Shipes v. Hanover Ins. Co., Civ. A. No. 87-69-3-MAC (WDO).

• Citation: 670 F. Supp. 354
• Decision Date: 30 September 1987
• Docket Number: Civ. A. No. 87-69-3-MAC (WDO).
• Parties: Ray SHIPES, Plaintiff, v. The HANOVER INSURANCE CO., Defendant.
• Court: U.S. District Court — Middle District of Georgia

670 F. Supp. 354

Ray SHIPES, Plaintiff, v. The HANOVER INSURANCE CO., Defendant.

Civ. A. No. 87-69-3-MAC (WDO).

United States District Court, M.D. Georgia, Macon Division.

September 30, 1987.

Burton Lee, Elizabeth R. Francisco, Macon, Ga., for plaintiff.

Cubbedge Snow, III, Macon, Ga., for defendant.

ORDER

OWENS, Chief Judge.

This action is before the court on cross motions for summary judgment. The issue, the proper calculation of benefits due an injured employee pursuant to O.C.G.A. § 33-34-8(c), is one that Georgia courts have not previously addressed. While the parties, plaintiff Ray Shipes and defendant Hanover Insurance Company, disagree as to the proper calculation of these benefits, they agree that the construction of the statute is a question of law and a matter properly determinable by this court. The nature of the dispute and counsel's thorough briefing of the question negate any need for an oral hearing on the motions.

The relevant facts are not in dispute. Plaintiff was injured on October 10, 1985, while in the course of and in the scope of his employment. Plaintiff was driving a company vehicle at the time of the incident. Thus, plaintiff was eligible under separate policies of insurance for both workers' compensation benefits and personal injury protection benefits (PIP). Defendant Hanover Insurance Company carried both policies for plaintiff's employer, Macon Mine and Mill.

Based upon plaintiff's average weekly wages of $224.67, defendant Hanover paid plaintiff $149.78 in weekly workers' compensation benefits, leaving lost wages of $74.89. These payments continued until November 24, 1986. Relying upon O.C.G. A. §§ 33-34-4, 33-34-5 and 33-34-8, the no-fault policy and Georgia case law, defendant then computed 85% of plaintiff's remaining lost earnings and paid weekly to plaintiff an additional $63.66. The sum of these payments ($213.44) resulted in a weekly shortfall for plaintiff of $11.23 for the fifty-eight weeks plaintiff received workers' compensation benefits. That shortfall prompted this lawsuit.¹

Discussion

Defendant contends that benefits recoverable under either basic PIP or optional PIP, as those coverages are defined in O.C. G.A. §§ 33-34-4(a)(2)(B) and 33-34-5(a)(1)(B) respectively, may not exceed 85% of one's lost income or wages. Defendant further asserts that the benefits recoverable under O.C.G.A. § 33-34-8(c), benefits recoverable by an injured employee when his employer carries both workers' compensation insurance and no-fault insurance, likewise are limited to 85% of either (a) employee's salary, or (b) "lost wages," lost wages defined as the difference between the employee's weekly salary and the amount paid to the employee under workers' compensation. In support of its interpretation, Hanover cites Brown v. Boston Old Colony Insurance Co., 247 Ga. 287, 275 S.E.2d 651 (1981), and Atlanta Casualty Co. v. Sharpton, 158 Ga.App. 758, 282 S.E.2d 214 (1981).

In Brown, the court determined that section 33-34-8, as amended in 1979, clearly permits an employee to receive payments from both workers' compensation and no-fault policies provided by his employer. The court said, however, that no-fault benefits "may be reduced by the amount paid under workers' compensation where the benefits payable under the chapter are provided by an employer obligated to provide workers' compensation benefits." Brown, 247 Ga. at 288, 275 S.E.2d at 652. The court did not address the manner of ascertaining the total benefits payable, but merely recited in the facts that the payments rendered under the no-fault policy represented 85% of the difference between the employee's weekly wages and the amount paid under workers' compensation.

In Sharpton, the issue before the court was whether an employee receiving from his employer's insurance carrier both workers' compensation benefits and payments under a no-fault policy was precluded from also collecting benefits under his (the employee's) no-fault policy. The court held such recovery permissible. The court did not address the proper method of apportioning payments under the workers' compensation and no-fault policies purchased by the employer. Instead, the court merely stated that the no-fault payments "represented the difference between 85% of his weekly wage ($180) and the workers' compensation payment." Sharpton, 158 Ga. App. at 758, 282 S.E.2d at 215.

As the above discussion demonstrates, defendant's reliance upon these two cases is misplaced. Neither case addressed the issue of the proper calculation of benefits payable pursuant to O.C.G.A. § 33-34-8(c). In both cases, the courts merely recited the benefits paid and proceeded to consider other issues.

To make certain of a proper interpretation, this court has carefully scrutinized section 33-34-8(c) and has considered the opinion of Georgia's Attorney General. See 1980 Op. Att'y. Gen. No. 80-61.² The plain language of the statute prescribes the method of correlating workers' compensation benefits and no-fault benefits. The prefatory clause explains that the statute is applicable "in those instances where the benefits payable under this chapter have been provided for at the expense of an employer who is also obligated by statute to provide compensation for its employees under any workers' compensation law...." Macon Mine and Mill is such an employer, and, in fact, holds both workers' compensation and no-fault policies issued by defendant Hanover.

The statute next identifies the no-fault benefits payable to an injured employee as "the benefits payable without regard to fault under this chapter for loss of income or earnings incurred during disability as a result of a motor vehicle accident...." Though the amount of these benefits may be increased by the applicable policy, the policy must compensate an injured person, up to an aggregate minimum limit of $5,000.00, for at least "eighty-five percent of the loss of income or earnings during disability with a maximum benefit of $200.00 per week." O.C.G.A. § 33-34-4(a)(2)(B) (1987). The policy purchased by Macon Mine and Mill provided for the minimum 85% coverage with an increased aggregate benefit limit of $50,000.00. Thus, under the no-fault policy alone, defendant Hanover could have been required to pay 85% of plaintiff Shipes' loss of income or earnings, up to the maximum benefit of $200.00 per week. Applying the formula to p...