Arline v. Administrator, Unpublished Decision (9-26-2000)
Arline v. Administrator, Unpublished Decision (9-26-2000)
Opinion of the Court
OPINION
Sarah L. Arline was injured in an automobile collision on February 23, 1995. On September 22, 1997, a copy of a First Report of an Injury, Occupational Disease or Death she had provided to her employer on January 24, 1997 was filed with the Ohio Bureau of Workers' Compensation ("BWC"). She sought workers' compensation benefits for her injuries, but the BWC issued an order denying benefits because her application had not been filed within two years of the injury. A district hearing officer for the Industrial Commission of Ohio ("commission") affirmed the decision of the BWC. A staff hearing officer for the commission agreed, and further review has been denied by the commission.Dr. Arline by then had retained legal counsel, who filed a direct appeal to the Franklin County Court of Common Pleas. A judge of that court granted summary judgment, again finding that Dr. Arline had failed to meet the requirement of R.C.
Counsel for Dr. Arline has now pursued a further direct appeal to this court, assigning a single error for our consideration:
The Trial Court erred in granting Defendant's Motion for Summary Judgment on the basis that Plaintiff's claim was time barred.
Dr. Arline was employed by LifeCare Alliance when she was injured. LifeCare Alliance is a state-fund employer, as opposed to a self-insuring employer, for purposes of workers' compensation matters. This fact was apparently unknown to her.
R.C.
(A) In all cases of injury or death, claims for compensation or benefits for the specific part or parts of the body injured shall be forever barred unless, within two years after the injury or death:
(1) Written notice of the specific part or parts of the body claimed to have been injured has been made to the industrial commission or the bureau of workers' compensation;
(2) The employer, with knowledge of a claimed compensable injury or occupational disease, has paid wages in lieu of compensation for total disability;
(3) In the event the employer is a self-insuring employer, one of the following has occurred:
(a) Written notice of the specific part or parts of the body claimed to have been injured has been given to the commission or bureau or the employer has furnished treatment by a licensed physician in the employ of an employer, provided, however, that the furnishing of such treatment shall not constitute a recognition of a claim as compensable, but shall do no more than satisfy the requirements of this section;
(b) Compensation or benefits have been paid or furnished equal to or greater than is provided for in sections
4123.52 ,4123.55 to4123.62 , and4123.64 to4123.67 of the Revised Code.(4) Written notice of death has been given to the commission or bureau.
(B) The bureau shall provide printed notices quoting in full division (A) of this section, and every self-insuring employer who shall post and maintain at all times one or more of the notices in conspicuous places in the workshop or places of employment.
If the words of R.C.
Now comes Sarah Arline and after being first duly cautioned and sworn, states the following:
1. At all times material hereto, I have been a physician who is licensed to practice medicine in the State of Ohio.
2. I have been employed for the past eleven years at LifeCare Alliance including at the time of the accident in question in 1995, as well as at the time I filed the claim with the personnel office at LifeCare.
3. I had always taken all insurance questions to the LifeCare Alliance personnel office and did the same thing with the Workers' Compensation papers on the claim which is the subject of this court case.
4. It was always my understanding that LifeCare alliance was self-insured which is why I turned all my forms in to the personnel office like all other insurance forms and incident reports.
5. The BWC form indicated to give the form to your self-insuring employer.
The forms utilized by the BWC for initial reports about work-related injury and disease tell the injured worker to "complete as much of this form as possible" and to "[t]ear off this sheet and return completed form to your local BWC Customer Service Office." The forms then include on the first page a section describing treatment received and a section to be completed by the employer. The employer section provides a space for the employer to certify or reject the claim, with an explanation. Dr. Arline also provided the trial court with copies of the forms she ultimately filed with the BWC.
