Garrett v. Seventh Ward General Hosp.

660 So. 2d 841, 1995 La. LEXIS 2033, 1995 WL 562295
CourtSupreme Court of Louisiana
DecidedSeptember 22, 1995
Docket95-C-0017
StatusPublished
Cited by73 cases

This text of 660 So. 2d 841 (Garrett v. Seventh Ward General Hosp.) is published on Counsel Stack Legal Research, covering Supreme Court of Louisiana primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Garrett v. Seventh Ward General Hosp., 660 So. 2d 841, 1995 La. LEXIS 2033, 1995 WL 562295 (La. 1995).

Opinion

660 So.2d 841 (1995)

Betty GARRETT
v.
SEVENTH WARD GENERAL HOSPITAL.

No. 95-C-0017.

Supreme Court of Louisiana.

September 22, 1995.
Rehearing Denied November 17, 1995.

*842 William R. Mustian, III, for applicant.

Alton B. Lewis, for respondent.

LEMMON, Justice[*].

This case involves the interpretation of La.Rev.Stat. 23:1225 C(1)(c), which allows an employer a reduction in his obligation to pay workers compensation benefits when the employee collecting workers' compensation benefits from the employer is contemporaneously receiving "benefits under disability benefit plans...." The issue before the court is whether the employer is entitled to the reduction when the employee is receiving both workers' compensation benefits and Social Security disability benefits.

Facts

In January and April of 1988, plaintiff sustained injuries on the job, and the employer began paying workers' compensation benefits. In April of 1989, plaintiff also began receiving Social Security disability benefits.

In November of 1990, plaintiff filed the initial petition in the present action seeking to recover certain unpaid medical expenses. In answering the suit, the employer asserted its right to a reduction of benefits under La.Rev.Stat. 23:1225, but did not pursue the matter at the time. A dispute then developed over whether plaintiff was disabled. Because of that dispute and because the amount of the Social Security disability benefits plaintiff was receiving exceeded her worker's compensation benefits,[1] the employer discontinued paying compensation benefits.

The hearing official found that plaintiff was temporarily totally disabled, and that part of the judgment is not in dispute at this time. The hearing officer also rejected the employer's request for reduction in benefits, reasoning:

The statute is clear.[2] The defendant may only reduce benefits for injuries producing permanent, total disability. There was never any evidence to indicate the claimant's condition was permanent and permanent disability benefits were never paid by the defendant. (emphasis in original).

*843 The court of appeal, in an unpublished opinion, reversed the judgment in part and awarded the reduction. The intermediate court reasoned that Section 1225 does not define the term "disability benefit plan," that Section 1225 C(1)(c) provides a setoff for disability benefit plans generally, and that the broad term reasonably encompasses Social Security disability benefits. The court noted that "[t]his conclusion is consistent with the intent of the statute which, when read as a whole, is to insure that workers do not profit through their disability."

This court granted certiorari, 95-0017 (La. 3/10/95), 650 So.2d 1167, to address the narrow statutory construction issue of whether the Legislature's use in Section 1225 C(1)(c) of the term "benefits under disability benefit plans," the receipt of which triggers an employer's right to a reduction of its workers' compensation obligation, contemplated Social Security disability benefits.

History of Wage-Loss Benefit Coordination Laws

Workers' compensation is part of an employer-based system of wage-loss protection. The overall system of benefits by which an employer provides its employees with protection against loss of wages also includes unemployment compensation, nonoccupational sickness and disability insurance, and old age and survivors' insurance. 4 Arthur Larson, Worker's Compensation § 97.10 (1995). Despite the general recognition that these benefit devices are part of an overall system, "the jerry-built character of American social legislation has resulted at many points in failure to anticipate and provide for appropriate coordination." Id. at § 97.20. As a result, duplication of benefits was quite common and led to legislative efforts to coordinate benefits.

Wage-loss benefit coordination laws are designed to achieve a dual purpose: (1) to assure, when an employee suffers a wage loss because of disability, unemployment, advanced age or death, that a certain minimum portion of the employee's actual wages is continued or, in the case of death, that the employee's dependents receive some degree of recovery of lost support; and (2) to preclude an employee from contemporaneously collecting duplicative wage-loss benefits under different parts of the overall system of employer-based protection against loss of wages. Benefit coordination laws are based on the premise that an employee experiencing a period of wage loss should not be permitted to receive duplicative benefits from different parts of the overall system provided by the employer and thereby recover more than the amount of his or her actual wages. The theory is that an employee experiencing only one wage loss should be entitled to receive only one wage-loss benefit from the employer. Benefit coordination laws thus avoid duplicative benefits collected from the employer and prevent social legislation from becoming a "grab bag" of assorted, unrelated wage-loss benefits. 4 Arthur Larson, Worker's Compensation § 97.10 (1995).

As early as 1956, Congress addressed the obvious overlap between state workers' compensation benefits and federal Social Security disability benefits. Concerned that such overlapping benefits would lead to an erosion of state workers' compensation programs and would reduce employees' incentive to return to work and thus impede rehabilitative efforts, Congress included in the initial Social Security disability benefits enactment a provision calling for a full offset of Social Security disability benefits if the employee was contemporaneously receiving workers' compensation benefits. Richardson v. Belcher, 404 U.S. 78, 92 S.Ct. 254, 30 L.Ed.2d 231 (1971). While that offset was quickly repealed in 1958, it was re-enacted in 1965 as part of a major amendment to the Social Security Act.

Simply stated, the present federal statute requires that the amount of Social Security disability payments be reduced when the combined amount of such disability payments and the employee's workers' compensation benefits exceeds eighty percent of the employee's "average current earnings."[3] 42 U.S.C. § 424a(a)(1991). By adopting an offset *844 in the form of an eighty percent federal ceiling, Congress "reduced the duplication inherent in the programs and at the same time allowed a supplement to workmen's compensation where the state payments were inadequate." Richardson v. Belcher, 404 U.S. at 83, 92 S.Ct. at 258.

The federal offset statute was modified for a period of time by a provision in Section 424a(d) that the federal offset did not apply if the state workers' compensation law itself provided for an offset of Social Security disability benefits against state workers' compensation benefits in the event of an overlap. By this "reverse offset" provision, Congress allowed the states to provide a benefit for local employers by enacting such a provision, with no reduction in the overall benefits received by employees.[4]

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Bluebook (online)
660 So. 2d 841, 1995 La. LEXIS 2033, 1995 WL 562295, Counsel Stack Legal Research, https://law.counselstack.com/opinion/garrett-v-seventh-ward-general-hosp-la-1995.