On November 2, 2018, the Supreme Court of Appeals of West Virginia affirmed a group of consolidated cases involving the time period within which occupational pneumoconiosis (OP) workers' compensation claims may be filed. The statute of limitations in OP claims in West Virginia (WV) is defined by state law. The cases reviewed by the court presented an interesting question of statutory interpretation in workers' compensation OP claims.
WV's Statute of Limitations in OP Claims
The individuals claiming benefits in the consolidated cases considered by the supreme court had been outside of the workforce for a number of years and did not have medical diagnoses of pneumoconiosis. Instead of relying on medical evidence, these individuals filed claims in the hope that statutory presumptions regarding pulmonary impairment would buoy their claims and ultimately lead to an award of benefits.
What Is the Statute of Limitations in OP Claims?
The applicable statute of limitations, WV Code § 23-4-15(b), provides two scenarios under which an individual can timely file a WV occupational pneumoconiosis claim:
· He or she has been exposed to hazardous dust in the workplace within the past three years; or
· He or she has been diagnosed with pulmonary impairment by a physician in the past three years.
In interpreting the time period to file an OP claim in WV, the applicant enjoys the benefit of the most recent occurrence-exposure or diagnosis.
The administrator who received the workers' compensation OP claims for the cases in question applied the standard set forth by state code for the appropriate time period to file an OP claim in WV. In applying this standard, the claims administrator found that none of the applicants satisfied either scenario required by the statute.
All of the applicants were more than three years removed from any hazardous dust exposure. Moreover, none of the applicants had been diagnosed with pulmonary impairment. Based on these findings, the claims administrator denied the applications for benefits.
Workers' Compensation OP Claims Decisions and Appeals
All of the applicants protested the WV occupational pneumoconiosis claim denials. At the initial level of administrative review, the Workers' Compensation Office of Judges ruled that the workers' compensation OP claims had been properly filed. Essentially, the Office of Judges found that individuals who had previously been exposed to a dust hazard at work could file a claim for benefits at any time. Under this interpretation, the statute of limitations was rendered meaningless.
In response to the Office of Judges' ruling, the Insurance Commissioner and two private employers appealed this issue to the Workers' Compensation Board of Review. The Board of Review concluded that the claims had been properly denied under the claims administrator's interpretation of the law governing the time period to file an OP claim in WV. This reversal of the Office of Judges set up the review at the Supreme Court of Appeals of West Virginia.
The Supreme Court of Appeals of WV Confirms the Statute of Limitations in OP Claims
The Supreme Court held oral arguments on October 10, 2018. Legal counsel for the applicants pointed out that pneumoconiosis is a progressive condition of the lungs that often manifests years after the applicant leaves the workforce. Counsel for the plaintiffs stated that forcing applicants to adhere to the statute of limitations would deter applicants from asserting their claims.
On behalf of the Insurance Commissioner and the private employers, Henry C. Bowen of Jenkins Fenstermaker, PLLC laid out the rationale for the position adopted by both the claims administrator and the Board of Review in the occupational pneumoconiosis claims defense. He noted that the statute of limitations gives significant leeway to an applicant in filing a claim either within three years of the date of last exposure to hazardous dust or within three years that a doctor diagnoses pulmonary impairment in the claimant.
Bowen also pointed out that the plain language of the statute provides applicants with a multi-year window in which to file an application for benefits. No need existed to file and process claims for individuals with no diagnosis of pneumoconiosis, specifically because those individuals were already protected by the statute's allowance of a three-year period for filing following a diagnosed impairment.
Following arguments, the court issued its written opinion on this matter. The court concluded that the claims administrator and the Board of Review had properly denied the applications filed by the claimants.
According to the court's syllabus points, the plain language of the statute allows an applicant to file a claim within three years of being exposed to hazardous dust. If the claim is not ripe at that time, or the claimant chooses not to file in that time period, a second time period remains available for filing after the claimant is diagnosed with a pulmonary impairment.
Occupational Pneumoconiosis Claims Defense for Insurers and Employers
In this case, the court adhered to the language of the statute of limitations in OP claims as it is written and provided greater certainty to claimants and employers as to when a valid application for benefits can be filed. When you need legal defense of a WV occupational pneumoconiosis claim, the experienced workers' compensation attorneys of Jenkins Fenstermaker can help. Call us at (304) 523-2100, toll-free at (866) 617-4736, or complete our online contact form today.