CHARLESTON — The West Virginia Supreme Court of Appeals affirmed a decision by the West Virginia Workers' Compensation Office of Judges to reject a claim for benefits from a truck driver who struck a pothole.
The claims administrator rejected Kevin Taylor's claim on Sept. 28, 2018, and on April 30, 2020, the Office of Judges affirmed the claims administrator’s decision. Taylor then appealed to the Board of Review, who affirmed the Office of Judges' decision on Sept. 18, 2020, according to a memorandum decision filed on Feb. 1.
Taylor alleges that he suffered a back injury after hitting a pothole in his coal truck on Aug. 15, 2018, and reported that pain shot through his lower back and up his spine. He was taken to Raleigh General Hospital for treatment and he was diagnosed with low back L4-5 disc pain due to an occupational injury.
Taylor underwent a CT scan that did not find an acute fracture of the lumbar spine, however, the CT scan did reveal multilevel degenerative facet arthropathy, disc bulge posteriorly at L4-5, as well as posterior ligamentous hypertrophy and facet arthropathy contributing to spinal canal stenosis.
When Taylor complained of back pain when he arrived at work on Aug. 15, 2018, Taylor told his supervisor he pulled a muscle at home. Later that night, Taylor told his supervisor that he hit a pothole and his back started hurting to the point that he wanted to go home
Taylor received a diagnosis of lumbar disc disease, disc herniation bulging and spinal stenosis and the claims administrator considered Taylor’s application and issued an order on Sept. 28, 2018, stating that documentation from Dr. Ralph Simms was received with a diagnosis of lumbar disc disease, and after an investigation, the claim was rejected as a non-work-related injury.
"Based upon the preponderance of the evidence of record, the Office of Judges found that Mr. Taylor has a pre-existing lower back condition, and he did not sustain a discrete new back injury at work on August 15, 2018," the decision states. "As a result, the claims administrator’s Order dated September 28, 2018, which rejected Mr. Taylor’s application for workers’ compensation benefits, was affirmed."
The Board of Review adopted the findings of fact and conclusions of law of the Office of Judges and affirmed the decision on Sept. 18, 2020.
"After review, we agree with the decision of the Office of Judges, as affirmed by the Board of Review," the decision states. "The preponderance of the evidence of record indicates that Mr. Taylor did not suffer a discrete new back injury in the course of and resulting from his employment on August 15, 2018. As such, the evidence establishes that Mr. Taylor was not rendered temporarily and totally disabled by a work-related injury."
West Virginia Supreme Court of Appeals case number: 20-0804
