Daimlerchrysler Corp. v. Self-Insuring, Unpublished Decision (2-2-2006)
Daimlerchrysler Corp. v. Self-Insuring, Unpublished Decision (2-2-2006)
Opinion of the Court
{¶ 2} This court referred the matter to a magistrate of this court, pursuant to Civ.R. 53(C) and Loc.R. 12(M) of the Tenth District Court of Appeals, who issued a decision, including findings of fact and conclusions of law. (Attached as Appendix A.) The magistrate concluded that relator has not demonstrated that SIEEB abused its discretion in finding that the self-insured complaint filed by the claimant was valid, and that relator has an adequate remedy in the ordinary course of law pursuant to the declaratory judgment provisions of the Ohio Revised Code. The magistrate accordingly recommended that this court deny the requested writ. Relator has filed objections to the magistrate's decision, and the matter is now before this court for a full, independent review.
{¶ 3} Relator's two objections to the magistrate's decision are as follows:
1. The Magistrate erred by finding that respondent Self-Insuring Employers Evaluation Board did not abuse its discretion in upholding the validity of the self-insured complaint filed against relator DaimlerChrysler Corporation.
2. The Magistrate erred by finding that relator DaimlerChrysler Corporation has an adequate remedy at law by means of a declaratory judgment action pursuant to the provisions of R.C. Chapter 2721.
{¶ 4} In this mandamus action, relator must establish that: (1) it has a clear legal right to the relief requested; (2) respondent SIEEB is under a clear legal duty to perform the act requested; and (3) relator has no plain and adequate remedy in the ordinary course of the law. State ex rel. Berger v.McMonagle (1983),
{¶ 5} By its first objection, relator argues that the magistrate erred in finding that SIEEB did not abuse its discretion in upholding the validity of the self-insured complaint filed against relator. Relator contends that SIEEB erroneously concluded that it had acted unlawfully in its attempt to directly recoup an overpayment, which was caused by a clerical error, from the claimant. Regarding the issue of whether relator improperly sought to recoup an overpayment directly from the claimant, SIEEB determined that "[n]o right exists under Ohio law for a self-insuring employer to unilaterally recoup overpayments of workers' compensation benefits directly from their employees, via payroll deduction, personal check, or otherwise. In the absence of such a right, the employer acted unlawfully in this case by demanding such payment from the injured worker." (Oct. 14, 2004 SIEEB Order, at 2.)
{¶ 6} In this mandamus action, relator seems to argue that its actions relating to its attempt to recover the overpayment were not precluded by any Ohio law and, therefore, because they were not contrary to law, they were not unlawful. Relator asserts that in order for an action to be "unlawful," it must have "broken some law." (Relator's Memorandum in Support of Objections to Magistrate's Decision, at 3.) It then follows, according to the reasoning of relator, that SIEEB's order was erroneous. We find that relator's definition of "unlawful" is not entirely accurate. As applicable in this case, Black's Law Dictionary defines "unlawful," as "[n]ot authorized by law; illegal." Black's Law Dictionary (7th Ed. 1999) 1536.
{¶ 7} In assessing whether SIEEB abused its discretion, the magistrate analyzed R.C.
{¶ 8} Subsequent to the magistrate's decision in this case, this court, in State ex rel. DaimlerChrysler v. Lopez, Franklin App. No. 04AP-882, 2005-Ohio-4640, at ¶ 4, determined that R.C.
{¶ 9} Therefore, in this case, relator was not "limited" to recovering an overpayment under R.C.
{¶ 10} Accordingly, we overrule relator's first objection to the magistrate's decision.
{¶ 11} Under its second objection, relator argues that the magistrate erred in finding that relator has an adequate remedy at law pursuant to the declaratory judgment provisions of R.C. Chapter 2721. Considering relator has failed to demonstrate a clear legal right to the relief requested, we need not address whether there exists an adequate remedy at law. Therefore, relator's objection as to that issue is moot.
{¶ 12} Based on our independent review of the record, we adopt the magistrate's findings of fact and conclusions of law, as amplified herein, as to the issue of whether relator has demonstrated a clear legal right to the relief requested. In accordance with the magistrate's decision, we deny the requested writ of mandamus.
