Bodwell v. Webster Corp. (Dec. 10, 1996)
STATE OF VERMONT
DEPARTMENT OF LABOR AND INDUSTRY
Warren Bodwell File No.:H-16780
By: J. Stephen Monahan
General Counsel
v.
For: Mary S. Hooper
Commissioner
Webster Corporation
MOTION FOR STAY DENIED
A decision was issued in this matter on October 22, 1996.
A defendant seeking a stay must demonstrate:
1. That it is likely to succeed on the merits;
2. That it would suffer irreparable harm if the stay were not granted;
3. If a stay were issued it would not substantially harm the other party;
and,
4. The best interest of the public would be served by the issuance of a stay.
See, In Re Insurance Services Office, Inc., 148 Vt. 634 (1987).
In this case the defendant has not made the necessary showing. The Defendant's only suggestion that it is likely to succeed on the merits is with regard to whether claimant has reached a medical end result which is a question of fact, see Coburn v. Frank Dodge and Sons Supreme Docket No. 95-475 filed 8-30-96. Defendant, in effect, disputes the factual findings made by the hearing officer. A simple factual dispute is not a sufficient basis on which to grant a stay. This is especially true where it appears that some of defendant's own medical evidence indicated the claimant was not at an end medical result.
Under 21 V.S.A. §675(b), an order by the Commissioner shall be of full effect from issuance unless stayed by the Commissioner, notwithstanding any appeal that may be filed, and no stay shall exist unless granted pursuant to that subsection. The section was enacted to prevent the filing of appeals in order to delay payment of an award by the Commissioner, based upon the legislature's belief that such delays unduly burdened injured claimants and
forced them to accept settlements for less than the award in order to meet their financial obligations. The legislature anticipated that the granting of stays would be the exception, not the rule. E.g., Patricia Pratt v. Georgia Pacific Corporation, State File No. B-7365 (February 6, 1992); Fernand Cyr v. R.A.B. Construction, State File No. T-618 (January 20, 1993).
Therefore, the stay is NOT GRANTED.
DATED at Montpelier, Vermont this 10th day of December 1996.
______________________
Mary S. Hooper
Commissioner
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Bodwell v. Webster Corp. (Oct. 22, 1996)
STATE OF VERMONT
DEPARTMENT OF LABOR AND INDUSTRY
Warren Bodwell File #: H -16780
By: Barbara H. Alsop
v. Hearing Officer
For: Mary S. Hooper
Webster Corporation Commissioner
Opinion #: 62-96WC
Hearing held at Montpelier, Vermont, on August 23, 1996.
Record closed on September 11, 1996.
APPEARANCES
Richard H. Munzing, Esq., for the claimant
Thomas P. Simon, Esq., for the employer
ISSUES
1. Whether the claimant suffered a compensable mental impairment arising out of and in the course of his employment?
2. If the answer to #1 is affirmative, what is the extent of the claimant's permanent impairment as a result of this injury?
THE CLAIM
1. Temporary total disability compensation pursuant to 21 V.S.A. §642.
2. Permanent partial disability compensation pursuant to 21 V.S.A. §648 for 25% permanent partial impairment attributable to a mental injury.
3. Medical and hospital benefits pursuant to 21 V.S.A. §640.
4. Attorneys' fees and costs pursuant to 21 V.S.A. §678(a).
STIPULATIONS
1. At all relevant times, the claimant was an employee within the meaning of the Workers' Compensation Act.
2. At all relevant times, the defendant was an employer within the meaning of the Workers' Compensation Act.
3. In the course of his employment for the defendant, the claimant was involved in two motor vehicle accidents on June 5, 1994, and November 22, 1994.
4. In the event that this claim is determined to be compensable, the claimant was temporarily totally disabled from November 25, 1994, to April 9, 1995, and was temporarily partially disabled from April 10, 1995, to October 1, 1995.
EXHIBITS
1. Joint Exhibit 1: A notebook containing medical records, discovery responses, the employee's personnel file, and Federal Highway statistical material.
2. Claimant's Exhibit A: Curriculum Vitae of Dr. Philip Kinsler
3. Defendant's Exhibit I: Curriculum Vitae of Dr. Walter Borden
PROCEDURAL NOTE
The claimant in his proposed findings and rulings made a claim for vocational rehabilitation benefits. This claim was not presented on the Form 6, Notice and Application for Hearing, filed by the claimant, nor was it mentioned at the pretrial conferences held in this case on May 8, 1996, and June 14, 1996. Rule 7(b) of the Workers' Compensation and Occupational Disease Rules requires disclosure of the issues to be tried at the time of the pretrial
conference. Failure to disclose the issue precludes its consideration in the final hearing, particularly where, as here, no evidence has been submitted on this issue at the hearing.
