Doucette v. Hallsmith/Sysco Food Services, Inc.

2011 ME 68, 21 A.3d 99, 2011 Me. LEXIS 68, 2011 WL 2278165
CourtSupreme Judicial Court of Maine
DecidedJune 9, 2011
DocketWCB-10-669
StatusPublished
Cited by8 cases

This text of 2011 ME 68 (Doucette v. Hallsmith/Sysco Food Services, Inc.) is published on Counsel Stack Legal Research, covering Supreme Judicial Court of Maine primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Doucette v. Hallsmith/Sysco Food Services, Inc., 2011 ME 68, 21 A.3d 99, 2011 Me. LEXIS 68, 2011 WL 2278165 (Me. 2011).

Opinions

Majority: SAUFLEY, C.J., and LEVY, SILVER, MEAD, GORMAN, and JABAR, JJ.

Concurring: SAUFLEY, C.J., and LEVY, and GORMAN, JJ.

Concurring/Dissenting: ALEXANDER, J.

SILVER, J.

[¶ 1] Hallsmith/Sysco Food Services, Inc. (Sysco), appeals from a decision of a Workers’ Compensation Board hearing officer (Collier; HO) awarding Matthew Doucette the protection of the Act for a 2004 work injury and total incapacity benefits for a violation of the “fourteen-day rule.” See Me. W.C.B. Rule, ch. 1, § 1. Sysco contends that the award for the fourteen-day rule violation should be vacated because (1) the third-party administrator attempted to file its notice of controversy electronically on the fourteenth day although it was not transmitted to the Board until the fifteenth day; (2) Doucette suffered no incapacity as a result of the injury; and (3) the award is unfair and imposes excessive costs on the workers’ compensation system. We affirm the judgment.

[101]*101I. BACKGROUND AND PROCEDURE

[¶ 2] Matthew Doucette, now age twenty-nine, injured his back on April 1, 2004, while working as a selector in the warehouse for Sysco. He felt pain in his lower back after lifting a bag of onions onto a pallet. Doucette timely reported the injury to his supervisor, and was sent for treatment. Diagnosed with lumbar strain, he was restricted from lifting more than twenty pounds. Doucette was put on light duty for approximately two weeks, at which time he was released to full duty. He did not lose any earnings as a result of this injury. Sysco terminated Doucette’s employment in May 2004 for reasons unrelated to his back injury. He had no further problems with his back until 2008, when he reinjured it while working for a different employer.

[¶ 3] On January 15, 2009, Doucette filed a petition for award against Sysco for the 2004 injury, alleging entitlement to “total/partial compensation from April 1, 2004 to the present and continuing.” The hearing officer concluded that Doucette is entitled to the protection of the Act even though he suffered no loss of earnings as a result of the injury, and is not entitled to wage loss benefits. Doucette also asserted a fourteen-day rule violation against Sysco for failing to file a notice of controversy (NOC) within fourteen days of receiving the petition for award.1 The rule requires that an employer “[w]ithin 14 days of notice or knowledge of a claim,” accept a claim, pay without prejudice, or deny the claim and file a NOC.

[¶ 4] Gallagher Bassett Services, Inc. (Gallagher Bassett), served as a third-party administrator for Sysco for the 2004 date of injury. On January 16, 2009, a claims representative for Gallagher Bas-sett learned that Doucette’s petition for award alleging the April 1, 2004, date of injury had been filed. Gallagher Bassett’s file for Doucette’s 2004 injury showed that Doucette had received treatment on three dates and was released to full duty work on April 21, 2004. It was the claims representative’s intention to file a “partial denial,” which required the filing of a NOC with the Board and also required specific coding to be entered into Gallagher Bas-sett’s computer system.

