## Facts

- Paula Wood, a nurse employed by Fletcher Allen Health Care (FAHC), suffered a work-related shoulder injury in November 1995 and received temporary total disability (TTD) benefits.
- In mid-1997, her physician recommended shoulder surgery for the work injury, but advised postponement because Wood was pregnant.
- FAHC issued a notice discontinuing TTD benefits effective August 21, 1997, asserting pregnancy was a superseding intervening cause.
- The Commissioner reviewed the notice, found insufficient support for discontinuance, and ordered benefits to continue pending a hearing.
- After hearing, the Commissioner ruled that Wood’s TTD benefits should not be terminated due to pregnancy and the related delay in surgery; reconsideration was denied.
- Wood gave birth in February 1998 and underwent the shoulder surgery in June 1998.
- FAHC appealed the administrative decision.

## Issues

1. Whether Wood’s pregnancy was a superseding intervening cause that severed the causal link between the work injury and continued disability, permitting discontinuance of TTD benefits.
2. Whether pregnancy could be treated as a “flare-up” ending the employer’s responsibility for the original work injury during the pregnancy period.
3. Whether delaying surgery on a physician’s recommendation due to pregnancy constituted an unreasonable refusal of medical treatment justifying discontinuance of benefits.
4. Whether continuing TTD benefits during pregnancy granted impermissible special treatment to pregnant workers in violation of equal protection under the Vermont Constitution.

## Decision

- The Vermont Supreme Court affirmed the Commissioner’s decision continuing TTD benefits.
- Pregnancy did not constitute a superseding intervening cause because the work injury, not pregnancy, caused the ongoing inability to work.
- The evidence did not support treating pregnancy as a “flare-up” that would end liability for the work injury.
- Delaying surgery on medical advice was reasonable and did not amount to refusal of treatment.
- Continuing benefits under these circumstances did not violate equal protection because the decision applied a generally applicable workers’ compensation policy rather than a pregnancy-specific preference.
- The Court deferred to the Commissioner’s factual findings, which were supported by the record and not clearly erroneous.

## Legal Principles

- TTD benefits are payable when a work injury causes total disability for work under 21 V.S.A. § 642.
- An employer remains liable for disability caused by a compensable work injury unless an independent, superseding intervening cause breaks the causal chain.
- A non-work condition that does not itself disable the claimant or aggravate the compensable injury does not, without more, sever causation merely because it delays treatment.
- Benefits may be affected by an unreasonable refusal of recommended medical treatment, but reasonableness is assessed in light of medical advice and circumstances; a medically advised delay is not a refusal.
- Administrative findings in workers’ compensation cases receive deference on appeal and are not disturbed absent clear error or lack of evidentiary support.
- Equal protection is not violated where a benefits decision applies neutral causation and treatment-refusal standards rather than granting pregnancy-based exemptions.

## Conclusion

The court held that a claimant who remains totally disabled due to a compensable work injury does not lose TTD benefits simply because pregnancy delays surgery, where pregnancy is not independently disabling and the claimant reasonably follows medical advice; applying these standards does not create unconstitutional special treatment for pregnant workers.


Wood v. Fletcher Allen Health Care, 739 A.2d 1201 (Vt. 1999)