 23,
Code, 1931, as amended, a valid award of such compensation must be made by
the workmen's compensation commissioner during the lifetime of the claimant;
and if such claimant dies before such award is made his dependent widow is
not entitled to receive any part of an award which could have been made during
the lifetime of the claimant.
Syl. pt. 2, Ferguson v. State Workmen's Compensation Commissioner, 152 W. Va. 366, 163 S.E.2d 465 (1968).
Powell v. Department of Labor and Industries, 79 Wash.2d 378, 384, 485 P.2d 990, 993 (1971).
Defendants claim that there can
be no recovery for disability benefits inasmuch as Holiday has died. They
rely on Section 52-1-47(C) which provides that in no case shall compensation
benefits for disability continue after the disability ends or after the death
of the injured workman[.] This section provides that compensation benefits
for disability terminate upon death of the worker. This section does not prohibit
the payment of disability benefits to which the worker was entitled prior
to death. Defendants state that Section 52-1-47 places a limitation on all
the benefits authorized by Sections 52-1-41 to -46. Our response is that Section
52-1-47 says nothing about payment of disability benefits to which the worker
was entitled prior to death. And more recently, a Maryland court explained:
The survival provisions of the Act were construed in State v. Richardson. We there held that compensation payable as
used in the non-abatement provision, Md. Code (1957), Art. 101, § 36(4)(c),
did not require an award to have been rendered prior to the claimant's death.
After reviewing decisions in other states, this Court felt constrained, in
view of the phraseology of § 36(4)(c) of the Maryland statute, to follow
the reasoning of those cases which sustained awards made when the claimant
had filed a claim but died from other non-compensable causes before a hearing
could be held. Sears, Roebuck and Company, Inc., 340 Md. 304, 309, 666 A.2d 1239,
1244 (1995)(citation and internal quotations omitted). See also, Curry
v. State Incus. Ins. System, 956 P.2d 810, 114 Nev. 328 (1998); Robinson
v. Newburgh, 849 S.W.2d 532, ___ Ky. ___ (1993).
Holiday v. Talk of the Town, Inc., 102 N.M. 540, 541, 697 P.2d 959, 960
(1985).
Footnote: 10
In case a personal injury, other than occupational pneumoconiosis or other
occupational disease, suffered by an employee in the course of and resulting
from his or her employment, causes death, and disability is continuous from date of such
injury until date of death, or if death results from occupational pneumoconiosis
or from any other occupational disease, the benefits shall be in the amounts
and to the persons as follows:
(a) If there be no dependents, the disbursements
shall be limited to the expense provided for in sections three and four of
this article.
(b) If there be dependents as defined in subdivision
(d) of this section, such dependents shall be paid for as long as their dependency
shall continue in the same amount as was paid or would have been paid the
deceased employee for total disability had he or she lived. The order of preference
of payment and length of dependence shall be as follows: . . . .
(e) If a person receiving permanent total disability
benefits dies from a cause other than a disabling injury leaving any dependents
as defined in subdivision (d) of this section, an award shall be made to such
dependents in an amount equal to one hundred four times the weekly benefit
the worker was receiving at the time of his or her death and be paid either
as a lump sum or in periodic payments, at the option of the dependent or dependents.
Direct premium rating experience charges for the payment of such benefits
granted as a result of a second injury award of permanent total disability
shall not be made to the employee's employer. It is the intent of the Legislature
that the amendments to this subsection enacted during the regular session
of the Legislature in the year one thousand nine hundred ninety-nine be construed
so as to make dependents eligible for benefits under this subsection retroactive
to the second day of February, one thousand nine hundred ninety-five.
W. Va. Code § § 23-4-10 (1999).