Background
David Lambert, a truck driver for Quanta Services, Inc., alleged that he sustained a work-related injury on August 24, 2023, while lifting a cable. On that date, he reported to an on-site nurse that he had injured his right biceps and received treatment from August 24 through September 8, 2023. However, medical records revealed that Lambert had significant preexisting right shoulder pathology documented before August 24, 2023: he had sought treatment for right shoulder pain in February 2023 (revealing degenerative changes in the acromioclavicular joint), received steroid injections in February and April 2023, and received another injection in July 2023. Notably, during his initial post-injury treatment in August and early September 2023, Lambert reported only biceps pain and consistently denied shoulder pain to the treating nurse.
Lambert continued working after the alleged August 24 injury. Four months later, on December 22, 2023—the day he was laid off—Lambert presented to an emergency room claiming a work-related right shoulder injury. An MRI on January 3, 2024, revealed a full-thickness tear of the supraspinatus tendon, partial tears of the infraspinatus and subscapularis tendons, a labral tear, and a likely biceps tendon tear. He underwent shoulder surgery in March 2024. The claim administrator rejected the claim on February 9, 2024, citing three reasons: failure to immediately report the injury, failure to seek timely medical attention, and that “pain” is a symptom rather than a diagnosis. The Workers’ Compensation Board of Review affirmed the rejection on June 27, 2025.
The Court’s Holding
The Intermediate Court of Appeals affirmed the Board’s decision. The court applied West Virginia’s well-established standard that compensability requires three elements: (1) a personal injury, (2) received in the course of employment, and (3) resulting from that employment. The employee must establish by a preponderance of the evidence a causal connection between the disability and employment.
The court found that the Board was not clearly wrong in concluding that Lambert failed to prove compensability. The Board’s findings—supported by substantial evidence—included: on August 24, 2023, Lambert sought treatment only for right biceps pain and denied shoulder pain throughout his treatment with the on-site nurse through September 8, 2023; medical records documented extensive preexisting right shoulder conditions with multiple steroid injections before the alleged injury date; Lambert’s testimony denying prior shoulder problems was refuted by contemporaneous medical records, undermining his credibility; and he continued working after the alleged injury and filed the claim only four months later following a layoff. Under West Virginia Code § 23-4-1c(a)(2), the timing of claim filing after a layoff is probative evidence weighing against compensability.
Key Takeaways
- Establishing causation between work and injury is demanding: preexisting medical conditions for the same body part create a substantial evidentiary burden for the claimant.
- Temporal inconsistencies are fatal to compensability: reporting biceps injury on the alleged injury date but claiming shoulder injury four months later undermines the causal nexus.
- Delayed claim filing, particularly after job loss, is probative evidence that weighs against compensability and can shift the burden on the claimant.
- Contemporary medical records and credibility determinations regarding prior treatment history are central to causation analysis; claimant’s own testimony may be rejected if contradicted by medical documentation.
Why It Matters
This decision reinforces West Virginia’s rigorous causation requirement in workers’ compensation cases. The court’s affirmance emphasizes that claimants must establish a clear temporal and medical connection between work activities and claimed injuries. For workers with preexisting conditions affecting the body part in question, the burden is substantially elevated to prove that a subsequent injury arose from work rather than from or in continuation of the preexisting condition. The decision underscores the significance of: contemporaneous injury reporting matching the later-claimed diagnosis, prompt medical attention, and claim filing while still employed or shortly thereafter.
Employers and insurers will likely rely on this precedent to challenge workers’ compensation claims involving prior medical treatment to the affected body part, temporal gaps between reported injury and claim filing, or inconsistencies between initial injury descriptions and later-alleged conditions. The decision also illustrates the court’s deference to Board factfindings under the “clearly wrong” standard of review, making Board determinations concerning credibility and causal inference difficult for claimants to overturn on appeal.