DocketNumber: C.A. No. PC 2009-0231
Judges: CARNES, J.
Filed Date: 1/31/2011
Status: Precedential
Modified Date: 7/6/2016
From May 12, 2005 to December 11, 2006, Appellant was paid a weekly workers' compensation indemnity benefit of $475.88 pursuant to the Workers' Compensation cause of action he filed with the Workers' Compensation Court, Barry Holland v. South KingstownSchool Department, W.C.C. No. 06-7895, resulting from the injuries he had sustained in his work-related automobile accident.Id. On or about December 20, 2006, a "Final Decree" was entered into between Appellant's counsel and counsel for the Department: "discharging the school department from all liabilityunder the Workers' Compensation Act resulting from injuriessustained by Appellant in the May 12, 2005 automobile accident, inconsideration of payment by the school department to Appellant inthe amount of One Dollar ($1.00)[sic]." Id. (Emphasis added.) On or about December 20, 2006, Appellant also entered into an agreement with the Department, whereby the Department agreed to pay Appellant the sum of $24,960 for eighteen months of medical coverage from the date of the agreement forward and the sum of $3,800 for a so-called "Medicare set aside[,]" plus attorneys' fees and accumulated sick, vacation and longevity pay.Id. at 3-4.
In September of 2007, correspondence commenced between Appellant and the Board regarding the payments received by Appellant from the Department for his work-related injuries. Id. at 4. On October 29, 2007, the Board issued a decision denying Appellant's request to exclude payments made to Appellant per his agreement with the South Kingstown School Department from the offset provisions of G.L. 1956 §
Appellant requested a hearing before a hearing officer, which was scheduled for March 11, 2008. (Appellant's Ex. 1; Letter from Hearing Officer Teresa M. Rusbino, Esq. to Michael A. St. Pierre (Feb. 12, 2008)). Pre-hearing memoranda were submitted by the Board and Appellant (Resp't's Ex. 1; Appellant's Ex. 3), and a hearing was held before Hearing Officer Teresa Rusbino (hereinafter "Hearing Officer") on March 11, 2008, at which time arguments were presented by counsel for Appellant and the Board and testimony was heard from Christine Preston ("Preston"), Senior Claims Representative of the Rhode Island Interlocal Risk Management Trust, and Michael Feeney ("Feeney"), an attorney for the Trust. (3/11/2008 Tr.)
Preston testified that she handled workers' compensation claims for the Trust and was involved in the 2006 negotiations to resolve Appellant's then-pending workers' compensation claim with the Department. (3/11/2008 Tr. at 25:11-27:1.) Preston testified that Appellant was paid $24,960, representing the cost of ongoing family health care coverage for an eighteen month period until Appellant reached the age of sixty-five (65) and became Medicare eligible. (3/11/2008 Tr. at 28:13-29:24.) Preston further testified that had the workers' compensation benefits claim remained open and had Appellant continued collecting workers' compensation benefits while remaining in the employ of the Department, the Department would have continued to cover that health benefit. (3/11/2008 Tr. at 29:8-30:23.) Additionally, Preston testified that the so-called Medicare set-aside of $3800 paid to Appellant "is necessary on all Worker's [sic] *Page 4 Compensation claims for those injured in the Worker's Comp. forum, particularly when they reach a certain age." (3/11/2008 Tr. at 29:21-23.)
On cross-examination, Preston acknowledged that the Trust initially became involved in settlement negotiations when the Appellant filed a workers' compensation claim, because they determined that the Trust had exposure on the claim. (3/11/2008 Tr. at 39:3-40:21.) According to Preston, the Trust determined that it was unlikely that Appellant would return to work for the Department due to his injuries, and that Appellant would have continued to receive workers' compensation benefits, possibly for the rest of his life if the matter had not been settled. (3/11/2008 Tr. at 39:3-22, 41:4-20.) Preston further acknowledged that neither the $3800 Medicare set-off nor the $24,960 in futuro medical coverage would have been paid to Appellant had he not been injured at work. (3/11/2008 Tr. at 48:20-49:4.)