FINDINGS OF FACT
1. The above stipulations are accepted as true, and the exhibits are admitted into Evidence. Notice is taken of all forms filed with the Department in this matter.
2. The claimant, a 57 year old man, has spent the bulk of his adult life as a long haul truck driver. On June 5, 1994, the claimant was driving northbound on Interstate 95 in Connecticut when he saw a minivan flipping end over end in the southbound lane coming towards him. At first he could not even recognize what the object was, but as his comprehension cleared, he realized it was a van, and that objects were flying from it. Although initially he thought the objects might be luggage, he realized almost immediately that they were human bodies.
3. The claimant tried to reach authorities on his CB radio, but was unsuccessful. He pulled into a weigh station a short distance away, and found that a woman was already there, calling for help. The claimant resumed his course, including the last stop on his route, and then headed home. The claimant described the rest of the day as "scary," stating that he was nauseous, sweaty and that he did not "feel like driving." He indicated that this was unusual for him.
4. When the claimant reached home, his wife had a meal prepared for him, but he was unable to eat it. He was sick to his stomach, vomiting, and his mouth got dry. He spoke with his wife about the accident, and spent most of the night awake, nervous and upset.
5. Within a few days, the claimant made a statement to the Connecticut State Police. After that, his life appeared to return to normal. He did not feel that his witnessing of the accident affected his ability to do his job.
6. The claimant reported that he had never seen an accident like this in all of the years of his trucking. He had never been in an accident with serious bodily injury, and he knew that the people he saw must be dead. This was confirmed by the state police when he made his statement. The claimant has produced evidence that in 1994, there were .54 fatal accidents in New England per million miles.
7. On November 22, 1994, the claimant was driving his regular route, and had completed a delivery at Old Saybrook. He returned to Route 1, northbound, and as he went through the first intersection, the light turned yellow. A car turning right onto Route 1 hit the right rear of his truck. The claimant testified that he felt as if the June incident was happening all over again, that he could see "bodies all over the place." He thought his trailer must have gone right over the car. He pulled over, and saw that the car was pulled off to the side of the road.
8. The claimant ran over to the car to see if everyone was okay, and the driver was on the telephone. She would not respond to his questions. He went around to the other side of the vehicle and spoke with the passenger, a little girl. She indicated that she was not hurt, but she was crying. The police took statements from each of the parties, and were not critical of the claimant. Although there was extensive damage to the car, there was no damage to the truck.
9. The claimant had great difficulty driving the truck. He described a sensation of driving through a tunnel with dim lights. He finished the last two stops in his delivery schedule with difficulty and then he headed back to Brattleboro. For the rest of the day, he experienced rubbery knees and a dry mouth, and he was very upset and sweating. He felt as if he was not aware of what was on either side of him, and so he drove more slowly than usual.
10. When he returned home, his wife did not even bother to fix supper for him. He vomited again. He talked extensively with his wife about both incidents, and was unable to sleep that night. This second incident occurred on the Tuesday of Thanksgiving week, and the claimant was not scheduled to work again until Friday.
11. On Thanksgiving, the claimant did not eat much, which was rare for him. He again got sweaty, with rubbery knees and "marble mouth." He did not go to see a doctor, as he believed that the symptoms would resolve spontaneously.
12. On Friday, the claimant went into work, but his symptoms returned. He reported his problem to Mike DeSilva, and went home. Mr. DeSilva did not question his going home. The claimant called in sick on Sunday, and went to see a doctor on Monday, after he again called in sick. He saw the associate of his regular doctor, who gave him pills to help him sleep. On Tuesday or Wednesday, he went to see his regular doctor, Dr. Barry Stern, who took him out of work. The claimant stayed out of work until April 10, 1995.
13. The claimant treated with Dr. Stern for a period of time. Dr. Stern, a General Practitioner with an interest in psychiatric problems, prescribed Prozac and Zanax for the claimant, and sought to have the claimant seen by a psychologist. The claimant was first sent to a counselor named Ben Lichtenberg through the Employee Assistance Program at work. Records of that counseling have not been made available at the hearing. Dr. Stern referred the claimant to Dr. Philip J. Kinsler, a psychologist, whom. the claimant began to see on February 20, 1995.