[¶ 5] The claims representative started the process of filing a NOC on January 26, 2009, by entering the coding and the date of injury. The information went to another department within Gallagher Bassett, the Electronic State Reporting (ESR) Unit, which she anticipated would “kick” the report forward to the Maine Workers’ Compensation Board. On January 27, 2009, the claims representative received a rejection notice from the ESR department because the claim required additional information, including a jurisdictional claim number (JCN). The claims representative then learned that because the claim had not been electronically reported back in 2004, she needed to generate a first report of injury in order to obtain a JCN. After initially rejecting the first report of injury due to a coding error, the Board accepted it on January 29, 2009. A JCN was generated and the claims representative believed she had transmitted the partial denial/NOC to the Board on January 29, 2009, the fourteenth day. On that same date, she sent a hard copy of the NOC by certified mail to Doucette and his attorney. The NOC in the Board’s file, however, indicates a date of filing of January 80, 2009. Because Gallagher Bassett’s elec[102]*102tronic communication system did not transmit the NOC to the Board until after midnight, the NOC was filed on the fifteenth day.

[¶ 6] The claims representative did not learn that there had been a late filing until March 19, 2009. Upon learning of Dou-cette’s claim that he was entitled to payment for total benefits from the date of incapacity due to the late-filed NOC, Gallagher Bassett attempted to determine the extent of Doucette’s claim of incapacity. On April 13, 2009, having received no response from Doucette, Gallagher Bassett paid Doucette a sum equal to one dollar for each working day after April 1, 2004.

[¶ 7] Because the Board did not receive the NOC until after midnight on the fifteenth day, the hearing officer determined that Sysco was in violation of the fourteen-day rule. The hearing officer found:

[T]he insurer diligently attempted to file the NOC in a timely fashion but ... a series of internal problems, culminating in the insurer’s own automated system bundling electronic claims for filing after midnight on the night of January [29], resulted in the NOC being transmitted to and received at the Board (and therefore “filed” under the Rule) in the early morning hours of January 30, 2009, which was the 15th day after the employer received notice of the claim for incapacity benefits.

See Me. W.C.B. Rule, ch. 3, § 2(2)(A)2 (providing that a document is filed with the Board when the Board receives it). Thus, the hearing officer ordered Sysco to pay Doucette total incapacity benefits from April 1, 2004, to April 13, 2009, the date the violation was cured, with credit for earnings and statutory offsets.3

[¶ 8] Sysco filed a motion for additional findings of fact and conclusions of law, and a motion requesting that the hearing officer stay the enforcement of the fourteen-day rule violation pending a ruling on that motion. The hearing officer granted the stay, but ultimately denied Sysco’s motion for additional findings of fact and conclusions of law, and lifted the stay. In denying the motion, the hearing officer stated:

On the issue of the fourteen day violation, the enforcement of any deadline can seem arbitrary and harsh as applied to a given set of facts. If an employee misses a notice date or exceeds a limitations period his or her claim may be unenforceable. But a deadline does provide the advantage of clarity. In this case, the NOC was filed on the fifteenth day, January 30, 2009. Therefore the Board’s Rule was violated and the penalty must stand.

[¶ 9] Sysco then filed a notice of appeal and a motion to stay enforcement of the hearing officer’s decision on the fourteen-day rule violation. We issued a per cu-riam opinion on December 23, 2010, in which we denied Sysco’s motion for a stay. Doucette v. Hallsmith/Sysco Food Servs., Inc., 2010 ME 138, ¶¶ 5-6, 10 A.3d 692, 694. “Recognizing the urgency of the issue presented for appeal,” we treated the motion for a stay and Doucette’s response as the petition for appellate review and response pursuant to M.RApp. P.

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Doucette v. Hallsmith/Sysco Food Services, Inc.
2011 ME 68 (Supreme Judicial Court of Maine, 2011)

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Bluebook (online)
2011 ME 68, 21 A.3d 99, 2011 Me. LEXIS 68, 2011 WL 2278165, Counsel Stack Legal Research, https://law.counselstack.com/opinion/doucette-v-hallsmithsysco-food-services-inc-me-2011.