Lead Opinion
OPINION
In this sрecial action review of an industrial commission award granting benefits for time lost from work for medical treatment, the carrier raises the following issues:
1. Whether a July 8, 1981, notice of claim status became final because the claimant abandoned a request for hearing protesting it.
2. Whether the administrative law judge erred in awarding temporary compensation benefits because claimant’s absences from work were compensated by sick leave pay equivalent to his regular wages.
3. Whether claimant failed to meet his burden of proving a causal relationship between the injury and his condition.
Claimant, Donald S. Ballard, filed a claim for worker’s compensation benefits for an injury sustained April 24, 1981, while at work. On July 8, 1981, the carrier issued a notice of claim status accepting the claim for benefits but disallowing disability compensation because no time was lost from work in excess of seven days. On January 25, 1982, the carrier issued a notice of claim status terminating all benefits effective September 3, 1981, and determining that the injury resulted in no permanent disability. On February 19, 1982, claimant filed a rеquest for hearing protesting both the July 8, 1981, and January 25, 1982, notices. The protest of the July 8, 1981, notice was untimely.
On March 22, 1982, the carrier issued a notice of claim status rescinding its January 25, 1982, notice. This notice indicated that claimant was continuing to receive medical treatment. On May 5, 1982, the commission sent a letter to the parties stating that a review of the file revealed that the carrier’s March 22, 1982, notice appeared to resolve the issues in dispute. The letter further stated that unless notified to the contrary, the commission would assume that clаimant had abandoned his right to a hearing on the matter. The claimant did not directly reply to this letter.
On June 21, 1982, the carrier issued another notice of claim status terminating all benefits without permanent impairment. On August 16, 1982, claimant sent a letter to the commission stating that he had lost time from work and continued to need medical treatments. He requested an investigation to determine compensation benefits for the time lost from work from the
On August 31, 1982, claimant also filed a request for hearing protesting the June 21, 1982, notice. On September 22, 1982, the commission sent a letter to the parties stating that it could not determine whether the claimant was entitled to compensation and referred the matter to the hearing division. Thereafter, claimant withdrew his August 31, 1982, request for hearing. On December 6, 1982, a hearing was conducted and claimant testified to the time lost from work from the injury and subsequent medical treatments. Mr. Frank L. Russo, the employer’s supervisor in charge of payroll, testified regarding the employer’s sick leave policy.
The administrative law judge awarded 82.5 hours of compensation benefits for time lost from the injury and attending medical treatments subsequent to the injury. A supplemental decision affirming the award on review was issued and this special action followed.
JURISDICTION
For the first time on appeal, the carrier argues that the administrative law judge lacked jurisdiction to determine whether claimant was entitled to benefits because claimant abandoned his request for hearing protesting a July 8,1981, notice of claim status. As a general rule, failure to raise an issue before the administrative tribunal precludes appellate review. See Stephens v. Industrial Commission,
The carrier cites no authority to support its position that a notice of claim status that has been protested becomes res judicata if the protest is abandoned. Although the carrier’s assertion may be correct, we find that the carrier has waived the issue.
On - February 19, 1982, claimant filed a request for hearing protesting both the July 8, 1981, and January 25, 1982, notices of claim status.
The administrative procedure set forth in A.R.S. § 23-1061(J) provided claimant with an alternative manner of determining whether he was entitled to compensation. Although the commission determined it could not resolve the issue without a hearing, the hearing conducted encompassed the same issues that would have been litigated pursuant to the February 19, 1982, request for hearing. Even if the clаimant abandoned the February 19, 1982, request for hearing, the carrier has waived the issue because it failed to assert the finality of the July 8, 1981, notice at the A.R.S. § 23-1061(J) hearing. The res judicata effect of a notice of claim status is an affirmative defense that the carrier should have raised at the A.R.S. § 23-1061(J) hearing on the issue of whether claimant was absent in excess of seven days from work. Cf. Superlite Builders v. Industrial Commission,
DOUBLE RECOVERY
Following the April 24, 1981, injury, claimant was absent from work on Monday, April 27, 1981; Tuesday, April 28, 1981, and Wednesday, April 29, 1981.
