Siaperas v. Montana State Compensation Insurance Fund

CourtCourt of Appeals for the Ninth Circuit
DecidedMarch 26, 2007
Docket05-35459
StatusPublished

This text of Siaperas v. Montana State Compensation Insurance Fund (Siaperas v. Montana State Compensation Insurance Fund) is published on Counsel Stack Legal Research, covering Court of Appeals for the Ninth Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Siaperas v. Montana State Compensation Insurance Fund, (9th Cir. 2007).

Opinion

FOR PUBLICATION UNITED STATES COURT OF APPEALS FOR THE NINTH CIRCUIT

PATSY SIAPERAS,  Plaintiff-Appellant, No. 05-35459 v.  D.C. No. CV-04-00013-RWA MONTANA STATE COMPENSATION INSURANCE FUND, OPINION Defendant-Appellee.  Appeal from the United States District Court for the District of Montana Richard W. Anderson, Magistrate Judge, Presiding

Submitted February 5, 2007* Seattle, Washington

Filed March 27, 2007

Before: Raymond C. Fisher and Richard C. Tallman, Circuit Judges, and Richard Mills, District Judge.**

Opinion by Judge Mills

*This panel unanimously finds this case suitable for decision without oral argument. See Fed. R. App. P. 34(a)(2). **The Honorable Richard Mills, Senior United States District Judge for the Central District of Illinois, sitting by designation.

3521 SIAPERAS v. MONTANA STATE COMPENSATION 3523

COUNSEL

Robert C. Kelleher, Sr., Butte, Montana, for the plaintiff- appellant.

Charles G. Adams, Keller, Reynolds, Drake, Johnson, and Gillespie, P.C., Helena, Montana, for the defendant-appellee. 3524 SIAPERAS v. MONTANA STATE COMPENSATION OPINION

MILLS, District Judge:

FACTS & PROCEDURAL HISTORY

Patsy Siaperas severely injured her back on August 17, 1996, while working for High Plains Pizza in Dillon, Mon- tana. She filed a workers’ compensation claim and was deter- mined to be permanently totally disabled pursuant to § 39-71- 702, Montana Code. The State of Montana Mutual Insurance Fund (the “State Fund”), as the insurer of Siaperas’ employer, accepted liability for Siaperas’ injury. The State Fund com- puted her disability rate to be $369.23 (two-thirds her $553.84 average current earnings (“ACE”)). Once Siaperas’ bonuses came to light, the State Fund recognized that her ACE was $759.99 and that her disability rate should have been $506.66. However, Montana law capped workers’ compensation bene- fits at $384 per week; thus, the underpayment amounted to $14.77 per week.

What brought this case to the fore is what happened when Siaperas sought Social Security Disability Insurance benefits (“SSDI”) from the Social Security Administration. On June 28, 2002, an administrative law judge found Siaperas to be totally disabled as of February 6, 1997, for purposes of SSDI. As a result, Siaperas received SSDI retroactively to December 1, 1999, at a rate of $290.74 per week. On April 16, 2003, the State Fund reduced Siaperas’ workers’ compensation benefits by $145.37, an amount equal to 50% of her SSDI. The reduc- tion was done pursuant to § 39-71-702(4) Montana Code. The State Fund notified Siaperas that she had been overpaid bene- fits totaling $25,397.59. On May 6, 2003, an adjuster for the State Fund notified Siaperas that a recalculation showed her overpayment to be the still higher figure of $28,299.17.

Siaperas contested the State Fund’s calculations before the Montana Workers’ Compensation Court, Siaperas v. Montana SIAPERAS v. MONTANA STATE COMPENSATION 3525 State Fund, WCC No. 2003-0841, unsuccessfully arguing that an off-set of her benefits violated the U.S. Constitution’s Equal Protection Clause as well as 42 U.S.C. § 424a. She appealed to the Montana Supreme Court, but was again unsuccessful on this issue. See Siaperas v. Mont. State Fund, 100 P.3d 167 (Mont. 2004) (unpublished disposition). She then filed a declaratory judgment action in the U.S. District Court for the District of Montana. The parties consented to having their case heard by U.S. Magistrate Judge Richard W. Anderson.

Siaperas made no Equal Protection claim. However, she again contended that § 424a barred the State Fund from reducing her benefits below 80% of her ACE. Although Siap- eras’ Second Amended Complaint did not argue preemption, the district court considered whether Montana law was pre- empted by § 424a. The State Fund moved to dismiss the case under Federal Rule of Civil Procedure 12(b)(6). Judge Ander- son sided with the State Fund on both issues and granted the State Fund’s motion on April 7, 2005. Siaperas timely appealed.

STANDARD OF REVIEW

The court uses a de novo standard when reviewing a district court’s decision to grant a motion to dismiss for failure to state a claim. Bassiri v. Xerox Corp., 463 F.3d 927, 929 (9th Cir. 2006). “Upon review, we ‘must construe the complaint in the light most favorable to the plaintiff and must accept all well-pleaded factual allegations as true.’ ” Syverson v. Int’l Bus. Machines Corp., 472 F.3d 1072, 1075 (9th Cir. 2007) (quoting Shwarz v. United States, 234 F.3d 428, 435 (9th Cir. 2000)). Dismissal is proper only when there is no cognizable legal theory or an absence of sufficient facts alleged to sup- port a cognizable legal theory. Balisteri v. Pacifica Police Dep’t, 901 F.2d 696, 699 (9th Cir. 1990). 3526 SIAPERAS v. MONTANA STATE COMPENSATION ANALYSIS

[1] A person who receives SSDI and workers’ compensa- tion benefits cannot receive combined benefits that exceed 80% of her ACE. See 42 U.S.C. § 424a(a). When a person’s combined benefits exceed 80% of her pre-disability earnings, SSDI must be reduced via an “offset.” Id. Nevertheless, a state can reduce its own workers’ compensation benefits on the basis of social security disability benefits. Id. at § 424a(d). This is commonly referred to as a “reverse offset.” To prevent a person from being subjected to state and federal offsets, the Social Security Act provides that a person’s workers’ com- pensation benefits will not be offset if the state is executing a reverse offset. Id.

The State Fund executed a reverse offset against Siaperas’ SSDI. The reverse offset, which totaled 50% of Siaperas’ SSDI, was authorized by Montana law. See § 39-71-702(4) Mont. Code Ann. (authorizing reduction “by an amount equal . . . to one-half the federal periodic benefits for the week”). That law has been tested and deemed constitutional. See McClanathan v. Smith, 606 P.2d 507 (Mont. 1980).

[2] After the reverse offset, Siaperas’ combined benefits totaled less than 80% of her ACE. Siaperas contends that § 424a prevents her combined benefits from being reduced to an amount that is less than 80% of her ACE. Section 424a creates a benefits “ceiling” that prevents individuals from obtaining more than 80% of their ACE. See Bubnis v. Apfel, 150 F.3d 177, 179 (2d. Cir. 1998); accord, Berger v. Apfel, 200 F.3d 1157, 1159 (8th Cir. 2000); Merz v. Sec’y of Health & Human Serv., 969 F.2d 201, 204 (6th Cir. 1992); Draper v. Sullivan, 899 F.2d 1127, 1128 (11th Cir. 1990); Sciarotta v.

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