Separate and Distinct: N.H. Supreme Court Clarifies that Dependents’ Workers’ Comp Death-Benefit Claims Are Independent Under RSA 281-A:26; RSA 281-A:42-d Clock Runs from Denial of the Dependent’s Claim and the Injury Date Is the Date of Death

Case: Appeal of State of N.H. (Adjutant General), 2025 N.H. 40 (N.H. Sept. 12, 2025)

Court: Supreme Court of New Hampshire

Panel: Countway, J. (opinion of the Court); MacDonald, C.J., and Donovan, J., concurred.

Introduction

In this significant workers’ compensation decision, the Supreme Court of New Hampshire affirmed the Compensation Appeals Board’s (CAB) award of death benefits to the widow of a longtime New Hampshire firefighter who died from intrahepatic cholangiocarcinoma (ICC). The case presented three principal issues:

Timeliness: Whether the widow’s death-benefit claim was time-barred by RSA 281-A:42-d’s 18-month petition deadline because the decedent’s own earlier claim had been denied.
Causation: Whether competent medical evidence supported the CAB’s findings of medical and legal causation.
Statutory presumption: Whether the CAB applied the correct version of RSA 281-A:17 (the firefighter-cancer presumption), and whether any error was reversible.

The Court held that a dependent’s claim for death benefits under RSA 281-A:26 is separate and distinct from the decedent employee’s claim; the RSA 281-A:42-d 18-month clock thus runs from the denial of the dependent’s own claim, not from the denial of the worker’s earlier claim. The Court further clarified that, for a dependent’s death-benefit claim, the relevant “date of injury” is the date of death. Finally, the Court upheld the CAB’s causation findings, concluding that competent medical evidence supported both legal and medical causation, and any error in applying the version of RSA 281-A:17 was harmless because legal causation was independently established on the record.

Summary of the Opinion

Timeliness (RSA 281-A:42-d): A dependent’s claim for death benefits is not a continuation of the employee’s claim. It is a new, separate claim. Therefore, the 18-month deadline to petition for a hearing runs from the denial of the dependent’s death-benefit claim, not from denial of the decedent’s claim. The dependent’s claim here was timely.
Date of injury for death claims: For a dependent’s death-benefit claim, the injury date is the date of death. The dependent’s rights arise at death and are governed by the law then in effect.
Medical causation: The CAB reasonably credited the widow’s occupational medicine expert (Dr. Cochran). The absence of extensive disease-specific statistical studies for a rare cancer (ICC) does not render an expert’s testimony incompetent where the opinion is grounded in peer-reviewed literature and a credible exposure history.
Treating physician weight: Although treating physicians’ reports must be accorded substantial weight, the CAB may accept or reject expert opinions, in whole or in part. The CAB permissibly relied on Dr. Cochran over the treating oncologist and the employer’s expert.
Firefighter cancer presumption (RSA 281-A:17): Even assuming the CAB applied the wrong version of the statute, any error was harmless because the CAB made independent findings establishing legal causation.
Disposition: Affirmed.

Factual and Procedural Background

The decedent served as a volunteer firefighter beginning around 2002, then full-time from around 2008, while also working full-time at Pease Tradeport for the State (Adjutant General). He had a pre-employment medical exam and was cancer-free. He quit smoking in 2000. In February 2019, he sought treatment for what became diagnosed as ICC (bile duct cancer). The employer filed an injury report but denied workers’ compensation benefits, and the decedent did not pursue the claim. He died in January 2020.

The widow successfully obtained “line of duty” death (LODD) benefits under RSA 21-I:29-a on appeal. She later filed for workers’ compensation death benefits in January 2023; the employer and Department of Labor denied the claim. On appeal, the CAB awarded benefits, finding both legal and medical causation and rejecting timeliness and statutory arguments. The employer sought reconsideration, which was denied, and appealed to the Supreme Court.

