Thomas v. Logue, Administrator, Ohio Bureau of Workers’ Compensation

• Court: Ohio Court of Appeals
• Writing for the Court: DORRIAN, J.
• Citation: Thomas v. Logue, Administrator, Ohio Bureau of Workers’ Compensation, 191 N.E.3d 1155 (Ohio App. 2022)
• Decision Date: 12 May 2022
• Docket Number: 21AP-385
• Parties: Lamar THOMAS, Plaintiff-Appellant, v. John LOGUE, ADMINISTRATOR, OHIO BUREAU OF WORKERS’ COMPENSATION, Defendant-Appellee.

191 N.E.3d 1155

Lamar THOMAS, Plaintiff-Appellant,

v.John LOGUE, ADMINISTRATOR, OHIO BUREAU OF WORKERS’ COMPENSATION, Defendant-Appellee.

No. 21AP-385

Court of Appeals of Ohio, Tenth District, Franklin County.

Rendered on May 12, 2022

On brief: Garson Johnson LLC, James A. DeRoche, and Jeffrey D. Johnson, Hudson; Weisman, Kennedy & Berris Co., L.P.A., R. Eric Kennedy, and Daniel P. Goetz, Cleveland; Ciano Goldwasser, LLP, and Andrew S. Goldwasser, for appellant. Argued: James A. DeRoche.

On brief: Brennan, Manna & Diamond, LLC, Robert A. Hager, Justin M. Alaburda, and Daniel J. Rudary, Akron; Dave Yost, Attorney General, and Timothy M. Miller, Columbus, for appellee. Argued: Daniel J. Rudary.

DECISION

DORRIAN, J.

{¶ 1} Plaintiff-appellant, Lamar Thomas, appeals the June 28, 2021 decision and judgment entry of the Court of Claims of Ohio finding defendant-appellee, Ohio Bureau of Workers’ Compensation ("BWC"), was entitled to judgment as a matter of law and granting BWC's motion for judgment on the pleadings. For the following reasons, we reverse.

I. Facts and Procedural History

{¶ 2} On March 4, 2021, appellant filed a complaint in the Court of Claims asserting claims for equitable restitution and unjust enrichment in addition to seeking declaratory and injunctive relief. In his complaint, appellant alleged that on September 5, 2013, he was injured in the course and scope of his employment in an automobile accident. Appellant filed a claim for workers’ compensation benefits, and such claim was allowed by BWC for cervical and lumbar sprain. According to appellant, his injury was caused by the negligence of a third party, and appellant pursued a separate claim against such party.

{¶ 3} As a result of his injury, appellant sought medical treatment from a physician and received physical therapy. Appellant's physician, Dr. Adam Friedman, authored a report opining that, as a result of the accident, appellant sustained a lumbar sprain and substantially aggravated pre-existing degenerative disc disease as well as pre-existing spondylothesis. On June 14, 2014, appellant filed a request with BWC for an additional allowance for the conditions in Dr. Friedman's report.

{¶ 4} In response to appellant's request for additional allowances, BWC referred the claim to an independent medical examiner, Dr. Gerald Yosowitz, who reviewed appellant's medical records and opined that the additional conditions identified by Dr. Friedman were degenerative and unrelated to the injury sustained by appellant in the automobile accident. Based on Dr. Yosowitz's review, BWC referred appellant's claim to the Industrial Commission of Ohio ("commission").¹ In front of the commission, BWC argued the commission should deny appellant's request for additional allowances.² On January 16, 2015, the commission hearing officer disallowed the claim for the requested additional conditions based on Dr. Yosowitz's report. On February 26, 2015, a second commission hearing officer denied appellant's appeal of the January 16, 2015 commission decision. On March 20, 2015, the commission refused appellant's appeal. As a result, appellant was not able to participate in the workers’ compensation fund for the additional conditions.

{¶ 5} Appellant further alleged that following the settlement of his third-party claim, BWC asserted a right of subrogation in the amount of $6,044.36 from appellant's settlement pursuant to R.C. 4123.93 and 4123.931. BWC's asserted subrogation interest was based in part on a list of medical bills in the amount of $5,544.01. Among the charges listed by BWC for appellant's medical bills was the cost of the record review and report performed by Dr. Yosowitz. Appellant paid BWC $6,044.36 from his third-party settlement to satisfy BWC's asserted subrogation interest. In his complaint, appellant alleged BWC had no legal right to recover the cost of Dr. Yosowitz's services as part of its subrogation interest on the proceeds of appellant's third-party claim and, therefore, BWC was unjustly enriched.

{¶ 6} On April 30, 2021, BWC filed an answer. On May 3, 2021, BWC filed a motion for judgment on the pleadings pursuant to Civ.R. 12(C). On May 14, 2021, appellant filed a memorandum contra BWC's May 3, 2021 motion. On June 28, 2021, the Court of Claims filed a decision holding that BWC's motion for judgment on the pleadings should be granted because appellant could prove no set of facts in support of his claims that would entitle him to relief and BWC was entitled to judgment as a matter of law. On the same date, the Court of Claims filed a judgment entry granting BWC's motion for judgment on the pleadings.

II. Assignment of Error

{¶ 7} Appellant appeals and presents the following sole assignment of error for our review:

The trial court erroneously interpreted "subrogation interest" [ R.C. 4123.93(D) ] to include administrative costs that neither the injured worker nor the statutory subrogee could recover from a liable third party.

