Simpson v. Industrial Claim Appeals Office

219 P.3d 354, 2009 WL 1013161
CourtColorado Court of Appeals
DecidedJune 25, 2009
Docket07CA1581
StatusPublished
Cited by3 cases

This text of 219 P.3d 354 (Simpson v. Industrial Claim Appeals Office) 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
Simpson v. Industrial Claim Appeals Office, 219 P.3d 354, 2009 WL 1013161 (Colo. Ct. App. 2009).

Opinion

Opinion by

Judge CASEBOLT.

In this workers' compensation proceeding, claimant, Richard Simpson, seeks review of the final order of the Industrial Claim Appeals Office (Panel), affirming the order of the administrative law judge (ALJ), finding that employer, Benchmark/Elite, Inc., and its current insurer, Colorado Insurance Guaranty Association (CIGA), had overpaid benefits to claimant and were entitled to credit for the overpayment. We affirm in part, set aside in part, and remand.

Claimant was injured in an admitted, work-related accident in April 2000. Benchmark was then insured by a carrier that later went bankrupt, requiring CIGA to take over the claim. Benchmark and its insurer (employer, collectively), admitted and paid temporary total disability (TTD) benefits and, later, benefits for permanent partial disability (PPD). Following claimant's receipt of Social Security disability benefits, employer admitted liability for permanent total disability (PTD) benefits.

Employer discovered that it had overpaid claimant for TTD and PPD, which apparently happened when duplicate payments were made by the two insuring entities. After claimant applied for and received a lump sum award for PTD, employer, through various admissions it filed, credited the lump sum amount against the overpayment. Claimant objected, asserted that his base PTD rate was wrongly computed, requested penalties, and sought a hearing.

The ALJ concluded that employer had overpaid benefits to claimant and approved the offset against the Iump sum award. The ALJ allowed the remaining overpayment to be recovered over the next five years at a weekly rate. The ALJ held that claimant's PTD rate was correctly computed based on the state average weekly wage (AWW) rate in effect at the time of his injury, and declined to consider his request for penalties.

On review, the Panel affirmed, concluding that the ALJ had not misapplied the law in determining that employer had overpaid claimant and was entitled to reimbursement. The Panel further held that the Workers Compensation Act (Act) does not provide for *358 an escalation of benefits from the maximum allowed under the state AWW amount in effect at the time of injury. The Panel also determined that substantial evidence supported the ALJ's finding that an overpayment had been made. Accordingly, the Panel held that any error the ALJ may have made by refusing to proceed on claimant's penalty issue was harmless. Claimant appeals the Panel's order.

While this appeal was pending, respondents withdrew their claim for recoupment of double payment of TTD benefits While claimant accepted that withdrawal, he nevertheless continues to contend that an overpayment issue exists here. Accordingly, the discussion in parts I through VII below relates to any overpayment issue still remaining. Further, remand is required for the ALJ to modify the order to implement respondents' withdrawal of the claim for recoupment of double payments of TTD.

Following oral argument in this case, the supreme court decided Avalanche Industries, Inc. v. Clark, 198 P.3d 589 (Colo.2008). We requested supplemental briefs addressing the effect of that case here.

I. Recovery of Overpayment

Claimant asserts that recovery of an overpayment arising from an employer's error is barred by case law. In particular, claimant argues that HLJ Management Group, Inc. v. Kim, 804 P.2d 250 (Colo.App.1990), prohibits the retroactive reimbursement for an overpayment. We disagree.

HLJ Management held that, when an employer's mistake in an admission results from its own erroneous calculation and not, for example, from fraud, it cannot retroactively withdraw or modify the admission and is bound thereby, at least until an ALJ enters an order as to prospective payments. Id. at 258. However, in 1997, the General Assembly amended section 8-48-8083(1) & (2)(a), C.R.9$.2008, to permit reopening of an award on grounds of "overpayment," and specified that the reopening would not affect an earlier award as to money already paid "except in cases of overpayment."

As the Panel and employer note, HLJ Management was decided several years before the cited amendment to the Act permitted employers to reopen a claim on the basis of overpayment. Thus, at the time HLJ Management was announced, employers had no statutory means to review and recalculate payments made as they do under the version of the Act applicable here.

We therefore reject claimant's contention.

II. Definition of Overpayment

Claimant nevertheless challenges the Panel's interpretation and application of the definition of "overpayment." He argues that overpayment means offsets that are provided by payments received from other disability plans such as Social Security disability and not sums that are erroneously paid by an employer. He contends that the statutory definition of overpayment specifically refers only to offsets that are defined in section 8-42-108, C.R.S.2008. We disagree.

Section 8-40-201(15.5), C.R.8.2008, defines an overpayment as:

[MJoney received by a claimant that exceeds the amount that should have been paid, or which the claimant was not entitled to receive, or which results in duplicate benefits because of offsets that reduce disability or death benefits payable under said articles [articles 40 to 47 of title 8]. For an overpayment to result, it is not necessary that the overpayment exist at the time the claimant received disability or death benefits....

In interpreting a statute, we must "effectuate the intent and purpose of the General Assembly." Anderson v. Longmont Toyota, Inc., 102 P.3d 323, 326 (Colo.2004). We apply "the plain and ordinary meaning of the statute, if clear." Id. at 827. We also give deference to reasonable interpretations of a statute adopted by the agency charged with its administration. Dillard v. Indus. Claim Appeals Office, 121 P.3 301, 304 (Colo.App.2005), aff'd, 184 P.3d 407 (Colo.2006).

Claimant reads the statutory language "because of offsets that reduce disability or death benefits payable under said articles" to *359 apply to all three categories of overpay-ments. However, he reads the definition too narrowly. Claimant's interpretation would require us to ignore the plain meaning of the word "or" in the statute that delineates separate categories of overpayments. The statute makes clear that the phrases are disjune-tive such that three categories of possible overpayment are included in the statutory definition: one category is for overpayments created when a claimant receives money "that exceeds the amount that should have been paid"; the second category is for money received that a "claimant was not entitled to receive"; and the final category is for money received that "results in duplicate benefits because of offsets that reduce disability or death benefits" payable under articles 40 to 47 of title 8. § 8-40-201(15.5).

This statutory construction is also consistent with section 2-4-214, C.R.3.2008, which repudiates the last antecedent rule as a presumed rule of statutory construction.

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Related

85 Sanchez v. Industrial Claim Appeals Office
2017 COA 71 (Colorado Court of Appeals, 2017)
BENCHMARK/ELITE, INC. v. Simpson
232 P.3d 777 (Supreme Court of Colorado, 2010)

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Bluebook (online)
219 P.3d 354, 2009 WL 1013161, Counsel Stack Legal Research, https://law.counselstack.com/opinion/simpson-v-industrial-claim-appeals-office-coloctapp-2009.