State ex rel. Baker Material Handling Corp. v. Industrial Commission

631 N.E.2d 138, 69 Ohio St. 3d 202
CourtOhio Supreme Court
DecidedMay 4, 1994
DocketNo. 93-5
StatusPublished
Cited by86 cases

This text of 631 N.E.2d 138 (State ex rel. Baker Material Handling Corp. v. Industrial Commission) is published on Counsel Stack Legal Research, covering Ohio Supreme Court primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
State ex rel. Baker Material Handling Corp. v. Industrial Commission, 631 N.E.2d 138, 69 Ohio St. 3d 202 (Ohio 1994).

Opinions

Alice Robie Resnick, J.

This case presents two important workers’ compensation issues. The first issue is whether a self-insured employer who, subsequent [205]*205to the initial allowance of a claim, certifies a medical condition as allowed on a C-174 form has conclusively granted that additional condition as part of the claim. The second issue involves the effect of post-PTD retirement upon a claimant’s eligibility for PTD compensation.

I

Allowance of Additional Condition by Self-Insured Employer

In Ohio, employers are required to make semiannual premium payments to the State Insurance Fund for the purpose of establishing coverage for their employees who suffer work-related injuries. R.C. 4123.35(A). Certain qualifying employers, however, may “be granted the privilege to pay individually compensation, and furnish medical, surgical, nursing and hospital services and attention and funeral expenses directly to injured employees or the dependents of killed employees.” R.C. 4123.35(B). These self-insured employers pay “no premium to the State Insurance Fund.” Fulton, Ohio Workers’ Compensation Law (1991) 306, Section 14.10.

State-fund employers and self-insured employers stand on different footing with regard to the processing and adjudication of workers’ compensation claims. State-fund employers simply make “premium payments to the fund. Self-insurers, on the other hand, are the initial processing agents of claims brought by their employees. The commission or bureau becomes involved only if the self-insurer denies a claim and the employee appeals.” Wargetz v. Villa Sancta Anna Home for the Aged (1984), 11 Ohio St.3d 15, 17, 11 OBR 49, 51, 462 N.E.2d 1215, 1217. Thus, “[a] self-insuring employer not only pays compensation directly to his injured employees but also adjudicates their claims for benefits in the absence of a dispute.” Young, Workmen’s Compensation Law of Ohio (2 Ed.1971) 239, Section 13.11. In addition, former Ohio Adm.Code 4121-9-01(C) (now 4123-19-01[C]) provided in pertinent part that:

“A self-insured employer may, without any prior order from the commission, grant or reftise to grant any claim made under the Ohio Workers’ Compensation Act.” (Emphasis added.)

In State ex rel. Saunders v. Metal Container Corp. (1990), 52 Ohio St.3d 85, 556 N.E.2d 168, this court held that the commission did not have continuing jurisdiction to correct its previous mistake regarding the medical condition allowed in a claim to the extent of changing the nature of the medical condition as certified by the self-insurer on a “C-50 Application for payment of Compensation and Medical benefits.” The court of appeals in that case, State ex rel. Saunders v. Metal Container Corp. (Nov. 29, 1988), Franklin App. No. 87AP-509, unreported, at 6, 1988 WL 129162, explained as follows:

[206]*206“[When] * * * the employer is self-insured[,] [t]he initial determination of allowed conditions necessarily is made by the employer in such a situation. The district hearing officer cannot modify that finding over the objection of the claimant, upon the assumption that the self-insured employer erroneously certified the condition. The district hearing officer had no jurisdiction under R.C. 4123.52, or otherwise, to modify the original finding of the employer as to the allowed condition over the objection of the claimant. The employer who made the determination and certified the claim cannot now complain, as it attempted to do before the district hearing officer in March 1986 that it, the employer, had made an erroneous determination and certification as to the allowed condition.”

Based on similar reasoning, at least two appellate courts have held that a self-insured employer makes a conclusive determination to amend a claim by virtue of certifying an additional condition as “allowed” on the C-174 form. Garrett v. Jeep Corp. (1991), 77 Ohio App.3d 402, 602 N.E.2d 691; State ex rel. Jones v. Indus. Comm. (Oct. 20, 1983), Franklin App. No. 83AP-256, unreported, 1983 WL 3734.

Baker proposes that the C-174 form be limited to its purpose, which, Baker contends, “is to advise the Industrial Commission of the type of compensation being paid to a claimant, not to provide a record of the claimant’s allowed conditions * * In support, Baker relies on this court’s decision in State ex rel. Riggs v. Oak Lake Farms, Inc. (1986), 26 Ohio St.3d 173, 26 OBR 149, 497 N.E.2d 720. In Riggs, the claimant’s treating physician had submitted a medical report in which he opined that the claimant was permanently and totally disabled. The commission argued that this report was “unreliable because, both prior and subsequent to the date of his report, [the doctor] submitted to the Bureau of Workers’ Compensation ‘C-19’ billing forms on which he (or someone in his employ) had checked boxes indicating that the [claimant’s] disability was ‘temporary total’ rather than ‘permanent total.’ ” Id. at 176, 26 OBR at 151, 497 N.E.2d at 722. In rejecting the commission’s argument, we stated in part that “the ‘C-19’ form is designated as a ‘fee bill.’ Its purpose is to allow the treating physician to be reimbursed for services rendered — not to provide a medical record of the claimant’s condition or history, or to state an opinion of the claimant’s level of disability.” (Emphasis sic.) Id.

The reasons for limiting a C-19 form to its purpose under the circumstances in Riggs do not apply in this case. In the case of the C-19 fee bill, the physician’s office often simply reports “the claimant’s legal status (in terms of disability) according to the determination of the bureau.” Id This is in fact the accurate way for the physician to fill out the C-19 form because the claimant’s legal status is the “last legally recognized disability.” Id. at 176, 26 OBR at 151, 497 N.E.2d at 722-723. The self-insured employer, on the other hand, is the initial processor [207]*207of claims. As such, it does not simply report the legal status of the claim “according to the determination of the bureau,” but itself initially determines such status. In fact, in this case it was Baker, not the commission, which had determined claimant’s “last legally recognized” medical condition when, by a letter dated March 14, 1983, it recognized the claim for “lumbo sacral sprain.” Clearly, when a self-insured employer certifies an additional condition as allowed in the claim, it is not acting in accordance with any perception (or actual limitation) that it is bound to report the claimant’s last legally recognized status. If this were its perception, it certainly would not certify an additional allowance.

Baker also argues that its reporting of “herniated disc” was a clerical error, and that if the commission has authority to change and modify its prior orders, then self-insured employers, who are also “obligated to initially adjudicate claims, * * * have the inherent authority to correct clerical errors.” The continuing jurisdiction of the commission to modify or change former findings or orders emanates from R.C. 4123.52 and its predecessor, G.C. 1465-86. In balancing the commission’s continuing jurisdiction under R.C.

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Cite This Page — Counsel Stack

Bluebook (online)
631 N.E.2d 138, 69 Ohio St. 3d 202, Counsel Stack Legal Research, https://law.counselstack.com/opinion/state-ex-rel-baker-material-handling-corp-v-industrial-commission-ohio-1994.