Ramsey v. Shaw’s Supermarkets, Inc., and Sedgwick Claims Management Services

Decided: April 21, 2021
Topic: Notice, Mistake of Fact

The issue in this case was whether it was appropriate, in the absence of any testimony or other evidence on the issue, for the ALJ to infer that the employee was operating under a mistake of fact as to the cause of his bilateral knee condition until a medical causation opinion was obtained.

The employee had been working long-term for Shaw’s Supermarkets as a grocery manager. His job often involved stocking shelves, which required frequent bending and kneeling. Over a period of several years, he experienced pain in both knees that worsened progressively.

On August 22, 2017, the employee saw his primary care physician. It was around this time that the employee began to question whether his work was the cause of the knee condition. The primary care physician did not issue a causation opinion until December 1, 2017. In the meantime, the employee was seen on November 3, 2017 by Shaw’s chosen medical provider where his bilateral knee condition was deemed to be work related. Shaw’s was notified that same day.

Shaw’s alleged that the employee’s claim should be denied because he failed to provide notice within the thirty-day period required by statute. Once an employer raises the issue of notice, the employee bears the burden of persuasion to show that notice was timely.  Despite no testimony from the employee that he was under a mistake of fact regarding the cause and nature of his bilateral knee pain, the ALJ (Goodnough) found that the employee was under a mistake of fact until he was given a medical opinion regarding the compensable nature of his knee condition on November 3, 2017. As a result, the ALJ concluded that notice was timely.

Shaw’s appealed arguing that the ALJ erred by tolling the notice period for mistake of fact when the employee provided no evidence that he was operating under a mistake of fact as to the cause of his condition. The employee argued that the absence of a medical causation opinion until November 3, 2017 was sufficient to support the ALJ’s factual finding that the employee was under a mistake of fact or that knowledge of the work-relatedness of the injury should not have been imputed to him because of the differing medical causation opinions.

The Appellate Division vacated the decision and ordered the employee’s petitions denied on remand based on late notice. They found that the record did not contain competent evidence to support the ALJ’s finding of mistake of fact. They further noted that the absence of a medical opinion on causation, by itself, does not permit an inference that the employee was mistaken as to the cause and nature of his knee condition.

To see the full text of the decision: https://www.maine.gov/wcb/Departments/appellate/2021decisions/21-16_Ramsey_v._Shaw’s_Supermarkets_4-21-21.pdf

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