Doucette v. Hallsmith/Sysco Food Services, Inc.
21 A.3d 99
| Me. | 2011Background
- Doucette injured back in 2004 while employed by Sysco; treated for lumbar strain and placed on light duty with no wage loss, later released to full duty before leaving Sysco for unrelated reasons.
- Sysco’s third-party administrator Gallagher Bassett attempted to file a notice of controversy (NOC) within 14 days of notice, but transmission to the Board occurred on the 15th day due to internal processing and coding issues.
- Doucette filed a petition for award on January 15, 2009 seeking benefits from April 1, 2004 and continuing; the Board awarded protection of the Act but rejected wage loss, and found a 14-day rule violation.
- Gallagher Bassett sent a hard copy NOC by certified mail and attempted electronic filing; the Board ultimately received the NOC on January 30, 2009 (15th day) after midnight, constituting a violation.
- Hearing officer ordered Sysco to pay Doucette total incapacity benefits from April 1, 2004 until April 13, 2009 (cure date), with credits; Sysco appealed to the Maine Supreme Judicial Court (SJC).
- Court affirms the fourteen-day rule violation finding and the award of total incapacity benefits from the date of incapacity, but dissent cautions about fairness where no incapacity existed and potential need for rule refinement.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether the NOC filed on the 15th day violates the fourteen-day rule. | Doucette | Sysco | Yes, the NOC filed on the 15th day violated the rule. |
| Whether the fourteen-day rule penalty is appropriate where the employee had no incapacity. | Doucette entitles total benefits from date of incapacity; prior lack of wage loss does not negate penalty. | Sysco argues no actual incapacity occurred; penalty should not apply. | Penalties apply; misfiling triggers total benefits from date of incapacity despite no wage loss. |
| What is the proper start date for default benefits under the rule in cases with later aggravation injuries? | Doucette should receive benefits from the earlier date of incapacity. | Benefits should start from the aggravating injury date, not the earlier injury date. | Benefits run from the date of incapacity tied to the aggravating injury (2008) for defaults; prior period not covered. |
| Does the Board have authority to apply equitable considerations to modify a statutory fourteen-day rule penalty? | Doucette seeks fairness given the insurer’s diligence. | Board should apply rule as written without equity overrides. | No equitable relief; rule stands but may prompt future rule refinement. |
Key Cases Cited
- Bridgeman v. S.D. Warren Co., 2005 ME 38 (Me. 2005) (upheld fourteen-day rule and clarified start of default benefits from date of incapacity; promotes timely NOC filing)
- Doucette v. Hallsmith/Sysco Food Servs., Inc., 10 A.3d 692 (Me. 2010) (affirmed rule validity and penalties for late NOC filing; expedited review on stay granted)
- Wentworth v. Manpower Temp. Servs., 589 A.2d 934 (Me. 1991) (established limits on precluding late-defect claims; pre-dates Bridgeman)
- Hird v. Bath Iron Works Corp., 512 A.2d 1035 (Me. 1986) (limitations on equitable relief in workers' compensation rulings)
- Guar. Fund Mgmt. Servs. v. Workers' Comp. Bd., 678 A.2d 578 (Me. 1996) (limits on equitable considerations in Board decisions)