Opinion
C.A. No. 01A-07-002
Date Submitted: November 9, 2001
February 22, 2002
Henry C. Davis, Esquire, Georgetown, DE.
Susan A. List, Esquire, Tybout Redfearn Pell, Wilmington, DE.
Dear Counsel:
This is the Court's decision on the appeal by Karen McIntire (hereinafter "Claimant") from a decision of the Industrial Accident Board (hereinafter "Board"). The Board denied Claimant's petition to determine compensation due for injuries to her lower back allegedly related to a lifting incident at work. This Court affirms the Board's decision.
I. PROCEDURAL HISTORY
Claimant petitioned the Industrial Accident Board to order her employer, Uncle Willie's (hereinafter "Employer") to pay Worker's Compensation benefits for lower back pain which she alleges derives from a work-related incident. Claimant's petition sought total disability for the two time periods following her surgeries as well as medical expenses. On June 16, 2001, the Board held that Claimant had not met her burden of proving that an alleged January 1999 incident at the workplace occurred which caused her back injury, and it denied Claimant's petition to determine benefits due.
On June 20, 2001, Claimant appealed her case to this Court. She alleged that the Board erred as a matter of law by not addressing whether Claimant was "forced" to elect between two remedies in order to receive treatment. The parties have subsequently briefed this issue of forced election and it is now ripe for decision.
II. FACTS A. Testimony of Witnesses
Claimant testified to the following. On January 31, 1999, Claimant was standing on a footstool lifting and lowering crates of milk from a very high shelf in the cooler room at the Employer's convenience store. At one point, she began to feel pain in her groin radiating to her lower back. She told her supervisor, Gail Jefferson, that she needed to sit down and rest because she had hurt her back. The Claimant eventually required both a automotive lumber discectomy and a lumber fusion surgery on her back.
Edward Quinn, M.D. testified that the lifting and bending caused the Claimant's back pain, which in turn caused the referred pain in her groin. Robert Keehn, M.D., opined that he could not relate Claimant's current lower back pain to the incident in the cooler on January 31, 1999. After reviewing Claimant's extensive medical records, he believed that her back pain is traceable to any of her previous injuries.
Claimant's husband testified to the following. Claimant's primary insurance carrier, Peninsula Oil, initially refused to pay Claimant's medical bills because of Dr. Freed's statement that Claimant suffered from a strained hip and back, which the company believed indicated a work injury. Furthermore, the Claimant received worker's compensation denials in the mail even though she had never solicited benefits. Mr. McIntire sent these denials to the insurance company in hopes of receiving money for the Claimant's medical bills. Although the health insurance company purportedly asked them to do so, the McIntires did not write any letters stating that the injury was definitely work-related or that they would forgo applying for worker's compensation benefits. The health insurance company eventually paid its portion of Claimant's medical bills, but eventually told her that because she had been terminated she would have to switch to COBRA Insurance.
Peninsula Oil is apparently a parent company of Uncle Willie's and provides health insurance for employees of Uncle Willie's. As a result, the company that would pay her health insurance owns the company that would pay her Worker's Compensation benefits.
B. The Board's Findings
The Board concluded that the Claimant had not met her burden of proving that the January 1999 work accident occurred and that it caused her low back injury. The Board found as follows:
Based on the history provided to him, Dr. Quinn concluded that a January 1999 work accident caused Claimant's low back injury. In November 1999, however, when Claimant first saw Dr. Quinn, she told him that she had severe groin pain when getting out of bed in March 1999. Claimant only later told him of a January 1999 work accident. In addition, Dr. Quinn recorded no specifics of the mechanism of injury. Dr. Keehn, on the other hand, concluded that no work injury occurred, based on the absence of support in the medical records, which are extensive and which include notes from several doctors.
Based on the absence of any support from the medical records or coworkers, the Board finds that Claimant did not prove that a January 1999 work accident occurred. The doctors agree that there is no mention in the medical records of such a work accident. In addition, according to the records, Claimant reported to Dr. Freid in June 1999 that she felt severe groin pain when she was getting out of bed in December 1998. She did not mention a work accident to him and she reported an onset of pain that predates the alleged work accident. Furthermore, the disability notes that she provided to Uncle Willie's did not reference any work injury.
Claimant testified that she told her supervisor, Mrs. Jefferson, of the work accident right after it happened. Mr. Williams' investigation, however, produced a statement from Ms. Jefferson that she was not aware of any work accident. The Board finds that if a work accident had occurred, some mention in the medical records or some support from a coworker would have been present.
For these reasons, the Board accepts Dr. Keehn's testimony over that of Dr. Quinn's and finds that Claimant did not suffer a work injury.
See Board's Decision at 7.
III. STANDARD OF REVIEW
The Supreme Court and this Court have repeatedly emphasized the limited appellate review of the factual findings of an administrative agency. The function of the reviewing Court is to determine whether the agency's decision is supported by substantial evidence. Johnson v. Chrysler Corporation, 213 A.2d 64, 66-67 (Del.Supr. 1965); General Motors v. Freeman, 164 A.2d 686, 688 (Del.Supr. 1960). Substantial evidence means such relevant evidence as a reasonable mind might accept as adequate to support a conclusion. Oceanport Ind. v. Wilmington Stevedores, 636 A.2d 892, 899 (Del.Supr. 1994); Battisa v. Chrysler Corp., 517 A.2d 295, 297 (Del.Super. 1986), app. dism., 515 A.2d 397 (Del.Supr. 1986). The appellate court does not weigh the evidence, determine questions of credibility or make its own factual findings. Johnson v. Chrysler, 213 A.2d at 66. It merely determines if the evidence is legally adequate to support the agency's factual findings. 29 Del. C. § 10142(d).
