In Judice v. FedEx Ground Package System, Inc., et al., 2025-Ohio-1051, (9th Dist.) claimant fractured his right distal tibia when he fell at work. Claimant removed his boots to walk through a metal detector. He put them back on and fell while trying to balance on his left leg to tie his right shoelaces resulting in the fracture. The commission allowed the claim and the company appealed to the Summit County Court of Common Pleas. The trial court granted summary judgement for the company finding no causal connection between the injury and claimant’s employment because the company lacked control over claimant’s shoelaces and the fall was not caused by a condition of his employment or work environment. The claimant appealed to the Ninth District Court of Appeals and the appellate court reversed and remanded the matter back to the trial court for further consideration. The parties agreed the injury occurred in the course and scope of claimant’s employment but disagreed on whether it arose out of his employment. “Arising out of employment” requires an analysis of the totality of the circumstances test. There are three factors to consider: (1) the proximity of the scene of the accident to the place of employment, (2) the degree of control the employer had over the scene of the accident, and (3) the benefit the employer received from the injured employee’s presence at the scene of the accident. Because the trial court only considered the second factor when it determined the injury did not arise out of the claimant’s employment, the trial court’s judgment was reversed.
Ohio courts have previously found similar injuries have not been compensable. See LaFon v. Iron Tiger Logistics, 2015-Ohio-2428 (2d Dist.) where the claimant fell climbing into a company shuttle bus. He tripped on his untied shoes and fell forward injuring his right shoulder. The Second District Court of Appeals found the trial court correctly granted summary judgment to the company since the injury did not arise out of the employment. The claimant’s untied shoes were entirely within his control. Also see Underwood v. Midwest Stamping & Mfg., 1998 WL 472322 (6th Dist. Aug. 7, 1998) where the claimant tripped and fell over his untied shoelaces while walking away from his work station. The claimant was on a paid lunch break at the time of his fall. The Sixth District analyzed all three factors in the totality of the circumstances test and found an insufficient causal connection between the fall and his work activities, conditions or environment of his employment and held the claim was not compensable. The trial court must now determine whether Judice is distinguishable because the claimant was required to remove his shoes to go through the metal detector at work and then required to put them back on. These types of falls at work are very fact specific and should be defended through the hearing process. Contact our office to speak to one of our attorneys if you have a similar injury at your work place.
Res judicata bars claimant’s second request for TTD Compensation for the same time period.
In Huber v. Industrial Commission of Ohio, 2025-Ohio-1029 (10th Dist.) decided March 25, 2025, the Tenth District Court of Appeals held a second request for compensation for an identical time period was barred by res judicata, a legal theory that prevents the relitigating of an issue already decided by a court or administrative proceeding. Huber involved a claim with a 2020 date of injury allowed for left shoulder strain, left shoulder adhesive capsulitis, and cervical sprain. On August 15, 2022, left subacromial bursitis, left supraspinatus tendon tear, and left acromioclavicular arthritis were additionally allowed. On September 6, 2022, the Commission denied claimant’s request for temporary total disability compensation “TTD” from May 6, 2022 through September 6, 2022 listing all allowed and disallowed conditions in the SHO order including the three newly allowed conditions. A second request for TTD from September 8, 2022 through November 14, 2022 was also denied by the commission. Claimant filed a third motion on September 15, 2022 for TTD from May 6, 2022 and continuing based on the “newly allowed” acromioclavicular osteoarthritis. The commission denied this third request based on a lack of new and changed circumstances and res judicata. Claimant filed a mandamus action with the Tenth District Court of Appeals, requesting the Court order the Commission to vacate the SHO order and pay TTD beginning on May 6, 2022. The court denied claimant’s request, finding the commission did not abuse its discretion when it applied res judicata to deny claimant’s second request for TTD compensation. The Court emphasized the September SHO order considered all the allowed conditions, including the newly allowed acromioclavicular osteoarthritis and found there was also found some evidence to support the commission’s decision to deny TTD. If you have questions concerning res judicata or a claim with a similar issue, please contact an attorney at Bugbee & Conkle, LLP to discuss your options.
Medicare Set-Aside Arrangements (“MSA”) New Reporting Requirements
Section 111 of the Medicare, Medicaid, and SCHIP Extension Act of 2007 (referred to as “Section 111”) added mandatory requirements for workers’ compensation settlements involving Medicare Set-Aside Arrangements (“MSA”). An MSA is only required when a claimant is either a Medicare recipient or has a reasonable expectation of being Medicare recipient within 30 months and certain thresholds are met. The Center for Medicare and Medicaid Services (“CMS”) announced via their website, user guides, and an updated operations manual this would take effect on April 4, 2025. The purpose of the change is to ensure CMS is not paying medical expenses that are covered under a workers’ compensation claim. All workers’ compensation claims settlements settling the medical payments of a workers’ compensation claim must be reported to CMS. The payors of an MSA should report the MSA total amount, the number of years the MSA is expected to cover, and if the MSA is in a lump sum or structured payment (an annuity). If the MSA is in an annuity, the payor must also supply information on the initial seed money and the annual deposit amount. CMS will provide Medicare notice a beneficiary has an MSA responsible for payment of all workers’ compensation related care. Please contact our office if you have questions about these requirements.