SAMUEL J. GOINS III, Claimant Below, Petitioner
WEST VIRGINIA DIVISION OF NATURAL RESOURCES, Employer Below, Respondent
Appeal No. 2050791) (Claim No. 2014003117)
Samuel J. Goins III, by Gregory S. Prudich, his attorney,
appeals the decision of the West Virginia Workers'
Compensation Board of Review. West Virginia Division of
Natural Resources, by Lisa A. Warner Hunter, its attorney,
filed a timely response.
issue on appeal in this case is the compensability of the
claim. The claims administrator rejected the claim on
December 10, 2014. The Office of Judges affirmed the
rejection in its September 1, 2015, Order. The Board of
Review affirmed the Order on March 7, 2016. The Court has
carefully reviewed the records, written arguments, and
appendices contained in the briefs, and the case is mature
Court has considered the parties' briefs and the record
on appeal. The facts and legal arguments are adequately
presented, and the decisional process would not be
significantly aided by oral argument. Upon consideration of
the standard of review, the briefs, and the record presented,
the Court finds no substantial question of law and no
prejudicial error. For these reasons, a memorandum decision
is appropriate under Rule 21 of the Rules of Appellate
Goins, a natural resources officer, alleges he injured his
back in the course of his employment on July 11, 2013, while
moving brush from a boat. Sergeant M. S. Lott wrote a
statement on July 15, 2013, indicating he was Mr. Goins's
immediate supervisor. He stated that Mr. Goins contacted him
on July 11, 2013, to say that some branches fell on West
Virginia Division of Natural Resources' boat and that he
would have to spend some time clearing them off. Later that
day, Sergeant Lott told Mr. Goins of a meeting the next day.
At that time, Mr. Goins stated that his back was hurting and
he had been having trouble with it all week. He further told
Sergeant Lott that he spent the night in his camper the night
before, slipped on the floor, and hurt his back. Later that
same day, Mr. Goins reported to Sergeant Lott that he had
hurt his back while moving brush off of the boat. He went to
the emergency room and told them that it was a pre-existing
condition from an injury sustained in the military.
dated July 22, 2013, from the claims administrator to Mr.
Goins indicates West Virginia Division of Natural Resources
reported Mr. Goins's claim for benefits. Mr. Goins was
reportedly supplied with the WC-1 form and instructed to
complete it if he wished to file a claim. He was advised that
he had six months to complete and return the form. On August
18, 2013, the claims administrator wrote a letter to Mr.
Goins stating that it was unable to determine if the claim
was compensable and required a WC-1 form to be completed.
Goins underwent an MRI on August 1, 2013, which showed
degenerative changes throughout the thoracic spine. Multiple
degenerative changes, disc bulging at multiple levels, and
canal stenosis were seen in the cervical spine. Mr. Goins was
treated by Rammy Gold, M.D., between August 29, 2013, and
April 28, 2014. Treatment notes indicate he underwent an
EMG/nerve conduction study of the right extremities which
showed no signs of neuropathy or radiculopathy. On August 29,
2013, Dr. Gold saw Mr. Goins for pain in the cervical and
thoracic spine as well as the bilateral shoulders. He
diagnosed thoracic and low back pain, degeneration of the
lumbar discs, lumbosacral neuritis/radiculitis, and lumbar
notes from Medical Center, Memorial Campus indicate Mr. Goins
sought treatment for his lower back on November 14, 2013. At
that time he alleged that he injured his back in July while
moving brush from a boat. His history showed he suffers from
chronic low back pain. He requested referral to a
neurosurgeon. On September 16, 2013, an MRI revealed L3-4 and
January 9, 2014, letter to the claims administrator, Mr.