IV. DISCUSSION OF LEGAL ISSUES A. Whether The Board Erred By Forcing Claimant To Elect Between Remedies
In her Notice of Appeal, the Claimant asserted that the Board erred as a matter of law because the Employer forced her to choose either worker's compensation or health insurance in order to obtain treatment. Specifically, the Claimant asserted that: "The Board did not address or resolve this problem in deliberating and making a finding, thus the Board has enforced the Employer's illegal requirement that the Employee elect remedies." See Notice of Appeal dated June 15, 2001.
Likewise, on October 4, 2001, Claimant filed an Opening Brief asserting that "the Board entirely ignored that issue in the decision as if the argument had not be [sic] put before the Board along with evidence supporting the election of remedies forced on the Claimant by the Employer's self-insured medical insurance and self-insured worker's compensation claims practices." See Opening Brief at 9. On October 24, 2001, the Employer filed an Answering Brief on Appeal which correctly dissected the Board's decision. "The Board noted that, although the claimant's primary health insurance stopped paying her bills at one point because they thought her injury was work related . . . the primary health insurance resumed coverage after Claimant withdrew her position with IAB." See Answering Brief at 7. This evidences the fact that the Board was aware that the health insurance company waited until Claimant withdrew her petition before paying her claims.
In Claimant's Reply Brief dated November 7, 2001, Claimant clarified her argument. She cited 19 Del. C. § 2363(a), which statutorily precludes an election of remedies. See Reply Brief at 3. This section provides that "the acceptance of compensation benefits . . . shall not act as an election of remedies, but such injured employee . . . may also proceed to enforce the liability of such third party for damages in accordance with this section." However, the legislative intent behind this statute pertains to preserving suits against third parties. In Re Dockham Ingrahm v. Miller, Del. Super., No. 95C-02-091, Quillen, J., (Letter Op.) (June 12, 1997), this Court noted:
Our courts have long held recognized this statutory prohibition on the election of remedies in the worker's compensation area. See, e.g., Miller v. Ellis, Del. Super., 122 A.2d 314, 315 (1956). To force an injured party to choose between accepting immediate compensation and foregoing that compensation in favor of a lengthier third-party civil action, one that may not be remunerative, runs contrary to that purpose, hence the enactment of 19 Del. C. § 2363.
Id. at 2-3.
Furthermore, the Supreme Court found that § 2363 was very clear in stating that the worker's compensation statute does not force an election of remedies on a claimant as to a third-party defendant. Messick v. Star Enterprise, 655 A.2d 1209, 1212-13 (Del.Supr. 1995). We do not have such a situation here, however, because Claimant is not trying to preserve her right to sue a third party.
Claimant disagrees, and asserts that the statute "also works to preserve Claimant's rights to worker's compensation regardless of the election of remedies forced through other means." See Claimant's Reply Brief at 5. Claimant also believes the Board's action "nullified" Section 2363(a). Id. This Court finds that the statute cannot be enlarged to include the current situation without relevant legal authority, and Claimant has presented none.
It is paramount that the public policy behind the worker's compensation statute reflects a desire that the financial relief "be the sole remedy for personal injury or death by accident that occurs within the employment relationship." Sewell v. Delaware River and Bay Authority, Del. Super., C.A. No. 99A-07-003, Stokes, J. (Mem. Op.) (February 29, 2000) at 8. Before a claimant "is entitled to compensation, he or show must show that the injury for which compensation is sought is work-related." Id. The Board had substantial evidence to hold that Claimant has not demonstrated this all-important fact.
The Claimant has presented no proof that the Board denied Claimant any of the benefits of a legally adequate hearing. The Claimant had a full and fair opportunity to go before the Board and demonstrate a compensable injury. She was able to call witnesses and submit evidence, including a voluminous medical file, for the Board's perusal. The Claimant had full subpoena power and was able to access all information from her doctors as to the exact cause of the injury.
Lastly, according to Mr. McIntire's testimony, he was never forced to elect between remedies. He testified to the following:
Mr. McIntire: They [health insurance company] wanted me to give them a written letter stating it was not work-related so they would go ahead and cover it.
Mr. Davis: Did you do that?
Mr. McIntire: No, sir, I did not.
Mr. Davis: Did they eventually cover the process anyway?
Mr. McIntire: Yes, they did.
Mr. Davis: And after she was treated, another petition [for worker's compensation] was filed. Is that correct?
Mr. McIntire: Yes. After she got her surgery, I contacted you and asked you to go ahead and continue on with the Worker's Compensation.
Mr. Davis: At any time did you enter into a contract on an agreement of any sort that you would not make a claim with Worker's Compensation?
Mr. McIntire: No, they wanted me to but I wouldn't. See Hearing Transcript at 62-63.
The Board therefore did not force Claimant to elect whether her injury was related to her lifting incident at work or her pre-existing medical problems. It simply decided after evaluating the evidence that this injury was not work-related.
V. CONCLUSION
The decision of the Board is hereby affirmed.
IT IS SO ORDERED.