Paradis v. Pine State Trading

Name

Insurance Company

MMTA Workers' Comp Trust

Date Decided

April 27, 2017

Panel Members

Timothy Collier

Glen Goodnough

Sue Jerome

File Size

188 KB

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Summary from the Troubh Heisler Attorneys

Mr. Paradis delivered beverages for Pine State and injured his back at work on 8/19/11. He got treatment and was given restrictions and a helper, so he was able to continue working, but he missed 2 days of work. Although Mr. Paradis did not actually request payment of WC incapacity benefits, Pine State filed a “full-denial” Notice of Controversy on 10/24/11, “questioning why Mr. Paradis was losing time sporadically.” On 4/23/12, Pine State laid Mr. Paradis off because they could no longer accommodate his work restrictions. Mr. Paradis had a prior non-work-related knee injury which continued to degenerate, so he had knee replacement surgery in June 2012 and recovered by January 2013.

On 5/19/14, Mr. Paradis wrote to Pine State asking for payment of total incapacity benefits from the date of the layoff to the present and continuing. Pine State declined to pay benefits and pointed out that it had already filed a full-denial NOC in 2011 and would therefore not file another one. Mr. Paradis filed petitions, and Judge Knopf granted them, both on the merits of the case and because of a “14-day violation.” She found that when the employee lost two days from work due to his work injury in October of 2011 “there was no claim for benefits,” and therefore no obligation to file a NOC. Instead, “the first articulation of any claim for lost time benefits was set forth in the May 19, 2014 letter.” Accordingly, there was an ongoing 14-day violation due to the failure to file another NOC within 14 days of receiving the 2014 letter. Although Dr. Donovan’s §312 IME apportioned 50% of the incapacity to Mr. Paradis’ non-work-related knee, Judge Knopf declined to reduce his benefits accordingly, because the knee condition was a pre-existing condition and not a subsequent non-work injury under §201(5). Pine State appealed.

The Appellate Division panel upheld Judge Knopf’s decision, holding that “the filing of a protective NOC in the absence of a claim for benefits does not discharge an employer's future obligation under the 14-day rule.” The panel ruled that another NOC in 2014 would not have been “duplicative” of the earlier one because “there was no claim for benefits” at the time the 2011 NOC was filed. The panel also held that pre-existing conditions that gradually worsen do not qualify as a “subsequent medical conditions” for which an offset is available under §201(5).

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