Within the Scope?
An employee is injured during his/her regular commute to and from work.
Not within C&S - Going & Coming Rule
T/F - Claimant is deported to his/her home country. Claimant's benefits are suspended/terminated under Sec. 2353
False. Del. Valley Field Servs. v. Ramirez, 105 A.3d 396 (2012), aff’d 61 A.3d 617.
Employer must establish this to earn a credit for a claimant's missed DME.
Bad faith – i.e., repeated failure to attend examinations
To establish causation of an injury, the claimant must show ___________ as set forth in Reese v. Home Budget Ctr., 619 A.2d 907 (Del. 1992)
The injury would not have occurred but for the accident - setting or trigger
T/F - Comp carrier can require the claimant to use the carrier's preferred provider.
True. Boone v. Syab Services/Capitol Nursing, 72 A.3d 501 (Del. 2013) (TABLE)
Acts incident to employment, such as eating, drinking, smoking, restroom, etc. are protected under.....
Personal Comfort Doctrine
Claimant falls from scaffold. and breaks leg. Alcohol in his system. Employer must establish this to be successful on forfeiture defense.
Proximate Cause
In a third-party tort claim, the WC carrier is responsible for its pro rata share including attorneys’ fee. This is known as...
Keeler Credit
Surgery which would have been required eventually is compensable if need is ____________ by work accident.
Accelerated
T/F - Where a claimant is working two jobs, AWW is calculated using wages from both jobs.
False. Peterman v. Caulk, 612 A.2d 159 (Del. 1992) (TABLE)
Employee arrives to work, slips on ice in employer's parking lot.
Within C&S - Premises Rule
Claimant refuses medical care. Employer must establish this to succeed on forfeiture defense.
The refusal is unreasonable to that specific claimant - not just generally for anyone in claimant's position
When Employer is seeking a credit for overpayment of benefits, the Board will look to this.
Respective degree of fault of the parties.
To establish recurrence of total disability, claimant must show...
“Return” of an impairment; must be change in condition
When there's a Nally case, liability shifts to employer #_ if there’s a worsening of condition and unusual exertion.
Employer #2
HVAC cleaner finishes one job for employer, then proceeds to drive to the next job, picks up an iced coffee, and then, is injured in MVA.
Within C&S - Traveling Employee Exception
Claimant misses 3 DMEs. Employer must establish this for Claimant's benefits to be suspended during period of non-cooperation.
No Good Cause for Claimant's failure to attend examinations
Carrier who is seeking reimbursement under Section 2363 has an ethical duty to __________ or otherwise not undermine, claimant’s 3rd party tort case.
Cooperate; Baio v Commercial Union Ins. Co., 410 A.2d 502 (Del. 1979)
T/F - Medical marijuana is not subject to the Fee Schedule and the carrier does not have to pay sticker price.
False. Giles & Ransome v. Kalix, 2018 WL 4922911 (Del. Super. Ct. Oct. 9, 2018)
This case set forth the proposition that “[a] displaced employee ... who does not know or have reason to know that [he] is a displaced employee cannot be expected to seek new employment.”
Hoey v. Chrysler Motors Corp., 655 A.2d 307 (Del. 1994
Manager's wife comes to office. Accuses claimant of having an affair with Manager husband. Then, proceeds to attack claimant and injures her.
Not within C&S. Rose v. Cadillac Fairview Shop. Ctr., 668 2d 782 (Del. 1995); Brogan v. Value City Furniture, 2002 WL 499721 (Del. Super. Ct. Mar. 27, 2002)
Claimant is trimming tree. Falls out of tree b/c harness was not tied off. Employer must show this to succeed on forfeiture defenses
Deliberate or Reckless Indifference and/or intentional violation of safety rule
A Carrier's failure to pay benefits owing for workers’ compensation benefits may result in penalties under the wage payment and collections act. This seminal case is..
Huffman v. C.C. Oliphant & Sons, Inc., (Del. 1981)
“Objective Causal Nexus Test” is applied when a claimant asserts this injury/claim
Stress Claim. State v. Cephas, 637 A.2d 20 (Del. 1994)
This is known as the "Bathing Suit Test."
Visible, offensive and embarrassing when the body is normally clothed, to include bathing suit and recreational attire.