Missouri: Court Keeps Civil Case Alive for Work-place Injury

Missouri: Court Keeps Civil Case Alive for Work-place Injury

The employer lost its summary judgment in a suit by an employee involving an injury at work based on a plain error review by the court of appeals. The claimant had a pending worker's compensation case which had not resolved whether claimant had an accidental injury. The court concluded summary judgment would result in manifest injustice to the claimant because it would prematurely end any civil suit on the merits when the defense was based on a question of fact regarding whether there was an accidental injury to be determined by the commission.   The case is Cooper v Chrysler Group, No. ED 96549 (Mo. App. 12-13-11)

The claimant filed a worker's compensation claim which required proof that the accident was the prevailing factor in his injuries and that any treatment arose from his accident.  The dispute involving the 2007 accident arose whether or not a 2008 surgery was work-related.  The employer admitted that claimant sustained a workplace accident but disputed that surgery was necessary as a result of the accident.  The claimant filed suit and agreed the accident was not the prevailing factor in his injuries.  The trial court had affirmed summary judgment in the employer's favor on the ground that plaintiff's exclusive remedy was under worker's compensation law.

The eastern district indicated that the circuit court violated the primary jurisdiction of the Commission to make the decision whether claimant sustained accidental injury.    The primary jurisdiction doctrine provides the courts will not decide a controversy within the jurisdiction of an administrative tribunal until after the tribunal has rendered its decision.  A claimant may file a tort claim while a case remains pending before the commission but the court abuses its discretion to render summary judgment on the merits. 

Judge Crane concludes if the Commission "does not find an accidental injury, plaintiff should then be able to pursue his civil cause of action." Judge Romines in a concurring opinion indicated that legislative reform narrowing the definition of accidental injury inevitably resulted in more civil suits:  "Clearly the legislature prefers jury trials."  Judge Romines' also authored the recent controversial  opinion in Johme v St. John's Mercy Healthcare, pending before the Mo. Supreme Court, 2011 Mo. App. LEXIS 1412  (SC 92113, appeal transferred 10-23-11). 

Cooper on its merits is fundamentally a procedural issue that summary judgment is premature based on the primary jurisdiction doctrine.   The case facts, however, contain several warnings for employers.  Denying cases in comp may result in a civil tort case.  This case goes one step further.    The case facts warn employers that even admitting accident and providing benefits comp does not preclude a civil case when a dispute arises regarding further medical care.  

Plaintiff, in this case, pursues benefits and claims work benefits on the premise that work is the prevailing factor, and then in a civil case denies work in the prevailing factor.  This is similar to the pleadings in State v KCP&L Greater Mo. Operations Co. v Hon. Cook, 2011 Mo. App. LEXIS 1161 (Mo. App. 2011).  In that case claimant lost a summary judgment motion in which claimant denied his work was the prevailing factor in his mesothelioma and the court in a landmark decision concluded post-reform changes abolished an exclusive remedy defense in occupational disease tort cases.  Cooper does not go that far on the merits.  

The need for future medical treatment, such as a surgery, is not a determination of prevailing factor in the definition of accidental injury  but whether the treatment is reasonably required as defined by 287.140, according to Tillotson v St. Joseph Medical Center, 347 S.W.3d 511 (Mo. App. 6-14-2011). Tillotson is not mentioned in the Cooper opinion.  The Cooper case fundamentally involved a fight over a surgery, and not whether claimant had an accident or needed at least some treatment related to an accident, as he had received physical therapy.

The determination required by the Commission is not as simple as suggested by the Cooper opinion.  Determining what accident injury means not may be more than whether  claimant had an injury to his back (this appears undisputed) or that he needed some care (also apparently undisputed) but that claimant's accident caused a surgical condition.  The opinion does not specify why the employer disputed the surgery.   The Cooper opinion indicates claimant can simultaneously pursue tort and comp remedies but leaves unanswered the impact of election of remedies when claimant settles a comp case for a back injury but claims in tort he should have received something more that the claimant failed to prove in the comp claim.  The case leaves the employer in the odd posture of trying to convince the Commission that work is the prevailing factor (which claimant now denies) but maintaining its defenses to dispute the surgery. 

Source: Martin Klug, Huck, Howe & Tobin. Read Martin Klug's Mo. Workers' Comp Alerts.

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