Wolford v. Pinnacol Assurance

107 P.3d 947, 2005 WL 451913
CourtSupreme Court of Colorado
DecidedMarch 21, 2005
Docket03SC472
StatusPublished
Cited by37 cases

This text of 107 P.3d 947 (Wolford v. Pinnacol Assurance) is published on Counsel Stack Legal Research, covering Supreme Court of Colorado primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Wolford v. Pinnacol Assurance, 107 P.3d 947, 2005 WL 451913 (Colo. 2005).

Opinion

MARTINEZ, Justice.

Petitioner, Charlene Wolford, appeals from a court of appeals decision affirming the district court’s entry of summary judgment in favor of respondent, Pinnacol Assurance (Pinnacol). See Wolford v. Pinnacol Assurance, 81 P.3d 1079 (Colo.App.2003). This case was initiated by Wolford against Pinna-col in the civil division of the Denver District Court (the district court) as a separate attempt from her workers’ compensation ease to enforce a 1995 administrative law judge (ALJ) order awarding her $81,251.63 in permanent partial disability (PPD) workers’ compensation benefits. The district court found, and the court of appeals agreed, that as a matter of law Wolford forfeited her right to recover PPD benefits because she was convicted under section 8-43-402, C.R.S. (2004), of making false statements to obtain temporary total disability (TTD) benefits. We hold that to give effect to all provisions in the Workers’ Compensation Act (the Act) and preserve the intent of the General Assembly, a conviction under section 8-43-402 only requires the forfeiture of the compensation that was obtained as a result of false statements. Accordingly, we reverse the decision of the court of appeals and order the ease remanded to the district court for proceedings consistent with this opinion.

I. Facts and Procedure

In November 1992, Wolford was working as a counselor for Support, Inc. (Support) when she was sexually assaulted by an emotionally disturbed patient. The attacker brutally grabbed her, threw her against the wall, bit her ear, and tried to rip off her clothes. As a result of the attack, Wolford suffered from post-traumatic stress disorder that included symptoms of depression, impaired concentration, insomnia, recurring nightmares, hyperphagia, and extreme anxiety. Wolford also suffered physical injuries to her neck and shoulders.

Although Wolford attempted to return to work, she was unable to continue working as a counselor for Support. Wolford sought workers’ compensation benefits from Support and its workers’ compensation insurer, Colorado Compensation Insurance Authority, now doing business as Pinnacol. 1 Support and Pinnacol conceded liability for the workers’ compensation claim and started paying Wol-ford monthly TTD benefits.

In May 1993, while receiving her TTD benefits, Wolford began working as a secretary for a law firm. She continued this employment until November 1994, just before her physician determined that she had reached maximum medical improvement (MMI).

Having reached MMI, Wolford then sought PPD benefits and future psychiatric medical benefits from Pinnacol. Pinnacol requested, and Wolford received, a division-sponsored independent medical examination (DIME). After a hearing on the extent of Wolford’s permanent medical impairment, on *949 July 26, 1995 an ALJ ordered Pinnacol to pay Wolford PPD benefits totaling $81,251.63 as well as future medical benefits.

Pinnacol appealed the order to the Industrial Claims Appeals Office (ICAO), which affirmed on January 17, 1996. Pinnacol appealed and in an unpublished opinion the court of appeals affirmed the order.

Concurrent to Pinnacol’s appeal of the workers’ compensation order for PPD and medical benefits, Wolford was investigated and charged with three counts of willfully making false statements to obtain workers’ compensation benefits under section 843-402, 3 C.R.S. (1995 Supp.), and one count of theft pursuant to section 18-4-401(2)(a), 8B C.R.S. (1995 Supp.). These charges were based on allegations that Wolford filed sworn statements that she had not been working, a requirement of receiving her TTD benefits, when in fact she was working as a secretary between May 1993 and November 1994.

In June 1996, Wolford pleaded guilty in the criminal division of the Denver District Court (the criminal court) to one count of willfully making false statements to obtain workers’ compensation benefits under section 843402 and on August 19, 1996, was sentenced to six years probation and ordered to pay restitution. The court probation department recommended that Wolford’s restitution be set based upon the TTD benefits Wolford received after returning to work on May 3,1993, and continuing through November 1994 when she stopped working. During that time, Wolford received forty-two payments totaling $16,693.63 in TTD compensation. Although at the time of her sentencing Wolford had also received several PPD compensation payments, neither the probation department nor the district attorney sought restitution for those payments. As a result, the criminal court only ordered restitution of the TTD compensation Wolford received after she started working. 2

Although the court of appeals had affirmed the award for PPD and future medical benefits in July 1996, Pinnacol continued to dispute the award because of Wolford’s conviction under section 843402. In September 1996, Pinnacol filed a Final Admission of Liability with the Division of Workers’ Compensation stating: “Pursuant to C.R.S. 843-402, as amended, claimant forfeits all right to compensation upon conviction.... Benefits terminated as of [August 19, 1996].” Pinna-eol argued that under section 8-43-402 a conviction for willfully making false statements to obtain any workers’ compensation benefit resulted in the forfeiture of all benefits associated with a claim regardless of whether the false statements were related to the benefits.

Wolford requested a hearing before an ALJ on the limited issue of whether or not her conviction under section 8-43-402 resulted in the forfeiture of her future medical benefits. The hearing did not address the forfeiture of her PPD benefits. The ALJ found that although section 8413-402 stated that a claimant “shall forfeit all right to compensation under [the Act] upon conviction,” future medical benefits were not “compensation” and Wolford was still entitled to those benefits. Pinnacol appealed the ruling and the ICAO and the court of appeals affirmed. See Support, Inc. v. Indus. Claim Appeals Office, 968 P.2d 174, 176 (Colo.App.1998).

Following the court of appeals’ ruling, Wolford demanded that PPD benefits also be paid because, like the future medical benefits, the PPD benefits were not forfeited pursuant to her conviction under section 8-43-402. Pinnacol refused to pay PPD benefits 3 and, in April 2000, Wolford requested another hearing with an ALJ to decide the issue. Before the hearing could be held, however, Wolford filed this separate action in the district court against Pinnacol seeking enforcement of the original 1995 ALJ order for PPD benefits.

In the district court, Wolford asserted that the forfeiture provision of section 843402 is limited to only those benefits obtained through her false statements and does not allow for the forfeiture of benefits to which Wolford is otherwise entitled. Any other interpretation, according to Wolford, would *950 result in a windfall for Pinnacol.

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Bluebook (online)
107 P.3d 947, 2005 WL 451913, Counsel Stack Legal Research, https://law.counselstack.com/opinion/wolford-v-pinnacol-assurance-colo-2005.