Poremba v. S. Nev. Paving

132 Nev., Advance Opinion 2'3
IN THE SUPREME COURT OF THE STATE OF NEVADA
WILLIAM POREMBA, No. 66888
Appellant,
vs.
SOUTHERN NEVADA PAVING; AND
FILED
S&C CLAIMS SERVICES, INC., APR 0 7 2016
Respondents.
BY
CHIEF DEPUIVCCE
Appeal from a district court order denying a petition for
judicial review in a workers' compensation matter. Eighth Judicial
District Court, Clark County; Valorie J. Vega, Judge.
Reversed and remanded with instructions.
Dunkley Law and Mark G. Losee and Matthew S. Dunkley, Henderson,
for Appellant.
Lewis Brisbois Bisgaard & Smith, LLP, and Daniel L. Schwartz and
Jeanne P. Bawa, Las Vegas,
for Respondents.
BEFORE DOUGLAS, CHERRY and GIBBONS, JJ.
OPINION
By the Court, CHERRY, J.:
NRS 616C.215(2)(a) provides that when an injured employee
who receives workers' compensation also recovers damages from the
responsible party, the amount of workers' compensation benefits must be
reduced by the amount of the damages recovered. We held in Employers
Insurance Co. of Nevada v. Chandler, 117 Nev. 421, 23 P.3d 255 (2001),
that an insurer may refuse to pay additional funds via reopening a
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workers' compensation claim until the claimant demonstrates that he or
she has exhausted any third-party settlement funds and that medical
expenses are considered to be compensation that an insurer may withhold
until the recovery amount has been exhausted.
In this appeal, we clarify that while a claimant may exhaust
his or her settlement funds on medical benefits, he or she is not restricted
to using settlement funds on medical benefits. Although workers'
compensation funds may only be spent on specific expenses, such as
medical treatment, Nevada law does not preclude settlement funds from
being used to cover typical household expenses.
FACTS AND PROCEDURAL HISTORY
Appellant William Poremba worked for respondent Southern
Nevada Paving as a construction driver. On July 22, 2005, in the course of
his duty, Poremba was driving a truck when another driver struck the
truck with his backhoe. Poremba suffered injuries to his head, neck, back,
and knee. Poremba filed a workers' compensation claim, which Southern
Nevada Paving, through respondent S&C Claims (collectively S&C), •
accepted. S&C eventually closed the claim, sending Poremba a letter with
instructions on how to reopen the claim should his condition worsen.
Poremba also sued the backhoe driver and his employer. That
lawsuit was settled on July 30, 2009, for $63,500, with a significant
amount of that settlement paid directly to cover health-care providers'
liens. Poremba personally received $34,631.51. He spent approximately
$14,000 of the money he received on additional medical treatment.
Poremba claims to have spent the remaining settlement money on
personal living expenses, such as mortgage payments and food for his
family.
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Poremba attempted to return to work, but he was unable to do
so. Additionally, his doctors instructed him not to go back to work. On
January 10, 2013, Poremba sought to reopen his claim, but S&C denied
his request. Poremba administratively appealed, and S&C filed a motion
for summary judgment, arguing that our decision in Chandler precluded
Poremba from reopening his claim because he spent settlement funds on
expenses other than medical costs. After an evidentiary hearing, an
appeals officer summarily granted S&C summary judgment. Poremba
petitioned the district court for judicial review. The district court denied
the petition, and this appeal followed.
DISCUSSION
Poremba asserts that the appeals officer erred in granting
summary judgment because, legally, he is not required to prove that he
spent his excess recovery on medical expenses and because factual issues
exist as to whether his injury had worsened, necessitating additional
compensation. S&C argues that Chandler "clearly stands for" the
proposition that a claimant who receives a third-party settlement may not •
spend any of that money on home loans or family expenses and reopen his
or her workers' compensation claim when his or her medical situation
changes. S&C argues that the point is to prevent a double recovery,
asserting that double recovery means simply to recover from two sources
for the same injury. We disagree. Although Chandler requires a claimant
to exhaust all settlement funds before seeking additional funds by
reopening his or her workers' compensation claim, we never required that
those settlement funds be spent solely on medical expenses. Workers'
compensation is a limited-scope benefit while personal injury recoveries
are designed not only to pay for medical bills, but to compensate for pain
and suffering and provide for lost wages.
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This court's role in reviewing an administrative agency's
decision is identical to that of the district court. Elizondo v. Hood Mach.,
Inc., 129 Nev., Adv. Op. 84, 312 P.3d 479, 482 (2013). Although we defer
to an agency's findings of fact, we review legal issues de novo, including
matters of statutory interpretation. Taylor v. State, Dep't of Health &
Human Servs., 129 Nev., Adv. Op. 99, 314 P.3d 949, 951 (2013). We defer
to an agency's interpretations of its governing statutes or regulations only
if the interpretation "is within the language of the statute." Id. (internal
quotations omitted). "It is unquestionably the purpose of worker's
compensation laws 'to provide economic assistance to persons who suffer
disability or death as a result of their employment." Breen v. Caesars
Palace, 102 Nev. 79, 83, 715 P.2d 1070, 1072-73 (1986) (quoting State
Indus. Ins. Sys. v. Jesch, 101 Nev. 690, 694, 709 P.2d 172, 175 (1985)).