14. Dr. Kinsler treated the claimant with individual psychotherapy through 1995 and the spring of 1996. Based on his education, experience and consultations with the claimant, Dr. Kinsler diagnosed the claimant as suffering from Post-Traumatic Stress Disorder ("PTSD") and agoraphobia with panic attacks. Dr. Kinsler treated the claimant regularly until he started working an eight hour day again, and less frequently thereafter. Among the symptoms being treated by Dr. Kinsler were panic attacks and fear of driving. The panic attacks included sudden sweatiness, a dry mouth, a pounding heart hyperventilation, and a fear that he was having a heart attack. The claimant also suffered from flashbacks and daydreams involving the two accidents.
15. The claimant returned to work on a part-time basis on April 9, 1995, and continued to work in that capacity until his full return to work on October 1, 1995. At no time has the claimant reached his pre-accident average weekly wage. The claimant was given a position in the office as he was unable to drive the tractor-trailer truck at all, and only after a period of therapy was he able to drive his car. The claimant worked at a job that was created for him, functioning as a safety officer of sorts. Among other tasks, he maintained the drivers' logs and filings for the company. Initially he got to work by having his wife drive him, but he later reached the ability to drive himself.
16. The claimant noted that he had and has difficulty as a passenger in a car if he does not have confidence in the driver's abilities. He is not able to drive himself unless he knows the route he is taking, and has a specific destination. He is not able to travel long distances without suffering symptoms consistent with a panic attack. He does not handle winter weather well, and will leave for work very early to insure that he arrives in a timely manner. As a result, he is frequently at work early.
17. The claimant on one occasion got behind the wheel of a truck to move it a short distance in the yard. He suffered a serious anxiety attack, and was only barely able to move the vehicle at all. In describing the incident at the hearing, the claimant exhibited signs of distress both at the outcome of the attempt and at the logical conclusions that were drawn from his failed attempt.
18. Prior to the second accident, the claimant had an active social life. He was very involved in Republican party politics in New Hampshire, attending meetings and helping to organize campaigns. He was an avid baseball fan for years, and for many years a season ticket holder for the Yankees. In the summer, he would travel with a group of friends to Yankee Stadium as often as two weekends a month. In this activity, the claimant became friends with a number of members of the staff at the Yankees, and had the occasion to meet
George Steinbrenner at least once. The Yankee connection represented a significant source of social gratification to the claimant. The claimant also regularly used to travel to the New Hampshire coast to see other family members. He has been unable to continue these activities because of his difficulties with driving and with crowds since the accidents. He and his wife rarely go out to eat because of these problems.
19. Dr. Kinsler testified that the claimant's symptoms fit the DSM IV definition of PTSD attributable to the claimant's witnessing of the first accident. Specifically, he found that the trauma of seeing bodies flying from a vehicle and bouncing on the pavement, leading to death, qualified as a trigger under the definition, which specifically cites the witnessing of the death of another as a potential trigger. He indicated that it was not uncommon to have a second stimulus, as here, which triggered the condition caused by the primary stimulus. He found that the claimant's experience of flashbacks and daydreams was consistent with the diagnosis of PTSD. He noted that it was not uncommon for the mind of a PTSD sufferer to race, presenting images similar to strobe pictures, and that the claimant's descriptions coincided with this. Dr. Kinsler witnessed the claimant in the throes of panic attacks, and made findings that the claimant's experiences were in fact panic attacks. He determined that the claimant was suffering from anticipatory anxiety, a fear of situations that may be reminiscent of the triggering incident. A normal result of anticipatory anxiety is the restriction of behavior where a sufferer begins to avoid wider and wider circles of reminiscent things.
20. Dr. Kinsler did not perform any psychological testing on the claimant. He ascribed this decision to two factors. The first is that testing is appropriate when there is a conundrum with regard to the diagnosis. In this case, the diagnosis was reasonably straight forward, and hence testing was not required. The second was a practical reason, in that mental health care is frequently rationed by insurers, and testing would be a waste of precious
time in a case where intensive therapy is required. Nonetheless, Dr. Kinsler had the opportunity to review the results of tests performed on the claimant by Dr. Walter Borden for the insurer. Based on those results, he determined that the MMPI 2 showed peaks on physiological concerns and worrying, while the descriptive analysis centered on anxiety, which was consistent with Dr. Kinsler's diagnosis. The results of the Millon inventory showed anxiety as 100% of the scale, while the depression score was not significant.
