PTD benefits claim fails without enhanced PPD

A claimant’s right shoulder injury failed to reach the threshold necessary to meet the requirements for permanent total disability (PTD) benefits, the Eastern District of the Missouri Court of Appeals ruled on July 8, affirming denial of a benefits award.

Patrick Ryan worked in various trades over five decades. Throughout his career, he suffered several work-related injuries, beginning with an injury to his right knee in 2004, which resulted in a workers’ compensation settlement for 75 percent of the right knee, or 120 weeks of permanent partial disability (PPD).

In 2007, Ryan injured his left shoulder and cervical spine, followed by a 2011 injury to his right shoulder and spine.

When he filed a claim against the Second Injury Fund, an administrative law judge (ALJ) concluded his combined disabilities resulted in a greater disability than their simple sum, resulting in an award of enhanced PPD of 60.66 weeks.

Ryan sustained injuries to his cervical spine and right shoulder in 2015 and brought a claim for PTD based on the most recent injuries together with his preexisting disabilities.

The ALJ issued an award in favor of Ryan, finding all his preexisting disabilities to be a direct result of compensable injuries as defined in §287.020.

Appealing to the Commission, the Fund argued the ALJ erred by adding a portion of the 2011 enhanced PPD to the 2011 right shoulder disability so that it reached the 50-week statutory threshold and that the right shoulder disability could not be properly considered under the second condition of §287.020.3.

The Commission reversed the award and Ryan appealed.

Jointed by Chief Judge John P. Torbitzky and Judge James M. Dowd, Judge Michael S. Wright affirmed.

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Ryan told the court that his 2011 right shoulder injury was a qualifying injury that satisfied the “direct result” requirement of §287.020.3(2)(a)a(ii).

Pursuant to subsection 3 of §287.020, Ryan needed to meet two conditions to make a compensable PTD claim against the Fund, the court explained: he must have at least one qualifying preexisting disability that is medically documented, equaling a minimum of 50 weeks PPD, which met one of the four categories listed in §287.020.3(2)(a)a(i)-(iv).

At issue was § 287.020.3(1)(a)a(ii): a preexisting injury that is “[a] direct result of a compensable injury as defined in section §287.020[.]”

Ryan contended that the Commission should have applied the enhanced amount of PPD attributed to his right shoulder injury, and with the load factor applied, the 46.4 weeks of PPD the Commission attributed to the right shoulder injury rose above the 50-week threshold.

However, Ryan ran up against a recent decision from the Missouri Supreme Court, Eckardt v. Treasurer of Missouri, where the court held that an enhanced PPD should not be used in determining whether a claimant is entitled to PTD benefits from the Fund.

“[W]e are bound to apply Eckardt’s holding to the present matter,” the court said.

Enhanced PPD, sometimes referred to as a “loading factor” or “multiplicity factor” acts as “a special or additional allowance for cumulative disabilities resulting from a multiplicity of injuries,” the court said, and enhanced PPD came into effect only when a claimant sought PPD benefits under the pre-2013 version of the workers’ compensation statutes.

“However, ‘effective January 1, 2014, the legislature eliminated claims for PPD and, in so doing, also eliminated the attendant load factor analysis,’” the court wrote. “Nothing in subsection 3’s statutory framework, ‘which this Court is bound to strictly construe, permits or even suggests a load factor may be applied to increase the amount of PPD attributed to a preexisting disability.’ As a result, without application of the loading factor, this Court holds Ryan’s 2011 right shoulder injury does not reach the 50-week threshold and cannot be considered in combination with his Primary Injuries to determine if he is entitled to PTD benefits.”

The court affirmed the Commission.

The Fund was represented by Assistant Attorney General Kimberly C. Fournier. The AG’s Office did not respond to a request for comment on the case.

Neither did Hannibal attorney Branson L. Wood, III, who represented Ryan.

The case is Ryan v. State of Missouri, No. ED112149.