Writ denied.
Bryant and Sadler, JJ., concur.
Jim Petro, Attorney General, and Dennis L. Hufstader, for respondent Self-Insuring Employers Evaluation Board.
Gallon Takacs Co., L.P.A., and Martha Wilson-Burres, for respondent Cynthia A. Miners.
Findings of Fact:
{¶ 14} 1. Claimant sustained a work-related injury on May 9, 2003, and subsequently filed a claim with the Ohio Bureau of Workers' Compensation ("BWC").
{¶ 15} 2. Due to her injury, claimant was off work from May 15 through June 3, 2003.
{¶ 16} 3. By letter dated July 25, 2003, relator, through its third-party administrator, ESIS, certified claimant's claim for: "right medial/lateral epicondylitis," and indicated that temporary total disability ("TTD") compensation would be paid to claimant from May 15 through June 3, 2003, because claimant was able to return to work on June 4, 2003. As such, relator requested that the hearing scheduled for August 1, 2003 be cancelled.
{¶ 17} 4. Due to clerical error, relator paid TTD compensation to claimant for the period from May 15 to July 6, 2003, instead of May 15 to June 3, 2003. By letter dated September 2, 2003, relator informed claimant of the overpayment and sought repayment in the amount of $3,036. In a September 2, 2003 letter, relator instructed claimant that she had the choice of repaying the money to relator in one of two ways:
* * * [Y]ou were overpaid Workers' Compensation benefits in the amount of $3036.00.
To complete the process, please sign and return the enclosed Payroll Deduction Authorization form immediately. * * *
-OR-
You may elect to pay the entire amount due by sending a personal check or money order in the amount of $3036.00 made payable to DaimlerChrysler Corporation within the next 30days. * * *
If you have questions, please contact me[.] * * *
(Emphasis sic.) Attached to the letter relator provided the following additional information:
Period of Time Paid:
TT paid 5/15/03-7/6/03 $4876.00 TT should be 5/15/03-6/3/03-1840.00 (EE RTW 6/4/03) TT OVERPAID $3036.00
{¶ 18} 5. By letter dated September 17, 2003, claimant, through counsel, sent a letter to ESIS requesting documentation concerning the overpayment and seeking medical records pertaining to six of claimant's workers' compensation claims.
{¶ 19} 6. On November 18, 2003, claimant filed a self-insured complaint against relator with the BWC's self-insured department. The complaint alleged that relator had not advised claimant that the overpayment could be taken out of future awards of compensation and was only given the option of a payroll deduction or making payments on the overpayment. Furthermore, the complaint alleged that relator had not provided the documentation claimant sought regarding the overpayment or provided copies of medical records as requested.
{¶ 20} 7. By letter dated November 26, 2003, ESIS responded on behalf of relator to claimant's self-insured complaint, in pertinent part, as follows:
This overpayment was recognized through an audit of the file and it is my understanding it did not arise through the reversal of an IC order. Our overpayment letter was reviewed previously by BWC Auditors and found to be acceptable upon slight modifications which were made several months ago.
My client, DaimlerChrysler, is supportive of the method of recovery here and indeed has challenged other allegations of a violation with respect to overpayments and their recovery. There is no foundation for this alleged complaint. Mr. William Holt, Attorney at Law and Disability Programs Manager with DaimlerChrysler, has spoken at great length in other instances and made it clear that a violation cannot exist if there is no clear principal of law, rule, or policy that proscribes the involved behavior. The law and rules do not proscribe this behavior. He previously stated that he is not even aware of clear policies that proscribe the behavior but, if they exist, they would conflict with other policies that do not appear to proscribe the behavior.