Feeney testified that the Department was seeking to limit what it perceived as a potentially infinite exposure due to Appellant's potential to collect workers' compensation benefits for the remainder of his life. (3/11/2008 Tr. at 59:13-60:6, 64:7-65:16.) On cross-examination, Feeney discussed the in futuro medical coverage payment to Appellant and testified, in part, that "[T]here had to be some mechanism to allow [Holland] to continue his health care because without being allowed to continue his health care, there would be no settlement. He wasn't going to go and accept the Worker's Comp. settlement package without having the health care resolved. . . ." (3/11/2008 Tr. at 64:14-19.)
On October 20, 2008, the Hearing Officer issued her decision affirming the Board's denial of Appellant's request to exclude the medical coverage and Medicare set-aside payments from the offset provisions of Section
In addition to the above-described facts, it is important to note that the Appellant, at all times relevant hereto, was suffering from the non-work related medical conditions which included bladder cancer and Wegener's Granulomatosis, a disease of the renal system. (3/11/2008 Tr. at 10:10-12:3.) Appellant's counsel argued at the hearing that the purpose for structuring Appellant's retirement as outlined in the above facts was to maximize the funds available to Appellant to insure that he had sufficient funds to pay for the monthly medical benefit that was going to be substantial until he reached age 65, when he would qualify for Social Security. (3/11/2008 Tr. at 11:9-14:5.)
"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 *Page 6 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,
The agency in this case utilizes a two-tier review process, in which grievances are heard first by a hearing officer, who issues a written decision that is submitted to the Retirement Board. The Board considers the decision, along with any further briefs or arguments, and renders its own decision. ERSRI Reg. § 10.00(a). This two-step procedure has been likened to a funnel. EnvironmentalScientific Corp. v. Durfee,
"Although factual findings of an administrative agency are afforded great deference, a dispute involving statutory interpretation [or, by analogy, an agency rule adopted pursuant to an enabling statute] is a question of law to which [the courts] apply de novo review." Rossi v. Employees' Retirement System ofthe State of Rhode Island,
§
45-21-31 . Offset of workers' compensation or personal injury recovery. — Any amounts paid or payable under the provisions of any workers' compensation law, or as the result of any action for damages for personal injuries against the municipality by which the member was employed, on account of death or disability of a member occurring while in the performance of duty, are offset against and payable in lieu of any benefits payable out of funds provided by the municipality under the provisions of this chapter on account of the death or disability of the member. If the value of the total commuted benefits under any workers' compensation law or action is less than the actuarial reserve on the benefits otherwise payable from funds provided by the municipality under this chapter, the value of the commuted payments is deducted from the actuarial reserve, and the benefits that may be provided by the actuarial reserve so reduced are payable under the provisions of this chapter. (Emphasis added.)
This Court's analysis begins by noting the disjunctive "or" in the second line of the statute. The word "or" is defined "as `[a] disjunctive particle used to express an alternative or to give a choice of one among two or more things.'" In re Abby D.,
Section
The Supreme Court of Rhode Island has held that "if two statutes are found not to be inconsistent with one another and relate to the same subject matter, they are deemed `in pari materia and should be considered together so that they will harmonize with each other and be consistent with their general object and scope."Sch. Comm. of Cranston v. Bergin-Andrews,
The tenor of §
Within the context of an administrative appeal, where a statute is ambiguous, the Court defers to the interpretation of the agency that has been charged with administering and enforcing the statute. This is so "even when the agency's interpretation is not the only permissible interpretation that could be applied." Auto BodyAss'n of Rhode Island,
Accordingly, the Court defers to the agency's reasonable reading of the statutes. Thus, the Hearing Officer did not commit an error of law or act in excess of statutory authority when she excluded the medical coverage and Medicare set-aside payments from the offset provisions. As such, the full Board did not commit an error of law when they adopted the Hearing Officer's findings.
