DINGO COAL COMPANY, INC . V MCQUADE TOLLIVER ; WORKERS' COMPENSATION FUNDS, SUCCESSOR TO SPECIAL FUND ; HON . DONALD G . SMITH, ADMINISTRATIVE LAW JUDGE ; AND WORKERS' COMPENSATION BOARD
Annotate this Case
Download PDF
RENDERED : March 18, 2004
TO BE PUBLISHED
uyrrmt (~Vurf
of 1 1fin
2003-SC-01 78-WC
DINGO COAL COMPANY, INC .
V
APPEAL FROM COURT OF APPEALS
2002-CA-0580-WC
WORKERS' COMPENSATION BOARD NO. 79-52015
MCQUADE TOLLIVER ; WORKERS'
COMPENSATION FUNDS, SUCCESSOR
TO SPECIAL FUND ; HON. DONALD G . SMITH,
ADMINISTRATIVE LAW JUDGE; AND
WORKERS' COMPENSATION BOARD
APPELLEES
OPINION OF THE COURT
AFFIRMING
The claimant injured his back in 1979 and received benefits for a 15%
occupational disability . He moved to reopen the award in 2000 and was later awarded
a total disability. Appealing decisions that affirmed the award, the employer asserts that
the Administrative Law Judge (ALJ) erred by failing to determine that the December 12,
1996, amendment to KRS 342 .125(1)(d) is remedial and by increasing the claimant's
award absent objective medical evidence of a worsening of functional impairment .
Although we agree that the disputed amendment is remedial, it does not govern the
criteria for awarding additional benefits with respect to a reopened claim. Garrett Mining
Co . v. Nye , Ky., 122 S .W .3d 513 (2003); Woodland Hills Mining, Inc. v. McCoy, Ky., 105
S .W .3d 446 (2003). We conclude, therefore, that the Court of Appeals was correct in
affirming the award but that its reasoning was incorrect.
In the initial claim, the parties introduced conflicting evidence from eleven
physicians, two of whom were psychiatrists . Some thought that the claimant should quit
working altogether due to disk abnormalities at L4-5 and L5-S1 . Others thought that his
back problems were minor. The claimant testified that he thought he could not return to
work and that virtually any position was uncomfortable. He had sought Social Security
Disability benefits without success . The "old" Workers' Compensation Board relied
upon Dr. Goodman who assigned a 10% "permanent partial disability to the body as a
whole" and apportioned it equally to the injury and pre-existing conditions . In his
opinion, the claimant should not lift more than 50 pounds but was capable of light work.
Furthermore, if he did so, he would gradually improve .
The claimant's motion to reopen alleged that his physical condition had
deteriorated and that his occupational disability had increased . It was supported with a
report from Dr. Muckenhausen indicating that his physical problems due to the injury
had worsened since the initial decision . The motion was granted, after which the parties
proceeded to take additional proof.
At reopening, the claimant testified that he had neither worked nor sought work
since 1979. He asserted, however, that his back and leg pain were more severe than at
the time of the initial award . Although he had not undergone back surgery, he required
more medication, including Oxycontin, Lortab, steroid injections, and various other
medications . He stated that he used a cane for walking . His activities were more
restricted because his pain increased with activity, and his leg would give way. He had
more difficulty sleeping, sitting, bending, lifting, carrying, kneeling, crouching, and
crawling, and he had lost 50 pounds in the past three years . He thought that he could
not return to any of his previous work and knew of no work that he could perform.
Dr. Muckenhausen examined the claimant and reviewed his medical records in
October, 2000, at which time he complained of low back pain that radiated into his hips
and legs. A physical examination revealed tenderness in the lower thoracic and lumbar
spine with muscle spasms and trigger points paraspinally, sciatic groove tenderness,
and a reduced range of motion . Diagnostic studies revealed degenerative changes
throughout the lumbar spine. She diagnosed progressive degenerative disc disease
with a lumbosacral radicular involvement, anxiety, and depression, and she attributed
the claimant's present condition to his work-related injury. She assigned an 18-20%
AMA impairment and restricted the claimant to lifting no more than 10 pounds, to
frequently lifting or carrying less than 10 pounds, to limited standing, walking, sitting,
and pushing or pulling . Furthermore, she thought that his condition had progressed, as
evidenced by his increased complaints and the positive findings on examination .
