Moore v. DC DOES and Marshall Heighst Community Development
Moore v. DC DOES and Marshall Heighst Community Development
Opinion
Bryant Moore injured his back in a 2008 car crash while working for Marshall Heights Community Development Organization, Inc. ("Marshall Heights"). An administrative law judge ("ALJ") dismissed Moore's claim for workers' compensation benefits, and the Compensation Review Board ("CRB") agreed. In an unpublished memorandum opinion and judgment, this court affirmed the CRB's rulings on the two issues that the board had analyzed under
I. Background
In March 2010 the Office of Workers' Compensation authorized Moore to visit a neurosurgeon and receive medical reimbursements related to the injuries he sustained in the car accident. Marshall Heights made periodic payments to Moore for lost wages and medical benefits that totaled $15,325.73. (The organization had terminated Moore in March 2009 because it no longer had grant funding for his position.) Moore also sued the parties allegedly responsible for the accident and procured a $15,000 settlement, unbeknownst to Marshall Heights. In June 2012 Moore sought further payments through the Office of Workers' Compensation. After Marshall Heights discovered that Moore had settled with third parties, it moved to dismiss the claim.
Although Moore acknowledges that Marshall Heights did not approve his third-party compromise, he contends that *161 the word "compensation" does not encompass medical benefits. The CRB - a panel within the Department of Employment Services - disagreed in a decision issued on June 16, 2017. Adopting statutory interpretation conducted by the ALJ, and focusing especially on the provisions of § 32-1535(e), the board concluded that the result advocated by Moore "is illogical and the statute simply cannot be read this way." Therefore, it said, Moore's unauthorized settlement absolved Marshall Heights from liability for all further payments. Moore again petitioned for review. 2
II. Legal Analysis
This court reviews an agency's interpretation of a statute that it administers using the two-part test of
Chevron, U.S.A. Inc. v. Nat. Res. Def. Council, Inc.
,
When an employee is injured by a third party, he or she "need not elect" at the outset between pursuing civil damages from the tortfeasor and receiving compensation under the statute.
See
If the claim has been assigned to the employer, it may pursue reimbursement from third parties by seeking a judgment or entering into a compromise.
See
Of course, the injured person may file a third-party action if he or she does so within the time allowed. If the worker receives a judgment against the third person, the amount of any workers' compensation award is reduced accordingly. "[T]he employer shall be required to pay as compensation under this chapter a sum equal to the excess of the amount which the Mayor determines is payable on account of such injury or death over the amount recovered against such third person."
We twice have addressed the impact of unauthorized settlements, interpreting the language of § 32-1535(g) strictly to bar further recovery from the employer. In
Pannell-Pringle
this court held that an unauthorized settlement barred a claim for future disability benefits even if the settlement occurred before the agency issued a compensation order.
See
This case centers on the meaning of "compensation" in § 32-1535(g), which states:
If compromise with such third person is made by the person entitled to compensation or such representative of an amount less than the compensation to which such person or representative would be entitled under this chapter, the employer shall be liable for compensation as determined in [ § 32-1535(f) ], only if the written approval of such compromise is obtained from the employer and his insurance carrier by the person entitled to compensation or such representative at the time of or prior to such compromise in a form and manner prescribed by the Mayor.
We conclude that the meaning of "compensation" in § 32-1535(g) is ambiguous. The definitional section of the chapter identifies "compensation" as "the money allowance payable to an employee or to his dependents as provided for in this chapter, and includes funeral benefits provided herein."
See
This court has explored the distinction between wage-loss benefits and medical benefits in different scenarios. In
Santos v. District of Columbia Dep't of Emp't Servs.
,
However, this court has recognized that the portion of the statutory scheme governing when compensation shall commence "specifically refers to medical benefits as encompassed within the meaning of compensation."
C & P Tel. Co. v. District of Columbia Dep't of Emp't Servs.
,
The court reviewed another part of the workers' compensation statute, the notice provision, in
Safeway Stores, Inc. v. District of Columbia Dep't of Emp't Servs.
,
Such cases illustrate the context-specific meaning of the word "compensation." Just as
Santos
considered legislative intent in reviewing one portion of the workers' compensation statute,
Pannell-Pringle
noted that § 32-1535(g) "contains strong language limiting the liability of the employer when the employee has entered into an unauthorized settlement."
