Cox v. Worker's Compensation Bd. of Indiana, 94S00-9608-CQ-564
| Decision Date | 26 December 1996 |
| Docket Number | No. 94S00-9608-CQ-564,94S00-9608-CQ-564 |
| Parties | James COX & Terry McCall, et al., Appellants/Plaintiffs, v. WORKER'S COMPENSATION BOARD OF INDIANA, et al., Appellees/Defendants. |
| Court | Indiana Supreme Court |
William R. Groth, Fillenwarth Dennerline Groth & Towe, Indianapolis, for Appellants/Plaintiffs.
Pamela Carter, Attorney General, Beth H. Henkel, Mary Wertz, Deputy Attorneys General, Indianapolis, for Appellees/Defendants.
The United States District Court for the Southern District of Indiana has requested our response to the following certified question as to issues regarding the Indiana Worker's Compensation Act:
Whether, in worker's compensation cases involving injuries that have not yet reached their state of maximum medical improvement, the Worker's Compensation Act empowers the Worker's Compensation Board to issue enforceable and appealable decisions as to limited issues--including whether the claim is compensable under the Act, whether temporary total disability benefits have been properly terminated, and whether certain medical care was reasonable and necessary under the Act--without disposing of all the issues that may exist or may arise between the parties? See Ind.Code § 22-3-4-8.
This question arises out of a federal class action brought on behalf of injured workers who file claims for worker's compensation benefits under the Act and who are unable to obtain an enforceable award establishing their right to benefits because they are determined not to have reached a state of "maximum medical improvement." This concept, also designated "quiescence" in the jargon of worker's compensation, essentially means that the worker has achieved the fullest reasonably expected recovery. The plaintiff class alleges that the Indiana Worker's Compensation Board has a policy of not determining claims until the worker's injuries have reached quiescence, and that this policy deprives the plaintiff class of property rights without due process of law in violation of the Fourteenth Amendment to the United States Constitution. Class certification was unopposed and the court certified a plaintiff class under Fed.R.Civ.P. 23(b)(2). On August 1, 1996, the parties submitted a joint motion to certify questions of state law to this court. In that motion, the parties stipulated to the following facts:
1. The Indiana Worker's Compensation Board believes that a decision of a Single Hearing Officer is not ripe for full Board review when that decision involves only temporary benefit issues and, therefore, does not issue decisions which dispose of less than all the issues between the parties. The Board bases this contention on Indiana Court of Appeals decisions holding that an award of the full Board that disposes of less than all the issues between the parties is not subject to judicial review by the Courts of Appeals.
2. The foregoing delays a claimant from obtaining a binding adjudication on threshold issues, such as whether his or her claim was compensable under the Act, whether weekly [temporary total disability] benefits were properly terminated, or whether certain medical care was reasonable and necessary under the Act, until a Board award or order can be issued terminating the entire controversy between the parties.
The complaint sets forth allegations illustrating the difficulties this class of plaintiffs encounters. James Cox alleges that he was injured in an accident arising in the course of his employment in October 1994, and that he received medical care. In April 1995, the insurance company providing worker's compensation liability coverage to Cox's employer notified Cox of its conclusion that Cox's injury had reached a permanent state. Consequently Cox received no further temporary disability benefits and his employer refused to authorize further medical treatment. Cox disagreed with the insurer and filed an application for relief from the Board. He alleges that he remains temporarily totally disabled as a result of his work-related injury and requires additional medical care. He further alleges his injuries have not reached quiescence and will not unless additional treatment is provided. The Board, according to the complaint, refuses to rule on Cox's application because his injuries have not reached quiescence.
Another plaintiff, Terry McCall, alleges that he became disabled due to repetitive activities in his work as a meatcutter and that his condition became permanent in August 1994. Subsequently, his condition worsened and his doctor advised him that surgery was necessary. He was willing to undergo surgery to improve his condition but his employer refused to pay for surgery or resume payment of temporary total disability benefits. McCall also applied to the Board but he too finds himself stymied by the Board's adherence to a policy of deferring a final determination by the full Board until a claimant's injuries have reached quiescence. He alleges that he remains temporarily totally disabled as a result of his work-related injury and, until the completion of the recommended surgery, will not reach the quiescence necessary to be rated for a permanent partial impairment award. 1
Thus, Cox and McCall contend they and the class find themselves in a Catch-22: they cannot get the treatment they need to achieve quiescence without a Board award to pay for it, and at the same time they are unable to obtain a decision from the Board because their injuries are not quiescent. The Board, on the other hand, contends its policy of not issuing a decision by the full Board until a claimant's injuries have reached quiescence is demanded by Indiana law. The Board reaches this conclusion based upon its view that any resolution of these issues would not be appealable under Indiana law. The Board argues that it should have discretion to hear cases only when all the issues between the parties can be determined at once and that it would be an "exercise in futility" to resolve issues before they are appealable. The Board also points to the difficulties raised by having unappealable awards paid out, then later found to have been in error.