"This court has a long-standing policy of liberally construing these laws to
protect workers and their families." Id. at 83, 715 P.2d at 1073 (quoting
State Indus. Ins. Sys., 101 Nev. at 694, 709 P.2d at 175).
Whether NRS 616C.215(2) allows a claimant to reopen his or her workers'
compensation claim after exhausting his or her settlement funds on
nonmedical expenses
Nevada law allows an insurer to claim an offset when the
claimant receives money from a lawsuit against the party responsible for
the injury. NRS 616C.215(2). In pertinent part, the statute provides as
follows:
2. When an employee receives an injury for
which compensation is payable pursuant to the
provisions of chapters 616A to 616D, inclusive, or
chapter 617 of NRS and which was caused under
circumstances creating a legal liability in some
person, other than the employer or a person in the
same employ, to pay damages in respect thereof:
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(a) The injured employee .. may take
proceedings against that person to recover
damages, but the amount of the compensation the
injured employee . [is] entitled to receive
pursuant to the provisions of chapters 616A to
616D, inclusive, or chapter 617 of NRS, including
any future compensation, must be reduced by the
amount of the damages recovered. . . .
(b) If the injured employee . . receive[s]
compensation pursuant to the provisions of
chapters 616A to 616D, inclusive, or chapter 617
of NRS, the insurer.... has a right of action
against the person so liable to pay damages and is
subrogated to the rights of the injured employee or
of the employee's dependents to recover therefor.
Id. (emphasis added). On its face, this statute does not foreclose a
claimant from pursuing reopening of his or her workers' compensation
claim, but merely entitles the insurer to an offset based on the settlement
the claimant received.
In 2001, this court held that an insurer may withhold
payment of medical benefits until the claimant has exhausted any funds
received from a third-party settlement. Chandler, 117 Nev. at 426, 23
P.3d at 258. Chandler did not limit how the claimant may exhaust the
settlement funds, despite S&C's assertions to the contrary. Accordingly, it
is important to clarify Chandler and settle this issue moving forward. In
Chandler, we held that "compensation," as specified in NRS 616C.215.
included medical benefits. Id. We never ruled that wage replacement, or
any other type of specific payments, were to be excluded. We concluded
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that Chandler had to exhaust his settlement proceeds, but we did not
decide how he had to exhaust those proceeds. Id.'
We conclude that it is prudent to clarify whether, according to
Chandler, medical treatment is the only expense on which one is
permitted to exhaust his or her settlement funds. We hold that it is not.
When a person is injured, he or she may sue the responsible
party for payment to cover a variety of costs. Restatement (Second) of
Torts § 924 (1979). While medical treatment is certainly among those
costs, a plaintiff may also recover damages for lost wages if the
defendant's actions prevented the plaintiff from working. Id. These lost
wages, naturally, are meant to cover expenses that one's paycheck would
normally cover, such as rent or mortgage, utilities, and groceries.
S&C is correct that the policy behind NRS 616C.215 is to
prevent a double recovery. Chandler, 117 Nev. at 426, 23 P.3d at 258.
S&C, however, mischaracterizes double recovery. Double recovery is
characterized based not on the event necessitating the compensation, but
on the nature of the compensation provided. S&C cites to Tobin u.
Department of Labor & Industries, 187 P.3d 780 (Wash. Ct. App. 2008), for
the proposition that a claimant should not receive a double recovery as
well. Tobin, however, explains that double recovery prevents the claimant
from receiving compensation from the insurer and "retain[ing] the portion
of damages which would include those same elements." 187 P.3d at 783
'In 2007, we again held that compensation, for the purposes of
workers' compensation laws, includes medical benefits. Valdez Li. Emp'rs
Ins. Co. of Neu., 123 Nev. 170, 177, 162 P.3d 148, 152 (2007). We did not
limit the term "compensation" to medical benefits.
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(internal quotations omitted). The Tobin court held that the insurer was
only entitled to the portion of prOceeds from the third-party suit that
correlate to the benefits it provided as a worker's compensation insurer.
Id. at 784. The Tobin court continued:
[The insurer]'s position would give it an
"unjustified windfall" at [the claimant]'s expense.
Under [the insurer]'s interpretation, it would be
entitled to share in damages for which it has not
provided and will never pay compensation. We do
not interpret these statutes to require such a
fundamentally unjust result. [The insurer] did
not, and will never, compensate [the claimant] for
his pain and suffering, therefore it cannot be
"reimbursed" from funds designated to compensate
him for his pain and suffering.
Id (internal citations omitted) (emphasis added).
