Adzima v. UAC/Norden Division
Adzima v. UAC/Norden Division
Opinion of the Court
The plaintiff, widow of the deceased employee, Emil Adzima, appeals from a judgment of the Court of Common Pleas sustaining the finding and award of the workmen’s compensation commissioner for the seventh district in denying benefits. The plaintiff’s appeal challenges the denial of her motion to preclude the defendants from asserting a defense, and the denial of her motion to correct the findings of the commissioner.
The material facts are not in dispute: Emil Adzima was employed by United Aireraft/Norden Division, located in Norwalk, Connecticut. On January 4, 1972, he slipped on some oil and, to avoid falling, twisted his body completely around. As a result of the accident, a myelogram was performed on February 9, 1972; on April 13, 1972, Adzima decided to undergo the surgery recommended by his treating physicians to relieve the pain in his lower back. Despite the surgical intervention he continued to complain of pain. A second myelogram was performed on October 25 and on November 6 it was suggested by his treating physician that his pain could be relieved by further surgery. Adzima, however, refused to have further surgery up to and including November 19, 1972. On that day, Emil Adzima died as a result of a coronary occlusion which was unrelated to the accident. From the date of the accident until his death the defendant insurance company, on behalf of the employer, paid in full all benefits due the decedent under the Work
The record discloses the following evidence pertinent to the determination of the plaintiff’s appeal. On December 11, 1973, approximately thirteen months following the employee’s death, the plaintiff sent a written notice of claim to the employer and its insurer seeking $12,350 in benefits for disability due to a specific injury to the decedent’s back under the provisions of § 31-308 (m)
Upon the plaintiff’s appeal from the decision of the commissioner, the Court of Common Pleas found that on February 2, 1972, the insurer sent to the injured employee an “agreement as to compensation,” commonly called a “voluntary agreement,” which the decedent did not sign and return; that the defendant insurer treated the claim as a compensable injury under the statute, and had made all payments of compensation and related medical bills to the date of death, and that as of that date the employee was under active treatment. The court concluded that, as the defendant had initially accepted liability to pay compensation, there was no contest which required notice pursuant to § 31-297 (b). The court sustained the commissioner’s finding and decision and dismissed the appeal. It is from that judgment that the plaintiff has appealed to this court.
We first address the plaintiff’s claim that the compensation commissioner erred by refusing to preclude the defendant employer from contesting the plaintiff’s right to receive compensation due to the defendant’s failure to file any notice with the commissioner of an intention to contest liability or the extent of the deceased’s disability. The plaintiff argues that that issue of preclusion is controlled by § 31-297 (b)
Attention must be focused upon the precise facts of Menzies. In that ease, the employer had contested the initial claim, of the employee as to the employer’s liability for compensation: the employer argued that the plaintiff’s injury did not “arise out of and in the course of his employment.” It was in this context — a disclaimer of initial liability — that we held that an employer was precluded from asserting a defense if it failed to specifically indicate grounds for a contest over liability. In the present ease, however, the defendant employer issued to the employee, Adzima, a voluntary agreement,
We have taken this occasion to again review the legislative history of § 31-297 (b); see Menzies v. Fisher, supra, 341-47; to determine whether it is necessary or appropriate to extend the “conclusive preclusion of defense” provision of that statute beyond situations where an employer contests its initial liability to pay compensation, to a situation such as the present case, where the employer disputes only the extent of the deceased’s disability. We have concluded that no such extension is warranted. First, the statute itself clearly delineates a distinction between liability and disability: “Whenever liability to pay compensation is contested by the employer,” the employer must file a specific defense. If the employer does not contest liability, it has “no right thereafter to contest the employee’s right to receive compensation on any grounds or the extent of his disability(Emphasis added.) The statute clearly speaks to a threshold failure on the employer’s part to contest “liability”: to claim, for example, that the injury did not arise out of and in the course of employment; see Menzies v. Fisher, supra, 340; that the injury fell within an exception to the coverage provided by workmen’s compensation; see Draus v. International Silver Co., 105 Conn. 415, 418, 135 A. 437 (1926); or that the plaintiff was not an employee of the defendant, but an independent contractor; see Biederzycki v. Farrel
Moreover, in Menzies, our discussion of the legislative history of § 31-297 (b), to which we may refer; Bird v. Plunkett, 139 Conn. 491, 504, 95 A.2d 71 (1953); 2 Sutherland, Statutory Construction (3d Ed.), p. 502; did not identify any intention on the part of the legislature that the “preclusion of defense” provision of § 31-297 (b) was designed to apply beyond a contest over initial liability. The legislature’s object in amending § 31-297 (b); see Menzies v. Fisher, supra, 342-43, quoting 12 H.R. Proc., Pt. 9, 1967 Sess., pp. 4035-4037; did not encompass a “preclusion of defense” situation where the only contest between the employer and the injured employee concerned the extent of the employee’s disability.
