State ex rel. Baker Material Handling Corp. v. Indus. Comm.

Decision Date04 May 1994
Docket NumberNo. 93-5,93-5
Citation69 Ohio St.3d 202,631 N.E.2d 138
PartiesThe STATE, ex rel. BAKER MATERIAL HANDLING CORPORATION, Appellant and Cross-Appellee, v. INDUSTRIAL COMMISSION OF OHIO; Metzel, Appellee and Cross-Appellant.
CourtOhio Supreme Court

SYLLABUS BY THE COURT

1. A self-insured employer who, subsequent to the initial allowance of a workers' compensation claim, certifies a medical condition as allowed on a "Self Insured Semi-Annual Report of Claim Payments" (form C-174) has conclusively granted that additional condition as part of the claim.

2. An employee who retires prior to becoming permanently and totally disabled is precluded from eligibility for permanent total disability compensation only if the retirement is voluntary and constitutes an abandonment of the entire job market. (State ex rel. CPC Group, Gen. Motors Corp. v. Indus. Comm. [1990], 53 Ohio St.3d 209, 559 N.E.2d 1330, followed and applied; State ex rel. Chrysler Corp. v. Indus. Comm. [1991], 62 Ohio St.3d 193, 580 N.E.2d 1082, and State ex rel. Consolidation Coal Co. v. Yance [1992], 63 Ohio St.3d 460, 588 N.E.2d 845, modified.)

3. An employee who retires subsequent to becoming permanently and totally disabled is not precluded from eligibility for permanent total disability compensation regardless of the nature or extent of the retirement. (State ex rel. Brown v. Indus. Comm. [1993], 68 Ohio St.3d 45, 623 N.E.2d 55, followed; State ex rel. Chrysler Corp. v. Indus. Comm. [1991], 62 Ohio St.3d 193, 580 N.E.2d 1082, and State ex rel. Consolidation Coal Co. v. Yance [1992], 63 Ohio St.3d 460, 588 N.E.2d 845, distinguished.)

On February 24, 1983, claimant-appellee and cross-appellant, Earl Metzel, Jr., sustained an injury in the course of and arising out of his employment with appellant and cross-appellee, Baker Material Handling Corporation ("Baker"). Claimant filed an application for payment of compensation and medical benefits with the Industrial Commission of Ohio ("commission"). By letter dated March 14, 1983, Baker, a self-insured employer, recognized the claim for "lumbo sacral sprain." Thereafter, Baker began making temporary total disability ("TTD") compensation payments to claimant. On August 6, 1986, Baker filed a motion with the commission to determine the extent of claimant's disability. On April 20, 1987, a district hearing officer found that "this claim has been previously allowed for: Lumbosacral strain" and that "claimant's condition has become permanent * * * [and, therefore,] that temporary total compensation payments are not authorized beyond the date of hearing, 4/20/87." On May 29, 1987, claimant filed an application for permanent total disability ("PTD") compensation.

Between February 24, 1983, when claimant was injured, and May 29, 1987, when claimant filed for PTD compensation, Baker had submitted eleven C-174 forms, entitled "SELF INSURED SEMI-ANNUAL REPORT OF CLAIM PAYMENTS," to the Ohio Bureau of Workers' Compensation. Each form C-174 sought a certification from the self-insured employer as to the type and amount of compensation and medical expenses paid on the claim over the preceding six-month period and what the claim was allowed for. On three of these reports, respectively for the six-month reporting periods ending December 1, 1985, October 11, 1986 and December 31, 1986, Baker certified that "claim allowed for: * * * herniated disc."

On February 8, 1990, claimant took an early retirement under his group pension plan.

By letter dated August 8, 1990, Baker's representative, Industrial Advisors Bureau, Inc., advised claimant's attorney as follows:

"This is to acknowledge receipt of your requests for authorization from Dr. Koussandianos, which I have denied since the diagnosis included conditions not allowed in this claim. Please be advised that this claim has never formally been allowed for herniated disc. I note that Chris, from your office, sent me a C-174 signed by Anne Grattner giving herniated disc as part of the allowed conditions, however, if you review the orders in your file, you will find that the claim was only formally allowed for lumbosacral sprain. If you wish to have herniated disc as an allowed condition in this claim, please file a motion asking for a formal hearing."

Accordingly, on December 4, 1990, claimant filed a motion with the commission to amend the claim to include "lumbosacral sprain, herniated disc superimposed on early degenerative spondyloarthritis."

Before claimant's December 4, 1990 motion for additional allowance was heard, however, a hearing was held on his application for PTD compensation. On March 19, 1991, the commission entered an order finding that "the claimant is permanently and totally disabled [and] that compensation for such disability be awarded from 05/21/87." In granting claimant's application for PTD compensation, the commission stated "[t]hat the employer did recognized [sic ] claim for herniated disc by completing the [C-174] claim forms."

