David Carpenter's (dependent's) Case.

• Decision Date: 31 March 2010
• Citation: 923 N.E.2d 1026,456 Mass. 436
• Parties: David CARPENTER'S (dependent's) CASE.
• Court: United States State Supreme Judicial Court of Massachusetts Supreme Court

923 N.E.2d 1026

456 Mass. 436

David CARPENTER'S (dependent's) CASE.

Supreme Judicial Court of Massachusetts, Suffolk.

Argued Jan. 4, 2010.

Decided March 31, 2010.

COPYRIGHT MATERIAL OMITTED

John J. Canniff (John F. Keefe, Boston, with him) for the insurer.

Peter T. Toland, Woburn, for the claimant.

Paul M. Moretti & Scott K. Lueker, Boston, for Property Casualty Insurers' Association of America, amicus curiae, submitted a brief.

Present: MARSHALL, C.J., IRELAND, SPINA, COWIN, CORDY, BOTSFORD, & GANTS, JJ.

IRELAND, J.

David Carpenter (employee), a custodian at an elementary school in the city of Woburn (employer), died at the age of fifty-two while at work and after operating a heavy, commercial snow blower. He experienced "sudden cardiac death" (SCD) due to ventricular arrhythmia.¹ The employer's workers' compensation insurer, MIIA Workers' Compensation SIG (insurer), appeals from a decision of the reviewing board of the Department of Industrial Accidents (board) affirming a decision of an administrative judge awarding burial expenses under G.L. c. 152, § 33, and survivor benefits under G.L. c. 152, § 31, to the employee's widow. The insurer argues that the board incorrectly applied G.L. c. 152, § 7A (§ 7A), ² to the facts of this case; the board erroneously declined to consider the insurer's defense pursuant to G.L. c. 152, § 1(7A) (§ 1[7A]), ³ concerning the effect of the employee's preexisting coronary artery disease (CAD) on the element of causation; and the administrative judge erroneously applied § 1(7A). We transferred the case from the Appeals Court, see G.L. c. 152, § 12(2), on our own motion. We reject these arguments and affirm the board's decision, as modified herein.

1. Background. We summarize the facts found by the administrative judge and adopted by the board.⁴ On Monday, January 24, 2005, the employee was working with a coworker clearing a large amount of heavy snow from school grounds. It had snowed over the course of the weekend, leaving an accumulation of two feet of snow, and as a result, the school was closed. After arriving at work at about 7:00 a.m., the employee spent the morning operating a large, commercial-model snow blower, shoveling a tall snow drift with his coworker, and replacing a broken cotter pin on the snow blower. Although the snow blower was self-propelling, it weighed about 200 pounds and had to be manually maneuvered from side to side and around sharp corners.

At 12:15 p.m., the employee went to lunch with his wife. During lunch, he did not voice any complaints or indicate that he was not feeling well. He returned to work at approximately 1:30 p.m. At the time, it was cold outside, with temperatures ranging between nineteen and thirty-three degrees Fahrenheit.

The employee resumed operating the snow blower to improve the paths he had completed before lunch. His coworker heard the motor of the snow blower running continuously and, at approximately 1:50 p.m., went to check on the employee. He found the employee motionless, leaning against a snow drift "higher than a man" beside the snow blower. Emergency medical personnel were summonsed and determined on arrival that the employee had no pulse. By ambulance, the employee was transported to a nearby hospital, where he was pronounced dead. The employee had experienced SCD.

2. Standard of review. An aggrieved party may seek judicial review of a decision of the board concerning workers' compensation benefits. G.L. c. 152, § 12(2). As specified in G.L. c. 152, § 12(2), we review the board's decision in accordance with the standards set forth in G.L. c. 30A, § 14(7) (a)-(d), (f), and (g). Scheffler's Case, 419 Mass. 251, 257-258, 643 N.E.2d 1023 (1994). Pursuant to these statutory standards, we may reverse or modify the board's decision when it is "[i]n violation of constitutional provisions," "[i]n excess of the statutory authority or jurisdiction of the agency," "[b]ased upon an error of law," "[m]ade upon unlawful procedure," "[unwarranted by facts found... where the court is constitutionally required to make independent findings of fact," or is "[arbitrary or capricious, an abuse of discretion, or otherwise not in accordance with law." G.L. c. 30A, § 14(7) (a)-(d), (f), and (g). Under these standards, in determining whether the board properly affirmed the administrative judge's findings, we consider "whether the decision is factually warranted and not '[a]bitrary or capricious, ' in the sense of having adequate evidentiary and factual support and disclosing reasoned decision making." Scheffler's Case, supra at 258, 643 N.E.2d 1023. See Robinson's Case, 416 Mass. 454, 457, 623 N.E.2d 478 (1993) (standards identified in G.L. c. 152, § 12[2], "may overlap with the substantial evidence standard"). Where a statute is involved, "[although '[t]he interpretation of a statute by the agency charged with primary responsibility for administering it is entitled to substantial deference, ' Gate-ley's Case, 415 Mass. 397, 399, 613 N.E.2d 918 (1993), ultimately the 'duty of statutory interpretation is for the courts.' Slater's Case, 55 Mass.App.Ct. 326, 330, 770 N.E.2d 534 (2002)." Moss's Case, 451 Mass. 704, 709, 889 N.E.2d 43 (2008).

