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Media Alerts - Metro Machine Corp. v. Dir., Office of Workers' Comp. Programs, U.S. Dept. of Labor -- Fourth Circuit
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February 3, 2017
  Metro Machine Corp. v. Dir., Office of Workers' Comp. Programs, U.S. Dept. of Labor -- Fourth Circuit
Expansive Presumption Under Longshore and Harbor Workers' Compensation Act

Areas of Law: Federal Maritime Workers' Compensation, Administrative Law

Issue Presented: Whether claims for "secondary" injuries and injuries not listed on an original claim form are entitled to the Longshore and Harbor Workers' Compensation Act's presumption that they fall within the Act unless there is substantial evidence to the contrary.

Brief Summary:
The United States Court of Appeals for the Fourth Circuit denied the petition for review of a Benefits Review Board order affirming the ALJ's grant of a medical benefits claim under the Longshore and Harbor Workers' Compensation Act ("the Act"). The Fourth Circuit rejected the petitioner's argument that only primary injuries are entitled to the statutory presumption that they fall within the Act unless there is substantial evidence to the contrary. As long as a claimant identifies a primary injury that arose during work, secondary injuries are also entitled to the presumption. Moreover, the Act does not bar recovery for an injury that a claimant fails to identify on the original claim form but that evolves as a part of the claim without prejudice to the respondent.

Extended Summary: Claimant John Stephenson ("Claimant") began working for petitioner Metro Machine Corporation ("Metro") as a pipefitter in 1983. He had a long history of breathing problems and in 1996 was diagnosed with chronic obstructive pulmonary disease (COPD). On February 18, 2008, Claimant worked in the superstructure of a vessel and inhaled fumes from welding, burning, and the application of epoxy paint for over eight hours. During a subsequent eight-day hospitalization, Claimant was prescribed steroids, inhalers, antibiotics and albuterol. Upon discharge, he was prescribed a nebulizer and oxygen concentrator. After Claimant voluntarily retired in 2011, he was treated for a T7 vertebra fracture that his doctor attributed "most likely" to excessive coughing. In 2012, Claimant filed a claim for compensation under the Act.

The Act requires employers to provide medical care to employees who suffer an "injury." The Act defines injury to include both primary and secondary injuries. Primary injuries are those that arise out of, and in the course of, employment, while secondary injuries are those that "naturally or unavoidably result[]" from primary injuries. The Act also permits a presumption that any claim filed under it is presumed to fall within the Act unless there is substantial evidence to the contrary.

The only injury Claimant identified on his original claim form was exposure to fumes on February 18, 2008, that affected his lungs. At the informal conference regarding the claim, however, the claims examiner recommended payment of benefits for both Claimant's ongoing COPD and his fractured vertebra. Despite the recommendation, the ALJ only considered Claimant's COPD claim and found that he made a prima facie case showing harm, the worsening of the COPD, and a work incident that could have aggravated the harm. Therefore, the ALJ found that the presumption applied to the claim. Claimant moved for reconsideration due to the ALJ's failure to consider his fractured vertebra claim. After granting the motion, the ALJ rejected Metro's argument that the statutory presumption did not apply to the fractured vertebra injury because the Claimant did not identify it in his original claim form. Subsequently, the ALJ found the Claimant made a prima facie case with regard to the fracture and the presumption applied. The Benefits Review Board ("Board") affirmed the ALJ's decision. With regard to the vertebra fracture, the Board rejected Metro's arguments that the presumption could not apply to the claim because: (1) it was a secondary injury; and (2) it was outside the scope of Claimant's initial claim.

On appeal, the Fourth Circuit found no reversible error and denied the petition for review. After rejecting two of Metro's evidentiary arguments regarding the COPD claim, the court turned to Metro's argument that because Claimant's fracture was secondary and not identified in the original claim form, the presumption should not have applied to this claim regardless of whether Claimant made prima facie cases. In support of its argument that secondary injuries were not entitled to the presumption, Metro relied on two split-panel decisions by the Fifth Circuit in addition to the United States Supreme Court case U.S. Indus./Fed. Sheet Metal, Inc. v. Dir., OWCP, 455 U.S. 608 (1982). The Fourth Circuit found that Metro misread U.S. Industries. Contrary to Metro's reading, that case stands for just two propositions: (1) the statutory presumption only applies to injuries actually claimed; and (2) a claim must include a primary injury. Because the ALJ found that Claimant suffered a primary injury when his COPD was exacerbated, U.S. Industries posed no obstacle.

Addressing whether the presumption applied to the vertebra fracture, the court noted that Metro did not challenge that the claim evolved to include this injury. Moreover, Metro was made aware that Claimant was seeking medical benefits for this injury as early as the initial informal conference. Metro therefore could not claim that its ability to defend itself against this claim at the ALJ hearing, 16 months after the initial conference, was prejudiced by the failure of Claimant to initially include the injury.

The court also rejected Metro's argument that the ALJ failed to apply the "naturally or unavoidably results" standard under the Act for secondary injuries. While the court did agree that the ALJ made no reference to this standard, it concluded that the evidence clearly showed that this standard was met and remanding the case would be "futile." Finally, the court rejected Metro's argument that substantial evidence did not support the ALJ's conclusion that Metro failed to rebut the presumption with regard to the fracture.

To read the full opinion, click here.

Panel: Judges Traxler, Floyd and Thacker

Argument Date: 12/8/2016

Date of Issued Opinion: 1/20/2017

Docket Number: No. 15-2525

Petition denied by published opinion

Case Alert Author: Annie McGuire, Univ. of Maryland Carey School of Law

Counsel: ARGUED: Frank Nash Bilisoly, VANDEVENTER BLACK, LLP, Norfolk, Virginia, for Petitioners. Gregory Edward Camden, MONTAGNA, KLEIN, CAMDEN, LLP, Norfolk, Virginia; Matthew W. Boyle, UNITED STATES DEPARTMENT OF LABOR, Washington, D.C., for Respondents. ON BRIEF: M. Patricia Smith, Solicitor of Labor, Rae Ellen James, Associate Solicitor, Mark Reinhalter, Counsel for Longshore, Sean G. Bajkowski, Counsel for Appellate Litigation, Office of the Solicitor, UNITED STATES DEPARTMENT OF LABOR, Washington, D.C., for Respondent United States Department of Labor.

Author of Opinion: Judge Traxler

Case Alert Supervisor:
Professor Renée Hutchins

    Posted By: Renee Hutchins @ 02/03/2017 01:43 PM     4th Circuit  

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