At the end of September, the Kentucky Supreme Court was confronted with whether a workers compensation claimant may reopen a closed claim that did not initially include either permanent partial disability or future medical benefits. The case is called Lakshmi Narayan Hospitality Group Louisville v. Jimenez, 2022 Ky. LEXIS 296 (Ky. 2022).
Maria Jimenez was part of the housekeeping staff at a Holiday Inn in Louisville, Kentucky. She fell and suffered work-related injuries to her head, neck, shoulder, and back in June 2014; the Chief Administrative Law Judge (CALJ) awarded eight months of temporary total disability benefits in May 2017 and determined that there was neither permanent injury nor entitlement to "future medical benefits." In July 2019, Jimenez filed a motion to reopen the case two years after the award "due to a change in disability after being diagnosed with cervical disc disease and depression." Holiday Inn asserted that, under KRS §342.125, Jimenez's claim could not be reopened because the determination of her original award included the finding that she had suffered a temporary injury, not a permanent one, and determining the status of her injury would violate the doctrine of res judicata, which holds that no party can re-litigate an issue once a final decision on that issue has been reached by a court of competent jurisdiction.
The CALJ reopened the case, over Holiday Inn's protests, "[b]ecause Jimenez made a prima facie claim by a showing of grounds to reopen due to change in disability" (emphasis original) under KRS §342.125(1)(d). The case was reassigned to another administrative law judge (ALJ), who declared res judicata did not apply because Jimenez had "sustained her burden on reopening" and awarded both permanent partial disability and related medical expenses. Holiday Inn appealed to the Workers Compensation Board (Board), who reversed the ALJ. The Board did not dispute the worsening of Jimenez's condition, but rather said that the original award of temporary total disability "was supported by substantial evidence, and res judicata applied. The Kentucky Court of Appeals reversed the Board, saying that "where the statute expressly provides for reopening under specific conditions, the rule of res adjudicata has no application when the prescribed conditions are present" (internal quotes and citations omitted).
On appeal to the Kentucky Supreme Court, Holiday Inn reiterated that the issue of whether Jimenez suffered a permanent or temporary disability had already been decided, and she could not reargue the same case. The justices, however, pointed out that KRS §342.125(1) "allow[ed] the reopening and review of any award or order, provided one of the grounds for reopening…is satisfied" (emphasis original). Jimenez had submitted her petition under KRS §342.125(1)(d), which stated that a case could be reopened based on 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" (emphasis added). The very language of the statute, the justices reasoned, required a reevaluation of a claimant's injuries. It did not, however, require a claimant's original award be of either a temporary or a permanent nature to submit a motion to reopen the case. The verdict in favor of Jimenez was affirmed.
Editor's Note: The Kentucky Supreme Court also pointed out that the doctrine of res judicata, is not a "one size fits all" concept because "workers' compensation proceedings are administrative rather than judicial." (quoting Whittaker v. Reeder, 30 S.W.3d 138 (Ky. 2000)). A claim seen in court, whether criminal or civil, is adversarial: there are two parties arguing opposing points of view. Workers compensation, though it can become adversarial, primarily deals with the amount of an award rather than who gets the award.