BRODERICK L. BELL, Employee/Appellant, v. STATE, DEP’T OF TRANSP., SELF-INSURED, Employer.

WORKERS’ COMPENSATION COURT OF APPEALS
OCTOBER 30, 2013

No. WC13-5579

HEADNOTES

PENALTIES - SUBSTANTIAL EVIDENCE.  Substantial evidence supports the compensation judge’s findings regarding the delay in permanent partial disability payments.  The compensation judge did not abuse his discretion by denying additional penalties where the employer had good faith defenses to parts of the employee’s permanent partial disability claim.

Affirmed.

Determined by:  Milun, C.J., Wilson, J., and Cervantes, J.
Compensation Judge:  Rolf G. Hagen

Attorneys:  Timothy J. McCoy, McCoy, Peterson & Jorstad, Minneapolis, MN, for the Appellant.  Richard W. Schmidt, Whitney L. Teel, Cousineau McGuire Chartered, Minneapolis, MN, for the Respondent.

 

OPINION

PATRICIA J. MILUN, Chief Judge

The employee appeals the compensation judge’s partial denial of penalties for delays in payment of permanent partial disability benefits.  We affirm.

BACKGROUND

On March 9, 2010, the employee sustained traumatic injuries to multiple body parts while working on a highway construction crew for the Minnesota Department of Transportation, which was self-insured for workers’ compensation liability.  The employer admitted liability for the employee’s injuries.  On the date of injury, the self-insured employer was registered with CorVel, a Minnesota Certified Managed Care Plan.  At the direction of the self-insured employer, all of the employee’s medical care and treatment after the work accident were provided through the managed care plan network.

On October 5, 2011, the employee was directed by his managed care provider to present himself for an evaluation by Dr. Rita Wallace Reed, an occupational medicine specialist.  After the examination, Dr. Reed issued a health care provider report that detailed the doctor’s findings on permanent partial disability for the various body parts the employee injured in the accident.  The claims adjuster handling the case for the employer received Dr. Reed’s report and chart notes through an attachment to an e-mail dated October 18, 2011.  Dr. Reed opined in the chart notes that the employee had reached maximum medical improvement and assigned permanent partial disability ratings of 8% for a jaw fracture, 2% for scarring, 3% for left shoulder dislocation, 6% for left rotator cuff tear, 10% for his left wrist condition, and 0% for left arm fractures, for a total of 29% permanent partial disability.

While the chart notes listed all of the permanent partial disability ratings, the health care provider report did not list the 8% rating for the jaw fracture, which resulted in a total rating of 21% listed on that report.  The adjuster questioned the cumulative total in a letter to Dr. Reed dated December 5, 2011.  The adjuster also wrote the employee a letter dated December 2, 2011, stating that permanent partial disability payments would not be made at that time, that the total amount of permanent partial disability ratings was 21%, and that an independent medical evaluation for a second opinion on the permanent partial disability ratings would be scheduled.

On December 15, 2011, the employee retained an attorney.  The attorney contacted the adjuster, explaining that the permanent partial disability ratings totaled 29% according to the chart notes and requesting minimum permanent partial disability payments.  The adjuster responded in a letter dated December 23, 2011, that he had begun permanent partial disability payments for the rotator cuff tear and was in the process of scheduling an independent medical examination for the employee.  A notice of benefit payment, indicating payment for 6% permanent partial disability for the rotator cuff tear, was served on the employee on December 27, 2011.

On February 2, 2012, the employee brought a claim for penalties under Minn. Stat. § 176.225, subd. 1(b), for unreasonably or vexatiously delayed payment, under subd. 1(c) for neglect or refusal to pay compensation, and under subd. 5 for inexcusable delay in payment.  In a February 6, 2012, letter, the employer’s attorney made an informal demand for discovery of the names and addresses of any medical providers for the work injury or for any other similar injuries or conditions, copies of any medical records, and executed authorizations.  The letter also indicated that the employee would be scheduled for two independent medical examinations.  The employee’s attorney did not initially respond to this letter.  On April 3, 2012, the employer’s attorney sent a letter informing the employee and his attorney of the independent medical examinations scheduled for May 9, 2012, and May 21, 2012.  On April 19, 2012, the employee’s attorney sent the executed authorizations.  Additional permanent partial disability payments were made to the employee after the independent medical examinations.