On June 21, 1991, Baker filed a "Request for Rehearing" with the commission on the basis that the claim had never been allowed for herniated disc and that claimant had voluntarily removed himself from the labor market. On July 31, 1991, the commission construed Baker's request as a "Request for Reconsideration" and denied it.

On October 11, 1991, Baker filed a complaint for writ of mandamus in the Court of Appeals for Franklin County. The court of appeals found that since Baker had "listed the additional condition of herniated disc on at least three C-174 forms * * * [it] has recognized the allowed condition of herniated disc. Therefore * * * the commission did not abuse its discretion in finding [claimant] to be permanently and totally disabled." The court further found, however, that based on this court's decision in State ex rel. Chrysler Corp. v. Indus. Comm. (1991), 62 Ohio St.3d 193, 580 N.E.2d 1082, the commission must make a determination of whether claimant's retirement was voluntary. Accordingly, the court of appeals decided "that a writ of mandamus issue against respondent Industrial Commission of Ohio ordering it to conduct further proceedings to determine the issue of whether relator's retirement was voluntary."

This cause is now before this court upon an appeal and cross-appeal as of right.

David R. Cook, Cleveland, for appellant and cross-appellee, Baker Material Handling Corp.

Stewart Jaffy & Assoc. Co., L.P.A., Stewart R. Jaffy and Marc J. Jaffy, Columbus, Frank L. Gallucci, Jr., Co., L.P.A., and Frank Gallucci, Cleveland, for appellee and cross-appellant, Earl Metzel, Jr.

ALICE ROBIE RESNICK, Justice.

This case presents two important workers' compensation issues. The first issue is whether a self-insured employer who, subsequent to the initial allowance of a claim, certifies a medical condition as allowed on a C-174 form has conclusively granted that additional condition as part of the claim. The second issue involves the effect of post-PTD retirement upon a claimant's eligibility for PTD compensation.

I Allowance of Additional Condition by Self-Insured Employer

In Ohio, employers are required to make semiannual premium payments to the State Insurance Fund for the purpose of establishing coverage for their employees who suffer work-related injuries. R.C. 4123.35(A). Certain qualifying employers, however, may "be granted the privilege to pay individually compensation, and furnish medical, surgical, nursing and hospital services and attention and funeral expenses directly to injured employees or the dependents of killed employees." R.C. 4123.35(B). These self-insured employers pay "no premium to the State Insurance Fund." Fulton, Ohio Workers' Compensation Law (1991) 306, Section 14.10.

State-fund employers and self-insured employers stand on different footing with regard to the processing and adjudication of workers' compensation claims. State-fund employers simply make "premium payments to the fund. Self-insurers, on the other hand, are the initial processing agents of claims brought by their employees. The commission or bureau becomes involved only if the self-insurer denies a claim and the employee appeals." Wargetz v. Villa Sancta Anna Home for the Aged (1984), 11 Ohio St.3d 15, 17, 11 OBR 49, 51, 462 N.E.2d 1215, 1217. Thus, "[a] self-insuring employer not only pays compensation directly to his injured employees but also adjudicates their claims for benefits in the absence of a dispute." Young, Workmen's Compensation Law of Ohio (2 Ed.1971) 239, Section 13.11. In addition, former Ohio Adm.Code 4121-9-01(C) (now 4123-19-01[C] ) provided in pertinent part that:

"A self-insured employer may, without any prior order from the commission, grant or refuse to grant any claim made under the Ohio Workers' Compensation Act." (Emphasis added.)

In State ex rel. Saunders v. Metal Container Corp. (1990), 52 Ohio St.3d 85, 556 N.E.2d 168, this court held that the commission did not have continuing jurisdiction to correct its previous mistake regarding the medical condition allowed in a claim to the extent of changing the nature of the medical condition as certified by the self-insurer on a "C-50 Application for payment of Compensation and Medical benefits." The court of appeals in that case, State ex rel. Saunders v. Metal Container Corp. (Nov. 29, 1988), Franklin App. No. 87AP-509, unreported, at 6, 1988 WL 129162, explained as follows:

"[When] * * * the employer is self-insured[,] [t]he initial determination of allowed conditions necessarily is made by the employer in such a situation. The district hearing officer cannot modify that finding over the objection of the claimant, upon the assumption that the self-insured employer erroneously certified the condition. The district hearing officer had no jurisdiction under R.C. 4123.52, or otherwise, to modify the original finding of the employer as to the allowed condition over the objection of the claimant. The...

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