The certified question divides itself into multiple questions. Each question includes the component that the Board act "without disposing of all the issues that may exist or arise between the parties." With that common predicate, the questions before us become:
1. May the Board make an enforceable and appealable determination that temporary total disability benefits have been properly terminated?
2. May the Board make an enforceable and appealable determination whether certain medical care was reasonable and necessary?
3. May the Board issue an enforceable and appealable decision as to the compensability of a claim or other limited issues?
We first address whether Indiana's Worker's Compensation Act empowers the Worker's Compensation Board to issue decisions as to issues, that do not necessarily resolve all disputes between the parties. These include whether weekly temporary total disability benefits have been properly terminated, whether the claim is compensable under the Act, and whether certain medical care was reasonable and necessary.
Temporary total disability benefits may be awarded by agreement or by decision of the Board. Once temporary total disability benefits are in place, Ind.Code § 22-3-3-7(c) (1993) provides procedures for terminating those benefits. In certain instances (for example, death or reemployment), the employer may terminate temporary total disability benefits without notice to the employee. In all other circumstances, the employer must notify the employee and the Board of its intent to terminate benefits. The employee must then give notice within seven days to the employer and the Board of any disagreement; otherwise benefits are terminated. If the parties cannot reach an agreement, the Board must arrange for an evaluation of the employee by an independent medical examiner, who is to determine whether the employee remains temporarily disabled. Indiana Code § 22-3-3-7(c) provides that a party who disagrees with the medical examiner's opinion may apply to the Board for a hearing pursuant to Ind.Code § 22-3-4-5 (1993).
A second route to a hearing under Ind.Code § 22-3-4-5 is provided by Ind.Code § 22-3-4-5(a) if the parties had reached a compensation agreement and afterward disagree as to: 1) the continuance of payments under such agreement; 2) the period for which payments are to be made; or 3) the amount to be paid. Typically, these disputes arise from a change in conditions after an agreement is reached. Whether proceeding under Ind.Code § 22-3-3-7(c) or Ind.Code § 22-3-4-5(a), in each case an "application" by a party triggers the requirement that the Board hold a hearing "as early as practicable" and decide the dispute. The disputes resolvable under Ind.Code § 22-3-4-5 thus include deciding whether temporary total disability benefits were properly terminated. Ind.Code § 22-3-4-5(b) (1993). The hearing contemplated by Ind.Code § 22-3-4-5(b) may be decided by "any or all" of the Board members. Ind.Code § 22-3-4-6 (1993). The same section provides that "[t]he award shall be filed with the record of proceedings." Id. Thus, the Indiana Worker's Compensation Act explicitly empowers the Board to issue decisions regarding termination of temporary total disability benefits. It also provides for an "award" resulting from a "dispute" over that termination. Ind.Code §§ 22-3-4-5 and -6 (1993).
We must next address whether such an award is enforceable. The Act directly addresses this issue as well. Any party in interest may enforce "orders," "decisions," or "awards" of the Board pursuant to Ind.Code § 22-3-4-9(a) (1993). That section provides:
(a) Upon order of the worker's compensation board...
To continue reading
Request your trial
-
Ragucci v. Metropolitan Development Com'n of Marion County, 49S02-9805-CV-299
...plain, ordinary, and usual meaning, unless a contrary purpose is shown by the statute or ordinance itself. Cox v. Worker's Compensation Bd., 675 N.E.2d 1053, 1057 (Ind.1996). If the legislative intent is clear from the language of the statute, the language prevails and will be given effect.......
-
Indiana Wholesale Wine & Liquor Co., Inc. v. State ex rel. Indiana Alcoholic Beverage Com'n
...when construing a statute, the interpreting body attempts to give words their plain and ordinary meanings. Cox v. Worker's Compensation Bd., 675 N.E.2d 1053, 1057 (Ind.1996) (interpreting worker's compensation statute); Clifft v. Ind. Dep't of State Revenue, 660 N.E.2d 310, 316 (Ind.1995) (......
-
State v. Dugan
...to be given their plain, ordinary, and usual meaning, unless a contrary purpose is shown by the statute itself." Cox v. Worker's Comp. Bd., 675 N.E.2d 1053, 1057 (Ind.1996). It is just as important to recognize what the statute does not say as it is to recognize what it does say. Clifft v. ......
-
Hall Drive Ins, Inc. v. City of Fort Wayne
...their plain, ordinary, and usual meaning, unless a contrary purpose is shown by the statute or ordinance itself. Cox v. Worker's Comp. Bd., 675 N.E.2d 1053, 1057 (Ind.1996). Where possible, every word must be given effect and meaning, and no part is to be held meaningless if it can be recon......