A worker should not receive funds from two sources to pay for
the same lost wages or the same medical treatment. The worker, however,
should be permitted to use settlement funds for some medical treatment,
or reasonable lost wages expenses, and use workers' compensation funds
for other medical treatments. 2 Poremba was hurt in July 2005, has been
unable to work since, and sought to reopen his claim in January 2013.
This means that he only needed to spend approximately $384.79 per
month for the 90 months between the accident and his attempt to reopen
his claim to exhaust the $34,631.51 in funds. Poremba does not appear to
be trying to achieve a windfall, but to be properly using the system
designed to pay for his workplace injuries. To deny him the opportunity to
2 The record is silent as to whether Poremba's third-party settlement
was specifically allocated to cover medical expenses, pain and suffering,
and/or lost wages or if it was simply a general lump sum.
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use a system designed to protect injured workers because he used some of
his settlement money to feed himself and his family is patently unjust and
not supported by the statute.
Accordingly, we conclude that while S&C is entitled to an
offset based on the settlement funds received, that offset must include any
reasonable living expense for which the settlement funds were used.
Whether the funds were used for reasonable living expenses is a factual
determination best made by the hearing officer, or in this case, the appeals
officer.
Because Poremba was not required to choose between
reasonable living expenses, such as paying for housing and food for
himself and his family, and seeking workers' compensation to pay for his
medical treatment, we must• reverse the district court's denial of judicial
review and instruct the district court to remand to the appeals officer for
further proceedings consistent with this opinion.
Whether the appeals officer erred when issuing a decision without detailed
findings of fact and conclusions of law
Poremba argues that the district court erred when it found no
improper procedure because Nevada statutes require the appeals officer's
order to contain findings of fact and conclusions of law, and they were
absent in the appeals officer's order. He further argues that without these
findings, it is more difficult for a court to conduct a meaningful review.
S&C does not refute Poremba's arguments, but merely suggests that if
correct, the remedy would be a remand for a more detailed order. We
agree that a more detailed order is required.
Without detailed factual findings and conclusions of law, this
court cannot review the merits of an appeal; thus, administrative agencies
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are required to issue orders that contain factual findings and conclusions
of law. NRS 233B.125. In pertinent part, the statute reads:
A decision or order adverse to a party in a
contested case must be in writing or stated in the
record. . . . [A] final decision must include findings
of fact and conclusions of law, separately stated.
Findings of fact and decisions must be based upon
substantial evidence. Findings of fact, if set forth
in statutory language, must be accompanied by a
concise and explicit statement of the underlying
facts supporting the findings. 3
Id. (emphases added). Each and every clause in this statute contains
mandatory instruction for the appeals officer, leaving no room for
discretion.
The requirements for a claimant to reopen a workers'
compensation claim are contained within NRS 616C.390:
1. If an application to reopen a claim to
increase or rearrange compensation is made in
writing more than 1 year after the date on which
the claim was closed, the insurer shall reopen the
claim if:
(a) A change of circumstances warrants an
increase or rearrangement of compensation during
the life of the claimant;
(b) The primary cause of the change of
circumstances is the injury for which the claim
was originally made; and
3 This statute was amended in 2015 and changed the standard from
"substantial evidence" to "a preponderance of the evidence." 2015 Nev.
Stat., ch. 160, § 7, at 708. This change does not affect this opinion.
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(c) The application is accompanied by the
certificate of a physician or a chiropractor showing
a change of circumstances which would warrant
an increase or rearrangement of compensation.
(Emphasis added.) The statute is silent as to funds that the claimant
receives from any other source, See id.
Here, not only did the appeals officer fail to issue detailed
findings of fact or conclusions of law, the appeals officer precluded
Poremba from introducing evidence supporting reopening his case when
he admitted that he spent settlement money on expenses beyond medical
treatment. This illustrates that the appeals officer had the same false
impression of the law as do the insurers. Therefore, not only did the
administrative agency err when it failed to comply with NRS 233B.125's
mandate for detailed findings and conclusions, but because the appeals
officer's misunderstanding of the law prevented Poremba from presenting
the required evidence to reopen his claim, we are unable to review the
facts in this appeal. Accordingly, we must reverse and remand for an
evidentiary hearing and subsequent order containing detailed findings of
fact and conclusions of law as to whether Poremba meets the requirements
of NRS 616C.390, and if so, how much of an offset may S&C claim based
on the amount of settlement funds that Poremba used on reasonable living
expenses, including but not limited to medical treatment, housing, and
food for himself and his family.
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CONCLUSION 1
Accordingly, the judgment of the district court is reversed, and
we remand to the district court with instructions to remand to the appeals
officer for a new hearing and determination, consistent with this opinion.
We concur:
Voremba argued that the appeals officer improperly revived S&C's
motion for summary judgment. Because we conclude both that Chandler
does not prevent a claimant from exhausting his or her third-party
settlement funds on reasonable living expenses and that the appeals
officer's order must contain detailed factual findings and conclusions of
law, we decline to address this issue.
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