Superior Court affirms that claimant met the burden of proof for showing a recurrence of total disability through evidence that he needed regular yearly, week-long hospitalizations, that were found to equate to a worsening of claimant’s condition.
The claimant sustained a compensable work injury to his head and received compensation for total disability from August 5, 2013, through December 11, 2015, when he voluntarily terminated his temporary total disability benefits. Effective July 27, 2016, the claimant began receiving partial disability benefits. In July 2018, the claimant filed a DACD Petition alleging a recurrence of total disability effective January 25, 2018. The employer denied that there had been any change in the claimant’s condition after he had signed the agreement to voluntarily terminate his total disability benefits as of December 11, 2015.
The evidence before the Board included testimony of the claimant, his wife, two medical experts on behalf of the claimant and one medical expert on behalf of the employer. The Board stated it was convinced by the claimant’s medical experts that he had significant neck and back pain and, more importantly, constant painful headaches that were sometimes completely intractable. Consequently, the Board found that the claimant was not currently capable of regular gainful employment. Further, the Board stated that they found he had met his burden of proving a change in condition since December 11, 2015. The change being that the claimant now was required to get regular yearly, week-long hospitalizations due to the intractable headaches. The Board reasoned that the change in his condition—specifically that he now suffered semi-regular hospitalizations with a need for infusions to treat the intractable headache pain—made it clear that he had proven the recurrence, thus entitling him to total disability benefits.
In its appeal to the Superior Court, the employer argued that the Board committed legal error by applying the wrong standard in finding the recurrence of total disability. The employer contended that the Board needed to evaluate whether the claimant’s condition had worsened, but instead, they had focused merely on whether there was a change in the claimant’s medical treatment, which was not the appropriate legal standard.
The court set forth the legal standard that, after a claimant voluntarily terminates his benefits, he then bears the burden of establishing the right to additional benefits by showing a recurrence of total disability. The Delaware Supreme Court has defined a recurrence as the return of an impairment without the intervention of a new or independent accident. If a condition has not changed for the worse, then no recurrence has occurred.
As applied to this case, the court concluded that the Board did not commit legal error when it found the claimant suffered a recurrence of total disability. The court accepted the Board’s reasoning that the claimant now required regular yearly, week-long hospitalizations, which was something he had not required prior to terminating his total disability benefits on December 11, 2015. Further, the court found that this new treatment does equate to a worsened condition since the necessity of those hospitalizations shows how the claimant’s condition has worsened. Prior to having terminated total disability benefits back in 2015, the claimant was not required to be hospitalized for a week on an annual basis to deal with the intractable headaches. Therefore, the court concluded there was substantial evidence in the record to support the Board’s finding that the claimant suffered a recurrence of total disability and no legal error had been committed.
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