III. Assignment of Error—Interpretation of R.C. 4123.93(D)

{¶ 8} In his assignment of error, appellant asserts the court erred by granting judgment on the pleadings in favor of BWC because it incorrectly interpreted the statutory definition of the term "subrogation interest" under R.C. 4123.93(D) to include administrative costs paid by BWC unrelated to an injured worker's medical treatment or compensation.

A. Motion for Judgment on the Pleadings Under Civ.R. 12(C)

{¶ 9} Pursuant to Civ.R. 12(C), "[a]fter the pleadings are closed but within such time as not to delay the trial, any party may move for judgment on the pleadings." A court considering a motion under Civ.R. 12(C) must construe the material allegations in the complaint and all reasonable inferences to be drawn by the same in favor of the nonmoving party as true. Ohio Mfrs. Assn. v. Ohioans for Drug Price Relief Act , 147 Ohio St.3d 42, 2016-Ohio-3038, 59 N.E.3d 1274, ¶ 10. Viewing the allegations in such light, the court may only grant a motion under Civ.R. 12(C) where it finds no material factual issues exist and the movant is entitled to judgment as a matter of law. Hinkle v. L Brands , Inc. World Headquarters , 10th Dist. No. 21AP-80, 2021-Ohio-4187, 2021 WL 5564101, ¶ 9. Thus, a motion under Civ.R. 12(C) " ‘tests the allegations of the complaint and presents a question of law.’ " Jackson v. Ohio Dept. of Rehab. & Corr. , 10th Dist. No. 19AP-621, 2020-Ohio-1518, 2020 WL 1890724, ¶ 11, quoting Zhelezny v. Olesh , 10th Dist. No. 12AP-681, 2013-Ohio-4337, 2013 WL 5450882, ¶ 9. See Lytal v. Crawl for Cancer, Inc. , 10th Dist., 2018-Ohio-2017, 113 N.E.3d 1056, ¶ 8, citing State ex rel. Midwest Pride IV, Inc. v. Pontious , 75 Ohio St.3d 565, 570, 664 N.E.2d 931 (1996), citing Peterson v. Teodosio , 34 Ohio St.2d 161, 166, 297 N.E.2d 113 (1973) (stating that a court is permitted to consider both the complaint and answer in resolving the question of law presented by a Civ.R. 12(C) motion).

B. Subrogation Under Ohio Workers’ Compensation Law

{¶ 10} R.C. Chapter 4123 provides the statutory framework for Ohio's workers’ compensation system. See Stolz v. J & B Steel Erectors , Inc. , 146 Ohio St.3d 281, 2016-Ohio-1567, 55 N.E.3d 1082, ¶ 10. Under this chapter, the entity responsible for paying workers’ compensation benefits to an injured claimant has a right of reimbursement from any recovery obtained by the claimant from a third party responsible for the injury. Ohio Bur. of Workers’ Comp. v. Miller , 10th Dist. No. 12AP-753, 2013-Ohio-2072, 2013 WL 2247226, ¶ 10, citing Ohio Bur. of Workers’ Comp. v. McKinley , 130 Ohio St.3d 156, 2011-Ohio-4432, 956 N.E.2d 814, ¶ 27.³ This right of subrogation is codified in R.C. 4123.931(A), which provides that "[t]he payment of compensation or benefits [under workers’ compensation statutes] creates a right of recovery in favor of a statutory subrogee against a third party, and the statutory subrogee is subrogated to the rights of a claimant against that third party. The net amount recovered is subject to a statutory subrogee's right of recovery." R.C. 4123.93 defines the terms used in the provisions of workers’ compensation statutes related to subrogation:

(A) "Claimant" means a person who is eligible to receive compensation, medical benefits, or death benefits under this chapter or Chapter 4121., 4127., or 4131. of the Revised Code.

(B) "Statutory subrogee" means the administrator of workers’ compensation, a self-insuring employer, or an employer that contracts for the direct payment of medical services pursuant to division (P) of section 4121.44 of the Revised Code.

(C) "Third party" means an individual, private insurer, public or private entity, or public or private program that is or may be liable to make payments to a person without regard to any statutory duty contained in this chapter or Chapter 4121., 4127., or 4131. of the Revised Code.

(D) "Subrogation interest" includes past, present, and estimated future payments of compensation, medical benefits, rehabilitation costs, or death benefits, and any other costs or expenses paid to or on behalf of the claimant by the statutory subrogee pursuant to this chapter or Chapter 4121., 4127., or 4131. of the Revised Code.

C. Interpretation of R.C. 4123.93(D)

{¶ 11} This case presents a question of statutory interpretation regarding the scope of the statutory subrogee's subrogation interest as that term is defined under R.C. 4123.93(D). When interpreting statutory provisions, "our paramount concern is the legislative intent in enacting the statute." State ex rel. Steele v. Morrissey, Aud. , 103 Ohio St.3d 355, 2004-Ohio-4960, 815 N.E.2d 1107, ¶ 21, citing State ex rel. United States Steel Corp. v. Zaleski , 98 Ohio St.3d 395, 2003-Ohio-1630, 786 N.E.2d 39, ¶ 12. " ‘If the meaning of the statute is unambiguous and definite, it must be applied as written and no further interpretation is necessary.’ " State ex rel. Natl. Lime & Stone Co. v. Marion Cty. Bd. of Commrs. , 152 Ohio St.3d 393, 2017-Ohio-8348, 97...