Edwards v. Travelers Insurance

2001 ME 148, 783 A.2d 163, 2001 Me. LEXIS 151
CourtSupreme Judicial Court of Maine
DecidedOctober 26, 2001
StatusPublished
Cited by3 cases

This text of 2001 ME 148 (Edwards v. Travelers Insurance) 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
Edwards v. Travelers Insurance, 2001 ME 148, 783 A.2d 163, 2001 Me. LEXIS 151 (Me. 2001).

Opinion

ALEXANDER, J.

[¶ 1] Travelers Insurance Co., a workers’ compensation insurer for Crest Shoe Co., appeals from a decision of a hearing officer of the Workers’ Compensation Board awarding Goldie Edwards total incapacity benefits, but permitting an offset of $7.48 per week, as a result of Edwards’s lump sum settlement with another insurer for a subsequent injury. Travelers contends that it is entitled to continue paying 50% partial incapacity benefits pursuant to an arbitrator’s apportionment decision. We vacate the hearing officer’s decision and remand for determination of the appropriate level of benefits.

I. CASE HISTORY

[¶ 2] Goldie Edwards worked for Crest Shoe Co. in Lewiston from 1986 until Crest Shoe ceased operations in April 1992. In August 1991, Edwards reported a repetitive motion injury to her left wrist and arm caused by her job cutting heels. After a brief absence from work following the August injury report, Edwards returned to Crest Shoe, working in a light duty position and receiving partial compensation benefits until Crest Shoe ceased operations in April 1992. While employed at Crest Shoe, Edwards’s average weekly wage, not contested in these proceedings, was $291.64. In September 1992, Edwards signed a voluntary discontinuance of benefits for the reason that she had resumed work.

[¶ 3] Edwards then worked in several different jobs not related to this action. In March 1993, Edwards began employment in an inspection and stitching position with American Pride in Lewiston, which is insured for workers’ compensation purposes by Maine Employers Mutual Insurance Company (MEMIC). At American Pride, Edwards reported a repetitive motion injury to her right wrist in January 1994. Prior to this report of injury, Edwards’s average weekly wage at American Pride was $228.50, also not contested in these proceedings.

[¶ 4] After her injury report, Edwards ceased working and MEMIC voluntarily commenced payment of total incapacity benefits. Edwards then filed a petition for restoration of benefits from Crest Shoe/Travelers, and MEMIC sought apportionment against Travelers for contribution to MEMIC’s total incapacity payments. Apportionment was requested through arbitration as authorized by 39-A M.R.S.A. § 354 (Supp.1998), amended by P.L. 1999, ch. 354, § 9.

[¶ 5] Pursuant to the then applicable apportionment statute, 39-A M.R.S.A. § 354 (Supp.1998), amended by P.L. 1999, ch. 354, § 9, the arbitrator’s decision was limited to a choice between the submissions of the parties.1 The arbitrator [165]*165adopted the 5%o apportionment urged by Edwards and MEMIC, rejecting the 4%o apportionment urged by Travelers. Following the arbitration decision, Travelers assumed responsibility to reimburse MEMIC for 50% of the incapacity benefits paid to Edwards beginning January 13, 1994.

[¶6] On April 7, 1998, Edwards and MEMIC agreed to, and a hearing officer approved, a lump sum settlement of $95,000 for Edwards’s injury described as: “tendonitis-left upper extremity.”2 The settlement agreement also provided that: “Travelers will continue to pay based on current rate pending alteration by decree or rule .... ” The $95,000 settlement was allocated as follows:

(1) $54,000 for medical, psychiatric, and physical therapy expenses based on an estimated expense of $1,200 per year, for an estimated life expectancy of 45 years;3
(2) $15,000 for vocational rehabilitation, although Edwards’s position was that vocational rehabilitation services would be of no use;
(3) $17,512.26 for wage replacement incapacity benefits which, according to the agreement, were based on projected payments of only $32.43 per month for Edwards’s life expectancy of 45 years; and
(4) $8,487.74 for attorney fees and costs.

[¶ 7] Counsel for Travelers contends that she participated in the settlement discussion by telephone and that she agreed that Travelers would continue payment of 50% benefits. However, Travelers contends that it did not consent to the minimal amount attributed to future incapacity payments.

[¶ 8] In the fall of 1998, Edwards petitioned for restoration, payment of psychological counseling expenses, and to determine the extent of permanent impairment against Travelers. After hearings, the hearing officer of the Workers’ Compensation Board issued a decision that:

[166]*166(1) granted Edwards’s petition for restoration and awarded continuing benefits for total incapacity and permanent impairment. See 39 M.R.S.A. § 54-B (Supp.1991), repealed and replaced by P.L.1991, ch. 885, §§ A-7, A-8 (codified at 39-A M.R.S.A. § 214 (2001)); 39 M.R.S.A. § 56-B (Supp.1991), repealed by P.L.1991, ch. 885, § A-7;
(2) determined that Travelers was responsible for medical payments for psychological counseling and other treatments (mostly psychological counseling) received since the settlement with MEMIC “to the extent permitted by the Board’s fee schedule.” The hearing officer’s decision gave no consideration to any set-off from the $54,000 for future medical-related expenses which Edwards had received in April 1998; and
(3) required Travelers to pay total incapacity benefits based on Edwards’s average weekly wage of $291.64, with set-off of only $7.48 per week based on the 1998 lump sum settlement. In reaching this result, the hearing officer rejected Travelers’s position that it should be responsible for only 50% of total incapacity benefits based on the 1995 arbitration order. In doing so, the hearing officer concluded that, as a result of the settlement, Travelers remained the only “responsible” party to pay for incapacity benefits and, thus, was obligated to pay 100% of the benefit requirement, subject to the small set-off amount.4

[¶ 9] At Travelers’s request, the hearing officer then made further findings which did not alter the decision. Travelers then filed a timely petition for appellate review which we granted pursuant to 39-A M.R.S.A. § 322 (2001).

■ II. DISCUSSION

[¶ 10] We have long disfavored interpretations of the Workers’ Compensation Act which result in duplicate recoveries of benefits for particular injuries. See LaPointe v. United Eng’rs & Constructors, 680 A.2d 458, 460-61 (Me.1996); Webber v. Bath Iron Works Corp., 656 A.2d 748, 749 (Me.1995); Parker v. Bath Iron Works Corp., 644 A.2d 1037, 1039-40 (Me.1994); Bouford v. Bath Iron Works Corp., 514 A.2d 470, 474 (Me.1986), cert. denied, 479 U.S. 1065, 107 S.Ct. 951, 93 L.Ed.2d 1000 (1987); Stockford v. Bath Iron Works Corp., 482 A.2d 843, 845 (Me.1984); Bourque v. Frank X. Pomerleau, Inc., 472 A.2d 933, 936 (Me.1984).

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Bluebook (online)
2001 ME 148, 783 A.2d 163, 2001 Me. LEXIS 151, Counsel Stack Legal Research, https://law.counselstack.com/opinion/edwards-v-travelers-insurance-me-2001.