21. Dr. Kinsler treated the claimant by teaching relaxation techniques and by systemic desensitization. The relaxation techniques were designed to assist the claimant in dealing with his anxiety and panic attacks. The desensitization was aimed at reducing the effects of precipitating stimuli. In concert with Dr. Stern, he arranged medication appropriate to the PTSD diagnosis of low levels of Prozac combined with an anti-anxiety agent. This medical regimen was based on the teachings of Dr. Bessel van der Kolk, an expert in the field of PTSD, as acknowledged by both Dr. Kinsler and Dr. Borden.
22. Based on his treatment of the claimant and at the claimant's request, Dr. Kinsler evaluated the claimant's permanent partial impairment attributable to his work injury initially by reference to the AMA Guides to the Evaluation of Permanent Impairment, and later with reference to standards established by the state of Colorado as explained by Dr. Howard Entin. Under the AMA Guides, and recognizing that those Guides do not allow for a
numerical rating, Dr. Kinsler opined that the claimant had a permanent partial impairment of 30 to 35%. With resort to the Colorado standard, that number reduced to 16 to 25%, with the likelihood that the claimant fell in the higher range or at 25%. Under both standards, Dr. Kinsler found that the claimant had a moderate impairment in activities of daily living, based in large measure on the claimant's inability to function normally outside the home. He found that the claimant had a mild social impairment, again caused by his inability to engage in social activities of traditional importance to him, such as his summer infatuation with the Yankees. In the area of concentration, persistence and pace, Dr. Kinsler found no impairment under the Guides but a mild to moderate impairment under the Colorado standard. In the final category, a work performance category in the Guides, Dr. Kinsler found a severe impairment of the claimant's ability to perform the one job for which he was clearly qualified, driving a truck. In light of the claimant's ability to transfer to an office job, that impairment was reduced to a mild impairment. Under the Colorado system, the fourth category is adaptation to stress, and in this class, Dr. Kinsler found the claimant to be mildly impaired.
23. Dr. Walter Borden examined the claimant in his office in West Hartford, Connecticut, on July 21, 1995. This visit by the claimant was fraught with distress, requiring as it did the claimant's travel from his home in southern New Hampshire to Connecticut. The claimant arranged for a friend to drive him and his wife to the appointment in their RV. It was hoped that traveling in this manner would reduce the panic that would normally afflict the claimant in a trip of this length on a highway. The claimant had been aware of the necessity of this trip for some weeks before it occurred, and it had caused him increased anxiety as he anticipated the drive.
24. The claimant was told upon his arrival at Dr. Borden's office that the appointment would take about six hours. The claimant became agitated and panicked at this news, and Dr. Borden indicated that he would defer the examination if the claimant was unable to proceed. The claimant managed to calm down enough to begin the examination. There was a disruption that occurred at some time in the middle of the examination involving difficulty
with the RV in the parking lot. Apparently, the stores in the neighborhood were objecting to "noxious fumes" being given off by the RV, and had requested the assistance of the police. The claimant's wife was upset by this, which in turn upset the claimant.
25. Dr. Borden testified with regard to his examination and his conclusions from that examination. He indicated that "80% of the diagnosis is from history" and that past history is an essential part of the diagnosis. He relied on the claimant's report of his history, and did not interview Mrs. Bodwell or discuss the claimant with his employer or his treating physicians. He gave the claimant the tests referred to by Dr. Kinsler, specifically the MMPI 2, the Millon Clinical Multiaxial Inventory, and the Millon Behavioral Health Inventory. These tests suggested a somatoform disorder and anxiety. Dr. Borden testified that the test results were irrelevant to the diagnosis of depression because the claimant's depression was so obvious in the examination. Therefore, he was not concerned by the failure of the tests to show depression. Based on his examination of the claimant, Dr. Borden diagnosed the claimant as suffering from depression and anxiety.
