Hall v. Walmart, 1 CA-IC 17-0004

Background

Mable Hall injured her right hip/lower back in July 2014 and filed a workers' compensation claim in October 2014; insurer denied the claim initially.
An ALJ credited Hall’s treating physician over an independent examiner and awarded temporary benefits from August 6, 2014 until medically stationary; award affirmed on December 7, 2015.
Hall later submitted a March 7, 2016 letter construed as a request for hearing complaining insurer had not paid benefits; insurer mailed a check on March 24, 2016 with a Notice of Claim Status stating temporary benefits and treatment terminated April 15, 2015.
Hall, unrepresented, testified at a May 2016 hearing she had not received a closure notice; the ALJ said she would “keep that on the record as [a] protest.”
At an October 20, 2016 hearing the ALJ awarded additional temporary partial benefits (April 16–Oct 5, 2015); insurer then argued Hall’s failure to timely protest the March 24, 2016 notice deprived the ICA of jurisdiction.
On review the ALJ reversed, finding lack of jurisdiction because Hall did not request a hearing within 90 days of the notice; Hall appealed to the court of appeals.

Issues

Issue	Plaintiff's Argument	Defendant's Argument	Held
Whether ICA had jurisdiction to award benefits despite Hall’s failure to file a hearing request within 90 days of the Notice of Claim Status	Hall: she did not receive the closure notice and reasonably relied on the ALJ’s statement at the May hearing that her March 2016 letter would be kept on the record as a protest	Insurer: the March 24, 2016 notice became final because Hall failed to timely request a hearing under A.R.S. § 23-947	Reversed the Decision Upon Review and remanded because the ALJ failed to address statutory exceptions (nonreceipt, justifiable reliance) or whether insurer waived the untimeliness defense
Whether statutory exceptions excuse untimely protest (nonreceipt; justifiable reliance)	Hall: exceptions apply — she did not receive notice and reasonably relied on representations by the ALJ, employer, or ombudsman	Insurer: exceptions do not apply; notice was effective	Court: ALJ must make findings on whether exceptions under § 23-947(B) apply; record contained evidence of such exceptions so ALJ erred by not addressing them
Whether insurer waived the untimeliness defense by raising it late	Hall: insurer raised the closure argument only after the October hearing, so it may be waived	Insurer: timely preserved defense or it is effective regardless	Court: ALJ should consider whether insurer waived the defense; failure to address waiver was error
Adequacy of ALJ factfinding to support reversal	Hall: ALJ made assurances and there is unchallenged evidence about lack of receipt and inquiries made	Insurer: ALJ’s reversal was appropriate because statutory deadline passed	Court: ALJ’s Decision Upon Review lacked necessary findings on material issues; remand required for factfinding

Key Cases Cited

Landon v. Industrial Commission of Arizona, 240 Ariz. 21 (App. 2016) (standards for appellate review of ICA findings and law/fact distinctions)
Post v. Industrial Commission of Arizona, 160 Ariz. 4 (1989) (ALJ must find on all material issues to avoid appellate factfinding)
Stange Co. v. Industrial Commission of Arizona, 120 Ariz. 241 (App. 1978) (failure to timely request hearing does not automatically divest ICA of jurisdiction)
Frazier v. Industrial Commission of Arizona, 145 Ariz. 488 (App. 1985) (untimeliness is an affirmative defense that may be waived if not raised properly)