Kohlmeyer v. Second Injury Fund

915 N.E.2d 958, 2009 Ind. LEXIS 1408, 2009 WL 3617551
CourtIndiana Supreme Court
DecidedNovember 3, 2009
Docket93S02-0812-EX-642
StatusPublished

This text of 915 N.E.2d 958 (Kohlmeyer v. Second Injury Fund) is published on Counsel Stack Legal Research, covering Indiana Supreme Court primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Kohlmeyer v. Second Injury Fund, 915 N.E.2d 958, 2009 Ind. LEXIS 1408, 2009 WL 3617551 (Ind. 2009).

Opinion

DICKSON, Justice.

Indiana's statutory worker's compensation scheme enables certain totally disabled workers who have exhausted the maximum benefits from their employers to seek additional compensation from the Second Injury Fund. The principal disputes in this case are (1) whether a worker's Social Security Act disability benefits are includable in caleulating whether the worker qualifies to access the Second Injury Fund, and (2) whether the language in the award stipulation of the worker and his employer, which was approved by the Worker's Compensation Board, is binding upon the Board as to the worker's right to access benefits from the Second Injury Fund.

The underlying facts are undisputed. James Kohlmeyer (the worker) sustained a back injury in October 1996 while working for H.B. Zachry Company (the employer). The worker received temporary total disability benefits and medical services until the employer terminated payments, con-eluding that the worker had reached a state of maximum medical improvement. In October 1998 the worker filed a claim with the Indiana Worker's Compensation Board, challenging the cessation of his temporary total disability benefits and claiming entitlement to statutory medical treatment.

The October 1998 claim was resolved on April 2, 2001, when the Board approved and adopted a stipulation signed by the worker and the employer. Appellant's App'x at 11. Among other things, the stipulation resolved the parties' dispute as to the worker's "right to recover benefits for alleged permanent total disability and alleged future medical benefits," id. at 7, by stipulating that the worker was permanently totally disabled as a result of his work injuries and that in lieu of further medical care, the employer would pay the worker $85,000 in the form of lump sums for unpaid temporary disability benefits, for part of his anticipated medical expenses, for attorney fees and expenses, and for the purchase of annuity to provide payments of $1,000 per month through August 1, 2006. The stipulation declared that this payment satisfied the worker's "claims for worker's compensation disability benefits in coordination with social seeu-rity benefits," id. at 7, and that it was "calculated to be coordinated with [the worker's] receipt of Social Security Disability benefits." Id. at 8. It appears that such coordination of benefits, allowing Social Security Disability benefits to substitute for part of the benefits that might have been payable by the employer, enabled the worker and his son to receive total payments "substantially in excess" of those available solely under the Worker's Compensation Act. 1 Appellant's Br. at 5, see also Appellant's App'x at 16, 17. The stipulation also provided that "at the conclusion of five hundred (500) weeks from the date of the injury plaintiff shall be eligible to petition the Worker's Compensation Board of Indiana for second injury funds" and twice additionally expressly reserved the worker's "right to apply for additional compensation from the Second Injury Fund." Appellant's App'x. at 9.

*960 In 2006 the worker applied to the Worker's Compensation Board for benefits from the Second Injury Fund. At the ensuing hearing, the Single Hearing Member denied the worker's claim, finding that 500 weeks of disability benefits at the worker's temporary total disability rate would have totaled $154,665, that the total of temporary total disability payments made to the worker "together with the payments received pursuant to the Agreement results in a total figure no more than $136,381.82," and that the worker thus "has not exhausted the maximum benefits as defined in Indiana Code 22-3-3-13(h), a pre-condition to entry into the Second Injury Fund." Id. at 19. The Single Hearing Member's decision was affirmed and adopted by the Full Board. Id. at 23. The worker instituted this appeal against the Fund. The Court of Appeals affirmed. Kohlmeyer v. Second Injury Fund, 888 N.E.2d 281 (Ind.Ct.App.2008). We granted transfer.

1. Inclusion of Social Security Act Disability Benefits Under the Statute

The worker first contends that he is entitled to Second Injury Fund benefits because, in addition to remaining totally disabled, his receipt of 500 weeks of disability payments "in the amount of $165,405.43 with $29,028.61 of said amount being Social Security Disability payments" exceeds the $154,665.00 threshold required for him to qualify. Appellant's Br. at 8. The Fund responds that the worker's entitlement to Second Injury Fund benefits requires that the eligibility threshold be exhausted exclusively by "payments under the Worker's Compensation Act, not from outside sources such as Social Security." Appellee's Br. at 4.

The relevant statutory subsections provide:

(h) If an employee who is entitled to compensation under IC 22-3-2 through IC 22-3-6 either:
(1) ...; or
(2) exhausts the employee's benefits under section 10 of this chapter;
then such employee may apply to the board, who may award the employee compensation from the second injury fund established by this section, as follows under subsection (1).
(i) An employee who has exhausted the employee's maximum benefits under section 10 of this chapter may be awarded additional compensation equal to sixty-six and two-thirds percent (66 2/3%) of the employee's average weekly wage at the time of the employee's injury, not to exceed the maximum then applicable under section 22 of this chapter, for a period of not to exceed one hundred fifty (150) weeks upon competent evidence sufficient to establish:
(1) that the employee is totally and permanently disabled from causes and conditions of which there are or have been objective conditions and symptoms proven that are not within the physical or mental control of the employee; and
(2) that the employee is unable to support the employee in any gainful employment, not associated with rehabilitative or vocational therapy.

Ind.Code §§ 22-38-8-13(h)-(i) (emphasis added). The worker argues that the word "compensation" refers to Worker's Compensation disability payments but that the exhaustion of "benefits" in subsection (h)(2) refers to "the exhaustion of the amount of benefits for permanent total disability, without designating a particular source of payment, in order for the interpretation of the [Act] to be liberally construed in favor of employees and beneficiaries." Appellant's Reply Br. at 3.

*961 To the contrary, we find that the unambiguous statutory language does not an-thorize Second Injury eligibility to be calculated by including the receipt of benefits other than specific benefits provided under the Act.

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Related

Mayes v. Second Injury Fund
888 N.E.2d 773 (Indiana Supreme Court, 2008)
Kohlmeyer v. Second Injury Fund
888 N.E.2d 281 (Indiana Court of Appeals, 2008)
Hoffmann v. Brooks Construction Co.
41 N.E.2d 613 (Indiana Supreme Court, 1942)

Cite This Page — Counsel Stack

Bluebook (online)
915 N.E.2d 958, 2009 Ind. LEXIS 1408, 2009 WL 3617551, Counsel Stack Legal Research, https://law.counselstack.com/opinion/kohlmeyer-v-second-injury-fund-ind-2009.