26. Dr. Borden indicated that the claimant's depression arose from his failure to deal adequately with the death of his parents within months of each other some years before. In fact, the claimant was 18 years old at the time of his father's death, a number based on his father's age at the time of his birth and his reported age at the time of his death. Dr. Borden opined that the claimant's inability to grieve in his youth left him with certain vulnerabilities, and that the accidents in this case have given him a mechanism to explain his problems. Dr. Borden opined that the claimant reacted so strongly to the accidents because he was about the same age as his father was when he died, and his anxiety attacks seemed like heart attacks to the claimant. The claimant felt lonely and worthless, helpless and hopeless, which were feelings classically associated with depression according to Dr. Borden.
27. Dr. Borden has had experience with trauma victims and Viet Nam veterans. He testified that PTSD was first formulated as a diagnosis in response to participants in war. He indicated that his objection to the diagnosis of PTSD in this case was that the first accident was not of the type usually associated with PTSD in that the claimant did not know the people involved and that the incident was transitory, or short-lived. Dr. Borden testified
that the most common trigger for PTSD is minimally a momentary apprehension of serious bodily harm to oneself. However, under cross-examination he conceded that the DSM IV did not require that the apprehension of serious bodily harm be personal. He also conceded that witnessing violence to another could be a trigger although he alleged that there would normally need to be a relationship between the observer and the victim in order to promote
a traumatic reaction. The exception to the requirement for a personal connection would arise from a case of massive brutality, such as the Oklahoma City bombing or his patient who witnessed the killing fields of Cambodia. Finally, he conceded that PTSD could be triggered long after the traumatic event by an apparently unrelated event, citing again to his Cambodian patient.
28. Dr. Borden also questioned the claimant's report of the first accident, and decided that the claimant was involved in "reconstruction" of what he saw. The basis for this belief of Dr. Borden's is not clear, and it is not accepted. I find that the claimant's report of the accident is consistent with his earliest reports, and confirms that he realized he was seeing bodies skidding along the highway. Nonetheless, it is noteworthy that Dr. Borden conceded that the first accident was in a "gray" area, and could not be absolutely ruled out as a trigger for PTSD.
29. Dr. Borden also contested the conclusions of Dr. Kinsler with regard to permanency. He specifically objected to Dr. Kinsler's global claim of impairment due to the claimant's inability to travel in a motor vehicle comfortably. He indicated that the claimant's occasional trips to Yankee games did not qualify as a major social event, reflecting his lack of understanding of the significant amount of time the claimant spent in this endeavor. Moreover, in light of the alleged importance of history to Dr. Borden's diagnosis, his failure to acknowledge the claimant's substantial political involvement and his loss of that social activity is disturbing. His resulting analysis of the claimant's impairment as 1 to 5% is therefore questionable. However, it is Dr. Borden's position that the claimant is not at an end medical result, as he believes that the claimant's depression is treatable.
30. Finally, Dr. Borden testified that the diagnosis of depression was not inconsistent with PTSD, and that in fact depression was often an element of PTSD.
31. The claimant has presented evidence of his fee agreement with his attorney for various percentages of the amount recovered depending on the circumstances. Subject to the limitations of Rule 10(a), this is acceptable. The claimant has also produced evidence of expenses in the amount of $1888.79, the bulk of which is the invoice of Dr. Kinsler for $1,475.00, for a letter to the claimant's attorney for $100.00, a letter to the insurance carrier for $75.00, a five page report of March 28, 1996, for $90.00, two psychological evaluations for $367.50, preparation for a report for $225.00, a conference with claimant's counsel for $90.00, preparation for his testimony for $312.50, and his testimony for $225.00. Dr. Kinsler's bill is approved only in the amount of $907.50, given limitations in the Workers' Compensation Fee Schedule, Rule 40.000.
CONCLUSIONS
1. In workers' compensation cases, the claimant has the burden of establishing all facts essential to the rights asserted. Goodwin v. Fairbanks, Morse Co., 123 Vt. 161 (1963). The claimant must establish by sufficient credible evidence the character and extent of the injury as well as the causal connection between the injury and the employment. Egbert v. The Book Press, 144 Vt. 367 (1984).
2. Where the causal connection between an accident and an injury is obscure, and a lay-person would have no well grounded opinion as to causation, expert medical testimony is necessary. Lapan v. Berno's Inc., 137 Vt. 393 (1979). There must be created in the mind of the trier of fact something more than a possibility, suspicion or surmise that the incidents complained of were the cause of the injury and the inference from the facts proved must be the more probable hypothesis. Burton v. Holden & Martin Lumber Co., 112 Vt. 17 (1941).
