Gill v. Brescome Barton, Inc.
Gill v. Brescome Barton, Inc.
Opinion of the Court
Opinion
In this workers’ compensation action, the defendant insurance carriers (insurers) for the named defendant, Brescóme Barton, Inc. (employer), contest their rights of apportionment, if any, for indemnity benefits paid to the plaintiff, Ronald F. Gill, Jr.
The commissioner found the following facts concerning the plaintiffs injuries, which the insurers do not dispute. The plaintiff sustained an injury to his left knee that arose out of and in the course of his employment on July 2, 1997 (first injury). The plaintiff, employer and Liberty Mutual entered into a voluntary agreement as to the plaintiffs permanent partial disability rating. Attached to the voluntary agreement is an office note dated April 10, 2008, from Norman R. Kaplan, the plaintiffs treating orthopedic surgeon. Kaplan stated in the note that the plaintiffs condition had worsened since 2003 and that he “will definitely need a total knee replacement” within the next three to five years. On April 3, 2002, the plaintiff sustained an injury to his right knee that arose out of and in the course of his employment (second injury). The employer, who was then insured by Chubb, accepted the second injury.
The commissioner found that the plaintiff was scheduled for bilateral knee replacement surgery (surgeries) pursuant to the recommendation of his physician and
The commissioner also found that the plaintiff had accepted, without prejudice, Chubb’s offer to pay him indemnity at the relapse rate of $692.75 for his disability period following the surgeries pursuant to General Statutes § 31-307b, commonly known as the relapse statute. Liberty Mutual, however, contended that it is not responsible for 50 percent of the indemnity and offered to pay 37 percent of Chubb’s base rate, or $181.36. Chubb rejected the offer.
A formal hearing was held before the commissioner on January 10, 2011, and the record was closed on February 14, 2011. The commissioner framed the hearing issue as what amount are the insurers, respectively, obligated to pay the plaintiff for periods of total and temporary partial disability following the bilateral knee surgeries, where each surgery concurrently disables the plaintiff.
The commissioner’s findings and award is dated May 19, 2011. In it he found that the plaintiff had reached
Liberty Mutual appealed from the corrected finding and award to the board, primarily claiming that the commissioner erred by requiring Liberty Mutual to reimburse Chubb 50 percent of indemnity paid the plaintiff postsurgery.
In affirming the commissioner’s finding and award, the board reasoned that if the plaintiff had not sustained the second injury, Liberty Mutual would have been obligated to pay the entire cost and indemnity attributable to knee replacement surgery resulting from the first injury. The board noted that double recoveries are disfavored under the Workers’ Compensation Act (act); see Nichols v. Lighthouse Restaurant, Inc., 246 Conn. 156, 164, 716 A.2d 71 (1998); Pokomy v. Getta’s Garage, 219 Conn. 439, 454, 594 A.2d 446 (1991); and that any award that paid the plaintiff a full disability benefit simultaneously for each knee injury would be void as against public policy. The board agreed with the commissioner that it would be irrational to force the plaintiff to undergo two knee replacement surgeries at different times and noted that the act cannot be construed in a manner that creates an “absurd or unworkable result.” See First Union National Bank v. Hi Ho Mall Shopping Ventures, Inc., 273 Conn. 287, 291, 869 A.2d 1193 (2005).
Our resolution of the claims on appeal begins with the applicable standard of review. “The principles that govern our standard of review in workers’ compensation appeals are well established. The conclusions drawn by [the commissioner] from the facts found must stand unless they result from an incorrect application of the law to the subordinate facts or from an inference illegally or unreasonably drawn from them. ... It is well established that [although not dispositive, we accord great weight to the construction given to the workers’ compensation statutes by the commissioner and review board. ... A state agency is not entitled, however, to special deference when its determination
I
Liberty Mutual claims that the board failed to adhere to the doctrine of stare decisis when resolving Liberty Mutual’s appeal. Liberty Mutual claims that under appellate decisions concerning General Statutes § 31-299b,
“The doctrine of stare decisis counsels that a court should not overrule its earlier decisions unless the most cogent reasons and inescapable logic require it. . . . Stare decisis is justified because it allows for predictability in the ordering of conduct, it promotes the necessary perception that the law is relatively unchanging,
“It is a rare case in which a court will reverse an administrative body because of its failure to apply the doctrine of stare decisis, or because in a particular case it has departed from the policy expressed in earlier cases. ... In those cases where reversal is justified, the administrative decision must be palpably arbitrary, unreasonable or discriminatory. . . . Reconsideration of a previously stated policy is a prerogative of administrative agencies, which are ordinarily not restrained under the doctrine of stare decisis or on the grounds of equitable estoppel. ” (Citation omitted; internal quotation marks omitted.) Germain v. Manchester, 135 Conn. App. 202, 213-14, 41 A.3d 1100 (2012). “If a reviewing court is satisfied that the administrative agency has provided a reasoned analysis for departing from its own established policy indicating that prior policies and standards are being deliberately changed and not casually ignored, so that agency’s path may reasonably be discerned, the court will affirm the agency’s decision.” 73A C.J.S. 165, Public Administrative Law & Procedure § 292 (2004); see Germain v. Manchester, supra, 214.