A.R.S. § 23-1062(B) states:
The first installment of compensation is to be paid no later than the twenty-first day after written notificatiоn by the commission to the carrier of the filing of a claim except where the right to compensation is denied. Thereafter, compensation shall be paid at least once each two weeks during the period of temporary total disability and at least monthly thereafter. Compensation shall not be paid for the first seven days after the injury. If the incapacity extends beyond the period of seven days, compensation shall begin on the eighth day after the injury, but if the disability continues for one week beyond such seven days, compensation shall be cоmputed from the date of the injury.
(Emphasis added).
Noting some ambiguity in the last sentence of A.R.S. § 23-1062(B), the administrative law judge interpreted the terms “incapacity” and “disability” to mean the same thing. Specifically, he found:
Considering all of the evidence as a whole and also considering the provisions of A.R.S. § 23-1062, the undersigned finds that the applicant’s incapacity extended beyond the period of the first seven days after his injury and that his disability continued for one week beyond those seven days. This is based upon construing the Statute to mean that for purposes of computing the beginning of compensation, the words ‘disability’ and ‘incapacity’ mean the same thing and that the fact that the applicant must leave his job in order to get medical treatment which was reasonably required because of his industrial injury means that he has sustained an incapacity or disability within the meaning of A.R.S. § 23-1062 B and therefore, his compensation should be computed from the date of his injury.
The administrative law judge found that claimant’s temporary compensation benefits commenced from the date of injury. Claimant was awarded 82.5 hours of temporary compensation, which represented the total time lost from work between the date of injury and June 7, 1982. In the supplemental award affirming the decision granting benefits, the administrative law judge indicated that claimant was entitled to receive both compensation benefits and sick leave pay because the sick pay was merely a benefit accumulated for past services rather than the injury. The supplemental decision also noted that the carrier improperly assumed that the threshold waiting period set out in A.R.S. § 23-1062(B) commenced with the claimant’s disability. The administrative law judge found that the waiting period consisted of consecutive calendar days following the date of injury.
On appeal, the carrier attacks the award because claimant received double recovery: both sick leave pay and temporary compensation benefits. The carrier contends that the terms “incapacity” and “disability” as set forth in the last sentence of A.R.S. § 23-1062(B) should both be interpreted to mean loss of earning capacity. According to the carriеr, claimant sustained no loss of earning capacity because he received sick leave pay equivalent to his regular wages while absent from work.
[W]hen the statute says ‘disability,’ it means earning capacity disability even though the effect upon the workman’s earning capacity may be minimal.
The carrier argues that claimant sustained no loss in earning capacity because he received sick leave pay while absent from work. Under our Worker’s Compensation Act the degree of temporary partial disability is calculated by comparing “wages earned before the injury” with the “wages which the injured person is able to earn thereafter.” A.R.S. § 23-1044(A). Thus, actual earnings before the injury are compared with earning capacity after the injury.
There are a number of reasоns why an employee who receives the same or higher wages after an injury than he earned before the injury may nevertheless have suffered a loss of earning capacity. See 2 Larson, Worker’s Compensation Law § 57.31 et seq. (1983); Annot.,
Moreover, the ordinary meaning of the word “wages” as it applies to A.R.S. § 23-1044(A)
*20 The value received for the duties and labors which a workman performs, i.e., the value received for services actually rendered.
Parise v. Industrial Commission,
The Arizona Supreme Court has held time and again that the workmen’s compensation laws should be liberally construed so as to give the worker every benefit to which he is rightly entitled. Fullen v. Industrial Commission,
MEDICAL PROOF
Lastly, the petitioners argue that the claimant failed to sustain his burden of proving through expert medical testimony that the industrial accident caused the injury for which the medical treatment was needed. They cite Western Bonded Products v. Industrial Commission,
For the foregoing reasons, the award is affirmed.
