THOMAS E. STALNAKER, Claimant Below, Petitioner
TOWN OF MABSCOTT, Employer Below, Respondent
Appeal No. 2051021, Claim No. 2014025520
Thomas E. Stalnaker, by Michael E. Froble, his attorney,
appeals the decision of the West Virginia Workers'
Compensation Board of Review. Respondent, Town of Mabscott,
by Jeffrey B. Brannon, its attorney, filed a timely response.
issue on appeal is the compensability of the claim. The
claims administrator rejected the claim on May 19, 2014. The
Office of Judges reversed the decision in its December 3,
2015, Order. The Order was then reversed and vacated by the
Board of Review on June 8, 2016, and the claims
administrator's decision was reinstated. 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 that the Board of Review's decision is
based upon erroneous conclusions of law. This case satisfies
the "limited circumstances" requirement of Rule
21(d) of the Rules of Appellate Procedure and is appropriate
for a memorandum decision rather than an opinion.
Stalnaker, a police officer trainee, was injured while
exercising at the police academy on July 23, 2013. He sought
treatment the next day from A. E. Landis. Dr. Landis's
treatment note indicates Mr. Stalnaker was treated for an
injury to his right knee which occurred the day before at the
police academy. He reportedly slipped while getting up from
doing a pushup. Dr. Landis had previously seen Mr. Stalnaker
for left knee problems and symptoms related to degenerative
arthritis as well as a total hip replacement on the left
side. He had no pre-existing right knee injuries but has had
problems with it at times due to his significant degenerative
arthritis. At the time of examination Mr. Stalnaker had right
knee pain, swelling, and stiffness.
walking with a limp. An x-ray of the right knee showed
moderate degenerative changes, moderate effusion, and
irregularity of the femoral notch and tibial spines. Dr.
Landis diagnosed right knee sprain with underlying
degenerative changes. A West Virginia State Police Academy
report of injury was also completed that day. Dr. Landis
indicated on the form that Mr. Stalnaker sprained his knee at
work and was on restricted duty.
29, 2013, Dr. Landis saw Mr. Stalnaker for bilateral knee
complaints. The right knee was found to have degenerative
changes with contusions/sprains aggravating the arthritis.
Draining and injecting the right knee improved the symptoms.
The left knee also showed degenerative changes and was
swollen and tender. On August 21, 2013, Dr. Landis completed
a request for medical treatment form with the proper claims
administrator's logo, on top. Dr. Landis stated that Mr.
Stalnaker was injured while doing pushups. He diagnosed a
right knee sprain and placed him on restricted duty until
July 29, 2013.
Stalnaker's attorney wrote a letter to the claims
administrator on February 19, 2014, stating that Mr.
Stalnaker was injured on July 23, 2013, in a work-related
incident and that he informed his supervisor, Eddie Vaught,
of the injury on that day. The letter alleges that the
employer refused to turn in his workers' compensation
form for processing and refused to pay for medical services
with Dr. Landis. Mr. Stalnaker's attorney further asserts
that the Mayor/Police Chief's secretary informed Dr.
Landis that the Mayor/Chief was not going to sign the
employee's report of injury and would not let the claim
proceed. Mr. Stalnaker's attorney alleges the employer
violated West Virginia Code §23-4-1b (2005) because it
did not notify the claims administrator of the injury within
five days. The attorney alleged that Mr. Stalnaker repeatedly
tried to speak with Mayor/Chief Houck but he refused to speak
with him. Finally, Mr. Stalnaker appeared at a town council
meeting, resigned his position with the Town of Mabscott, and
again asked for the name of the proper claims administrator.
He was told it was Berkeley Mining. Mr. Stalnaker was unable
to find information regarding Berkeley Mining Insurance. As a
result, he contacted the West Virginia Insurance
Commissioner's Office to determine who the insurer was.
Mr. Stalnaker's attorney asserts that the employer
fraudulently withheld a valid claim from being processed and
requested that the claim be processed despite being filed
after the passing of the six month time frame.
claims administrator sent a letter to Mr. Stalnaker's
attorney on March 7, 2014, informing him that a report of
injury was not received and explained that it was unable to
process the claim until it received the form. Mr. Stalnaker
completed his section of the report of injury on March 28,
2014, indicating he injured his right knee on July 23, 2013,
while doing pushups. The physician's section was blank.
notes by Dr. Landis dated April 20, 2014, indicate Mr.