Liberty Mutual claims that the board failed to follow the precedent established by Hatt v. Burlington Coat Factory, supra, 263 Conn. 279, Mages v. Alfred Brown, Inc., 123 Conn. 188, 193 A. 780 (1937), Marroquin v. F. Monarca Masonry, 121 Conn. App. 400, 994 A.2d 727 (2010), and Maiz v. State/University of Connecticut Health Center, supra, No. 4701 CRB-6-03-07. Our review of each of those cases discloses that the facts regarding the injuries therein are distinguishable from the present case.
II
The essence of Liberty Mutual’s claims on appeal is that the board (a) failed to adhere to the applicable standard of review because it found facts with regard to the 2010 agreement not found by the commissioner and (b) improperly affirmed the commissioner’s finding and award as a matter of law. We conclude that the facts found by the board were gratuitous and unnecessary to the resolution of the legal issue before it, but that the board’s error, if any, was harmless. See Testone v. C. R. Gibson Co., 114 Conn. App. 210, 219, 969 A.2d 179 (error harmless if record reveals sufficient independent evidence to support decision), cert. denied, 292 Conn. 914, 973 A.2d 663 (2009). The findings of the commissioner are sufficient to support his award, which is grounded in the remedial purpose of the act.
A
Liberty Mutual claims that the board improperly found facts concerning the 2010 agreement that were not found by the commissioner. Assuming, without deciding; see footnote 10 of this opinion; that the board violated the standard of review by finding facts with respect to the 2010 agreement, we conclude that any error was harmless.
The following facts are relevant to Liberty Mutual’s claims. In its finding and award, the commissioner
In its decision, the board noted the commissioner’s finding that the 2010 agreement did not address the plaintiff’s relapse rate or the contribution each insurer was obligated to pay for indemnity. The board noted that workers’ compensation benefits derive exclusively from the act and that “ ‘[a] commissioner may exercise jurisdiction to hear a claim only under the precise circumstances and in the manner particularly prescribed by the enabling legislation.’ Cantoni v. Xerox Corp., 251 Conn. 153, 160, [740 A.2d 796] (1999).” The board found, however, that “the apportionment statutes and case law do not address the ‘precise circumstances’ ” of this case. It concluded that because the present dispute is one of first impression, it was required “to look at the expressed intent of the parties and the statutory approach to compensating total disability injuries in the absence of multiple liable parties.”
The board stated that lacunae are present in the act, and, that when issues are presented to it, the board has an obligation to reach a reasoned outcome consistent
Our Supreme Court has noted that “[o]ver the course of the last 100 years, [it] frequently has interpreted the provisions of our workers’ compensation statutory scheme by looking at the purpose and the legislative history of the act.” Marandino v. Prometheus Pharmacy, 294 Conn. 564, 577, 986 A.2d 1023 (2010). As discussed in part IIB of this opinion, the commissioner analyzed the plaintiffs injuries as being independent of one another, concluded that the replacement of either knee would involve a period of temporary total disability, determined that having simultaneous bilateral knee surgery benefitted the plaintiff as well as the insurers in that the plaintiff incurred only one period of recovery and decided that it made sense for the insurers to share equally the cost of indemnity. The board concluded that the commissioner’s award falls within the remedial purpose of the act. To require the plaintiff to undergo two surgeries at different times would constitute an absurd result under the act. See Linden Condominium Assn., Inc. v. McKenna, 247 Conn. 575, 583-84, 726 A.2d 502 (1999) (statutes cannot be construed to yield absurd result).
