Crocetto v. Lynn Development Corp.

• Decision Date: 11 August 1992
• Docket Number: No. 14475,14475
• Court: Connecticut Supreme Court
• Parties: Frank CROCETTO v. LYNN DEVELOPMENT CORPORATION.

Page 1212

612 A.2d 1212

223 Conn. 376

Frank CROCETTO v. LYNN DEVELOPMENT CORPORATION.

No. 14475.

Supreme Court of Connecticut.

Argued April 28, 1992.

Decided Aug. 11, 1992.

Edward T. Dodd, Jr., Waterbury, for appellant (defendant).

Deborah M. DelBuono, Wolcott, for appellee (plaintiff).

Before PETERS, C.J., and CALLAHAN, GLASS, BORDEN and BERDON, JJ.

BERDON, Associate Justice.

The sole issue in this appeal is whether a "subsistence allowance" provided to a former employee while enrolled in a workers' rehabilitation program constitutes "workers' compensation payments" within the meaning of General Statutes § 31-284b(a) ¹ so as to trigger mandatory health insurance coverage. In this case, the plaintiff, Frank Crocetto, who had been injured during the course of his employment with the defendant, Lynn Development Corporation, continued to receive health insurance coverage under the defendant's group plan until he exhausted his permanent partial disability benefits under General Statutes § 31-308. ² Subsequently, the plaintiff received a weekly subsistence allowance when he enrolled in a workers' rehabilitation program established under General Statutes § 31-283a. ³ While receiving the weekly subsistence allowance, he sought to have his health insurance coverage reinstated. The workers' compensation commissioner (commissioner) concluded that the plaintiff and his family had been entitled to insurance coverage from the time the coverage had been terminated to the time the plaintiff's participation in the rehabilitation program had ended. The commissioner, therefore, ordered the defendant to reimburse the plaintiff for medical expenses incurred during that period. The compensation review division (CRD) affirmed the commissioner's decision. The defendant appealed, ⁴ and we now reverse.

Although the parties dispute several factual allegations, the following facts are not contested. In November, 1984, during the course of his employment with the defendant, the plaintiff injured his back. The injury resulted in a 10 percent permanent partial disability of the back. At the time of the injury, the defendant supplied Blue Cross/Blue Shield health insurance to the plaintiff and his family. Following the injury, the plaintiff was no longer able to work for the defendant.

The plaintiff received temporary total disability benefits from November 30, 1984, until October 21, 1985, under the Workers' Compensation Act (act). Thereafter, he received permanent partial disability benefits under the act. During the period in which these temporary and permanent benefits were paid under § 31-308, the defendant continued to provide health insurance coverage to the plaintiff and his family pursuant to § 31-284b. When the plaintiff exhausted his permanent partial disability benefits in October, 1986, the defendant terminated the plaintiff's health insurance coverage.

Sometime after October, 1986, ⁵ the plaintiff received eight or nine weeks of supplemental partial permanent disability payments pursuant to General Statutes § 31-308a. ⁶ In September, 1987, the plaintiff enrolled in the vocational rehabilitation training program under § 31-283a. From September, 1987, to August 25, 1989, the period during which the plaintiff had attended the program, the CRD found that the plaintiff had received a weekly subsistence vocational rehabilitation allowance, ⁷ from the division of workers' rehabilitation, which was purportedly established under § 31-283a.

Because the plaintiff was receiving this subsistence allowance, he sought to reinstate his health insurance coverage in accordance with § 31-284b(a). The commissioner concluded that the plaintiff's receipt of the subsistence allowance triggered the statutory mandate for the defendant to provide health insurance coverage to the plaintiff and his family. Accordingly, the commissioner determined that the plaintiff should have been covered from October, 1986, when the health insurance coverage had been terminated, to August 25, 1989, when the plaintiff finished his vocational rehabilitation training and the subsistence allowance was terminated. He ordered the defendant to reimburse the plaintiff for any medical expenses that Blue Cross/Blue Shield would have covered during that period. Pursuant to the defendant's motion for articulation, the commissioner clarified his opinion and held that the plaintiff's family was also entitled to health insurance coverage. The defendant appealed to the CRD, which affirmed the decision of the commissioner.

