Procise v. Electric Mutual Liability Insurance

494 A.2d 1375, 1985 Me. LEXIS 748
CourtSupreme Judicial Court of Maine
DecidedJune 28, 1985
StatusPublished
Cited by23 cases

This text of 494 A.2d 1375 (Procise v. Electric Mutual Liability 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
Procise v. Electric Mutual Liability Insurance, 494 A.2d 1375, 1985 Me. LEXIS 748 (Me. 1985).

Opinion

VIOLETTE, Justice.

Michael Procise appeals from a judgment of Superior Court, Cumberland County, granting the defendants’ motion for summary judgment and dismissal, and denying Procise’s motion for leave to pursue further discovery. Although we disagree in part with the reasoning of the Superior Court, we nevertheless affirm the judgment.

I.

Michael Procise was an employee of General Electric Company in South Portland as a “burner”, cutting pieces of steel with a cutting torch, beginning in 1974 and was a member in good standing of Local No. 2139 of the International Association of Machinists and Aerospace Workers, A.F.L.-C.I.O. (Union). On June 28, 1976, General Electric and the Union entered into a three year collective bargaining agreement that recognized the Union as the employees’ sole bargaining agent with respect to rates of pay, wages, hours and other conditions of employment. Articles 16 and 17 of the agreement established grievance and arbitration procedures with respect to the above matters. Appendix B of the agreement provided for increased benefits for pensions, income extension aid and short and long term sickness and accident insurance benefits.

Procise claims that he suffered a back injury on September 28, 1976. He worked his regular shift on September 27th and 28th, but did not work on September 29th. Procise does not cite any particular incident that caused his injury, but rather indicates that he first became aware of the injury when he awoke with back pain and had difficulty getting out of bed. He telephoned General Electric’s dispensary twice on September 30, 1976 advising them that he was at Maine Medical Center with back pain.

Procise returned to work from October 11 until October 15th when he again went to Maine Medical Center with back pain. On October 18, 1976, he first visited a chiropractor, Dr. Robert P. Lynch, Jr., who then undertook the treatment of Procise’s back injury. Procise remained out of work again for about a month and a half.

All parties agree that, had Procise’s injury arisen out of and in the course of his employment, as defined by the Maine Workers’ Compensation Act, 39 M.R.S.A. § 1 et seq., he was entitled to receive workers’ compensation benefits through General Electric’s Workers’ Compensation insurance carrier, Electric Mutual Liability Insurance Company (Electric Mutual). Under the Act, Procise could receive up to % of his average gross weekly wage for total incapacity. If the injury, however, did not arise out of or in the course of his employment, the injury was covered by General Electric’s sickness and accident insurance program administered by Metropolitan Life Insurance Company. This program involved a short-term plan, under which the parties agreed that the employee would receive up to 60% of his weekly earnings during his initial disability, up to 26 weeks; and then, an unspecified amount under a long-term disability plan.

On October 19, 1976, Procise filled out the employee portion of a Statement of Claim for weekly sickness and accident benefits. General Electric benefits technician, Carol Grindel, received the Statement of Claim. On or about October 28, 1976, Procise indicated in his response to one question that his disability was not caused by an accident. On October 22, 1976, Dr. *1362 Lynch completed the doctor’s portion of the Statement of Claim, stating that the injury was, in his opinion, the result of injury arising out of and in the course of employment. All parties agree that, with Pro-cise’s permission, Grindel telephoned Dr. Lynch on or about October 28, 1976 and received the doctor’s permission to change his statement to state that the injury did not arise out of employment. She noted the change on her copy of the form “per Dr. Lynch 10/28/76.”

Procise alleges that Grindel took this action out of bad faith to deliberately steer his claim in the most advantageous direction for General Electric. The defendants argue that Grindel acted in Procise’s best interest to obtain his benefits as quickly as possible since the cause of the injury was unknown and the difference between the two benefits was negligible.

Procise received sickness and accident benefits from October 19, 1976 until November 29,1976 when he returned to work. Procise claims that he requested a light duty work assignment when he returned to work but this was denied by Richard Ox-ton, a General Electric employee responsible for job assignment and reassignments; and that he, Procise, was not informed until March 14, 1977, that he would need a statement by a treating physician before he could be placed on light duty. On March 16,1977, Dr. Lynch wrote such a letter to William Ellinger, a General Electric employee who managed union relations. Procise indicates that light duty work was available, but General Electric responds that no suitable work was available. On March 23, 1977, Procise ceased working for General Electric permanently.

On March 25, 1977, Procise completed a second Statement of Claim for weekly sickness and accident benefits. Again, he answered that the disability was not caused by an accident. Dr. Lynch again indicated that the disability resulted from an injury arising out of and in the course of employment. The Statement of Claim was altered so that Dr. Lynch’s statement agreed with Procise’s. Procise claims, however, that he never authorized this change. The defendants state that the change was made with the specific authorization of both Dr. Lynch and Procise.

Procise received sickness and accident benefits from March 31 through September 28, 1977, a total of 26 weeks including his previous benefits. Although General Electric informed him of the availability of long term disability benefits, Procise did not submit an application for long-term disability insurance benefits when his short-term disability benefits ended.

On October 28,1977, Procise, through his attorney, filed a Petition for Award of Compensation with the Worker’s Compensation Commission, claiming he sustained work related injuries on September 28, 1976 and on March 22, 1977. On April 1, 1980, he filed a Petition for Lump Sum Settlement in the amount of $20,000.00 with the Commission, which was approved April 11, 1980. In the petition, Procise stated he requested “that all compensation which may be or become due me in weekly payments from said employer (General Electric) on account of my injury of 9/28/76 and 3/22/77 be commuted by your Commission, and that payment thereof be made in a Lump Sum of $20,000.00 according to the provision of the Workers’ Compensation Act for the following reason: It is in my best interest.” The Petition then stated “A Lump Sum Settlement of a case is a FINAL SETTLEMENT.” Procise was represented by counsel in the Lump Sum Settlement proceeding.

II.

On May 21, 1981, Procise filed a complaint in Superior Court against five parties: Electric Mutual, General Electric, Carol Grindel, Richard Oxton, and William El-linger. In his complaint, Procise makes various allegations against these defend *1363 ants arising out of the handling of his compensation for his back problems.

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Bluebook (online)
494 A.2d 1375, 1985 Me. LEXIS 748, Counsel Stack Legal Research, https://law.counselstack.com/opinion/procise-v-electric-mutual-liability-insurance-me-1985.