A hearing was held on February 14, 2013.  The compensation judge found that the self-insured employer’s payment of permanent partial disability benefits related to the employee’s rotator cuff injury beginning December 27, 2011, was unreasonably and inexcusably delayed.  The judge awarded a penalty of 25% of the delayed payment under Minn. Stat. § 176.225, subd. 5, and also a penalty of 5% of the delayed payment under Minn. Stat. § 176.225, subd. 1.  The judge denied any additional penalties.  The employee appeals.

STANDARD OF REVIEW

The Workers’ Compensation Court of Appeals must determine whether the findings of fact and order are clearly erroneous and unsupported by substantial evidence in view of the entire record as submitted.[1]  Substantial evidence supports the findings if, in the context of the entire record, they are supported by evidence that a reasonable mind might accept as adequate.[2]  Fact findings are clearly erroneous if the reviewing court, looking at the entire evidence, is left with a definite and firm conviction that a mistake has been committed.[3]  Findings of fact should not be disturbed, even though the reviewing court might disagree with them, “unless they are clearly erroneous in the sense that they are manifestly contrary to the weight of the evidence or not reasonably supported by the evidence as a whole.”[4]  Questions of law may be considered by the Workers’ Compensation Court of Appeals de novo.[5]

DECISION

The Workers’ Compensation Act provides the Commissioner of the Department of Labor and Industry and compensation judges certain statutory powers to enforce payment of workers’ compensation benefits and to discourage conduct that results in practices that deny or delay payment of benefits to employees.[6]  An employer and insurer whose conduct results in the delay of payment may be assessed a penalty under the statute for the violation of the rules regarding payment.[7]  A range of penalties exist against an employer and insurer and in favor of an employee when the employer and insurer delay payment of workers’ compensation benefits to the employee.[8]

There is clear direction governing the general timing for permanent partial disability payments in the language of Minn. R. 5220.2550.  The rule contains important deadlines for the insurer regarding the timing of payments and notice requirements made to the employee.  For example, if a rating is disputed, Minn. R. 5220.2550, subp. 1.B., requires the insurer to notify the employee in writing within 30 days that an adverse medical examination has been scheduled and to begin periodic payments on the undisputed minimal ascertainable amount.  Minn. R. 5220.2550, subp. 1.B.(2), also requires that the disability rating must be determined and any remaining payments made within 120 days of the insurer’s receipt of the initial medical report containing a permanency rating.  In the present case, the employee maintains the compensation judge erred as a matter of law by analyzing the question of penalties under the statute without discussion of the relevant rule and by denying the employee’s claim for penalties for the delays in payment of permanent partial disability benefits beyond the minimum payment. We are not persuaded by the employee’s arguments.

On appeal, we review the compensation judge’s findings under the substantial evidence standard which limits our power as an appellate court to substitute our view of the facts for that of the compensation judge unless we form a “definite and firm conviction that a mistake has been committed.”[9]  Whether a penalty is appropriate under Minn. Stat. § 176.225 is generally a question of fact for the compensation judge,[10] and the extent of penalties imposed is generally within the sound discretion of the compensation judge.[11]

The insurer missed multiple deadlines for payment of permanent partial disability benefits and for scheduling an independent medical examination under Minn. R. 5220.2550, subp. 1.  Where the rules apply, the workers’ compensation act provides a statutory penalty for certain late payments.  The employee filed a claim petition seeking penalties.  The self-insured employer interposed an answer and a hearing was held before a compensation judge to address the issues of imposition and calculation of penalties under the statute.  The judge exercised his discretion by analyzing the facts and interpreting whether any delay was unreasonable or inexcusable pursuant to Minn. Stat. § 176.225.  The judge resolved the issues as the finder of fact based on his review of the conduct of the claims adjuster, the QRC, and counsel.  The judge found the delay in the initial minimum permanent partial disability payments was unreasonable and inexcusable, and awarded penalties on those grounds.  However, he found that penalties were not appropriate regarding other parts of the permanent partial disability claim where the employer raised defenses in good faith which were not frivolous or for the purpose of delay.[12]  The judge also determined that the employer was not solely responsible for delays in obtaining medical records which contributed to the delays in payment, and concluded that further penalties were not supported by the record.

When findings are based on determinations of fact, we give substantial deference to the compensation judge.[13]  Here, the compensation judge could reasonably conclude that the claim adjuster’s behavior did not result in unreasonable or inexcusable delay as that term is defined by case law and statute.  Based on our standard of review, we conclude that substantial evidence supports the compensation judge’s findings of fact and that the judge’s partial denial of the employee’s penalty claim did not constitute an abuse of discretion in this case.  We affirm.



