In a decision likely to interest workers’ comp insurers and claims managers, West Virginia’s highest court has affirmed that symptoms like pain - even if ongoing - aren’t enough to expand a claim. A worker needs a proper diagnosis backed by medical evidence.
The case involves John J. Delsignore, who was working as a tree feller in January 2021 when a falling branch struck him on the job for Timberline Logging Enterprises. The impact fractured and dislocated his right ankle, and he was rushed to Garrett Regional Medical Center in Maryland, where orthopedic surgeon Dr. Dona Alvarez performed surgery that same day.
Not long after, Delsignore filed a workers’ compensation claim. The claim administrator approved two conditions as compensable: a displaced trimalleolar fracture of the right leg and a contusion of the lower back and pelvis. That part was uncontested.
But a few months later, Delsignore began reporting continued ankle pain, swelling, and low back pain with sciatica. His doctor believed these were related to the injury and diagnosed him with post-traumatic arthritis in the ankle and pain in the left hip and lower back. Dr. Alvarez asked that these additional issues be officially added to the claim.
That request was denied. Delsignore challenged the decision, and the case made its way through the state’s workers’ compensation appeal system - first to the Board of Review, then the Intermediate Court of Appeals, and finally the Supreme Court of Appeals of West Virginia.
The heart of the dispute came down to medical proof. Delsignore underwent two independent evaluations with Dr. Christopher Martin, a physician in the Department of Occupational Medicine at West Virginia University. Dr. Martin didn’t dispute the original injuries, but he didn’t find evidence - such as X-rays or clear imaging - to support a current diagnosis of post-traumatic arthritis. In fact, he said arthritis typically doesn’t set in that quickly after an injury, though he acknowledged Delsignore might develop it later on.
Interestingly, Dr. Martin agreed that a custom brace and orthotic might help manage the ankle symptoms, as suggested by Dr. Alvarez. But he emphasized that treatment plans alone don’t establish a diagnosis, and that pain - no matter how limiting - is considered a symptom, not a condition, under West Virginia law.
The Workers’ Compensation Board of Review sided with the claim administrator, pointing out that x-rays didn’t show arthritis and that the hip and back issues were described only as “pain,” not as medically diagnosed injuries. The Intermediate Court agreed, and on May 1, 2025, the Supreme Court affirmed the decisions below.
The court reiterated that in West Virginia, you can’t add conditions to a claim just because someone is still hurting. The evidence has to show a medically supported diagnosis. Pain, as the court noted, is not compensable on its own.
There was also no dispute about what caused the injury. The courts didn’t question whether Delsignore was hurt on the job - they accepted that. But without clear evidence that the new complaints amounted to actual, diagnosable conditions, the claim couldn’t be expanded.
The court also addressed legal arguments raised by Delsignore’s attorneys about presumptions in favor of injured workers. Those didn’t apply, the court said, because there was no factual finding that the evidence was evenly balanced. Instead, the rulings consistently found that the medical proof fell short.
For insurance professionals, this case underscores the importance of solid documentation and clear diagnostic support when handling workers’ comp claims - especially when additional injuries are claimed after initial treatment. Courts are willing to acknowledge pain, but not compensate it unless there’s a concrete medical diagnosis to go with it.