Analysis

Precedents Cited and Their Role in the Decision

Brown v. Hubert, 100 N.H. 194 (1956): The Court relied on Brown’s central holding that the 1947 workers’ compensation amendment created a system in which an employee’s death “creates in a dependent widow or child a right of action separate and distinct from that of the deceased employee.” This principle—now reflected in RSA 281-A:26—meant that the widow’s claim was not tethered to the decedent’s earlier claim or its denial.
Hirsch v. Company, 97 N.H. 480 (1952): Hirsch establishes that dependents’ rights arise upon the employee’s death and are governed by the law then in force; correspondingly, for a dependent’s claim, the relevant injury date is the date of death. The Court invoked Hirsch to reject the employer’s position that the CAB committed legal error by using the decedent’s date of death as the injury date for the widow’s claim.
Appeal of Estate of Menke, 2025 N.H. 10 (2025): Cited for the canon that the Workers’ Compensation Law is to be liberally construed to effectuate its remedial purpose. This principle supported interpreting RSA 281-A:42-d in harmony with RSA 281-A:26 and longstanding precedent recognizing the independence of dependents’ claims.
Appeal of Vasquez, 175 N.H. 450 (2022): Cited for basic rules of statutory interpretation: plain meaning, holistic reading, and avoiding additions to the statutory text. The Court applied these to RSA 281-A:42-d and RSA 281-A:26 to conclude the dependent’s claim is distinct.
Appeal of Rancourt, 176 N.H. 139 (2023) and RSA 541:13: Establish the deferential standard of review for CAB factual findings (prima facie lawful and reasonable) and the “competent evidence” test. These standards guided the Court in affirming the CAB’s causation findings.
Appeal of Wittenauer, 175 N.H. 420 (2022) and Appeal of Estate of Dodier, 174 N.H. 548 (2021): Define the dual burdens of proof—legal and medical causation—by a preponderance of the evidence, and articulate the test for medical causation (work activities probably caused or contributed to the injury as a matter of medical fact).
Appeal of Kehoe, 141 N.H. 412 (1996) and Appeal of Newcomb, 141 N.H. 664 (1997): Emphasize that medical causation is a matter for medical experts and that the CAB’s decision stands if supported by competent evidence, even where contrary evidence exists.
Appeal of Morin, 140 N.H. 515 (1995): Acknowledges treating physicians’ opinions must be accorded substantial weight but are not conclusive; factfinders may accept or reject conflicting expert testimony.
Cunningham, Adm’x v. Manchester Fire Dep’t, 129 N.H. 232 (1987): Recognizes that statutory presumptions (here, firefighter heart-disease then; now firefighter cancer) relieve claimants of proving legal causation when conditions are met. The Court used this framework in discussing RSA 281-A:17.

Legal Reasoning

1) Timeliness Under RSA 281-A:42-d and the Independence of Death-Benefit Claims

RSA 281-A:42-d bars “compensation for disability, rehabilitation, medical benefits, or death benefits” unless the “claimant” petitions for a hearing within 18 months after receiving notice of denial. The employer argued that because “claimant” includes dependents (see N.H. Admin. R., Lab 101.02), the widow’s petition clock began running when the employer denied the decedent’s 2019 claim. The Court rejected that reading.

The Court harmonized RSA 281-A:42-d with RSA 281-A:26’s text—“[i]f death results from an injury, weekly compensation shall be paid to the dependents”—and long-standing precedent (Brown) to reaffirm that a dependent’s death-benefit claim is a separate and distinct right of action. Therefore, the “denial” that starts the 18-month clock for a dependent under RSA 281-A:42-d is the denial of the dependent’s death-benefit claim, not the denial of any earlier claim the decedent may have filed. Because the widow’s claim was denied in February 2023 and she timely petitioned thereafter, her claim was not time-barred.

The Court also clarified the relevant “date of injury” for a dependent’s claim: it is the date of death, when the dependents’ rights arise. This clarification aligns with Hirsch and undercuts the employer’s claim that using the date of death as the injury date was legal error.

2) Medical Causation: Competency of Expert Evidence for Rare Cancers

The widow’s occupational medicine expert (Dr. Cochran) opined, to a reasonable medical certainty, that the decedent’s ICC was causally related to exposure to multiple class I carcinogens during essential firefighting duties, including polycyclic aromatic hydrocarbons (PAHs). The employer’s expert (Dr. Pulde) disputed causation, and the treating oncologist’s views were also presented.

The Court upheld the CAB’s decision to credit Dr. Cochran. It rejected the argument that Cochran’s testimony was “not competent” merely because ICC is rare and disease-specific statistical analyses are limited. The Court emphasized:

Absence of extensive disease-specific epidemiology does not equate to a lack of scientific support where the expert relies on peer-reviewed literature about the disease, carcinogenic exposures in firefighting, and a credible occupational history.
Exact exposure levels are not always required where there is documented presence of carcinogens at fire scenes, in firehouses, and on gear, and the expert provides a reasoned chain of causation.
The CAB may weigh conflicting experts; treating physicians’ opinions, though afforded substantial weight, are not dispositive.

Applying the deferential “competent evidence” standard, the Court found the CAB’s medical-causation determination supported by the record.

3) Legal Causation and the Firefighter Cancer Presumption (RSA 281-A:17)

RSA 281-A:17, II establishes a prima facie presumption that certain cancers in firefighters are occupationally caused when statutory conditions are met. The CAB invoked the presumption, relying in part on the decedent’s cessation of smoking around 2000.

The employer argued the CAB should have applied the stricter pre–July 17, 2019 version requiring a guarantee of a “tobacco free life,” not the later definition of “tobacco free lifestyle” (no tobacco use 4+ times in a week during the prior 6 months). The Court assumed without deciding that the earlier version applied, but held any error was harmless because the CAB made independent, record-supported findings establishing legal causation even without the presumption. The takeaway is twofold:

The presumption relieves claimants of proving legal causation when conditions are met, but its absence does not prevent claimants from proving legal causation through evidence of workplace exposures.
For death claims, because dependents’ rights arise at death, the applicable statute may be the version in effect on the date of death (the Court signaled this through Hirsch, though it resolved this case on harmless-error grounds).