We conclude that it did. In the original compensation order, the ALJ reasoned *164 that allowing an employee to continue receiving medical benefits from an employer after the employee has compromised a claim against a third party without the employer's consent would allow the employee to receive double compensation and render the consent requirement meaningless by defeating the employer-protective purpose of § 32-1535(g). Specifically, the ALJ also noted that § 32-1535(e) provides that an employer who has been assigned a claim against a third party and recovers some amount of money from the third party may retain the value of past and future wage-loss payments and medical benefits paid to the employee.
If the term "compensation" did not include medical benefits, the employee could continue to receive those benefits from the employer in "the scenario in the case at bar" even after he had been compensated by the third party. Commenting that subsection (g) "cannot be read in a vacuum," the ALJ stated that it would be "illogical" to allow an employer to recover from a third party the medical benefits that it had paid to the employee (per subsection (e)) while allowing an employee "to extinguish that opportunity" under subsection (g). The ALJ also found it would be "inconsistent" to have the employer be "entitled to reimbursement for medical benefits from a third-party" yet "remain liable to claimant for such benefits following an unauthorized settlement" of that claim. These illogical and inconsistent results would obtain if a "claimant could settle his or her claim against the third-party without consequence to the right to receive future medical care, while not protecting the employer's right as to the third-party." The ALJ concluded that this interpretation "aligns with the Court of Appeals['] reasoning in Pannell-Pringle - the employer is not prejudiced by a low settlement."
In its compensation order on remand, the CRB adopted and relied on the ALJ's reasoning, stating that "the purpose of
We agree with the CRB's analysis based on the twin goals of avoiding double recovery by the employee and preventing prejudice to the employer by settlements that compromise the employer's lien. It is reasonable to conclude that unauthorized settlements that would permit either result bar an employee's claims for any further benefits under the statute. Given the ambiguity of the statutory term "compensation" and the reasonableness of the CRB's contextual interpretation in light of the statutory purpose, we defer to that interpretation and hold that, under
*165 III. Conclusion
Because the CRB reasonably interpreted "compensation" in
Affirmed.
The appellant unsuccessfully had argued that the statutory subsection should not apply to his case because (1) the settlement only covered emotional distress, pain, and suffering and (2) Marshall Heights lacked workers' compensation insurance at the time of the injury.
Moore raises additional arguments in his brief that he did not address to the agency. Since "[c]laims not properly preserved in the administrative setting are generally considered forfeited,"
Black v. District of Columbia Dep't of Human Servs.
,
After the events relevant here took place, the Council of the District of Columbia added that the cause of action is assigned back to the injured person if the employer has not acted within ninety days of the original assignment. See Workers' Compensation Statute of Limitations Amendment Act of 2014, 2014 D.C. Sess. Law Serv. 20-159 (West).
"[I]t is well settled that an employer who has paid workers' compensation benefits has an equitable lien against any such recovery to the extent of such benefits."
Washington Metro. Area Transit Auth. v. Reid
,
The statute defines the term "disability" as "physical or mental incapacity because of injury which results in the loss of wages."
Section 32-1507(a) lists many examples of "medical, surgical, [and] vocational rehabilitation services" that an employer must provide, including "nurse and hospital service," "medicine," and "crutches."
Hospital and medical bills compose about sixty percent of workers' compensation benefits paid nationwide. See 8 Larson § 94.01[1], at 94-3 (citing a 2015 report).
It is possible that a settlement agreement might not implicate either concern because it expressly includes compensation for only certain claims, e.g., medical benefits or disability benefits, without releasing other claims, such that the employee is not being paid twice and the employer's lien is not being compromised. This, however, is not the "scenario in the case at bar" to use the ALJ's phrase. Petitioner has not provided a copy of the settlement agreement. However, a letter from petitioner's counsel, noted by the ALJ, indicates that at least part of the settlement with the third-party tortfeasor was for medical services. As the employer argued to the CRB, the "employer would lose this protection" of § 32-1535(g) "if the claimant, as the claimant did herein, can use the medical bills paid by the employer as a foundation for his recovery in a third-party claim." The amount of settlement, $15,000, also corresponds with payments in the amount of $15,325 made by the employer to petitioner that included both disability and medical benefits.
Case-law data current through December 31, 2025. Source: CourtListener bulk data.