3. Discussion, a. Application of § 7A. The insurer asserts that the employee's SCD was inevitable and its occurrence at work was coincidental. Consequently, the insurer states that the board erred in affirming the administrative judge's decision, arguing that he improperly applied § 7A on the issue of the causal link between employment and death. In support of this argument, the insurer contends that the administrative judge's deci-sion preflects a misunderstanding of the medical evidence. We reject these arguments.

In Moss's Case, supra at 707-708, 889 N.E.2d 43, we provided a comprehensive overview of § 7A, see note 2, supra:

"Section 7A is designed to '[t]o aid the victim[ ] of an unwitnessed accident' who is unable to testify and therefore has difficulty meeting the burden of proving entitlement to compensation under G.L. c. 152. L.Y. Nason, C.W. Koziol, & R.A. Wall, Workers' Compensation § 17.4 (3d ed. 2003). See id. at § 10.11. The section by its terms establishes prima facie evidence of four separate aspects of a workers' compensation claim: (1) 'that the employee was performing his regular duties on the day of injury or death'; (2) 'that the claim comes within the provisions of [c. 152]'; (3) 'that sufficient notice of the injury has been given'; and (4) 'that the injury or death was not occasioned by the willful intention of the employee to injure or kill himself or another.' G.L. c. 152, § 7A. In Anderson's Case, [373 Mass. 813, 370 N.E.2d 692 (1977)], this court held that particularly the second of these, 'the claim comes within the provisions of [c. 152], ' reflected a legislative intent that where an employee was found dead at his job, this fact should establish prima facie evidence that the employee's death was causally related to his employment. The court stated:

Tor a claim to be compensable it must arise out of and in the course of employment. Clearly a causal relationship is required between the employment duties and the injury or death. In a case such as this one, where the employee was found dead at his place of employment, we construe the statute, § 7A, as establishing, inter alia, prima facie evidence of causal relationship between the employment and the injury or fatality. We believe that was the meaning intended by the Legislature, particularly in its use of the words, "and that the claim comes within the provisions of this chapter." Anderson's Case, ^ra at 816-817, 370 N.E.2d 692.'"⁵

An insurer may overcome the prima facie evidentiary effect of § 7A by assuming the burden of production. In Anderson's Case, supra, at 817, 370 N.E.2d 692, we explained:

"Prima facie evidence, in the absence of contradictory evidence, requires a finding that the evidence is true; the prima facie evidence may be met and overcome by evidence sufficient to warrant a contrary conclusion; even in the presence of contradictory evidence, however, the prima facie evidence is sufficient to sustain the proposition to which it is applicable."

If an insurer produces "evidence sufficient to warrant a contrary conclusion," id., on a fact set out in § 7A, a question of fact arises for an administrative judge to decide, and the judge must weigh the evidence and make credibility determinations in reaching a conclusion. Such credibility determinations are within the sole province of an administrative judge and are to be considered final by both the reviewing board and an appellate court. Lettich's Case, 403 Mass. 389, 394, 530 N.E.2d 159 (1988). See Pilon's Case, 69 Mass.App.Ct. 167, 169, 866 N.E.2d 977 (2007) ("Findings of fact, assessments of credibility, and determinations of the weight to be given the evidence are the exclusive function of the administrative judge"). Where, as here, "causal relation is a matter beyond the common knowledge and experience of the ordinary layman, the proof must rest upon expert medical testimony." Buck's Case, 342 Mass. 766, 769, 175 N.E.2d 369 (1961). "The probative value of this testimony is to be weighed by the fact-finding tribunal." Fitzgibbons's Case, 374 Mass. 633, 635, 373 N.E.2d 1174 (1978).

Before addressing the insurer's arguments, we summarize the findings and conclusions of the administrative judge, as well as the conclusions drawn by the board. The administrative judge first determined that the employee was in the course of his employment when he suffered SCD and that, consequently, the prima facie evidentiary effect of § 7A applied. He credited the findings of the limited autopsy conducted of the employee's heart. The autopsy indicated that the employee was suffering from an occlusion (narrowing) of over ninety per cent of the left anterior descending coronary artery. It also revealed that the employee had "patchy subendocardial fibrosis [scarring of the heart] but no...