On the basis of this analysis, we conclude that the commissioner’s findings are sufficient to support his award. If the board’s findings with respect to the insurers’ intent regarding incidental expenses deviated from the standard of review, we conclude that any error was
B
Liberty Mutual also claims that the board’s decision is not supported by competent evidence and that the order to reimburse Chubb 50 percent of the indemnity it pays to the plaintiff is erroneous as a matter of law. We disagree.
The commissioner found that neither insurer disputed that the plaintiffs need for bilateral knee surgery was reasonable and medically necessary. He also found that knee replacement surgery for either knee would result in a period of disability. Moreover, the plaintiffs “decision to undergo both knee replacements simultaneously benefits [him] in that he has only one period of recovery and also benefits both insurance carriers in that they are able to split many of the surgical and postsurgical costs that would be duplicative had the [plaintiff] opted for two separate surgeries.” In reviewing the commissioner’s analysis, the board found that forcing the plaintiff to undergo separate knee replacement at different times and to incur a longer period of disability would be irrational. We agree.
In deciding the claim, we are mindful of the act’s remedial purpose. “[T]he act indisputably is a remedial statute that should be construed generously to accomplish its purpose. . . . The humanitarian and remedial purposes of the act counsel against an overly narrow construction that unduly limits eligibility for workers’ compensation. . . . Accordingly, [i]n construing workers’ compensation law, we must resolve statutory ambiguities or lacunae in a manner that will further the remedial purpose of the act. . . . [T]he purposes of the act itself are best served by allowing the remedial legislation a reasonable sphere of operation considering
On appeal to this court, Liberty Mutual contends that the commissioner’s finding and award is erroneous as a matter of law because enforcement of the 2010 agreement pursuant to General Statutes § 31-303 was not identified in the notice of the formal hearing as an issue to be resolved.
Liberty Mutual argues that Hatt v. Burlington Coat Factory, supra, 263 Conn. 279, controls because the plaintiffs “single period of disability following his simultaneous surgeries will be a result of the inextricable combination of the two injuries. Therefore, inasmuch as it is necessary for the two injuries to combine to reach the same conclusions found in the Hatt case, the same would be applicable to the instant case.” (Internal quotation marks omitted.) This argument ignores the commissioner’s finding that the plaintiffs first and second injuries are separate and distinct and that neither injury affects the other. In fact, Liberty Mutual has acknowledged, as it must, that it would be liable for any temporary total disability the plaintiff would incur if he had knee replacement surgery for the first injury independent of the surgery for the second
We also disagree with Liberty Mutual’s claim that the board’s decision cites no law to support it. The board relied upon § 31-278, which provides in relevant part that “[e]ach commissioner . . . shall have all powers necessary to enable him to perform the duties imposed upon him by the provisions of’ the act. “The purpose of the [act] is to compensate the worker for injuries arising out of and in the course of employment, without regard to fault, by imposing a form of strict liability on the employer .... [The act] compromise^] an employee’s right to a common law tort action for work related injuries in return for relatively quick and certain compensation. . . . The act indisputably is a remedial statute that should be construed generously to accomplish its purpose. . . . The humanitarian and remedial
We agree with the reasoning of the commissioner and the board that the remedial purposes of the act are fostered by the plaintiffs undergoing bilateral knee replacement surgery with one period of recovery. The act is to provide for “relatively quick and certain compensation.” Mingachos v. CBS, Inc., supra, 196 Conn. 97. Moreover, the commissioner’s finding and award benefits the insurers in that they are able to share in the costs of the plaintiffs temporary total disability postsurgery. Although the commissioner ordered each insurer to pay 50 percent of the indemnity owed the plaintiff, he did not order the parties to apportion a percentage of the indemnity for a single injury or combination of injuries. The commissioner directed the insurers to pay 50 percent of the plaintiffs indemnity for a period of disability he elected to incur by having the separate first and second injuries treated by means of simultaneous bilateral knee replacement surgeries. Liberty Mutual acknowledges it is responsible for the plaintiffs first injury and that it would be hable for all costs if the plaintiff had knee replacement surgery for the
The decision of the workers’ compensation review board is affirmed.
