Battling Over Which Insurer Should be Liable for Work Injury Benefits

Workers who have been injured in multiple work-related incidents should have no problem obtaining benefits for treatment. However, the process can be complicated if those injuries were incurred at different times and while employed by different companies or while the same employer was insured by different companies.back injury

In the recent case of Greenville Country Club (Guard Insurance) v. Greenville Country Club (Technology Insurance), the question was which insurer should be responsible for paying benefits for an injured worker who suffered an aggravation of a previous injury. The question was which injury was aggravated. That was central in determining which insurer had to pay.

The plaintiff, from Delaware, suffered injuries to his lumbar spine in two separate – and compensable – work accidents. The first accident occurred in 2009, when the company was insured by Guard Insurance Group. The second occurred in 2012, when the company was insured by Technology Insurance.

The first incident happened when the plaintiff fell onto the floor while at work, causing him to suffer back injuries. Guard accepted liability for the claim and provided workers’ compensation benefits for three months. The second incident happened when the plaintiff fell onto his back while mowing a wet lawn. Technology accepted liability and provided workers’ compensation coverage for a full year.

In 2014, the plaintiff filed petitions against both insurers to determine who should be responsible for his medical bills – including coverage of his lumbar spine surgery – as well as his ongoing temporary total disability benefits.

Both accidents resulted in injuries to the claimant’s spine. The plaintiff underwent surgery in 2014 for an injury to his lumbar spine. His petitions indicated the cause of his ongoing medical condition was either the 2009 injury or the 2012 injury, or both.

Five medical experts testified during the subsequent hearing.

The workers’ compensation board concluded the original insurer was wholly liable for the plaintiff’s additional compensation. The board relied on the rule for determining successive carrier liability set forth in Standard Distributing Co. v. Nally.

The superior court affirmed this decision, as did, more recently, the Delaware Supreme Court.

Guard argued that when Technology accepted liability for the 2012 work injury, it also accepted the whole burden of liability for compensating all of the plaintiff’s lumbar spine injuries. The rule applied was improper, Guard argued, since it’s only applicable when a second work accident causes a new, distinct injury, as opposed to a continuation of the original injury. That meant that from that point forward, all of the responsibility for lumbar spine injuries and subsequent aggravations shifted to Technology.

The state supreme court disagreed, finding that the occurrence of a second injury to the same body part didn’t automatically shift all liability for a future aggravation of that injury to the second insurer without proof of causation.

The justices on the high court declined to re-weigh evidence in the case, giving great deference to the board and superior court decisions. They found an ample record that was considered, with substantial evidence to support the conclusions reached. The board is allowed to accept one expert’s testimony over another, and it is given a great deal of discretion in doing so.

The plaintiff met his burden of proving his injury stemmed from the 2009 injury, but Guard failed to prove the proximate cause was the 2012 injury.

Contact the Carolina workers’ compensation lawyers at the Lee Law Offices by calling 800-887-1965.

Additional Resources:

Greenville Country Club (Guard Insurance) v. Greenville Country Club (Technology Insurance), Nov. 2, 2016, Delaware Supreme Court

More Blog Entries:

Kirkman v. North Carolina Dept. of Public Safety – Injury During On-the-Job Training, Oct. 28, 2016, Asheville Workers’ Compensation Lawyer Blog

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