Ramos v. Becco Contractors, Inc.

2013 OK CIV APP 112, 315 P.3d 415, 2013 WL 6834808, 2013 Okla. Civ. App. LEXIS 105
CourtCourt of Civil Appeals of Oklahoma
DecidedNovember 21, 2013
DocketNo. 111367
StatusPublished

This text of 2013 OK CIV APP 112 (Ramos v. Becco Contractors, Inc.) is published on Counsel Stack Legal Research, covering Court of Civil Appeals of Oklahoma primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Ramos v. Becco Contractors, Inc., 2013 OK CIV APP 112, 315 P.3d 415, 2013 WL 6834808, 2013 Okla. Civ. App. LEXIS 105 (Okla. Ct. App. 2013).

Opinion

LARRY JOPLIN, Chief Judge.

{1 Petitioner Jose C. Ramos (Claimant) seeks review of the trial court's order refusing to enforce a provision of the joint petition settlement by and between Claimant and Respondents Beceo Contractors, Inc. and Beceo Contractors, Inc. (Own Risk # 19801) (collectively, Employer). In this review proceeding, Claimant asserts the trial court erred in refusing to enforce the joint petition settlement in its entirety.

T2 The basic facts are not seriously disputed. Claimant does not speak English. On or about December 15, 2004, Claimant suffered a serious accidental injury to his right foot arising out of and in the course of his employment by Employer. - Claimant filed his Form 3, including a nine-digit number in the blank for his Social Security number. Employer admitted occurrence of a compensable injury, and paid benefits for temporary total disability and medical treatment.

T8 Claimant sought benefits for permanent total disability. On consideration of the evidence, the trial court awarded benefits for permanent partial disability, disfigurement, continuing medical treatment and vocational rehabilitation, and reserved the determination of permanent total disability pending the outcome of vocational rehabilitation.

€ 4 The parties subsequently submitted to mediation in an attempt to finally resolve the claim. The parties agreed to settle the claim in consideration of Employer's payment to Claimant of $125,000.00, and:

[416]*416[In addition, the [Employer] agrees to fund [al [Medicare Set Aside] in the amount of $12,861.18. In the event the [Medicare Set Aside] as approved by [the Centers for Medicare and Medicaid Services, hereinafter CMS] exceeds this amount, the Claimant agrees to provide additional funding from the settlement proceeds.

15 At the hearing to approve the Joint Petition, Claimant acknowledged that he understood the terms and conditions for payment of the Medicare Set Aside:

Q. You are settling your case today for the sum of $125,000.00, plus $12,861.18. And you're also closing out your right to any combined injury claim that you might assert. Do you understand?
A. (Through the interpreter) Yes.
Q. You are going to agree that the $12,861.18 is to be used for what we call a Medicaid set-aside trust. Do you understand?
A. (Through the interpreter) Yes.
Q. You also are agreeing that when this Medicaid set-aside trust is submitted to CMS, that if they require additional money to be invested in the MSA, that you will provide that additional money from your part of the settlement. Do you understand that?
A. (Through the interpreter) Yes.
Q. That Medicaid set-aside trust is going to be administered by you. Do you understand?
A. (Through the interpreter) Yes.
. Q. So for every dollar you spend after today on medical treatment related to this injury, you will be using those funds. Do. you understand?
A. (Through the interpreter) Yes.
Q. And you will have to do the accounting to show CMS you spent the money for that purpose. Do you understand that?
A. (Through the interpreter) Yes.
Q. All medical bills that were incurred before today are the responsibility of your former employer. Do you understand?
A. (Through the interpreter) Yes.
Q. So if you get a bill that was incurred before today, I want you to forward that to your attorney, and he will forward it to my client for payment. You understand?
A. (Through the interpreter) Yes.
Q. Any medical treatment that you have after today will be paid by you, and you have to use this MSA money to pay for that service. Do you understand?
A. (Through the interpreter) Yes.
Q. Now, you will get the $12,861.18 upon CMS approving the Medicaid set-aside trust. Do you understand?
A. (Through the interpreter) Yes.
Q. So my client hasn't written that check yet, and they're going to do that as soon as we get approval on this settlement. You understand?
A. (Through the interpreter) Yes.
Q. So if you have medical bills between now and approval of the CMS, or MSA, you'll have to pay for that out of the money you're getting in this settlement. Keep your receipts. Then you can pay yourself back from the twelve thousand. You understand?
A. (Through the interpreter) Yes.
Q. Okay. Because if you need medical tomorrow, you're not going to have the money in hand from the MSA. You understand?
A,. (Through the interpreter) Yes.

Based on this testimony, and Claimant's expressed understanding of the parties' rights and obligations, the trial court approved settlement by Joint Petition filed June 1, 2009. Claimant became a naturalized citizen on December 18, 2011.

T6 Employer paid Claimant the principal amount of $125,000.00, but refused to fund the Medicare Set Aside or pay the stipulated amount to Claimant. Employer asserted that upon submission of the Medicare Set Aside provision to CMS, it was discovered that Claimant was not Medicare eligible, that the number reported by Claimant as his Social Security number for purposes of this Workers' Compensation claim was only a taxpayer identification number, and that Claimant's taxpayer identification number did not become his Social Security number, and [417]*417Claimant was not Medicare eligible, until he became a naturalized citizen in December 2011. Employer consequently argued that, because Claimant misrepresented his status as a holder of a valid Social Security number, eligible for Medicare benefits, at the time he filed his claim and at the time of settlement, the provision of the Joint Petition settlement calling for funding of a Medicare Set Aside was unenforceable on account of Claimant's misrepresentation of Social Security and Medicare eligibility.

T7 Claimant responded. Claimant pointed out he did not speak English Claimant further asserted he did not appreciate the difference between the nine-digit number issued to him as a taxpayer identification number and the same nine-digit number which became his Social Security number upon his naturalization, or the significance of the difference as it related to his Medicare eligibility, either at the time he filed his claim or at the time of settlement. Claimant argued alternatively that he settled his claim for the total sum of $137,361.18, and, regardless of the designation of the $12,861.18 as a Medicare Set Aside, he was nevertheless entitled to payment of the full settlement amount.

18 On consideration of the arguments of the parties' attorneys, but apparently without consideration of any testimony or evidence, the trial court held the Medicare Set Aside provision of the Joint Petition was unenforceable:

THAT on MAY 28, 2009, the parties entered into a Joint Petition Settlement including an MSA set-a-side of $12,361.18.

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Bluebook (online)
2013 OK CIV APP 112, 315 P.3d 415, 2013 WL 6834808, 2013 Okla. Civ. App. LEXIS 105, Counsel Stack Legal Research, https://law.counselstack.com/opinion/ramos-v-becco-contractors-inc-oklacivapp-2013.