West Virginia Supreme Court Allows Tolling of Six Month Time Limitation on Filing a Claim for Dependent’s Death Benefits Under Workers’ Compensation Act
West Virginia Code § 23-4-15 provides the statute of limitations for filing a claim for Workers’ Compensation dependent’s death benefits in West Virginia. In 1986, the Legislature adopted a six month period in which applications for these benefits may be filed. The code section specifically provides that a dependent must file for death benefits “within six months from and after the injury or death.” The code section further provides that such time limitation is a condition of the right and is jurisdictional. In April 2015, the West Virginia Supreme Court specifically found that this code provision did not intend to completely bar a claim for dependent’s benefits when, due to the medical examiner’s delay in preparing an autopsy report, there was no indication that an employee’s death was work-related until eight months after the death.
In the case described above, a 24 year old coal miner died in his sleep from a seizure on December 7, 2010. At the time, he left behind his mother, who was the petitioner in the Supreme Court case, and his 6 year old daughter, on whose behalf the mother petitioned the Court. Prior to his death, the decedent suffered a work-related injury on March 24, 2009, when a wrench hit him on the head. He lost consciousness for one minute and the injury resulted in a golfball-sized knot on his head. He was transported to the local hospital but was essentially released with pain medication and told to return for a follow up visit, if necessary. The claimant did not seek any additional medical treatment for this injury, and his claim was closed for temporary total disability benefits because he was not off work for more than three days.
Twenty-one months after this injury, the decedent died in his sleep. The medical examiner performed an autopsy on December 8, 2010, the next day. For reasons that were not developed in the evidence, the autopsy report was not completed and made available to the decedent’s family until August 24, 2011, more than 8 months after his death. The autopsy report declared that the claimant died as a result of a traumatic seizure disorder, which resulted from the 2009 work injury. The autopsy report did not establish when the decedent began to suffer from the seizure disorder, and his death certificate was amended to show that the claimant’s cause of death was a consequence of the traumatic seizure disorder.
The Supreme Court was faced with conflicting evidence as to whether the family knew at the time of the death that the decedent suffered from seizures. The autopsy report indicated that the decedent’s family reported witnessing seizure activity; however, the decedent’s mother responded to an interrogatory that the family did not know about the seizures. (The Supreme Court specifically found that there was no medical evidence at that time which linked the decedent’s death to his work-related injury.) The decedent’s mother, on behalf of the decedent’s daughter, applied for dependent’s death benefits on February 24, 2012, which was exactly 6 months after she received the autopsy report and amended death certificate finding that the decedent’s cause of death was related to his work-related injury from 2009. The claims administrator rejected the application for benefits, finding that it was filed more than 6 months after the decedent’s death, that the decedent’s mother was not the proper person to file the application on behalf of the daughter, as she was not the legal guardian, and that there was insufficient evidence to establish that the work-related injury caused the death.
The Workers’ Compensation Office of Judges affirmed the claims administrator’s order, and the Workers’ Compensation Board of Review affirmed the Office of Judges’ decision. However, the West Virginia Supreme Court of Appeals reversed the final Board of Review order and specifically found that the application for dependent’s death benefits was timely filed and that the decedent’s mother was the proper party to bring the claim for dependent’s death benefits on behalf of the decedent’s daughter.
The Supreme Court had previously held that the 6 month statute of limitations is a condition precedent to filing an application for dependent’s benefits and hence, jurisdictional. The Supreme Court read the statute so as to effectuate the legislature’s intent and specifically found that it was the legislature’s intent to protect employers from frivolous or outdated claims and for that reason provided that these time limitations are jurisdictional. The Supreme Court further explained, however, that a finding in this particular case, that the time limitation regarding dependent’s death benefits can never, under any circumstances, be tolled is patently unfair to the claimant and that such a finding would saddle the claimant with the impossible task of linking an injury to a death that occurred 21 months later. The Court relied upon its interpretation of the legislature’s intent of affording a claimant reasonable time to investigate his or her claim. Based upon the Supreme Court’s interpretation of the legislative intent in regard to the statute of limitations, it crafted a specific exception to the 6 month statute of limitations for filing dependent’s death benefits. The Supreme Court specifically held that:
Where a claimant to dependent’s death benefits under the Workers’ Compensation Act delays filing a claim because the claimant was unaware, and could not have learned through reasonable diligence, that the decedent’s cause of death was work-related, and the delay was due to the medical examiner completing and making available an autopsy report, the six-month time limitation on filing a claim in W. Va. Code § 23-4-15(a) is tolled until the claimant, through reasonable diligence, could have learned of the autopsy report finding that the decedent’s cause of death was, in any material degree, contributed to by an injury or disease that arose in the course of and resulting from the decedent’s employment.
The Supreme Court did limit its holding to death benefits under the Workers’ Compensation Act where the delay was on the part of the medical examiner and not the claimant. It also explained that this holding does not apply to claimants who delay having an autopsy performed and also explained that the claimant’s failure to timely file a claim within 6 months of when he or she could have learned that the employee’s death arose in the course of and resulting from employment will not be excused.
Finally, the Supreme Court also found that the decedent’s daughter’s grandmother was a proper party for filing the application on the daughter’s behalf. The Supreme Court relied upon W. Va. Code § 23-4-15(a) which provides that where an employee is mentally or physically incapable of filing an application, it may be filed by his or her attorney or by a member of his or her family.
In regard to this specific case, it should be noted that West Virginia Supreme Court Justice Benjamin filed a concurring decision emphasizing that the issue of causation was not resolved by the particular decision and that the employer can still challenge the causation issue on remand before the Office of Judges. The Supreme Court had previously called the jurisdictional statutory language found in this code section “clear and unambiguous.” Unfortunately, this decision means that the 6 month statutory cutoff for the filing of dependent’s death benefits can no longer be assumed to end at 6 months, as long as there is still any question regarding the cause of death of the decedent, which leaves much uncertainty for employers and insurance providers regarding whether dependent’s benefits will be filed in a death case.