Notes
. A.R.S. § 23-1061(J) provides:
The commission shall investigate and review any claim in which it appears to the commission that the claimant has not been granted the benefits to which such claimant is entitled. If the commission determines that payment or denial of compensation is improper in any way, it shall hold a hearing pursuant to § 23-941 within sixty days after receiving notice of such impropriety.
. Although the protest of the July 8, 1981, notice was untimely, the carrier never raised the issue in its request for review on appeal.
. The carrier does not raise the issue of whether the administrаtive law judge erred in finding claimant met the threshold seven day disability requirement set forth in A.R.S. § 23-1062(B) or in finding that claimant proved a disability extending one week beyond the seven days.
. A.R.S. § 23-1044(E) provides:
In case there is a previous disability, as the loss of one eye, one hand, one foot or otherwise, the percentage of disability for a subsequent injury shall be determined by computing the percentage of the entire disability and deducting therefrom the percentage of the previous disability as it existed at the time of the subsequent injury. This statute has been interpreted to mean thаt a preexisting disabling condition converts a subsequent scheduled impairment into an unscheduled impairment. Alsbrooks v. Industrial Commission,118 Ariz. at 483 ,578 P.2d at 162 .
. A comparison of actual earnings and earning capacity is also made in determining the degree of permanent disability. A.R.S. § 23-1044(C) and (D).
. A.R.S. § 23-1044(A) provides:
For temporary partial disability there shall be paid during the period thereof sixty-six and two-thirds per cent of the difference between the*20 wages earned before the injury and the wages which the injured person is able to earn thereafter. Unemployment benefits received during the period of temporary partial disability shall be considered wages able to be earned.
. The carrier correctly notes that the cases relied upon by the administrative law judge in his supplemental decision pertain to whether sick leave pay should be credited against an award. See Pet, Inc. Dairy Division v. Roberson,
If the payment of wages is intended to be in lieu of compensation, credit for wages is allowed. A credit is usually disallowed for any kind of sick pay for which it can be said that the claimant’s entitlement to the payment is based upon past service rather than on the injury itself. See 2 Larson, Worker’s Compensation Law § 57.46 at 10-164.15. The evidence indicates that claimant would receive sick leave benefits whether he was unable to work due to an industrial or non-industrial illness, and that claimant’s entitlement to sick leave pay was based upon accumulated past service. Thus, sick leave pay was not intended as a substitute for compensation benefits, but rather constituted a fringe benefit or incident of employment.
Dissenting Opinion
dissenting.
While I agree with the majority on the jurisdictional and medical proof issues, I disagree with them on the double recovery issue. The majority in essence holds, under the facts here, that claimant’s earned sick leave should not be considered as “wages,” pursuant to A.R.S. §§ 23-1041, 23-1044, and that claimant is entitled to receive his sick pay (which equals his regular pay) plus 82.5 hours of compensation from the petitioners (double recovery). I disagree.
In considering what constitutes “wages” for workers’ compensation purposes, consideration must first be given to the general policy underlying our workers’ compensation laws. The purpose of industrial compensation is to compensate an employee for lost earning capacity, Maness v. Industrial Commission,
The carrier argues that claimant sustained no loss in earning capacity because he received sick leave pay while absent from work. Under our Workers’ Compensation Act the degree of temporary partial disability is calculated by comparing “wages earned before the injury” with the “wages which the injured person is able to earn thereafter.” A.R.S. § 23-1044(A). Thus, actual earnings before the injury are compared with earning capacity after the injury.
2. Following the industrial injury the applicant lost no time from work on the day of the injury but within the first week .missed four and one-half days. The applicant was not disabled from work at any time following May 4, 1981, but took time off from work for medical treatment on many occasions. These absences from work for all purposes add up to ten and a half days.
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4. The applicant received sick leave pay for the hours lost from work after his disability ended but while he was receiving treatment for his injury.
