Potvin v. Lincoln Service & Equipment Co.

6 A.3d 60, 298 Conn. 620, 2010 Conn. LEXIS 374
CourtSupreme Court of Connecticut
DecidedOctober 19, 2010
DocketSC 18357
StatusPublished
Cited by41 cases

This text of 6 A.3d 60 (Potvin v. Lincoln Service & Equipment Co.) is published on Counsel Stack Legal Research, covering Supreme Court of Connecticut primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Potvin v. Lincoln Service & Equipment Co., 6 A.3d 60, 298 Conn. 620, 2010 Conn. LEXIS 374 (Colo. 2010).

Opinions

Opinion

ZARELLA, J.

The defendant Guaranty Fund Management Services1 appeals2 from the decision of the compensation review board (board), which upheld the decision of the workers’ compensation commissioner for the third district (commissioner) imposing sanctions against the Connecticut Insurance Guaranty Association (association)3 pursuant to General Statutes (Rev. to 2005) § 31-288 (b)4 and ordering the association to pay attorney’s fees5 pursuant to General Statutes § 31-[623]*6233006 for undue delay in processing a claim by the plaintiff, James Potvin, on behalf of an insolvent insurer pursuant to the Workers’ Compensation Act, General Statutes § 31-275 etseq., and the Connecticut Insurance Guaranty Association Act (guaranty act), General Statutes § 38a-836 et seq. The board concluded that the commissioner had the authority to impose sanctions against the association, that the sanctions were part of a “covered claim” under General Statutes § 38a-838 (5),7 which the association is obligated to pay in accordance with General Statutes § 38a-841 (1) (a) and (b),8 and [624]*624that the association is not immune from sanctions by virtue of General Statutes § 38a-850.9 The defendant claims that the board improperly determined that the commissioner has the authority to impose sanctions on the association and specifically argues that the board improperly (1) applied the Appellate Court’s decision in Pantanella v. Enfield Ford, Inc., 65 Conn. App. 46, 53, 782 A.2d 141, cert. denied, 258 Conn. 930, 783 A.2d 1029 (2001), to the facts of the present case, and (2) determined that the association is obligated to pay the sanctions because § 38a-850 provides a broad grant of immunity to the association, including immunity from sanctions, the sanctions imposed are not part of a “covered claim” within the meaning of § 38a-838 (5), and the association cannot be “deemed the insurer” under § 38a-841 (1) (b). The plaintiff responds that the board properly upheld the imposition of sanctions.10 We agree [625]*625with the defendant that the association is statutorily immune from the sanctions imposed in the present case and that the sanctions are not part of a “covered claim” within the meaning of § 38a-838 (5). Accordingly, we reverse the decision of the board.

The board found the following undisputed facts relevant to this appeal. “The [plaintiff] suffered a compensa-ble injury in 2000, which was accepted by his employer, Lincoln Service and Equipment [Company], in 2001. At that time, a voluntary agreement was approved by the [workers’ compensation] commission. The [plaintiff] had a knee replacement surgery performed in 2003 but, following the procedure, continued to complain of knee pain. [The association’s] umbrella organization, [the defendant],11 had the [plaintiff] examined by . . . MacEllis Glass [a physician] on January 12, 2005. . . . Glass strongly recommended that the [plaintiff] be [626]*626examined by another physician for consideration of a patellar replacement. [The defendant] authorized the [plaintiff] to be examined by a second [physician], [namely] John Grady-Benson, who noted an antalgic limp and recommended a bone scan of the patella. He also recommended [a magnetic resonance image (MRI)] of the [plaintiffs] lower spine to determine if he had a neurological disorder due to the right knee replacement. . . . Grady-Benson examined the [plaintiff] on April 6, 2005, and submitted a bill in the amount of $343 for the examination.

“[Although] this bill was properly submitted to [the defendant], it was not paid until September 15, 2005. During this period, an adjuster for [the defendant], Kristen Rogers, prepared an authorization for the [plaintiffs] MRI but decided not to issue the authorization, claiming [that] ‘she [had] realized the back injury was not part of the compensable injury.’ . . . Rogers claimed she orally authorized the bone scan in August, 2005. Counsel for [the defendant] offered to pay for the bone scan on September 1, 2005, on a ‘without prejudice’ basis but demurred on the issue of the MRI. Following an informal hearing before [the] commissioner ... on February 15, 2006, [the defendant] finally provided written authorization for the bone scan and [the] MRI.

“Following [the defendant’s authorization of] these medical tests, the [plaintiff] encountered numerous difficulties in getting [the defendant] to guarantee payment to Hartford Hospital for these tests. The [plaintiff] presented himself twice for the tests, both on July 10,2006, and July 11, 2006, and both times Hartford Hospital declined to perform the tests due to inadequate assurances of payment. The [plaintiff] then had the tests [covered by] private group insurance for which a $100 [627]*627co-pay was assessed.12 . . . Seven workers’ compensation hearings [were] held on these issues, including two formal hearings on November 20, 2006, and January 16, 2007, to discuss the unreasonable contest and undue delay of benefits. The . . . commissioner found that [the defendant] did not provide any medical reports that justified the delay in paying . . . Grady-Benson or [the delay in] scheduling . . . the MRI and bone scan recommended by . . . Grady-Benson.

“In his [f]inding and [a]ward of July 27, 2007, [the] commissioner . . . concluded that [the defendant had] unreasonably contested and delayed medical treatment benefits for the [plaintiffs] compensable knee injury . . . [and found that the defendant had] lacked a reasonable basis to delay payment for treatment, to contest the need for treatment, or to contest or delay the recommended diagnostic tests for the [plaintiff]. The commissioner concluded that the unreasonable delay of benefits was due to [the defendant’s] own fault and neglect in handling the claim. The commissioner did not find any monetary benefits were delayed for which interest could be granted. The commissioner further found that the undue delay in medical treatment caused the [plaintiffs] attorney to expend substantially more time representing his client than would be reasonably expected. Therefore, pursuant to § 31-300 . . . the . . . commissioner ordered [the defendant] to pay [the plaintiffs] counsel $8000 to compensate for [forty] hours of legal time occasioned by the unreasonable delay, and penalized [the defendant] $500 pursuant to § 31-288 (b) (1) .... The [defendant and the plaintiffs employer] filed a motion to correct, seeking to interpose factual find[628]*628ings that [the defendant] did not act unreasonably and . . . [that the defendant was] legally immune from sanction. The . . . commissioner denied [the motion], and [the] appeal [to the board followed].”

The board concluded that the commissioner had properly imposed sanctions against the association13 for its undue delay in processing the plaintiffs claim. In its decision, the board first concluded that the facts of Pantanella v. Enfield Ford, Inc., supra, 65 Conn. App.

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Bluebook (online)
6 A.3d 60, 298 Conn. 620, 2010 Conn. LEXIS 374, Counsel Stack Legal Research, https://law.counselstack.com/opinion/potvin-v-lincoln-service-equipment-co-conn-2010.