When Dr. Patrick examined the claimant in April, 2001, he complained of back
and hip pain and of his left leg giving out . Dr. Patrick observed an unsteady gait and
reduced range of motion in the back. Diagnostic studies revealed mild bulging at L4-5
and L5-S1 with degenerative changes but no nerve impingement or herniated disk. He
assigned a 5% AMA impairment and thought it unnecessary to assign restrictions
because the claimant would self-restrict .
In May, 2001, Dr. Goldman reviewed medical records, examined the claimant,
and received complaints of low back pain that radiated into the legs. He noted
degenerative changes throughout the lumbar spine with minimal diffuse bulges and
significant facet hypertrophy . Physical examination revealed reduced range of motion in
the lumbar spine and tenderness in the Sl joint and mid-line paraspinous muscles
bilaterally . The claimant's entire body appeared to be tremulous. He had a severely
restricted range of motion in the hip bilaterally and decreased sensation throughout both
legs. Noting the claimant's less than maximal effort on the functional capacity
evaluation, Dr. Goldman concluded that he magnified his symptoms. He assigned a 5%
impairment, indicating that there was no increased impairment or occupational disability.
He could not state whether the complaints of increased pain were credible but was of
the opinion that any increase was secondary to the natural progression of the
degenerative changes.
In June, 2001, Dr. Ensalada reviewed the claimant's medical records dating back
to 1980 . He found no change in disability as shown by objective medical evidence of a
worsening of impairment since 1981, although he acknowledged that the claimant
began complaining of increased pain in 1995. Dr. Ensalada noted that the claimant's
general health was poor and that he suffered from non-work related conditions as well
as his back problems. He concluded that the diagnostic studies showed only
degenerative changes that were related to the natural aging process and that the same
restrictions would apply as at the time of the initial award . In his opinion, the 1979 back
injury did not require the treatment that had been given .
Rejecting the employer's assertion that KRS 342 .125(1)(d) applied to the merits
of the reopening, the ALJ determined that it was substantive rather than procedural .
KRS 342 .0015 . Noting the conflicting medical opinions, the ALJ concluded that there
was sufficient evidence that the claimant's back injury was more disabling than it had
been at the time of the initial award . Furthermore, after considering his age, education,
work experience, the credibility of his testimony, and the restrictions imposed by Dr.
Muckenhausen, the ALJ determined that he was totally disabled under the standard of
Osborne v. Johnson, Ky., 432 S.W .2d 800 (1968). Although the award has been
affirmed on appeal, the employer continues to assert that the decision was erroneous .
Reopening is the remedy for addressing certain changes that occur or situations
that come to light after benefits are awarded . Under KRS 342.125, a motion to reopen
is the procedural device for invoking the jurisdiction of the Department of Workers'
Claims to reopen a final award . In order to prevail, the movant must offer prima facie
evidence of one of the grounds for reopening that are listed in KRS 342.125(1).
Stambaugh v. Cedar Creek Mining Co . , Ky., 488 S .W.2d 681 (1972) . Only after the
motion has been granted will the opponent be put to the expense of litigating the merits
of an assertion that the claimant is entitled to additional income benefits under KRS
342.730 . Id .
The grounds for granting a motion to reopen and the standards for awarding
increased benefits when the merits of the reopening are considered are not necessarily
consistent. In Peabody Coal Co . v. Gossett , Ky., 819 S .W.2d 33 (1991), the 1987
amendment to KRS 342.125(1) aligned what, at the time of Mr. Gossett's injury, had
been inconsistent standards for reopening and awarding income benefits. Relying on
the principle that statutes relating to remedies or modes of procedure do not normally
come within the legal conception of a retrospective law, the Court determined that the
amendment was remedial . Thus, it governed motions to reopen that were filed on or
after its effective date and was the standard by which Gossett's motion to reopen his
1981 award should have been decided . Since Gossett had offered prima facie
evidence of increased occupational disability, as required by the amended standard, we
remanded the claim for the taking of further proof and a decision on the merits .'