Goins indicated that he had completed his portion of the WC-1
and delivered the form to PARS Neurosurgical Associates. He
was told that Dr. Gold would complete the form and send it to
the claims administrator. Mr. Goins also emailed a copy of
the WC-1 to the claims administrator that day. The copy was
unsigned and the physician's section was left blank. On
January 31, 2014, the claims administrator informed Mr. Goins
that Dr. Gold's office had failed to complete the
physician's section of the WC-1 and that a completed form
had still not been received. On May 14, 2014, the claims
administrator sent an email to Mr. Goins's attorney
stating that it had not received a WC-1 completed by a
physician. It had only received one from Mr. Goins. The
claimant's counsel sent the claims administrator a WC-1
signed by a physician at Camden Clark Memorial Hospital on
October 24, 2014. It indicated Mr. Goins sustained an
occupational injury diagnosed as a lumbosacral sprain. The
claims administrator rejected the claim on December 10, 2014,
stating that Mr. Goins did not sustain a work-related injury
and that an application for benefits was not timely filed.
Goins testified in a deposition on January 22, 2015. He
asserted that he sought medical treatment and informed his
supervisor of his injury on July 11, 2013. He stated that he
filled out a Workers' Compensation form at the hospital.
Mr. Goins related that he was contacted by Eileen Kane, a
representative of the claims administrator, and was
interviewed by her. They then communicated through e-mail. He
was told to submit the necessary paperwork, which he alleges
he did through e-mail. He stated that all of this was
completed within six months of his injury.
Office of Judges affirmed the claims administrator's
decision in its September 1, 2015, Order. It stated that per
West Virginia Code § 23-4-15(a) (2010), an application
for benefits must be filed within six months of an injury. In
order to comply with the statute, it had to be determined
what constitutes the minimum amount of compliance necessary
to be deemed to have filed an effective application for
benefits. The Office of Judges determined that the problem
with the physician's section being left blank is
substantial. It found, per the record, that Mr. Goins sought
prompt medical attention as he was seen by his family doctor
and two specialists. However, none of them completed the
WC-1. The Office of Judges concluded that their failure to
complete the form indicates that none of them thought the
medical condition was occupationally related. The Office of
Judges considered Mr. Goins's argument that he cannot
force his physicians to complete a WC-1. The Office of Judges
determined that it was not an issue in this case since the
record shows he could have had the form completed by a PA-C
on July 11, 2013. Further, he was made aware of the problem
by the claims administrator on August 18, 2013.
Office of Judges next addressed the issue of whether it was
necessary for Mr. Goins to sign the WC-1. The Office of
Judges found that in Culurides v. Ott, 78 W.Va. 696,
90 S.E.2d 270 (1916), the Court held that an application
filled out and signed by the claimant's brother was found
to be a meritorious claim for benefits. The Office of Judges
therefore concluded that a WC-1 can be filed without the
signature of the injured worker, but presumably someone has
signed the application. The Office of Judges determined in
this case that the basic requirements for a WC-1 were not
fulfilled. The Board of Review adopted the findings of fact
and conclusions of law of the Office of Judges and affirmed
its Order on March 7, 2016.
review, we agree with the decision of the Board of Review.
Mr. Goins filed a WC-1 within the six month time frame. The
fact that it was unsigned does not disqualify the
application. The fact that the physician's section was
not completed brings into question the compensability of the
injury; however, it does not bar the application for benefits
entirely. The claims administrator was well aware that Mr.
Goins was purportedly injured in the course of his employment
and that he was attempting to apply for benefits. The West
Virginia Division of Natural Resources reported the injury to
the claims administrator four days after the injury occurred.
Further, West Virginia Code § 23-4-15(a) merely states
that an application must be filed, it does not provide
qualifications for what constitutes a completed application.
However, Mr. Goins failed to show by a preponderance of the
evidence that he was injured in the course of and resulting
from his employment. He made inconsistent statements of how
he injured his back. For example, he reported to Sergeant
Lott that his back hurt because he fell the night before.
Later that day, he told Sergeant Lott that he hurt his back
while clearing brush off of his boat, but then reported to
the emergency room that it was a pre-existing condition due
to a military injury. Additionally, MRI scans showed the
presence of degenerative changes and Dr. Gold found on
examination that the claimant suffered from degenerative
lumbar spine conditions.
the foregoing reasons, we find that though the decision of
the Board of Review was based upon erroneous conclusions of
law, its decision was still correct based upon the
evidentiary record. ...