Finally, it is evident that the claim of the plaintiff in this case was for further disability payments under General Statutes §31-308 (m). Recovery of benefits under that section, which allows further payments of compensation for partial incapacity arising out of, inter alia, a back injury, presupposes that the initial liability for compensation has already been accepted: benefits paid under that section would be in the nature of continuing disability payments, arising after acceptance of an employee’s initial claim. As such, the plaintiff could properly have sought further payments for disability by means of a motion to modify, under the provisions
In sum, we find no error in the court’s denial of the plaintiff’s motion to preclude.
H
The plaintiff next claims that the court erred in refusing to correct the commissioner’s finding by adding thereto sixty-nine admitted or undisputed facts; by refusing to substitute the plaintiff’s conclusions for certain conclusions of the commissioner, and in refusing to remand the dispute to the commissioner for further proceedings upon a corrected finding. The plaintiff’s argument is that, with the addition of the above facts, the commissioner could not reasonably have concluded that the deceased had not reached a state of maximum improvement with respect to his back injury at the time of his death.
The plaintiff concedes, as she must, that in order for her to be entitled to an award for the decedent’s back injury, that injury must have reached “a state of maximum improvement” at the time of the decedent’s death. See Finkelstone v. Bridgeport Brass Co., 144 Conn. 470, 472, 134 A.2d 74 (1957); Panico v. Sperry Engineering Co., 113 Conn. 707, 714, 156 A. 802 (1931). It would serve no useful purpose to set forth in detail the testimony of the plaintiff’s medical expert, Dr. Thomas Coceo, which tended to show that Adzima had reached a state of maximum improvement, which further surgery could not alter, with respect to his back injury. The defendant employer’s expert, Dr. Harry P. Engel, a neurosurgeon, testified that Adzima had not reached a medical end result in his back condition, and that further surgical intervention, or nonsurgieal therapy, could only improve Adzima’s back condition.
We are mindful of the principles underlying Connecticut practice in workmen’s compensation cases: that the legislation is remedial in nature; Kennerson v. Thames Towboat Co., 89 Conn. 367, 375, 94 A. 372 (1915); and that it should be broadly construed to accomplish its humanitarian purpose. DeCarli v. Manchester Public Warehouse Co., 107 Conn. 359, 364, 140 A. 637 (1928). It is still true, however, that the power and duty of determining the facts rests on the commissioner, the trier of facts. Czep
It is also well settled in our practice that “[t]he finding of the commissioner should contain only the ultimate, relevant and material facts essential to the case in hand and found by him, together with a statement of his conclusions and the claims of law made by the parties. It should not contain excerpts from evidence or merely evidential facts, nor the opinions or beliefs of the commissioner, nor the reasons for his conclusions. The opinions, beliefs, reasons and argument of the commissioner should be expressed in the memorandum of decision, if any be filed, so far as they may be helpful in the
In view of the above principles, we cannot say that the court erred in sustaining the commissioner’s finding as to the state of the improvement of the decedent’s back injury, based as it was on the conflicting expert medical testimony of the parties; nor do we find error in the court’s refusal to remand the case for further proceedings on a corrected finding.
There is no error.
“[General Statutes] See. 31-308. compensation for partial incapacity. . . . (m) for the loss of the use of the back, that number of weeks which the proportion of incapacity represents to the maximum of five hundred and twenty weeks.”
“[General Statutes] Sec. 31-297. hearing op claims, (a) If an employer and his injured employee, or his legal representative, as the case may be, fail to reach an agreement in regard to compensation under the provisions of this chapter . . . the commissioner shall appoint an early hearing upon the matter.”
“[General Statutes] See. 31-297. hearing of claims. ... (b) Whenever liability to pay compensation is contested by the employer, he shall file with the compensation commissioner, on or before the twentieth day after he has received a written notice of claim, a notice in accord with a form prescribed by the commissioners stating that the right to compensation is contested, the name of the claimant, the name of the employer, the date of the alleged injury or death and the specific grounds on which the right to compensation is contested, and a copy thereof shall be sent to the employee. If the employer or his legal representative fails to file the notice contesting liability within the time prescribed herein, the employer shall be conclusively presumed to have accepted the compensability of such alleged injury or death and shall have no right thereafter to contest the employee’s right to receive compensation on any grounds or the extent of his disability.”
