DocketNumber: C.A. No. PC 09-6797
Judges: DARIGAN, J.
Filed Date: 10/20/2010
Status: Precedential
Modified Date: 7/6/2016
Appellant contested this decision. Thus, pursuant to ERSRI procedures, a hearing was held on February 21, 2009. (ERSRI Decision, September 18, 2009 ("Decision") at 2.) The hearing consisted of testimony from Appellant and Mr. Karpinski, as well as exhibits of notices and medical records. Id. at 2-3. Additionally, as allowed by ERSRI Rules, both parties submitted post-hearing memoranda of law and Appellant submitted post-hearing medical records. Id. at 3.
Mrs. Galvin worked as a Supervising Nurse for the Department of Mental Health, Retardation and Hospitals from 1972 through 2006. (Admin. Hr'g Tr., February 21, 2008 ("Tr.") at 6-8.) In the summer of 2006, she was diagnosed with end stage renal failure disease.Id. at 7. She was unable to work by October 2006 as a result of the disease's progression. Id. at 8
During the hearing, Appellant testified about Mrs. Galvin's positive and active demeanor prior to her diagnosis.Id. at 7. He then described that she became confused, forgetful, and irrational as the disease worsened.Id. at 10-12. In particular, she began hiding bills under her bed and refusing to take her medication. Id. at 14, 19. He testified that as of November 2006, Mrs. Galvin did not express any interest in the couple's finances and left them to Appellant because she lacked the mental capacity. Id. at 23-24. He explained that Mrs. Galvin, who was consistently in and out of the hospital, was aware that her disease was terminal and a liver transplant was essential. Id. at 11.
Appellant further testified that in December of 2006, Mrs. Galvin was unable to operate a car and her friend declined to drive her to the Retirement Board. Id. at 21-22. She nevertheless arrived there by some unknown means on December 4, 2006 and executed an Application for Retirement and an Option Selection Form. (Ex. 3, Option *Page 3 Selection Form; Ex. 4, Application for Retirement.) On the Option Selection Form, Mrs. Galvin selected neither of the Joint and Survivor Options. (Ex. 4, Application for Retirement.) On the Application for Retirement, Mrs. Galvin listed Appellant in the selection, "Beneficiary Information for Death Beneficiary only," and signed and dated the Application. (Ex. 3, Option Selection Form) These forms, however, were not otherwise complete. (Decision at 5.)
After completing these forms, her condition continued to worsen.Id. She was readmitted to Roger Williams Hospital four days later, on December 8, and remained there until December 15, 2006.Id. The next day she arrived at the Mayo Clinic in Florida, where she remained through December 20, 2006. Id. The Hearing Officer noted the worsening of her physical problems during this period. Id. She was readmitted to Roger Williams Hospital in January 2007 and died on January 27, 2007. Id. As a result of her physical condition and his perception of her deteriorating mental state, Appellant asserted that Mrs. Galvin could not have understood the consequences of electing a death benefit option over a survivor's annuity when she executed the forms. Id.
Mr. Karpinski then testified about the justifications for his decision in the November 2007 letter. He explained that Mrs. Galvin's matter came to his attention because she had not chosen an option. (Tr. at 36.) During his testimony, he described a typical counseling interview when an applicant chooses his or her option and the information regarding such options that the counselor presents to the applicant during this meeting.Id. at 37-46. Mr. Karpinski specifically noted that the counselors are not trained in trying to assess the mental status of an applicant or the competency of the applicant to make a selection from the options. Id. at 45-46. *Page 4
After explaining the possible option scenarios and the Service Retirement Allowance ("SRA"), Mr. Karpinski testified about the numbers noted by the options SRA and SRA Plus for Mrs. Galvin's determination. (Decision at 7.) He confirmed that Mrs. Galvin had filled out neither Option One nor Option Two. Id. Mr. Karpinski stated that Option One is the joint survivor one hundred percent and Option Two also provides survivor benefits.Id. Mrs. Galvin's failure to choose either Option acted as an indicator to ERSRI that she was not interested in them. (Tr. at 50.)
He then explained the Application for Retirement and its activation of the termination process and establishment of a retirement date. (Decision at 8.) Although her State Termination Form was unsigned, Mrs. Galvin's termination date was listed as December 31, 2006. (Decision at 6; Ex. 4, Application for Retirement.) He also testified that it is necessary to be sure the termination date is correct on the State Termination Form. (Tr. at 54.) Mr. Karpinski explained that his November 2007 denial letter was based on "the lack of option selection form that designates a joint option that is available."Id. at 55-56.
