Establishing Maximum Medical Improvement and Scope of Compensable “Low Back” Injuries in West Virginia Workers’ Compensation

Introduction

In Roger Weese v. Harry Green Chevrolet, Inc., 2025 WL ____ (W. Va. Apr. 15, 2025), the Supreme Court of Appeals of West Virginia confronted two interrelated questions in a workers’ compensation dispute: (1) whether the claimant’s compensable “low back” injury had reached maximum medical improvement (MMI), thereby justifying termination of temporary total disability (TTD) benefits; and (2) whether a repeat MRI for a herniated disc must be authorized when that condition falls under a broad “low back” compensable claim. The Court reversed the Intermediate Court of Appeals (ICA) and remanded with directions, clarifying the preponderance‐of‐evidence standard for MMI and confirming that a general compensable diagnosis can encompass specific conditions—here, a lumbar herniated disc—without a separate diagnosis update.

Parties: Roger Weese (Claimant/Petitioner) v. Harry Green Chevrolet, Inc. (Employer/Respondent). Lower tribunals: West Virginia Workers’ Compensation Board of Review (“BOR”) and the Intermediate Court of Appeals (“ICA”).

Summary of the Judgment

The ICA had affirmed the BOR’s orders (1) closing Weese’s claim to TTD benefits as of November 1, 2021, on the ground that he had reached MMI and (2) denying a repeat MRI for a suspected lumbar herniated disc, because that condition was not separately “compensable.” On Weese’s appeal, the Supreme Court of Appeals held that:

• The preponderance of the medical evidence showed he had not reached MMI for his compensable “low back” injury as of the date the claim administrator closed TTD benefits.
• A broad compensable condition—“low back”—by definition included the disc pathology identified shortly after the injury, so no separate diagnosis update was required to authorize an MRI for a herniated disc.

The court reversed the ICA, reinstated Weese’s entitlement to TTD benefits, ordered authorization of the repeat MRI, and remanded the case to the BOR for an order consistent with these rulings.

Analysis

Precedents Cited

• West Virginia Code § 23-4-1g(a): Establishes that workers’ compensation factfinders weigh all evidence—medical and lay—by relevance, credibility, materiality, and reliability, and resolve ties in favor of the claimant.
• Duff v. Kanawha Cnty. Comm’n, 250 W. Va. 510, 905 S.E.2d 528 (2024): Clarifies standard of review on appeal from BOR to ICA to Supreme Court; law questions reviewed de novo, factual findings given deference unless clearly wrong.
• Dunlap v. State Comp. Dir., 149 W. Va. 266, 140 S.E.2d 448 (1965) & Barnett v. State Workmen’s Comp. Comm’r, 153 W. Va. 796, 172 S.E.2d 698 (1970): Reiterate the statutory nature of workers’ compensation and the elements of compensability (personal injury, in course and scope, arising from employment).

Legal Reasoning

1. MMI Determination & Preponderance Standard
The Court emphasized that an MMI finding is a factual determination to be made by weighing all medical opinions. Here, Weese’s treating physician, Dr. Biundo, and his treating physician’s assistant and physical therapist each concluded—based on ongoing symptoms, functional capacity limitations, and need for further therapy—that Weese had not yet reached MMI. By contrast, the employer’s IME physician, Dr. Grady, opined otherwise but (a) relied on an incorrect compensable diagnosis (“lumbar sprain” instead of “low back”), and (b) did not have the benefit of a contemporaneous functional capacity evaluation. Under § 23-4-1g(a), when evidence is in equipoise, the factfinder must adopt the resolution most favorable to the claimant. The Supreme Court found that the preponderance of evidence favored Weese.

2. Scope of Compensable “Low Back” Diagnosis
The ICA had reasoned that because “herniated disc” was not separately listed as compensable, diagnostic imaging for that condition could be denied. The Supreme Court rejected this formalistic approach. At the initial compensability stage, Dr. Biundo’s January 26, 2021 report had expressly noted “possible lumbar herniated disc” alongside radiculopathy and strain. The claim administrator thereafter held the injury compensable for “low back,” a generic designation broad enough to include disc pathology. As a matter of statutory construction and policy, a diagnosis update was unnecessary to secure treatment for a condition within the scope of the already‐compensable “low back” injury.

Potential Impact

• Fact-finders in West Virginia workers’ compensation cases must rigorously weigh treating– versus independent–medical‐examiner opinions, giving due credit to contemporaneous functional capacity evaluations and treating‐provider recommendations.
• Employers and claims administrators cannot deny treatment for anatomical subcategories (e.g., herniated discs) when a broader umbrella diagnosis (e.g., “low back”) was accepted as compensable early in the claim.
• This decision reinforces the preponderance standard and the claimant‐friendly tie‐breaking rule in W. Va. Code § 23-4-1g(a), strengthening injured workers’ access to benefits and ongoing medical care until true MMI is established.

Complex Concepts Simplified

• Maximum Medical Improvement (MMI): The point at which an injury has stabilized and no further improvement is expected, which triggers an end to TTD benefits.
• Temporary Total Disability (TTD) Benefits: Weekly indemnity payments for employees totally unable to work because of a compensable injury until they reach MMI or return to work.
• Compensable Condition: A medical diagnosis or injury that the employer or the Board has accepted as arising out of or caused by work.
• Diagnosis Update: A formal request to add new conditions to the list of compensable injuries; this case holds that new sub-diagnoses already contemplated in the initial claim need not be separately updated.
• Functional Capacity Evaluation (FCE): A detailed, standardized assessment of a claimant’s physical abilities—lifting, endurance, range of motion—to determine fitness for work and need for further treatment.

Conclusion

Roger Weese v. Harry Green Chevrolet, Inc. establishes two key precedents in West Virginia workers’ compensation law:

1. The preponderance‐of‐medical‐evidence standard requires factfinders to weigh all medical opinions—including functional capacity evaluations and treating‐provider views—and draw ties in favor of the claimant when assessing MMI.
2. A broad “low back” compensable designation encompasses associated pathologies (e.g., herniated discs) identified at or shortly after the time of injury, eliminating the need for separate diagnosis updates to secure appropriate medical imaging and treatment.

This decision strengthens injured workers’ access to ongoing benefits and care until they truly reach maximum medical improvement and clarifies the scope of compensable conditions under umbrella diagnoses.