Stalnaker had right knee pain, swelling, and tenderness. The
knee had trace effusion and full range of motion with minimal
crepitation. X-rays were unchanged. Dr. Landis diagnosed
contusion/sprain of the right knee, which had resolved, with
pre-existing, moderate degenerative changes. Dr. Landis
opined that there may be some progression of the degenerative
changes related to the injury but the current symptoms were
primarily the result of pre-existing arthritis. On April 29,
2014, Dr. Landis completed the physician's section of the
report of injury. The claims administrator rejected the claim
on May 19, 2014.
15, 2015, Mr. Stalnaker testified in a deposition that his
employer intentionally misled him to believe that Travelers
Insurance was not the employer's insurance carrier and
that the Mayor/Chief, his employer, refused to cooperate with
his application process. Mr. Stalnaker testified that he was
injured on July 23, 2014, and immediately informed the State
Police Academy and his supervisor, Edward Vaught, of the
injury. He initially completed an application with Travelers
Insurance but was then told by the Mayor/Chief's
secretary that the employer was insured by Beckley Mining
Insurance. Mr. Stalnaker stated that when he saw Dr. Landis
he was told that the doctor's office would fill out the
forms and send them to the employer. The Mayor/Chief's
secretary then informed Mr. Stalnaker that he needed to fill
out different forms. He took the forms to Dr. Landis and was
told by his office that Mayor/Chief Houck refused to submit
the claim because the injury was not reported within
twenty-four hours. Mr. Stalnaker then submitted a form to
Beckley Mining Insurance and it was denied. He then contacted
the insurance commission who indicated that there was no such
thing as Beckley Mining Insurance. Mr. Stalnaker alleges he
was misled by the employer because the Mayor/Chief dislikes
workers' compensation claims.
15, 2015, Edward Vaught testified in a deposition that he was
Mr. Stalnaker's supervisor and it was his duty to report
an injury to the Town's secretary and the Mayor/Chief
himself. Mr. Stalnaker contacted him on the date of injury
and informed him that he had injured his right knee. Mr.
Vaught stated that Mr. Stalnaker did not request information
about the correct insurance carrier on the date of injury.
Mr. Vaught said it was his belief that the employer was
responsible for reporting the injury to the insurance
carrier. Mr. Vaught stated that when he told the Mayor/Chief
of the injury, the response was not positive. He asserted
that the Mayor/Chief made comments which indicated he did not
want Mr. Stalnaker to make it through the police academy. No
other officers were injured while he worked for the employer
and that was the only injury he reported to the Town's
secretary and the Mayor/Chief.
Office of Judges reversed the claims administrator's
decision on December 3, 2015, and held the claim compensable
for right knee sprain. The Office of Judges found that Mr.
Stalnaker argued the employer intentionally misled him to
believe that the employer had a different insurer other than
Traveler's Insurance, the correct insurer. In support of
his allegation, he submitted a managed healthcare plan
request and medical treatment form filled out by Dr. Landis
on August 21, 2013, on Travelers Insurance letter head. He
then took the form to the employer and was told that
Travelers was not the correct insurer. He also alleges that
the employer failed to cooperate with the application process
because it disfavored workers' compensation claims. In
support, he submitted Mr. Vaught's deposition. Lastly,
Mr. Stalnaker alleges the employer violated West Virginia
Code 23-4-1b (2005) by not reporting the injury to the claims
administrator within five days of the employee giving notice.
The employer asserted that Mr. Stalnaker had some knowledge
that Travelers Insurance was the right insurance company and
that he relied on others to process his application, which is
not an excuse to miss the six month time frame. The Office of
Judges found that the employer offered no evidence disputing
Mr. Stalnaker's allegations that the employer misled him
about the correct insurer and refused to cooperate with the
Office of Judges found that Mr. Stalnaker offered unrefuted
evidence that he was instructed by the employer to disregard
a claim document that was addressed to the proper claims
administrator in August of 2013, and was told to file with
another insurer. The Office of Judges concluded that though
the form was not a report of injury, had Mr. Stalnaker filed
the form with Travelers Insurance in August of 2013, a
dialogue would most ...