Supreme Court says workers' compensation board can't seek overpayments

By Kyla Asbury | Jun 18, 2018

CHARLESTON — The West Virginia Supreme Court of Appeals ruled that a company that alleges it overpaid workers' compensation benefits could not reclaim the benefits.

Edward Reed received temporary total disability benefits from Exel Logistics for 2 1/2 years while he was undergoing rehabilitation, according to the June 6 majority opinion.

Later, Excel realized that it had paid 156 days past what it was required to pay to Reed and sought to be reimbursed for those days, deeming them an overpayment.

Justice Menis Ketchum authored the majority opinion and Justice Beth Walker dissented. Walker authored a dissenting opinion.

The Workers' Compensation Board of Review (WCBR) agreed with Excel, but the Supreme Court ruled that WCBR misread the law.

The Supreme Court ruled that WCBR "wholly failed" by not modifying or terminating the benefits until 156 days after the deadline. It then reversed the WCBR's ruling.

Reed was injured in 2013 when he stepped up into a truck and slipped. He injured his left ankle and was required to go through several surgeries to fix the injury.

Reed was awarded $67.37 per day by a workers' compensation claims examiner.

For 2 1/2 years, Reed went to physical therapy and doctor's visits. In November 2015, a physician decided he had reached his maximum degree of improvement.

The claims examiner then stopped Reed's benefits and entered an order refusing the approval of any more physical therapy evaluations or vocational evaluations.

Reed was then granted a 4 percent permanent partial disability award of $7,553.44.

Later, the claims examiner entered another order retroactively declaring Reed was improperly paid benefits for 156 days more than he should have been and sought to return that money to the company.

The claims examiner totaled the overpayment to $10,509.72 and, because of that figure, he refused to pay Reed the $7,553.44 he was owed for his permanent partial disability and declared that Reed owed $2,956.28 for the overpayment.

Reed appealed the decision by the claims examiner to the Office of Judges, which reversed the decision in 2017. The WCBR reversed the Office of Judges' award later that year. Reed then appealed again to the Supreme Court.

The Supreme Court ruled that the claims examiner failed to stop the payment of benefits at the end of 104 weeks, but that wasn't Reed's fault.

"We do not know why the claims examiner did not seek to modify or terminate the claimant's benefits at the end of 104 weeks; perhaps it was carelessness, or perhaps it was an act of grace to assist the claimant," Ketchum wrote in the majority opinion. "All we can say from this record is that the claimant relief to his detriment upon the claims examiner's actions, did not return to the workforce and continued to seek physical rehabilitation for his work-related injury."

The court ruled that the claims examiner didn't terminate the benefits in a timely manner, but could not seek to recover overpayments.

In her dissenting opinion, Walker wrote that she believed the WCBR was in the right for ruling that the company could seek overpayments for the extra 156 days.

Walker wrote that because West Virginia Code states the benefits could only be done for 104 weeks, claims administrator rightfully ruled that they were overpayments.

West Virginia Supreme Court of Appeals case number: 17-0864

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