In his decision, the Hearing Officer made findings of fact prior to analyzing the facts and law and making his final decision. (Decision at 8.) He noted that he must accord deference to ERSRI's original denial of benefits because the Hearing Officer's decision was a review of an action within the agency's responsibility.Id. at 9. The Hearing Officer cited the various levels of Mrs. Galvin's physical health, as well as her anxiety and depression, as recorded in the medical records. Id. at 11. He highlighted, however, the lack of evidence as to her mental capacity on December 4, 2006, the day *Page 5 that she executed the paperwork at the ERSRI offices. Id. He further declined to speculate as to her mental state and thoughts on that day. Id.
The Hearing Officer also examined the statute relied on by ERSRI, §
On appeal, Appellant argues that the Board's affirmation of the Hearing Officer's decision was improper because Mrs. Galvin lacked the mental capacity to determine a survivorship benefit when she executed the documents at the Board's offices on December 4, 2006. He maintains that if she had the capacity to make the decision, she would not have chosen a benefit which only returns her pension contributions each month without interest, but instead would have chosen a greater payment as a survivor's benefit. He therefore argues that the record lacks the substantial evidence to support the affirmation of the Hearing Officer's denial of death benefits to Mr. Galvin because the facts demonstrate that she was too confused and incompetent to enter into a contract.
In response, ERSRI argues that §
"The court shall not substitute its judgment for that of the agency as to the weight of the evidence on questions of fact. The court may affirm the decision of the agency or remand the case for further proceedings, or it may reverse or modify the decision if substantial rights of the appellant have been prejudiced because the administrative findings, inferences, conclusions, or decisions are:
(1) In violation of constitutional or statutory provisions;
(2) In excess of the statutory authority of the agency;
(3) Made upon unlawful procedure;
(4) Affected by other error or law;
(5) Clearly erroneous in view of the reliable, probative, and substantial evidence on the whole record; or
(6) Arbitrary or capricious or characterized by abuse of discretion or clearly unwarranted exercise of discretion."
In reviewing an agency decision, this Court is limited to an examination of the certified record in deciding whether the agency's decision is supported by substantial evidence. Center forBehavioral Health, R.I., Inc. v. Barros,
ERSRI uses a two-tier review process in which a hearing officer hears grievances and then issues a written decision, that is submitted to the Retirement Board. The Board considers the decision as well as any further briefs, and subsequently renders its own decision. ERSRI Reg. § 10.00(a). This two-tier system is similar to a funnel. Environmental Scientific Corp. v. Durfee,
When exhaustion is statutorily mandated, "a plaintiff aggrieved by a state agency's action first must exhaust administrative remedies before bringing a claim in court." Richardson v. Rhode IslandDept. of Educ.,
In this case, Appellant has, in fact, exhausted all of the administrative remedies available to him. The governing rule of appeals procedures for ERSRI, Section 10.00 of the Employees' Retirement System of Rhode Island Regulation 4, provides in pertinent part:
"(a) After consideration of the decision of the Hearing Officer and such other matters as shall be *Page 9 presented by counsel for any party to the proceeding, the Retirement Board shall make a decision. . . .
"(b) Any person aggrieved by the decision of the Retirement Board shall have all rights of an aggrieved party under . . . the Administrative Procedures Act. . . ."
In the instant case, Appellant is appealing the Retirement Board's decision that was based on the decision of the Hearing Officer. He has, therefore, adhered to § 10.00 and properly exhausted his administrative remedies before appealing to this Court. The Retirement Board issued its decision on November 12, 2009, and Appellant appealed within the APA required thirty days, on November 27, 2009. Accordingly, Appellant's administrative appeal is properly before the Court.
Our Supreme Court has held that the General Assembly has construed ERSRI with the authority, pursuant to §
Under this deference, this Court must examine ERSRI's interpretation of §
"Upon the death of a member after retirement, unless the member shall have selected any of the options provided in §
36-10-18 , a benefit shall be payable consisting of the excess, if any, of the total contributions of the member at date of retirement, without interest, over the aggregate amount of all retirement allowance payments received by the member prior to his or her death."
When the language of a statue is clear and unambiguous, a court "must interpret the statute literally and must give the words of the statute their ordinary meanings." Iselin,
This Court may not substitute its judgment for that of the Board's on determinations of credibility and questions of fact. SeeInterstate Navigation Co.,
Appellant further asserts that the Board should have presumed that Mrs. Galvin would have chosen an option that provides for greater survivor benefits if she had the capacity to contract. Conversely, ERSRI argues that §
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