Impact and Practical Implications

A. Timeliness and Litigation Strategy

Clear rule on the 18-month deadline: The RSA 281-A:42-d petition deadline for a dependent’s death-benefit claim begins when the dependent’s claim is denied, not when any prior claim of the decedent was denied. This ensures dependents are not penalized by the decedent’s litigation choices or timelines.
Recordkeeping and claims administration: Employers and carriers must maintain records and anticipate that dependents may timely pursue death-benefit claims even if a decedent’s earlier claim was denied or not pursued. Denying a decedent’s claim does not foreclose later dependent claims.

B. Date of Injury for Death Claims

Governing law at death: The Court’s reaffirmation that the dependent’s rights arise at death (and that death is the injury date for the dependent’s claim) has ripple effects on which statutory versions apply, potential benefit rates, and eligibility conditions.
Firefighter presumption timing: For deaths occurring after statutory amendments (e.g., July 2019 changes to the “tobacco free lifestyle” definition), dependents may be able to invoke the more current law, consistent with Hirsch.

C. Proving Causation in Rare Cancer Cases

Competent expert testimony without disease-specific statistics: The Court accepted a methodology that synthesizes general carcinogen literature, firefighting exposure studies, and an individualized occupational history. This is especially significant for rare cancers, where robust epidemiology may be lacking.
Expert selection: Occupational and environmental medicine experts who can bridge peer-reviewed science and practical exposure pathways may be persuasive before the CAB.
Treating physician opinions: While important, they are not dispositive; parties should not assume that treating oncologist testimony will control over well-supported occupational medicine opinions.

D. Relationship to LODD Benefits

The widow secured LODD benefits under RSA 21-I:29-a before pursuing workers’ compensation death benefits. The opinion underscores that these are distinct statutory schemes; obtaining LODD benefits does not preclude or automatically dictate workers’ compensation outcomes. Each claim must satisfy its own statutory criteria.

Complex Concepts Simplified

Separate and distinct claim: A dependent’s death-benefit claim under RSA 281-A:26 is a new right that arises at the worker’s death, independent of any claim the worker filed while alive. The dependent’s claim is not a “continuation” of the worker’s earlier claim.
Date of injury (death claims): For dependents, the “injury” date is the date of the employee’s death. This matters for determining which version of the law applies and for timeliness calculations about the dependent’s claim.
Legal vs. medical causation:
- Legal causation asks whether the injury is work-connected as a matter of policy and exposure context.
- Medical causation asks whether work probably caused or contributed to the injury as a matter of medical fact, typically proven through expert medical evidence.
Prima facie presumption (RSA 281-A:17): When statutory conditions are met, firefighters receive a presumption of legal causation for certain cancers, easing the burden of proof. The presumption does not eliminate the need to prove medical causation.
Competent evidence: Evidence that a reasonable factfinder may rely upon to support a finding. The Supreme Court will not reweigh evidence if the CAB’s decision is supported by competent evidence.
Harmless error: Even if a legal error occurred (e.g., applying the wrong statutory version), the decision stands if the outcome would be the same because the record independently supports the result.
Preponderance of the evidence: The standard of proof in workers’ compensation cases; the claim is more likely than not true.

Key Takeaways

Dependents’ death-benefit claims are independent of the decedent’s claims; RSA 281-A:42-d’s 18-month deadline runs from the denial of the dependent’s own claim.
For death claims, the injury date is the date of death; the law in effect at death governs dependents’ rights.
The CAB’s causation findings will be upheld if supported by competent evidence; rare disease status does not preclude competent expert medical opinions grounded in peer-reviewed science and credible exposure histories.
Treating physicians’ views receive substantial weight but are not controlling; the CAB may credit another qualified expert.
Even without the firefighter-cancer presumption, legal causation can be established through evidence of workplace exposures; any misapplication of the presumption may be harmless if legal causation is otherwise proven.

Conclusion

Appeal of State of N.H. (Adjutant General), 2025 N.H. 40, fortifies two core tenets of New Hampshire workers’ compensation law: dependents’ death-benefit claims are truly independent, and the system’s remedial purpose warrants practical, evidence-based adjudication of causation, even for rare illnesses. By aligning RSA 281-A:42-d’s petition deadline with the distinct status of dependents’ claims and reaffirming that the date of death is the operative injury date for those claims, the Court provides clarity that will guide practitioners, carriers, and the CAB in future cases. The decision also underscores that competent, credible expert medical testimony can carry the day despite limited disease-specific epidemiology, a message with real-world resonance in firefighter cancer litigation and beyond. The opinion’s careful synthesis of precedent, statutory text, and evidentiary standards will shape the handling of death-benefit and rare-cancer claims in New Hampshire for years to come.