Insurer Wins Appeal, Securing Reversal of ALJ Workers’ Comp Ruling
Case Study

Insurer Wins Appeal, Securing Reversal of ALJ Workers’ Comp Ruling

November 16, 2022

The Kansas Workers Compensation Appeals Board reversed an administrative law judge ruling against an insurance services company, agreeing with Goldberg Segalla partner James R. Hess the employer did not receive sufficient notice of the claimant’s alleged injury.

Kansas law requires notice of an injury to be timely given to the employer within 10 days of the last day worked by a claimant for the employer. The ALJ had ruled that claimant verbally told her supervisor her hands were hurting in 2019, which constituted “actual knowledge” by the employer of an injury.  The ALJ also found claimant in 2021 sent an email to her supervisor stating her intent to undergo surgery to her shoulder or elbow, which represented more than a “casual conversation,” and therefore indicating the company had actual knowledge of its worker’s injuries.

The Board has held an employer’s mere knowledge of a worker’s medical condition or accident is insufficient to satisfy the “actual knowledge of the injury” requirement of timely notice.  While an employer is required to provide medical treatment reasonably necessary to cure or relieve an injured worker, the requirement also allows a company to direct and control that treatment.  The Board held in this case the employer did not have actual knowledge of an injury due to the claimant’s failure to adequately provide notice of a work injury, and her failure to pursue benefits in a timely manner.  Moreover, despite the claimant having filed prior work comp claims, the claimant’s email to her supervisor failed to provide accurate information about her anticipated surgery from which the employer could understand she was reporting a work injury.

The claimant made no requests for benefits until after ten days following her last day of work, which took place on March 9, 2021.  Jim noted the plaintiff’s failure to request benefits prior to that date left Goldberg Segalla’s client without sufficient notice of her intent to pursue benefits, denying the company the ability to direct and control the treatment she received. Thus, Jim argued our client did not have sufficient notice of an injury because the plaintiff failed to take any steps to request, or pursue, workers compensation benefits as required by statute. He also argued the plaintiff failed to provide sufficient detail of a work injury for the employer to consider her ailment work-related.

The Board agreed and reversed the ALJ’s decision.