Workers' Compensation Defense

Craig Peed, the claimant, suffered severe head injuries in 2012 when a falling tree limb struck him while working for Essential Staffing, Inc. As a result of the injury, he was intubated due to a coma. In 2016, the claimant’s upper teeth fractured at the gum line, prompting him to file a petition for compensability. In 2018, the Industrial Accident Board (“IAB” or the “Board”) weighed competing medical testimony and found a causal link between his coma and intubation to the “desiccation” (drying out) of his upper teeth. The employer and carrier were therefore held responsible for the upper-teeth dental work.

Approximately five years later, Mr. Peed developed issues with his lower teeth, which had worn down to stumps and exposed the nerve roots. His treating dentist performed root canals and recommended crowns. The claimant filed a new petition for additional compensation, arguing that the 2018 IAB findings definitively established that his coma-induced desiccation caused long-term dental damage. The claimant’s treating dentist also testified that the dental bridges placed on the upper teeth caused the lower teeth to wear down.

The employer vigorously defended the petition with their own medical expert, who testified that Mr. Peed’s lower teeth problems were due to poor pre-accident dental care and unrelated to the work injury.  Additionally, the expert testified that dental bridges on the upper teeth would not naturally cause rapid wear on the opposing lower teeth, and noted it was unlikely for someone to develop severe pain in “nine teeth in a row” just six months after previously reporting zero pain during routine visits.

The IAB found the employer’s medical expert more credible and determined that the claimant failed to meet his burden of proof, denying compensation for Mr. Peed’s lower teeth issues.  The Board also found that the claimant’s treating dentist lost credibility by relying on post-root canal X-rays—taken after the teeth had already been ground down to the gum line—to support the claim that the teeth had naturally deteriorated from the accident.

The claimant appealed the IAB’s decision, first to the Superior Court of Delaware and then to the Delaware Supreme Court. Mr. Peed argued that the Board was bound by its 2018 decision under the doctrines of res judicata and collateral estoppel, claiming that the Board had already established his coma caused long-term dental decay. The Supreme Court disagreed. It found that the 2018 decision determined causation only for the upper teeth, while the 2023 petition involved the lower teeth under different clinical circumstances. The Court also clarified that, although the IAB cannot retroactively alter a past award, 19 Del. C. § 2347 permits the Board to evaluate whether a new claim is related to the original industrial accident. Additionally, the Court addressed a procedural objection about late-disclosed defense expert opinions, holding that the IAB’s relaxed evidentiary rules and the claimant’s opportunity for cross-examination were sufficient. The Delaware Supreme Court ultimately affirmed the Superior Court’s ruling and the Board’s denial of benefits for the lower teeth issues.

In Delaware workers’ compensation cases, a claimant’s prior successful petition can often feel like an insurmountable hurdle for employers and insurers. However, the Supreme Court of Delaware recently delivered a pivotal victory for the defense in Peed v. Essential Staffing, Inc., reinforcing that a prior finding of causation does not give claimants a “carte blanche” for subsequent, distinct medical conditions. This decision provides important guidance for insurance adjusters and employers contesting causation on long-tail claims.

A few takeaways from this decision:

• Separate the Anatomy: Never assume a settled or adjudicated claim dictates the outcome of a new body part.  Force the claimant to prove causation anew if the anatomy or clinical presentation changes (e.g., left knee v. right knee, upper teeth v. lower teeth).
• Examine Pre- and Post-Procedure Evidence: The turning point in this case was the treating provider’s use of post-procedure X-rays.  Always verify that the medical evidence depicting “degeneration” was captured before any surgical intervention or alteration took place.
• Equip Your Experts for Cross-Examination: The Court affirmed that defense experts can offer new, responsive opinions during depositions if new medical details come to light.  Ensure your defense experts are thoroughly briefed on the claimant’s long-term treatment records and are ready to pivot to address newly raised medical theories.