Appeals court reverses denial of total disability benefits

A Missouri appeals court has ruled that a former manual laborer qualifies for permanent total disability benefits from the state’s Second Injury Fund, reversing a previous decision that denied his claim based on a technical interpretation of disability thresholds.

The November opinion by Judge Michael S. Wright of the Missouri Court of Appeals, Eastern District affirmed the plaintiff’s request for reversal and remand of a previous judgment that denied his claim for permanent total disability benefits.

At the center of the opinion is the issue of how to interpret Section 287.220.3 of the Missouri Worker’s Compensation Act regarding permanent disability benefits from the Second Injury Fund, and whether Patrick Ryan, a long-time manual laborer, was qualified for permanent total disability benefits after his final workplace injury in August 2015, when he was injured while handling heavy objects at the Hannibal Board of Public Works. He had suffered a series of injuries over the course of 20 years throughout his career.

Ryan received workers’ compensation and permanent partial disability for injuries in 2004 and 2007. The Second Injury Fund awarded him additional enhanced disability benefits after the 2007 injury acknowledging that the new injuries combined with the 2004 knee injury created a greater disability.

In 2011, Ryan was injured again at work. He settled with Hannibal Public Works, receiving compensation for 20 percent permanent partial. The fund determined that Ryan had 404.4 weeks of disabilities from all his claims, and the combination of injuries created a greater disability than their simple sum. Ryan was awarded an additional 60.66 weeks of enhanced benefits from the fund, which was paid without appeal.

The final 2015 injury prompted the legal battle that took the case to the appellate court. Ryan had settled with his employer those injuries, but his permanent total disability claim against the Second Injury Fund was more contentious. Experts testified that the combination of Ryan’s injuries left him permanently and totally disabled, unable to return to work or find any substantial employment. An administrative judge initially ruled in Ryan’s favor, but the Labor and Industrial Relations commission reversed the decision despite acknowledging that Ryan was indeed permanently and totally disabled.

The denial of the PTD claim hinged on the commission’s interpretation of the Second Injury Fund law, believing that Ryan did not meet the strict qualifying criteria established by 2013 amendments to the law. The 2011 injury, which resulted in 46.4 weeks of disability, fell just shy of the law’s required 50-week minimum threshold.

The administrative judge had attempted to bridge this gap by including a portion of Ryan’s previous “enhanced” disability benefits, which would have pushed the shoulder injury over the 50-week threshold. However, the commission ruled these enhanced benefits could not be counted toward meeting the 50-week requirement since the benefits were not a “direct result” of the shoulder injury but from the combination of multiple injuries. Despite agreeing that Ryan’s total disability resulted from the combination of his work injuries, the commission found that he failed to meet the specific legal requirements needed to receive permanent total disability benefits from the fund.

The appeals court reversed the commission’s decision, ruling that Ryan should receive permanent total disability benefits from the fund, finding that additional “enhanced” disability benefits he received from the fund in 2011 should be counted toward reaching the 50-week minimum threshold.

The court also rejected the commission’s argument that these enhanced benefits couldn’t be counted because they weren’t a “direct result” of the shoulder injury alone.

“We find the commission improperly defined the term ‘direct result’ and failed to adhere to the canons of statutory interpretation,” the Nov. 26 opinion stated. “Here ‘direct result’ is unambiguous and this court finds the 2011 right shoulder injury is a direct result of compensable injuries … In dispute is the commission’s finding that the enhanced PPD attributed to the 2011 right shoulder disability is not a direct result of a compensable injury because the enhancement or loading factor is a superseding cause in the form of a pre-existing condition. This court holds this finding is unsupported by case law and contradicts the purpose of the fund.”

Presiding Judge John P. Torbitzky dissented in a separate opinion, arguing that strict interpretation of Missouri law prevents awarding of benefits in this case, rejecting the “enhanced” disability benefits to reach the 50-week minimum threshold.

The legislature amended the law in 2013 specifically to address the fund’s insolvency problems, and Torbitzky said the majority’s ruling broadens the fund’s liability contrary to legislative intent.

“The facts of this case and strict construction of the applicable law prevent me from finding fund liability,” Torbitzky stated.

The case is Patrick Ryan v. State of Missouri, Second Injury Fund, No. ED112149.