In this opinion the other judges concurred.
Neither the plaintiff nor the employer is a party to this appeal.
On appeal, Liberty Mutual has not contested the commissioner’s finding and award as to the plaintiffs relapse rate.
In its brief on appeal, Liberty Mutual cites a colloquy among the commissioner and counsel for the insurers during the formal hearing. The relevant portions of the transcript reveal the following exchange:
“[Commissioner]: And there is no dispute as to the medical necessity or the reasonableness of the surgeries, correct?
“[Counsel for Liberty Mutual]: Correct, commissioner, I believe there is even an agreement in your file. . . .
“[Commissioner]: And that will be administered by the last carrier, which is Chubb, correct . . . ?
“[Counsel for Chubb]: Yes, commissioner, pursuant to an agreement entered into by the parties at an informal hearing with a writing on March 10, 2010. Chubb will administer the bilateral total knee replacements and seek reimbursement from the Liberty for 50 percent of all expenses related to the surgery and prescription meds.
“[Counsel for Chubb]: Let me just, for the record, the argument of Chubb is that as each one of these surgeries are from separate and distinct injuries and each one of these surgeries in and of itself could make the [plaintiff] temporarily totally disabled medically, that any other law other than a 50/ 50 apportionment between Liberty and the Chubb is inappropriate because they aren’t, they aren’t melding together to make the [plaintiff] temporarily totally disabled, the surgeries aren’t melding together, they are separate and distinct, and each one could make the claimant temporarily totally disabled. ... We would seek 50 percent of the temporary total disability payments from the Chubb as it would pertain to [the plaintiffs] recuperative period. ... If the commission should so find that the relapse rate is the appropriate rate in this case, I would ask that that relapse rate of $692.75 be apportioned 50/50 between the Chubb and Liberty. Obviously, if the commission chooses no relapse rate and reverts to the prior temporary total disability rate ... I would argue 50 percent of whatever rate is chosen by the commissioner. . . .
* * *
“[Commissioner]: Okay. So the only issue I need to sort out is what, if any, amount Liberty will have to pay.
* * *
“[Commissioner]: You are going to have the surgery, [plaintiff], and you’re going to have it at the relapse rate that [Chubb’s counsel] described. The issue of who is to pay what, Chubb is going to pay for the surgery and authorize the surgery, Chubb is going to administer the claim, and I will determine what amount if any liberty has to pay back Chubb in regards to the weekly paycheck, the indemnity portion but not the medical portion, they already worked out, okay?”
The plaintiffhad bilateral knee replacement surgery on February 24,2011.
Liberty Mutual filed a motion to correct the finding and award. The commissioner accepted two corrections that do not affect the issues on appeal.
Liberty Mutual gave the following reasons for its appeal to the board: (1) the commissioner erred in ordering it to reimburse Chubb 50 percent of the indemnity paid to the plaintiff postsurgery, (2) the finding and award fails to cite any statute or case law that provides a legal basis for reimbursement, (3) there is no legal basis for the reimbursement ordered, (4) Chubb’s reliance on common law apportionment andMund v. Farmers’ Cooperative, Inc., 139 Conn. 338, 94 A.2d 119 (1952), to seek reimbursement from it is legally incorrect, and (5) the commissioner erred in denying Liberty Mutual’s motion to correct in its entirety.
General Statutes § 31-278 provides in relevant part: “Each commissioner shall . . . have the power to certify official acts and shall have all powers necessary to enable him to perform the duties imposed upon him by the provisions of this chapter. . . .”
General Statutes § 31-299b provides in relevant part: “If an employee suffers an injury or disease for which compensation is found by the commissioner to be payable according to the provisions of this chapter, the employer who last employed the claimant prior to the filing of the claim, or the employer’s insurer, shall be initially liable for the payment of such compensation. The commissioner shall, within a reasonable period of time after issuing an award, on the basis of the record of the hearing, determine whether prior employers, or their insurers, are liable for a portion of such compensation and the extent of their liability. If prior employers are found to be so liable, the commissioner shall order such employers or their insurers to reimburse the initially liable employer or insurer according to the proportion of their liability. • • •”
The board concluded that none of the following cases relied upon by the parties controlled the issue in this case. We agree.
