Montgomery County v. Willis

979 A.2d 209, 187 Md. App. 514, 2009 Md. App. LEXIS 139
CourtCourt of Special Appeals of Maryland
DecidedAugust 28, 2009
Docket3081, September Term, 2007
StatusPublished
Cited by3 cases

This text of 979 A.2d 209 (Montgomery County v. Willis) is published on Counsel Stack Legal Research, covering Court of Special Appeals of Maryland primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Montgomery County v. Willis, 979 A.2d 209, 187 Md. App. 514, 2009 Md. App. LEXIS 139 (Md. Ct. App. 2009).

Opinion

HOLLANDER, J.

In this appeal, we must determine whether an employer is entitled to judicial review of an Order issued by the Workers’ Compensation Commission (the “Commission”), denying the employer’s request to refer a worker’s compensation claim to the Insurance Fraud Division (the “Division”) of the Maryland Insurance Administration.

Valerie Willis (the “Employee” or the “Claimant”), appellee, a former Montgomery County Police Officer, obtained compensation benefits for a work related injury sustained in July 2001. Montgomery County (the “County” or the “Employer”), appellant, claimed that after the work-related event, but before benefits were awarded, the Employee sustained a non-work related injury that she failed to disclose. On that basis, pursuant to Md.Code (2008 Repl.Vol.), § 9-310.2 of the Labor and Employment Article (“L.E.”), the County filed a “Request for a Hearing for Referral to the Maryland Insurance Fraud Division.” After an evidentiary hearing, the Commission determined there was insufficient evidence of fraud, and declined to refer the matter to the Division. Thereafter, the County sought judicial review in the Circuit Court for Montgomery County. The Claimant moved to dismiss, arguing, inter alia, that the Commission’s Order was not appealable. The circuit court agreed and dismissed the appeal.

This appeal followed. The County presents one question for our review, which we quote:

When an employer seeks reimbursement of workers’ compensation benefits based on its belief that an employee *518 wrongfully obtained those benefits, is the Commission’s determination subject to review in the circuit court as a final order of the Commission? [1]

For the reasons that follow, we shall reverse and remand to the circuit court for further proceedings.

FACTUAL AND PROCEDURAL BACKGROUND 2

Valerie Willis, a former Montgomery County Police Officer, injured her left knee during a training exercise on July 20, 2001. Despite the injury, Ms. Willis continued to work. She injured her knee again during “a shooting scenario” in August 2001, for which she did not seek medical treatment. Rather, she cared for her knee herself while continuing to work. Then, on December 31, 2001, appellee injured her knee for a third time. On this occasion, however, the injury was not work-related. Appellee was diagnosed with a ruptured anteri- or cruciate ligament (“ACL”), for which she underwent surgery on January 30, 2002.

On January 26, 2002, a few days before appellee’s first surgery, Willis’s direct supervisor, Corporal Ed Shropshire, filed with the Commission an “Employer’s First Report of Injury or Illness” for appellee. He listed July 20, 2001, as the date the Employer had been notified of appellee’s injury.

On March 4, 2002, the Claimant signed a form titled “Employee’s Claim Workers’ Compensation Commission,” in which she represented that she had twisted her left knee during a training exercise on July 20, 2001, and that she had given notice to Lieutenant Rodney Hill on that date. Appellee filed a “Corrected Claim” with the Commission on April 21, 2002, indicating that she injured both her left knee and her back on July 20, 2001. The claim listed July 21, 2001, as the “1st day *519 unable to work,” and reflected that Willis returned to work on July 26, 2001. Neither the initial claim nor the corrected claim referred to the incident of December 31, 2001. Nor did the County have any records pertaining to the December 2001 occurrence. According to the County, the claim was “accepted” but “no medicals were forthcoming.”

On June 4, 2002, the Commission issued an Order, finding that Willis sustained an accidental injury “arising out of and in the course of employment” on July 20, 2001. But, the Commission ordered that the claim for compensation “be held pending until such time as the nature and extent of the claimant’s disability, if any, can be determined.”

Appellee had a second knee surgery on September 26, 2005, to repair a torn meniscus in the left knee, for which the County paid the medical expenses. Willis was awarded temporary total disability (“TTD”) from September 1, 2005, through February 23, 2006. 3 In April 2006, appellee sought TTD benefits dating to 2002. According to the County, at that point it obtained medical records for the period prior to June 2002, which “revealed an intervening event that was non work related.”

On November 20, 2006, through the Montgomery County Self-Insured Fund, appellant filed with the Commission a form titled “Request For A Hearing For Referral To Maryland Insurance Fraud Division” (the “Petition”). The preprinted form stated:

This form may be filed by any party at any time.
The Commission shall refer the case on the person named below to the Insurance Fraud Division in the Maryland Insurance Administration where the Commission finds, after a hearing, that a party requesting the referral has carried the burden of establishing by a preponderance of the evi *520 dence that the named person knowingly affected or knowingly attempted to affect the payment of compensation, fees, or expenses under Title 9 of the Labor Law by means of a fraudulent representation.
The undersigned alleges that the person named below violated section 9-310.2(a) of the Labor & Employment Article and requests a hearing before the Commission.

The Commission held an evidentiary hearing on the Petition on April 17, 2007. The Employer’s attorney represented that the matter concerned a claim of “Fraud.” Explaining “the basis of the fraud,” the County’s lawyer said:

[I]n May of 2002, ... [appellee] indicated that she twisted her knee on the job in July of 2001, the claim was accepted at that time. No medicals were forthcoming. The medicals we had, that we later received very soon thereafter, was June 24th, 2002 and beyond. So the claim was accepted.
Then in April of 2006, she made a claim for T.T.D. back in 2002, a back claim for temporary total disability. At that point, we were able to secure the medicals predating June of 2002. Those medicals revealed an intervening event that was non work related. That was the first time that the County was aware that there was a non work-related accident on or about December 30th or 31 st of 2001. And then we also found at that time that she had a surgery, an ACL reconstruction, related to that incident in January of 2002. That surgery was never paid for by the County, but a subsequent surgery of 9/26/2005 was paid by the County and the T.T.D. related to that.
And that’s the basis of the fraud that we were never informed of the—and there was no treatment from July of 2001 until January of 2002, until the intervening event. And the County was unaware and never informed of the intervening event.

Willis testified that she injured herself while on duty on July 20, 2001, while carrying a bullet proof shield.

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Related

Willis v. Montgomery County
3 A.3d 448 (Court of Appeals of Maryland, 2010)

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979 A.2d 209, 187 Md. App. 514, 2009 Md. App. LEXIS 139, Counsel Stack Legal Research, https://law.counselstack.com/opinion/montgomery-county-v-willis-mdctspecapp-2009.