3. The Workers' Compensation Act is modeled after the earlier English Workmen's Compensation Act. Bousquet v. Howe Scale Co., 96 Vt. 364 (1923). When a statute is adopted in Vermont from another state or country, if it has received a judicial interpretation there prior to its enactment in Vermont, it is to be taken that the language of the Vermont statute is used in the same sense given to it by such prior adjudication, unless some other sense is indicated by attendant provisions of the statute. Id., at 371, citing Warner v. Warner's Estate, 37 Vt. 356.
4. In Yates v. South Kirkby Collieries Limited, 2 K.B. 538 (1910), prior to the 1915 adoption of the Vermont Workers' Compensation Act, the English court ruled that a compensable injury occurred when a collier suffered a nervous injury after finding a coworker lying on the ground, mortally wounded.
5. In Bedini v. Frost, No. 94-624 (Vt. Sup. Ct. March 15, 1996), the Supreme Court confirmed that, in order for a mental injury caused by stress to be compensable under the Act, the claimant must show that the stresses at work were of a significantly greater dimension than the daily stresses encountered by all employees. The claimant has satisfied the evidentiary requirement to establish that the witnessing of a fatal accident in progress is a very unusual occurrence, and that it is a stressor of a significantly greater dimension than the daily stresses of other workers.
6. The credibility of the two doctors on the issue of causation is therefore the crux of this case. The weight to be given the respective testimony is determined not only by the content of the testimony but also by the demeanor of the witnesses. A witness who is responsive to the questions asked and who addresses the issues in the case concisely is more credible than one who rambles and chooses to answer something other than the question posed. In this regard, Dr. Borden's testimony fell well short of the mark. Moreover, his insistence that the claimant's difficulties arose from his incomplete grieving over the deaths of his parents some thirty years prior to the accident strains credulity when the claimant successfully handled the strains of his existence until the witnessing of a gruesome accident.
7. It must be said that Dr. Borden's claim that the accident was merely a focus through which 30 years of despair could be released does not relieve the employer of liability. If the claimant had, prior to the accident of June 5, 1994, an asymptomatic pre-existing condition and that condition became symptomatic as a result of the accident in question here, then the claim is compensable. See, inter alia, Campbell v. Heinrich Savelberg, Inc., 139 Vt. 31 (1980) and cases cited therein, Jackson v. True Temper, 151 Vt. 592 (1989), and Clark v. U.S. Quarried Slate Products, Opinion No. 8-95WC.
8. However, I find that the more probable hypothesis in this case is that the claimant, as a result of observing the accident of June 5, 1994, suffered Post Traumatic Stress Disorder, which was triggered by the second accident of November 22, 1994. I find that the claimant is not at an end medical result since his depression is arguably treatable. Further treatment specifically aimed at reducing the claimant's depression is appropriate. Because the claimant has not reached an end medical result, he is entitled to temporary total disability benefits and temporary partial disability benefits throughout his return to work, given that his wages at full time work did not ever equal his pre-injury average weekly wage. Because the claimant has not reached an end medical result, his claim for permanency is not ripe.
9. The claimant having prevailed is entitled to an award of attorney's fees in the amount of 20% of the total compensation awarded herein. Costs for Dr. Kinsler are awarded in the amount of $907.50, reflecting an award for the two letters ($175.00), $50.00 for the five page report [see Rule 40.112(B)], $367.50 for the evaluations, $90.00 for the conference with the attorney, and $225.00 for the testimony. There is no provision in the Fee Schedule for the payment for preparation time. The remaining costs of $413.79 are also awarded.
ORDER
THEREFORE, based on the foregoing findings of fact and conclusions of law, it is hereby ordered that:
1. Cigna Insurance Company, or in the event of its default Webster Corporation, pay the claimant temporary total disability benefits from November 25, 1994, to April 9, 1995; temporary partial disability benefits from April 10, 1995, through his termination; and temporary total disability benefits from his termination until he reaches an end medical result or has a successful return to work;
2. Cigna Insurance Company, or in the event of its default Webster Corporation, pay medical benefits pursuant to the terms of this decision;
3. Cigna Insurance Company, or in the event of its default Webster Corporation, pay attorney's fees in the amount of 20% of the sums awarded in Orders (1) and (2) and costs in the amount of $1,321.29; and
4. The claim for permanent partial disability benefits is denied as being premature.
DATED at Montpelier, Vermont this 22nd day of October 1996.
________________________________
Mary S. Hooper
Commissioner