Effective December 12, 1996, the legislature amended KRS 342.125(1) by
enacting KRS 342.125(1)(a) - (d). KRS 342 .125(1)(d) permits the reopening of a final
award upon evidence of a "[c]hange of disability as shown by objective medical
evidence of worsening or improvement of impairment due to a condition caused by the
injury since the date of the award or order." This requirement differs from the previous
standard for granting a motion to reopen where increased income benefits are sought
under KRS 342 .730 . It also differs from the standard for awarding such benefits in a
pre-December 12, 1996, claim. As we attempted to explain in our recent decision in
Woodland Hills Mining, Inc. v. McCoy, supra , the amendment does not govern the type
of evidence necessary to establish the right to greater benefits under KRS 342 .730 with
respect to a reopened claim . It changes only a procedural requirement, i .e., one of the
grounds upon which a motion to reopen may be granted. In other words, KRS
342.125(1)(d) addresses the necessary prima facie showing in order to prevail on a
motion to reopen that is filed on or after December 12, 1996. See KRS 342.0015 . It
has no effect on the substantive proof requirements for a claim that arose before its
effective date . Id. The merits of a worker's right to receive additional income benefits at
reopening are governed by the version of KRS 342 .730 that was effective on the date of
injury . See KRS 342 .125(6) ; Garrett Mining Co . v. Nye , supra ; Woodland Hills Mining,
Inc. v. McCoy, supra ; Maggard v. International Harvester Co. , Ky., 508 S.W.2d 777
(1974). Thus, reliance on Peabody Coal Co. v. Gossett, supra , is misplaced where an
See also Campbell v . Universal Mines , Ky., 963 S.W .2d 623 (1998) and AAA Mine Services v. Wooten ,
Ky., 959 S .W.2d 440 (1998), which involved standards for reopening under KRS 342 .125(2) [now KRS
342 .125(5)] that differed from the applicable standards for proving an entitlement to increased benefits
when the merits were considered.
6
appeal concerns the decision on the merits of a reopening for additional benefits under
KRS 342 .730.
The claimant's injury and award both occurred before December 12, 1996. His
subsequent motion to reopen was granted, and the merits of his assertion that he was
entitled to additional benefits were decided in his favor under the Osborne v. Johnson ,
supra , standard . As we have explained, that was the appropriate standard for
considering the merits of a motion to reopen a pre-December 12, 1996, award .
Therefore, the question before the Court is whether the increased award was supported
by substantial evidence . Special Fund v. Francis , Ky., 708 S .W.2d 641, 643 (1986) .
Having reviewed the evidence and considered the arguments of the parties, we have
concluded that the decision was not unreasonable and was properly affirmed on appeal .
The decision of the Court of Appeals is affirmed .
All concur.
COUNSEL FOR APPELLANT :
W. Barry Lewis
Francesca L. Maggard
Lewis and Lewis Law Offices
151 E . Main Street, Ste . 100
P .O. Box 800
Hazard, KY 41702-0800
COUNSEL FOR APPELLEE, MCQUADE TOLLIVER :
Edmond Collett
Monica J. Rice-Smith
Collett & Buckle, PSC
P .O. Box 1810
Yden, KY 41749
COUNSEL FOR APPELLEE, WORKERS' COMPENSATION FUNDS :
Joel D. Zakem
Kentucky Labor Cabinet
1047 U .S . Hwy. 127 South, Suite 4
Frankfort, KY 40601
Some case metadata and case summaries were written with the help of AI, which can produce inaccuracies. You should read the full case before relying on it for legal research purposes.
This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.