In terms of the allegation stating no documentation was provided regarding the overpayment, I will simply respond by saying the breakdown was accompanied within the overpayment letter. TT was paid through 7/6/03 although the claimant [returned to work] on 6/4/03. We sent the requested information in June for the original request and then again on 10/7/03. * * *
{¶ 21} 8. By letter dated February 27, 2004, relator was informed of the initial outcome of the investigation of claimant's complaint as follows:
* * * The complaint alleges that you, Daimler-Chrysler Corporation, informed the [injured worker] of the overpayment but did not tell her that the overpayment could be recouped from future awards. Instead, according to the complaint, you sent a letter requesting repayment through payroll deduction or by making payments. In the meantime, however, according to your documentation, the overpayment was recovered by deducting the full amount from a new period of TT which began on 08-26-2003 and ended 11-17-2003. It is BWC's position that overpayments are to be recouped by the percentages as outlined in ORC Section
(Emphasis sic.) Relator was also informed that the claimant's allegation that relator had failed to provide documentation and medical records was also valid.
{¶ 22} 9. By letter dated March 19, 2004, relator, through ESIS, requested reconsideration and provided the following explanation for relator's decision to recoup the overpayment from claimant in the manner attempted:
My client, DaimlerChrysler, asserts that the specific content of the overpayment letter was reviewed by the Bureau of Workers' Compensation at an audit in late 2002 and approved for use. Indeed the employer was present at the discussions involving this letter's format and the exact question of an "option" was addressed. The letter invites the claimant to call if there are any questions and, as per the employer, the auditors agreed that that opportunity was sufficient to allow an alternative to be addressed. * * * DaimlerChrysler suggests to you that there is no legitimate basis for the Ohio Bureau of Workers' Compensation to take two separate positions on the same issue and cannot overstress that this was specifically discussed with the auditors and that the employer was personally present at these discussions. In their opinion, DaimlerChrysler relied upon the Bureau's own personnel in proceeding as they have.
In terms of deducting the full amount, DaimlerChrysler contends that 4123.511(J) does not apply to all overpayments but that it is limited by its very own terms. It commences with the phrase "Upon the final administrative or judicial determination." The overpayment at issue was not one created by a "final administrative or judicial determination." Absent that fact pattern, they feel that code section does not apply.
{¶ 23} 10. By letter dated April 26, 2004, John Romig of the BWC's self-insured department issued a letter denying reconsideration of the self-insured complaint as it pertained to relator's attempt to recoup the overpayment and stated, in pertinent part, as follows:
While the Bureau has no reason to dispute the fact that an auditor approved a certain letter several years ago this employer has been advised on several occasions since that time that the information from the auditor was incorrect. Neither BWC nor a self-insuring may recoup an overpayment from future awards at 100% absent a specific finding of fraud.
On at least one previous occasion, Mr. Holt of Daimler has been informed of the Bureau's legal position on this issue. R.C.
In addition, I am enclosing the BWC policy contained in its Claims Management Guide that specifically addresses the recoupment of overpayments due to clerical error. This policy which I have enclosed indicates that" overpayments of compensation created by clerical error and return to work (RTW) are recouped according to ORC
{¶ 24} 11. By letter dated May 5, 2004, relator requested that the matter be submitted to SIEEB for further consideration; further asserting that relator's opinion that R.C.
{¶ 25} 12. On October 14, 2004, SIEEB issued its order upholding the validity of the self-insured complaint. SIEEB concluded that the overpayment did result from a clerical error. SIEEB explained relator's position as follows: relator argues that because the overpayment resulted from a clerical error and its unilateral declaration of an overpayment was not the result of a reversal of a prior order to pay compensation, relator was not restricted by R.C.
No right exists under Ohio law for a self-insuring employer to unilaterally recoup overpayments of workers' compensation benefits directly from their employees, via payroll deduction, personal check, or otherwise. In the absence of such a right, the employer acted unlawfully in this case by demanding such payment from the injured worker. See, e.g., State ex rel. Nestle USAPrepared Foods Div. v. Indus. Comm. (2003),
Additionally, a self-insuring employer is required pursuant to Ohio Administrative Code
The employer's September 2, 2003 letter to the injured worker in this case fails entirely to advise the injured worker of the basis of the overpayment declared in that letter. Further, the letter fails to advise the injured worker of her right to dispute the overpayment. Finally, the letter did not inform the injured worker that she had the right to have the overpayment recouped from future compensation awards, as permitted by law. By failing to provide the injured worker with information necessary to enable her to make an informed decision regarding the overpayment declared by the employer in this case, the employer failed to fulfill its obligations under Ohio Administrative Code
Although the employer has argued and presented testimony at hearing that the language used in its September 2, 2003, letter was based on a form that was approved by representatives of the Self-Insured Department of the Bureau of Workers' Compensation during a self-insured audit in October, 2002, the employer has failed to provide documentation of this approval. Therefore, the Board does not find the testimony of the employer's representative in this regard to be persuasive.