Dr. Arline alleges in the forms ultimately filed that she notified LifeCare Alliance of her injuries originally in 1995. The forms demonstrate that she provided the forms (as required) to her employer on January 24, 1997, but that the employer did not complete the employer's portion of the forms until September 3, 1997. Thus, if the employer had promptly completed the forms and forwarded them to the BWC, the forms would have been received within the two-year time allowed. Instead, the employer or its representative waited over seven months to process the forms and then indicated that it was rejecting the claim "due to the time of injury after working hours, untimely notification of injury and no medical evidence provided." The forms filed to apply for benefits indicate that the collision was reported to LifeCare Alliance on the day after the collision, that the time of the collision was 5:25 p.m. and that Dr. Arline indicated she was suffering from injuries to her neck and head and from left side numbness. This information was already on the forms when LifeCare Alliance received them.
Under the circumstances, a trier of fact could infer that LifeCare Alliance was painfully slow in processing the forms or deliberately delayed processing the forms until after the two-year limit had passed.
R.C.
The average citizen of Ohio has no clue about the difference between self-insuring and state-fund employers. Indeed, most lawyers do not understand the difference. Injured workers should not be penalized for their lack of knowledge in this regard.
In workers' compensation matters, we are consistently bound by the mandate of R.C.
Sections
4123.01 to4123.94 , inclusive, of the Revised Code shall be liberally construed in favor of employees and the dependents of deceased employees.
This statutory mandate is in accord with the purpose of workers' compensation. Workers' compensation is intended to be a simple, efficient system of assuring that people who are injured on the job are fairly compensated and receive the medical treatment they need. Workers' compensation was not created to maximize business profits or to provide political benefit to those who administer the system.
Since the BWC has installed as a practical matter a requirement that the First Report of Injury, Occupational Disease or Death forms be submitted to employers, whether state-fund or self-insuring, before the form is to be processed by the BWC, we find that employers are deemed as agents of the BWC for purposes of R.C.
We note that Ohio Adm. Code
This provision of the Ohio Administrative Code tracks the language of R.C.
Each day that an employer fails to file a report required by this section constitutes an additional day within the time period given to a claimant by the applicable statute of limitations for the filing of a claim based on the injury or occupational disease, provided that a failure to file a report shall not extend the applicable statute of limitations for more than two additional years.
Thus, for workers who claim seven or more days of disability, R.C.
The legitimate purpose of R.C.
If the BWC foresees significant problems resulting from the employers being deemed agents of the BWC for purposes of R.C.
A second option is to modify the First Report of an Injury, Occupational Disease or Death Form so the injured worker is not responsible for providing the original copy of the form to the treatment provider and to the employer before filing with the BWC. The report could be a carbonless copy form with page one going directly to the BWC, page two to the medical provider and page three to the employer. Pages two and three could be duplicates of page one — with pages color coded and marked "for the BWC," "for your employer" and "for your medical provider." Other solutions are readily discernible.
Applying our interpretation of R.C.
Judgment vacated and cause remanded with instructions.
KENNEDY, J., concurs, BRYANT, J., dissents.
Dissenting Opinion
Being unable to agree with the majority opinion, I respectfully dissent. Pursuant to statute, plaintiff was to have notified the Bureau of Workers' Compensation or the Industrial Commission of her injury within the statutorily prescribed two years or be barred from pursuing the claim. Plaintiff failed to do so. Instead, she gave the form intended for the bureau or the commission to her state-fund employer who delayed in forwarding it for filing.
While the majority suggests the bureau's forms are confusing or even misleading, the form prescribed for First Report of Inquiry ("FROI") plainly sets forth a telephone number for reporting claims or the procedure for completing the FROI, including the direction to mail the completed form to the bureau at the address provided. Although the form also contains directions for self-insuring employers, it at the same time indicates the employer should be able to tell the injured worker if it is a self-insurer. Accordingly, even if the bureau's forms could be made still clearer, the current form creates neither deception nor confusion, apart from that inherent in having a system of both self-insured and state-fund employers with differing procedures for each.
Rather, the time lapse which resulted in plaintiff's claim being barred occurred either in her own delay in processing the form or in the employer's holding the form. If the latter be the cause, plaintiff's remedy may lie in an action against her employer. See Vandemark v. Southland Corporation (1988),
In any event, plaintiff's remedy, if factually supported, lies in her potential action against her employer, not in deeming all employers to be agents of the bureau for purposes of R.C.
Case-law data current through December 31, 2025. Source: CourtListener bulk data.