Pursuant to G.L. 1956 §
In the current case, the Hearing Officer made numerous findings of fact with respect to the concerns expressed by Appellant. (ERSRI Dec. at 6.) The Hearing Officer recounted evidence she heard on the matter, including the testimony of Christine Preston, Senior Claims Representative for the Rhode Island Interlocal Risk Management Trust, and Michael J. Feeney, attorney for the Trust, who both testified that the Town of South Kingstown was seeking to limit what it perceived as potentially infinite liability by entering into a settlement agreement. (ERSRI Dec. at 4-6.) Additionally, the Hearing Officer relied on evidence that the Appellant, as a member of the Employees' Retirement System of Rhode Island, signed a Release to his employer, the Town of South Kingstown School Department. (Appellant's Ex. 2B.) The Release provides, in relevant part, that the Appellant, "for and in consideration of the sum of $31, 200" specifically: *Page 14
"[R]emises, releases and forever discharges the School Department, . . . elected and appointed officials . . ., from any and all other claims, actions, causes of action, grievances, arbitrations, suits, proceedings, debts, controversies, agreements, attorney fees, judgments and demands whatsoever, in law or equity, which the City, 2 its heirs, administrators, executors, successors and/or assigns have ever had, now have, or shall have but for the enforcement of this Agreement, from the beginning of the world to the date of this Agreement, whether currently asserted or not, for any and all matters in any way related to Holland's employment with the School Department. This includes, but is not limited to, Holland's right to file suit or otherwise seek or receive personal restitution for any alleged violation of Title VII of the Civil Rights Act of l964,
42 U.S.C. §§ 2000e . et. seq; the Age Discrimination and Employment Act,29 U.S.C. §§ 621 et seq; the Americans with Disabilities Act,42 U.S.C. §§ 12101 et seq; the Rhode Island Fair Employment Practices Act, R.I.G.L. §42-112-1 et seq; the Rhode Island Civil Rights of People with Disabilities Act, R.I.G.L. §42-87-1 et seq; or any other alleged violation of any local, state or federal law, regulation, rule of law, or ordinance having any connection whatsoever with Holland's employment and/or separation from employment with and/or separation from the School Department. The parties intend this provision to be all-encompassing and to act as a full and total release of any and all claims arising out of or in any way related to Holland's employment with and/or separation from the School Department, except as otherwise stated, whether or not specifically referred to herein." (Appellant's Ex. 2B) (emphasis added).
The very broad wording of the Release, and especially the phrases, "including but not limited to," "having any connection whatsoever," and the provision — "[T]he parties intend this provision to be all-encompassing and to act as a full and total release of any and all claims arising out of or in any way related to Holland's employment with and/or separation from the School Department, except as otherwise stated, whether or not specifically referred to herein" — clearly encompass an action for death or disability of the member occurring while in the performance of duty. Seeid. The testimony of the witnesses, as set forth in the record, makes it clear that the $28,760 provided to Holland, in return for his execution of the Release, was *Page 15 provided on account of the disability of a member occurring while in the performance of duty. See id.
While the courts are the ultimate arbiters regarding any dispute involving statutory interpretation, Rossi,
"Consistent with Rhode Island General Laws §
45-21-31 , you will note that the underlined text provides that any action for damages for personal injuries against the municipality must be offset. The statute expressly states that:`Any amounts paid or payable under the provisions of any workers' compensation law, or as the result of any action for damages for personal injuries against the municipality by which the member was employed, on account of death or disability of a member occurring while in the performance of duty, are offset against and payable in lieu of any benefits payable out of funds provided by the municipality under the provisions of this chapter on account of the death or disability of the member.'" Id. (Bold, underline, and italics in original.)
The Executive Director's factual determination that the Release was an "action for damages for personal injuries" is supported by Rhode Island case law. Rhode Island tends to classify injuries that result from violations of specific Civil Rights acts, such as those set forth in the Release, as personal injuries. The most common context in which the courts analyze this particular issue involves determinations as to which statute of limitations should be applied to state and federal law. Rhode Island's statute of limitations for personal injuries codified in G.L. 1956 §
The Rhode Island Supreme Court has held that the legislative intent behind §
The Court defers to the administrative agency's factual determinations provided that they are supported by legally competent evidence. See Arnold,
After review of the letter from the Executive Director contained in the official record, the Executive Director and Hearing Officer's decisions that relied on the written Release, and the aforementioned witness testimonies, this Court does not find that the Board's decision was totally devoid of competent evidentiary support in the record. As such, the administrative decision appealed from was neither arbitrary nor capricious and did not constitute an abuse of discretion. Although ample evidence was presented on both sides, this Court may not substitute its judgment for that of the ERSRI.See § 42-35-(g). When a hearing officer has relied on credibility determinations, the second-tier decision-maker should give great deference to the findings and conclusions of the hearing officer, unless they are clearly wrong. See EnvironmentalScientific,
Center for Behavioral Health, Rhode Island, Inc. v. Barros , 710 A.2d 680 ( 1998 )
Commerce Oil Refining Corporation v. Miner , 98 R.I. 14 ( 1964 )
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