Further, irrespective of whether Bureau of Workers' Compensation auditors verbally approved the statements contained in the September 2, 2003 letter, the method employed in that letter to collect the overpayment was not authorized by law. Self-insuring employers authorized by the Bureau of Workers' Compensation to administer their employees' claims under the workers' compensation laws of Ohio are required to be familiar with those laws. Approval of unlawful activity by Bureau of Workers' Compensation representatives, actual or perceived, does not make the activity lawful.
{¶ 26} 13. Thereafter, relator filed the instant mandamus action in this court.
Conclusions of Law:
{¶ 27} The Supreme Court of Ohio has set forth three requirements which must be met in establishing a right to a writ of mandamus: (1) that relator has a clear legal right to the relief prayed for; (2) that respondent is under a clear legal duty to perform the act requested; and (3) that relator has no plain and adequate remedy in the ordinary course of the law.State ex rel. Berger v. McMonagle (1983),
{¶ 28} Relator asserts that it is entitled to a writ of mandamus ordering SIEEB to vacate its order finding that claimant's complaint was valid because relator's method of attempting to recoup the overpayment of TTD compensation paid to claimant was a result of clerical error on the part of relator was improper and unlawful. Relator asserts that R.C.
{¶ 29} R.C.
Upon the final administrative or judicial determination under this section or section
(1) No withholding for the first twelve weeks of temporary total disability compensation pursuant to section
(2) Forty per cent of all awards of compensation paid pursuant to sections
(3) Twenty-five per cent of any compensation paid pursuant to section
(4) If, pursuant to an appeal under section
The administrator and the self-insuring employers, as appropriate, are subject to the repayment schedule of this division only with respect to an order to pay compensation that was properly paid under a previous order, but which is subsequently reversed upon an administrative or judicial appeal. The administrator and self-insuring employers are not subject to, but may utilize, the repayment schedule of this division, or any other lawful means, to collect payment of compensation made to a person who was not entitled to the compensation due to fraud as determined by the administrator or the industrial commission.
{¶ 30} Prior to the enactment of R.C.
{¶ 31} R.C.
{¶ 32} Furthermore, former R.C.
{¶ 33} In State ex rel. Weimer v. Indus. Comm. (1980),
{¶ 34} R.C.
{¶ 35} Upon review of R.C.
{¶ 36} Furthermore, this magistrate finds that relator has an adequate remedy in the ordinary course of law. R.C.
Courts of record may declare rights, status, and other legal relations whether or not further relief is or could be claimed. * * * The declaration may be either affirmative or negative in form and effect. Such declaration has the effect of a final judgment or decree.
R.C.
Any person * * * whose rights, status, or other legal relations are affected by a constitutional provision [or] statute * * * may have determined any question of construction or validity arising under such * * * constitutional provision [or] statute * * * and obtain a declaration or rights, status, or other legal relations thereunder.
{¶ 37} Relator, in essence, seeks a declaration of its rights to recoupment under the law, including under R.C.
{¶ 38} Based on the foregoing, it is the magistrate's decision that relator has not demonstrated that SIEEB abused its discretion in finding that the self-insured complaint filed by the claimant was valid. Furthermore, the magistrate finds that relator has an adequate remedy in the ordinary course of law pursuant to the declaratory judgment provisions of the Ohio Revised Code. As such, this court should deny relator's request for a writ of mandamus.
Reference
- Full Case Name
- State of Ohio Ex Rel. Daimlerchrysler Corporation, Relator v. Self-Insuring Employers Evaluation Board and Cynthia A. Miners
- Cited By
- 2 cases
- Status
- Unpublished