[1] Minn. Stat. § 176.421, subd. 1.

[2] Hengemuhle v. Long Prairie Jaycees, 358 N.W.2d 54, 59, 37 W.C.D. 235, 239 (Minn. 1984).

[3] Northern States Power Co. v. Lyon Food Prods., Inc., 304 Minn. 196, 201, 229 N.W.2d 521, 524 (1975).

[4] Id.

[5] Krovchuk v. Koch Oil Refinery, 48 W.C.D. 607, 608 (W.C.C.A. 1993), summarily aff’d (Minn. June 3, 1993).

[6] Minn. Stat. § 176.225.

[7] See Minn. R. 5220.2550, titled in part Payment of Permanent Partial Disability, which provides in part:

Subpart 1. Time of payment.  Permanent partial disability must be paid at the time specified in Minnesota Statutes, sections 176.021 and 176.101.  When permanent partial disability compensation is being paid periodically following the payment of temporary total benefits or following or concurrent with the payment of temporary partial benefits, the payments must be continued without interruption at the same intervals that the temporary benefits were paid.  When the employee reaches maximum medical improvement, the insurer must request an initial assessment of any permanent partial disability from the employee's physician.
A. When the extent of permanent partial disability is not disputed, upon receipt of a medical report containing a permanency rating or medical information from which the insurer may determine a rating, the employer or insurer must, within 30 days:
(1) make a lump sum payment or begin periodic payments to the employee; or
(2) inform the employee in writing of the disability rating and the time when the permanent partial disability payment will be payable under the statute.
B. When the extent of permanent partial disability is disputed, upon receipt of a medical report containing a permanency rating or medical information from which the insurer may determine a rating, the employer or insurer must, within 30 days:
(1) make a minimum lump sum payment or begin periodic payments based on the minimum undisputed permanent partial disability ascertainable; and
(2) notify the employee in writing that an adverse medical examination has been scheduled and the date, time, and place of the examination. The disability rating must be determined and any remaining permanent partial disability payments made or periodic payment begun, within 120 days of the insurer's receipt of the initial medical report containing a permanency rating; or
C. If permanent partial disability benefits are not currently payable under Minnesota Statutes, section 176.101, inform the employee in writing of the disability rating and the time when the permanent partial disability payment will be payable by statute.

[8] Minn. Stat. § 176.225.

[9] See Northern States Power Co., 304 Minn. at 201, 229 N.W.2d at 524.

[10] French v. Special Sch. Dist. No. 1, 70 W.C.D. 91, 104 (W.C.C.A. 2010) (citing Saarela v. Sun Country Airlines, slip op. (W.C.C.A. Sept. 25, 1998)).

[11] See e.g., Maxfield v. Stremel Mfg. Co., slip op. (W.C.C.A. Jan. 6, 1999); Crimmins v. NACM N. Central Corp., 45 W.C.D. 435, 442 (W.C.C.A. 1991), summarily aff’d (Minn. Nov. 26, 1991); Erickson v. Texaco Refining, 45 W.C.D. 181, 190 (W.C.C.A. 1991); Holden v. Fluorocarbon Co., 44 W.C.D. 168, 174 (W.C.C.A. 1990).

[12] Finding 6.  See Heise v. Honeywell, Inc., 48 W.C.D. 523, 540 (W.C.C.A. 1993) (an award of penalties is not appropriate where the employer and insurer interpose a good faith defense); see also Hines v. Kobiela, 308 Minn. 320, 324, 241 N.W.2d 814, 817, 28 W.C.D. 400, 404 (1976) (a penalty under Minn. Stat. § 176.225, subd. 1, may be justified "not because the employer-insurer merely made a mistake, but because the reason for their neglect and refusal to pay compensation was patently ill-founded and unwarranted"); Sass v. Fraser Constr. Co., 44 W.C.D. 447, 453 (W.C.C.A. 1991) (a judge may award penalties “where an insurer unreasonably delays or neglects to pay benefits which are unquestionably due”) (emphasis in original), summarily aff’d (Minn. May 9, 1991); Greene v. Independent Sch. Dist. No. 202, 36 W.C.D. 601, 602 (W.C.C.A. 1984) (the fact that the employer and insurer did not ultimately prevail on their defense to a claim does not necessarily create a basis for the imposition of penalties).

[13] See Hengemuhle, 358 N.W.2d at 59, 37 W.C.D. at 239.