There is no other finding either in the award or the supplemental award that overcomes the Continental Casualty Co. presumption. Thus, we must consider the question whether sick leave pay constitutes wages under the facts here. The Workers’ Compensation Act does not define “wages” as used in A.R.S. § 23-1041, et seq., which deals with the amount of compensation
From the Pettis opinion it is clear that in Arizona not every payment made to the employee by the employer constitutes “wages” for purposes of computing the injured employee’s average monthly wage. There the payment to the employee for the use of his saw was held not to be a part of his “wage under the contract of hire.” On the other hand,' from the Matlock opinion it is clearly evident that payments or benefits conferred upon an employee in return for his labor and services are includable in computing the average monthly wage, even though these payments or benefits do not on their face purport to be “wages”. Although the benefits provided in Matlock were not in the fоrm of money, it is our opinion that the Arizona Supreme Court would have reached the same result had the payments been in the form of a money reimbursement to Matlock for sums expended by him for such purposes. From the foregoing, it might be argued that the transportation allowance in this case should be considered the same as the extra benefits provided to the employee in Matlock, and thus should constitute a part of his “wages” for average monthly wage computation purposes. We do not think so. An important distinction must be rеcognized to exist between the “room and board” benefits provided in Matlock and the travel expense allowance provided in this case. In Matlock the extra benefits provided by the employer had the effect of helping Matlock meet his ordinary day-to-day requirements for food and lodging—requirements which would continue substantially unchanged whether Matlock was employed or not. On the other hand, the extra benefits here provided by the employer are directly related to meeting special transportation еxpenses entailed by reason of petitioner’s employment—expenses which will cease with the cessation of petitioner’s employment. While an unemployed worker must have a roof over his head, and continue eating regardless of whether employed or unemployed, he would no longer be required to expend money for travel to the jobsite if he were no longer employed. We think the principle to be derived from the foregoing is that “wages” do not include amounts paid to the employee to reimburse him fоr employment-related expenditures of a nature which would not be incurred but for his employment. Such payments are simply not intended as compensation for services rendered. Before any part of such allowances or reimbursements can be considered as a part of the employee’s “wages” there should be some showing that the payments are more than sufficient to reimburse the employee for the work-related expense so that in effect the excess can be considered as extra compensation to the workman for his services performed.
In Still v. Industrial Commission,
*23 Whether the benefits are obtained by virtue of a union agreement, as here, or by the effort of government, as in the case of social security contributions and unemployment insurance contributions, they are clearly obtained by “collective effort” and not by the individual effort of the employee. They are also not paid to the employee by the employer and would not be recoverable in an action at law by him against the employer.
In Industrial Commission v. Jordan,
Our case of Insurance Co. of North America v. Industrial Commission,
The facts sub judice are that claimant earned his accrued sick leave entitlement as a part of his regular employment; that he had to actually use his sick leave compensation in order to gain any benefit from it, and that he received sick leave compensation in the full amount of his wage, from the same payroll account, during the time he was not drawing his regular wages. In my opinion, under the cirсumstances, such sick leave compensation must be treated as wages under A.R.S. § 23-1041, et seq., and A.R.S. § 23-1044 in particular. My conclusion is based on the above cited cases. Pettis and Barron, in particular point the way. Here we have a benefit conferred on the claimant as a result of his employment contract with the county. The sick leave compensation was earned by claimant, and if not paid, it was recoverable by an action at law. Barron v. Ambout, supra. Cf. Field v. Industrial Commission,
The carrier correctly notes that the cases relied on by the administrative law judge in his supplemental decision pertain to whether sick leave should be credited against an award. (Pet, Inc. Dairy Division v. Roberson,
Thus, under the facts here the claimant is not entitled to double recovery. I would set the award aside.
. A comparison of actual earnings and earning capacity is also made in determining the degree of permanent disability. A.R.S. § 23-1044(C) & (D).
