Background
Crystal Barnes, an employee of Graham Packaging Company, LP, filed a workers’ compensation claim arising from a workplace incident on February 26, 2024, in which she alleged she was injured when a set of lockers fell onto her. The claim administrator denied the claim on March 12, 2024, asserting that an investigation had determined the alleged event was factually impossible, that the incident was unwitnessed, and that objective medical evidence of an injury was lacking.
Barnes successfully challenged the denial before the West Virginia Board of Review, which issued an order on March 4, 2025, finding the claim administrator’s denial unreasonable under West Virginia Code § 23-2C-21(c). The Board accordingly granted Barnes’s petition for attorney fees and costs. Graham Packaging appealed to the Intermediate Court of Appeals (“ICA”), which affirmed the Board’s order in a memorandum decision issued August 29, 2025. The employer then sought further review before the Supreme Court of Appeals of West Virginia.
The Court’s Holding
The Supreme Court of Appeals unanimously affirmed the ICA’s decision. The court applied its standard framework — reviewing questions of law de novo while deferring to the Board of Review’s factual findings unless clearly wrong — and found no reversible error warranting further examination. The decision was issued as a summary affirmance under West Virginia Rule of Appellate Procedure 21(c), with the court determining oral argument was unnecessary.
The court declined to disturb the Board’s conclusion that the claim administrator’s denial was unreasonable under § 23-2C-21(c), which requires the claim administrator to demonstrate that it possessed, at the time of denial, evidence or legal authority that was relevant, probative, and supportive of the denial. The Board had weighed all the evidence and found that neither the investigation report nor medical records from multiple facilities supported the claim administrator’s position that there was no evidence of a compensable injury.
Key Takeaways
- A workers’ compensation claim administrator’s denial is unreasonable under W. Va. Code § 23-2C-21(c) when the administrator cannot demonstrate it had relevant, probative evidence or legal authority supporting the denial at the time it was made — even if the incident was unwitnessed or the employer disputes how the injury occurred.
- The Board of Review’s factual findings in workers’ compensation appeals receive deference from West Virginia appellate courts and will not be disturbed unless clearly wrong, making a strong evidentiary record at the Board level critical for both claimants and employers.
- An employer’s reliance on an internal investigation concluding an incident was “factually impossible,” without medical records corroborating that conclusion, may be insufficient to render a denial reasonable and avoid an attorney fee award.
Why It Matters
This decision reinforces the meaningful teeth behind West Virginia’s attorney fee provision for unreasonable workers’ compensation denials. Employers and their claim administrators cannot rely solely on investigative conclusions that conflict with medical evidence from multiple treating sources; they must have contemporaneous, probative support for a denial or face fee liability. The ruling signals that characterizing an unwitnessed claim as “factually impossible” — without corroborating medical documentation — will not immunize a denial from an unreasonableness finding.
For claimants’ counsel, the case illustrates the value of building a thorough medical record early in the claims process. For employers and insurers, it underscores the need to carefully assess the totality of available evidence — including all medical records — before issuing a denial, rather than relying primarily on employer-commissioned investigations.