Pueblo School District No. 70 v. Toth

924 P.2d 1094, 1996 WL 29039
CourtColorado Court of Appeals
DecidedMay 2, 1996
Docket95CA0189
StatusPublished
Cited by12 cases

This text of 924 P.2d 1094 (Pueblo School District No. 70 v. Toth) is published on Counsel Stack Legal Research, covering Colorado Court of Appeals primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Pueblo School District No. 70 v. Toth, 924 P.2d 1094, 1996 WL 29039 (Colo. Ct. App. 1996).

Opinion

Opinion by

Judge ROTHENBERG.

In this workers’ compensation case, petitioners, Pueblo School District No. 70 and its insurer, the Colorado Compensation Insurance Authority (collectively referred to as the CCIA), seek review of a final order of the Industrial Claim Appeals (Panel) requiring the CCIA to pay a penalty for its delay in reimbursing claimant, Sandra L. Toth, for medical expenses. We affirm.

I.

Claimant became permanently and totally disabled as a result of two workplace injuries: one in 1985 and another in 1987. As part of the treatment for those injuries, her doctor prescribed over-the-counter pain relievers which she would buy. Her attorney then would submit the receipts to the CCIA for reimbursement under the Workers’ Compensation Act.

This practice went on routinely for about five years until April 1991, when claimant sought reimbursement from the CCIA in the amount of $19.68. Although the CCIA admits receiving the bill and admits responsibility for paying it, the sum was not paid to claimant for over two years. As relevant here, Colorado Workers’ Compensation Rules of Procedure Rule XIV(6), 7 Code Colo. Reg. 1101-3 (1990), required insurers to pay injured workers’ medical bills within 45 days of receipt. Nevertheless, the CCIA did not discuss the bill with claimant, and did not answer three letters from her attorney demanding payment.

Because of the delay, claimant requested a hearing and asked that penalties for nonpayment be imposed upon the CCIA pursuant to § 8-53-116, C.R.S. (1986 Repl.Vol. 3B) (repealed and reenacted with changes at § 8-43-304, C.R.S. (1995 Cum.Supp.)).

At the time of the hearing, the ALJ noted that the bill remained unpaid. The CCIA claims adjuster testified that: (1) the claimant’s receipt was received on April 1, 1991, but it was virtually illegible; (2) another bill was received on the same day which was paid, but receiving two bills on the same day confused the adjuster; and (3) it was the adjuster’s fault that the bill had not been paid.

The ALJ found no adequate explanation as to why the CCIA had not responded to the three demand letters, or why it still had not paid the bill as of the hearing date in 1993. Finding no legitimate excuse for the CCIA’s failure to pay, the ALJ imposed a fine of $10 per day for the 605 day delay.

The CCIA appealed the ALJ’s ruling to the Panel, successfully asserting that under Colorado Workers’ Compensation Rules of Procedure Rule VIII(O), only the director had jurisdiction to impose the penalties. On remand from the Panel, a second hearing was held and a different ALJ found the bill was paid 645 days late without excuse. The ALJ again recommended that the director impose penalties of $10 per day for the 645 days. The director adopted the ALJ’s recommendation and imposed a penalty of $6450 under former § 8-53-116. The Panel affirmed.

II.

The CCIA first contends that the assessment of penalties is not supported by the applicable law. We disagree.

Section 8-53-116 stated, in pertinent part:

Any ... person who violates any provision of ... this title, or does any act prohibited thereby, or fails or refuses to perform any duty lawfully enjoined within the time prescribed by the director or panel ... or fails, neglects, or refuses to obey any lawful order made by the director or panel ... shall be punished by a fine of not more than one hundred dollars for each such offense.

*1097 Section 8-63-117, C.R.S. (1986 Repl.Vol. 3B) farther provided that each day of noncompliance constituted a separate offense.

The imposition of a penalty under former § 8-53-116 is governed by an objective standard of negligence. As such, it is measured by the reasonableness of the insurer’s action and does not require knowledge that the conduct was unreasonable or in bad faith. Colorado Compensation Insurance Authority v. Industrial Claim Appeals Office, 907 P.2d 676 (Colo.App.1995). Thus, penalties may be assessed against an insurer neglecting to take action that a reasonable insurer would take to comply with either a lawful order or a provision of the Workers’ Compensation Act.

Here, the CCIA claims its actions were objectively reasonable—that is, a reasonable insurer under similar circumstances would have responded the same way. However, the CCIA offers no explanation for the two-year delay other than summarily to assert that its adjuster’s difficulty reading the receipt and the confusion with another claim letter were a reasonable response under the circumstances.

Rule XIV(6) established the standard for adjusting claims for payment of medical expenses in this ease. That rule required the insurer, within 45 days after receipt of a bill, to send certain information to the provider or the injured employee if payment was not possible within that period. Such information included a statement giving the reason for the delay of payment and the date when payment was expected.

It is undisputed that the CCIA took no action in compliance with Rule XTV(6). And, despite three written requests for payment between April 1991 and June 1992, petitioners did not advise claimant that the unpaid bill was illegible. As noted, the bill inexplicably remained unpaid at the time of the February 1993 hearing.

Based upon this evidence, the Panel concluded as a matter of law that the CCIA’s conduct was not reasonable and that penalties were imposed appropriately for petitioners’ failure to comply with the provisions of the Workers’ Compensation Act and the rules of procedure. We perceive no error in this conclusion.

Even if the matter may not be resolved as a matter of law, we must sustain a penalty so long as it is supported by substantial evidence, based on a reasonable reading of the entire record. Ace West Trucking, Inc. v. Public Utilities Commission, 788 P.2d 755 (Colo.1990). Such is the case here.

III.

The CCIA next contends that § 8-53-116 violates its right to due process. We are not persuaded.

Initially, we note claimant’s argument that, because the CCIA is a government agency and an arm of the State of Colorado, it is not a “person” under the Fourteenth Amendment. Thus, claimant asserts, the CCIA enjoys none of the benefits of the Fourteenth Amendment including its due process protection, and therefore it lacks standing to make this argument. See § 8-45-101 (Z), 3B C.R.S. (creating the CCIA as a political subdivision of the state); Williams v. Mayor and City Council of Baltimore, 289 U.S. 36, 53 S.Ct. 431, 77 L.Ed. 1015 (1933) (political subdivisions of a state are not “persons” protected by the Fourteenth Amendment); Simon v. State Compensation Insurance Authority, 903 P.2d 1139 (Colo.App. 1994), cert, granted,

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Bluebook (online)
924 P.2d 1094, 1996 WL 29039, Counsel Stack Legal Research, https://law.counselstack.com/opinion/pueblo-school-district-no-70-v-toth-coloctapp-1996.