As we noted initially, the deceased did not sign and return the voluntary agreement issued by the defendant employer. The plaintiff cannot, however, seriously argue that the agreement had no effect, or was not binding. The parties stipulated that the agreement had been issued, and a total of forty-live payments were paid and accepted between January 6, 1972, and November 20, 1972. In light of the conduct of the parties in these circumstances, the deceased having retained the benefits paid by the defendants in reliance upon the existence of a voluntary agreement, it cannot be said that the agreement was not valid and binding. Corriveau v. Jenkins Bros., 144 Conn. 383, 387, 132 A.2d 67 (1957); Freda v. Smith, 142 Conn. 126, 134, 111 A.2d 679 (1955); Skelly v. Bristol Savings Bank, 63 Conn. 83, 87, 26 A. 474 (1893); see Brighenti v. New Britain Shirt Corporation, 167 Conn. 403, 406-407, 356 A.2d 181 (1974); Cecio Bros., Inc. v. Greenwich, 156 Conn. 561, 564-65, 244 A.2d 404 (1968); see, generally, 1 Williston, Contracts (3d Ed. Jaeger) §3; 5 Williston, Contracts (Rev. Ed.) § 1479; 66 Am. Jur. 2d, Restitution and Implied Contracts § 2.
In discussing the inadequacies of a general denial of liability in the context of the more demanding provisions of § 31-297 (b), we alluded to the “numerous possible defenses” encompassed in a mere general denial. Significantly, all of these defenses were of a procedural nature going to a lack of work-relatedness (lack of employer-employee status, death due to suicide or homicide, or death due to intervening injury) that would defeat the initial liability of the employer to pay compensation.
Furthermore, the two cases cited in Menzies in support of the decision to place the burden on the employer to allege a defense to an employee’s claim both involved employers who had contested the work-relatedness of the claimant’s injury; they did not involve contests over the extent of the claimant’s disability. See Newell v. North Anson Reel Co., 161 Me. 461, 214 A.2d 97 (1965); Chapman v. Foremost Dairies, Inc., 249 S.C. 438, 154 S.E.2d 845 (1967).
Dissenting Opinion
(dissenting). I cannot agree that §31-297 (b), the preclusion statute, is limited to situations in which the employer contests a plaintiff’s right to compensation on the grounds that the injury alleged was not compensable because “it did not arise out of and in the course of employment.” To my mind the express language of the statute and our decision in Menzies v. Fisher, 165 Conn. 338, 347, 334 A.2d 452 (1973), both militate against such a narrow interpretation of this statute.
Section 31-297 (b), by its terms, provides that whenever liability to pay compensation is contested, the employer must file notice of his intention to contest the claim and of the specific reasons therefor. The use of the word “whenever” in this statute is significant. This term, which is used to delimit the applicability of the statutorily required notice of disclaimer, is defined in Webster’s International Dictionary, Third Edition, as meaning “at any or
In Menzies, when this court was first called upon to interpret § 31-297 (b), we focused upon the mischief sought to be remedied by the legislature in enacting the statute, noting that the objective of the legislature was to ensure that employers would bear the burden of promptly investigating claims and that employees would be timely apprised of the specific reasons for denials of their claims.
We observed in Menzies (p. 343) that the notice of disclaimer required by § 31-297 (b) was intended to “diminish delays in the proceedings, [to] discourage arbitrary refusal[s] of bona fide claims and [to] narrow the legal issues which were to be contested.” Those considerations of public policy, which led to the enactment of the statute, would seem to be as applicable when an employer contests the right of a claimant to receive compensation for a specific injury as when the employer contests the right of a claimant to periodic benefits under the statute for a loss of earnings due to an allegedly work-related injury.
I can see no injustice in the statute’s requiring a defending employer or insurance carrier to investigate a case seasonably and to respond specifically to claims as filed. As we stated in Menzies (p. 348), “If an employer has . . . grounds for denying liability for compensation, there is no sound reason why he should not be required to advise the claimant
In my view, an employer’s denial of a claim for benefits under the specific injury portion of the workmen’s compensation statute is a “contest” of “liability to pay compensation” within the meaning of §31-297 (b), and as such the statute requires that the employer give notice of his intention to contest the claim, as a precondition to a defense on the merits.
Reference
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