Injured Worker Must File Application During Lifetime to Receive Certain Benefits
By filing for workers’ compensation benefits after his death, a quadriplegic worker’s estate did not establish a clear legal right to the full award it sought, the Supreme Court of Ohio ruled today.
The 4-3 decision affirms the Tenth District Court of Appeals ruling upholding the Industrial Commission’s determination that the Bureau of Workers’ Compensation wasn’t required to award benefits during the worker’s lifetime when no application was filed and that, following his death, benefits were limited to two years instead of the 850 weeks the estate argued was appropriate.
In 1991, Dean Sziraki suffered catastrophic brain and spinal-cord injuries following a job-related car accident. He lost use of his arms and his legs and lived in a near-vegetative state in hospitals and other facilities until his death in January 2007. Dean’s mother, Marilyn, became administrator of her son’s estate and filed a claim for death benefits with the bureau. The bureau paid medical and funeral expenses and permanent total disability benefits, which had accrued since 2002 when the bureau approved those benefits but couldn’t pay them because there was no one with power of attorney or appointed as a guardian to receive the payments.
The estate appealed to the Industrial Commission, arguing that the death benefits should have also included a type of compensation called “scheduled-loss benefits,” under R.C. 4123.57(B). Scheduled-loss benefits are designed to pay injured workers for deprivation of earning capacity when they lose use of a body part. Because Dean had no use of any of his extremities, his estate sought what they claimed was the full allowable award of 850 weeks of compensation.
The Industrial Commission’s hearing officers determined that Dean would have been entitled to 850 weeks of compensation if he had filed for benefits while he was alive. However, because he didn’t apply during his lifetime, they determined that the commission was limited by a statute governing retroactive payments to an award of two years, or 104 weeks.
The estate asked the Tenth District Court of Appeals to order the commission to vacate the 104 weeks of benefits and instead award the full 850 weeks, and asserted that the bureau abused its discretion when it didn’t award the benefits during Dean’s lifetime solely because no application was submitted. The Tenth District denied the appeal, and the estate exercised its right to appeal to the Supreme Court.
The parties in this case agreed that no application for scheduled-loss benefits was filed during Dean’s lifetime and the bureau made no award. They also didn’t dispute that Dean was medically qualified for these benefits. The estate argued, however, that the bureau was authorized to award benefits without an application – pointing to a policy, published at one time on the bureau’s web site, which said: “The [Claim Service Specialist] may also allow and pay a [scheduled-loss] award without application if medical evidence is provided that supports payment of the scheduled loss award.” The bureau countered that the online policy was discretionary and didn’t create a duty for it to act.
R.C. 4123.57, which provides for scheduled-loss compensation, states that “the employee may file an application with the bureau of workers’ compensation” and makes other references to an application.
The Supreme Court in its per curiam (not authored by one justice) opinion today ruled that R.C. 4123.57 clearly conveys that an application begins the process of formally seeking benefits. The court stated: “[T]he statute’s use of the permissive term ‘may’ does not eliminate the necessity of an application as the vehicle for starting the process of determining eligibility for scheduled-loss benefits.” The court determined that the bureau’s online policy doesn’t have the same effect as law, so the bureau didn’t have a duty to pay the award without an application.
As a result, the court ruled: “[W]e agree with the court of appeals that the estate failed to demonstrate that the bureau had a clear legal duty to award scheduled-loss benefits to Dean during his lifetime in the absence of an application.”
The court also found that the commission didn’t abuse its discretion when it required the estate to file an application and that the statute governing retroactive payments prevented the commission from making an award for more than two years, calculated from Dean’s date of death.
The court’s majority opinion was joined by Justices Terrence O’Donnell, Judith Ann Lanzinger, Sharon L. Kennedy, and Judith L. French.
Chief Justice Maureen O’Connor and Justices Paul E. Pfeifer and William M. O’Neill dissented in an opinion authored by Chief Justice O’Connor.
Chief Justice O’Connor wrote that the bureau knew Dean was medically eligible for the scheduled-loss award, he was unable to seek benefits for himself or ask for help for that purpose, and he had no guardian or other representative acting for him. She pointed to bureau case notes, from as early as 1997 and in 2005, which stated that Dean had no power of attorney to act on his behalf. In a 2006 letter to Dean’s mother, the bureau also stated that, if she didn’t respond, it would refer the matter to the attorney general to consider an incompetency filing with the probate court for the appointment of a guardian.
On R.C. 4123.57’s wording related to applications, O’Connor stated: “That language makes clear that filing an application is permissive, not mandatory. The majority also ignores the General Assembly’s mandate, and our own precedent, that we must liberally construe R.C. Chapter 4123 in favor of employees.”
“ ... I would hold that the bureau had a clear legal duty to act by either exercising its discretion to confer benefits in the absence of an application or to pursue the referral to the attorney general’s office so that a proper guardian could be appointed to act on Dean’s behalf,” she continued.
“Rather than reinforcing the bureau’s dereliction of its duty by affirming this judgment, I would reverse the judgment of the court of appeals, grant a writ of mandamus, and return the matter to the commission to award the full 850 weeks of scheduled-loss benefits, not just the 104 weeks that were awarded because of the statute of limitations,” she wrote. “I would do this not to benefit the relatives of Dean Sziraki but to ensure that the welfare of future participants in the workers’ compensation system will not be jeopardized by the system’s inaction in the face of a clear duty.”
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