In this appeal, the defendant argues that § 31-284b(a) does not require an employer to provide health insurance coverage to an employee receiving a subsistence allowance and that the CRD, therefore, improperly affirmed the commissioner's conclusion that it was obligated to provide health insurance coverage to the plaintiff and his family. We agree.

Section 31-284b(a) mandates that an employer provide an injured employee with the same health insurance coverage that the employee had on the date of injury during the period in which the employee is "eligible to receive or is receiving workers' compensation payments" pursuant to the act. The issue, therefore, is whether a subsistence allowance is such a payment under the act. We normally accord great deference to the construction of a statute by the agency charged with its enforcement and only reverse when the agency has acted unreasonably, arbitrarily, illegally or in an abuse of its discretion. Griffin Hospital v. Commission on Hospitals & Health Care, 200 Conn. 489, 496, 512 A.2d 199, appeal dismissed, 479 U.S. 1023, 107 S.Ct. 781, 93 L.Ed.2d 819 (1986). We conclude, however, that a subsistence allowance is not a payment authorized by the act and, therefore, health insurance coverage should not be reinstated because of the award of such an allowance.

The plaintiff conceded at oral argument that a subsistence allowance is not authorized by statute or by administrative regulations. Instead, the plaintiff maintains that the first director of the workers' rehabilitation division initiated the distribution of the subsistence allowance in 1972 by drawing upon funds that were created under General Statutes § 31-283b ⁸ to finance the workers' rehabilitation division. Although the record is silent with respect to the workers' rehabilitation division's authority to award a subsistence allowance, we do not dispute that this may very well be the policy of the division. ⁹ The mere fact that a practice may exist to award subsistence allowances to participants in the rehabilitation program, however, does not persuade us that the receipt of such an allowance triggers an employer's obligation to provide health insurance coverage to an injured employee and his or her family. To constitute the basis for triggering the obligation to provide health insurance coverage, the subsistence allowance must have been required either by statute or by regulation authorized by the legislature and promulgated in accordance with the procedure outlined in the Uniform Administrative Procedure Act, General Statutes § 4-166 et seq. Salmon Brook Convalescent Home v. Commission on Hospitals & Health Care, 177 Conn. 356, 417 A.2d 358 (1979). We conclude that the ad hoc award of subsistence allowances do not qualify as "workers' compensation payments" under § 31-284b. Accordingly, we reverse the decision of the CRD.

This conclusion, however, does not end our inquiry. At oral argument, the defendant conceded that it had prematurely terminated the plaintiff's family health coverage while the plaintiff was receiving payments under § 31-308a. ¹⁰ The parties, however, dispute both the actual time the plaintiff received the payments and the length of time the commissioner intended to extend the payments. ¹¹ There is nothing in the record that enables us to resolve this dispute. We conclude, therefore, that the matter should be remanded to the commissioner for a determination of the period that the plaintiff should have received the payments under § 31-308a. Once that determination is made, the commissioner shall order the defendant to reimburse the plaintiff for any medical expenses incurred during that period by the plaintiff and his family that would have been covered by the defendant's health insurance carrier.

The judgment is reversed, and the case is remanded to the compensation review division with direction to remand the case to the workers' compensation commissioner for further proceedings consistent with this opinion.

In this opinion the other Justices concurred.

1 General Statutes § 31-284b(a) provides: "In order to maintain, as nearly as possible, the income of employees who suffer employment-related injuries, any employer, as defined in section 31-275, who provides accident and health insurance or life insurance coverage for any employee or makes payments or contributions at the regular hourly or weekly rate for full-time employees to an employee welfare fund, as defined in section 31-53, shall provide to such employee equivalent insurance coverage or welfare fund payments or contributions while the employee is eligible to receive or is receiving workers' compensation payments...