In Mages v. Alfred Brown, Inc., supra, 123 Conn. 188, Gabriel Mages injured his spine while in the employ of one employer who accepted the injury. Id., 190. Mages was later employed by a second employer when he fell and reinjured his spine and was no longer able to work. Id. Our Supreme Court held that the insurer for the second employer was liable for the disability because there were two injuries and Mages’ prior injury had no effect on the liability of the second employer, as Mages probably would have been able to continue to work save for the second injury. Id., 194. Mages is distinguishable from the facts of the present case where there are two separate injuries, each of which independently renders the plaintiff disabled.
The case of Marroquin v. F. Monarca Masonry, supra, 121 Conn. App. 400, is distinguishable, as well. This court determined that Halt did not control Marroquin because it was factually distinct. In contrast to Hatt, which involved “successive insurers for the same employer and a claimant with two separate and distinct injuries, each of which was suffered during a different insurer’s policy coverage, we are presented [here] with multiple insurers and a claimant with a single injury. We do find highly significant the Supreme Court’s statement in Hatt that in enacting § 31-299b, the legislature explicitly provided for an apportionment scheme in the single injury and multiple employer or insurer scenario . . . and we conclude that under § 31-299b, the commissioner had the authority to apportion liability to the responsible employer-insurer in this single injury and multiple employer or insurer scenario.” (Citation omitted; emphasis added; internal quotation marks omitted.) Id., 411-12. Because Marroquin concerned a single injury, it is inapposite to the present case.
Malz v. State/University of Connecticut Health Center, supra, No. 4701 CRB-6-03-07, also is distinguishable. In that case, Stephania Malz suffered an injury to her lumbar spine and cervical spine in 1990. She suffered a second injury to her cervical spine in 1994. The commissioner concluded that the insurance carrier for the 1994 injury was not entitled to apportionment pursuant to Hatt v. Burlington Coat Factory, supra, 263 Conn. 279, “where two separate compensable injuries contribute to subsequent disability.” In the present case, two separate injuries do not contribute to the plaintiffs disability-
Before the board, Chubb relied on Mund v. Farmers’ Cooperative, Inc., supra, 139 Conn. 338, for its apportionment claim. The board distinguished Mund in its opinion. Chubb does not rely on Mund on appeal before this court. We agree with the board that the facts of Mund are distinguishable from the present facts. In Mund, the claimant suffered a ruptured disc in 1946, but eventually was able to return to work, and subsequently reopened the disc in an accident in 1950. Id., 340-41. The commissioner found that the two ruptures of the disc were “equal, concurrent and contributing causes” of the claimant’s resulting disability. Id., 341. The injury was apportioned between the two carriers. Id.
We note that the general principles governing the construction of a contract are well established. “If a contract is unambiguous within its four comers, intent of the parties is a question of law requiring plenary review. . . . When the language of a contract is ambiguous, the determination of the parties’ intent is a question of fact, and the trial court’s interpretation is subject to reversal on appeal only if it is clearly erroneous.” (Internal quotation marks omitted.) Sagalyn v. Pederson, 140 Conn. App. 792, 795, 60 A.3d 367 (2013). Whether the 2010 agreement is ambiguous was not briefed by the insurers. Although that issue would affect the board’s standard of review, we need not decide the question of ambiguity to resolve Liberty Mutual’s claim.
The formal hearing notice listed three issues: “§ 31-299b—Apportion-ment of Liability; § 31-307b—Recurrence of Prior Injury; [General Statutes] § 31-310—Compensate Rate/Average Weekly Wage.”
The corollary to this acknowledgement is that Liberty Mutual is liable to pay the plaintiff indemnity for the disability resulting from knee replacement surgery due to the first injury whether it is done separately or in combination with the second injury knee replacement surgery. If both Liberty Mutual and Chubb paid the plaintiff temporary total disability for the same period of time, the plaintiff would receive a double recovery. The board properly noted that double recoveries under the act are disfavored. See Enquist v. General Datacom, 218 Conn. 19, 26, 587 A.2d 1029 (1991); see also 6 A. Larson & L. Larson, Workers’ Compensation Law (2012) § 110.02, pp. 110-3 through 110-6.
Reference
- Full Case Name
- RONALD F. GILL, JR. v. BRESCOME BARTON, INC.
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- 4 cases
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- Published