JOSEPH DOMINGUEZ v. NEW YORK SPORTS CLUB ET AL.
(AC 42089)
Appellate Court of Connecticut
Alvord, Elgo and Eveleigh, Js.
Argued January 13—officially released July 14, 2020
Syllabus
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The defendant employer and its workers’ compensation insurer appealed to this court from the decision of the Compensation Review Board, which reversed in part the decision of the Workers’ Compensation Commissioner granting in part the plaintiff employee‘s motion to preclude the defendants from contesting the compensability of his injuries pursuant to statute (
- The defendants could not prevail on their claim that the board improperly precluded them from contesting the extent of the plaintiff‘s injuries: because the plaintiff complied with the notice of claim requirements in
§ 31-294c (a) and the defendants did not file a responsive answer of any kind within the twenty-eight day period mandated by§ 31-294c (b) to indicate their intention to contest liability or to commence payment, the conclusive presumption of compensability in§ 31-294c (b) barred them from contesting the extent of the plaintiff‘s disability or his right to receive compensation, and this court concluded that, although the mechanics of the commence payment predicate in§ 31-294c (b) were ambiguous, the initial burden with respect to the commence payment predicate rested with the employer, which was consistent with the legislative policies and purposes embodied in§ 31-294c (b) , the broad remedial purposes of the Workers’ Compensation Act (§ 31-275 et seq. ) and the statutory (§ 31-294d ) requirement of an immediate response from employers with respect to medical expenses, and the placing of the initial burden on the employer comported with a primary purpose of§ 31-294c (b) , which is to keep the process of initiating a claim for compensation simple and accessible for laypersons, as§ 31-294c (b) does not require the claimant to furnish medical bills or a separate request for payment within twenty-eight days after commencing a claim; furthermore, it was entirely consonant with the legislative history and policies embodied in§ 31-294c (b) that an employer be required to provide notice to a claimant within the twenty-eight day period when the employer seeks to avail itself of the one year safe harbor provision in§ 31-294c (b) that permits an employer to make payments on a claim instead of filing a notice thаt it is contesting the claim. - This court declined to extend the limited exception in Dubrosky to the preclusion provision of
§ 31-294c (b) in situations in which employers dispute liability and the extent of a claimant‘s injuries, and fail to make payments for a claimant‘s medical care; the defendants did not accept liability for the plaintiff‘s injuries or make any payments for his medical care, and the complex nature of the workers’ compensation scheme required that policy determinations and the creation of exceptions to§ 31-294c (b) be left to the legislature.
Procedural History
Appeal from the decision of the Workers’ Compensation Commissioner for the Seventh District granting in part the plaintiff‘s motion to preclude the defendants from contesting liability as to his claim for certain workers’ compensation benefits, brought to the Compensation Review Board, which reversed the commissioner‘s decision in part, and the defendants appealed to this court; thereafter, Walter Dominguez, administrator of the plaintiff‘s estate, was substituted as the plaintiff. Affirmed.
John J. Morgan, for the appellee (substitute plaintiff).
Opinion
ELGO, J. This case concerns the mandate of General Statutes
The relevant facts were stipulated to by the parties and are not in dispute. On June 29, 2016, the plaintiff completed a form 30C,3 in which he sought compensation for the exacerbation of a preexisting injury to his upper left extremity. The plaintiff allegedly sustained that exacerbation in the course of his employment with the defendant “while moving equipment or other items in the [defendant‘s] gym” on March 24, 2016. The Workers’ Compensation Commission received the plaintiff‘s notice of that claim for compensation on July 5, 2016; the defendant received it on July 6, 2016. Over the next seven weeks, the defendant did not file any response to that notice.
On August 26, 2016, the plaintiff filed a motion, pursuant to
The defendant filed a belated form 43 with the Workers’ Compensation Commission on September 19, 2016—seventy-five days after receiving the plaintiff‘s form 30C. In the portion of the form titled “Reason(s) for Contest,” the defendant stated: “Alleged injury did not arise out of or in the course of employment; no medical records supporting compensability presented to employer and no request for medical or indemnity benefits presented to employer for payment to date.”
A formal hearing was held before the Workers’ Compensation Commissioner (commissioner) on February 6, 2017, at which the sole issue was whether to grant the plaintiff‘s motion to preclude. In her subsequent decision, the commissioner found that the defendant had not filed a timely form 43 within the twenty-eight day period of
The plaintiff filed a petition for review with the board, claiming that the commissioner had improperly applied the Dubrosky exception. The board agreed, emрhasizing that, unlike the defendant employer in Dubrosky, the defendant here contested its liability for the injury in question.6 Concluding that “the present matter
As a preliminary matter, we note certain well established precepts that govern our review. The workers’ compensation system in this state “is derived exclusively from statute“; Wiblyi v. McDonald‘s Corp., 168 Conn. App. 92, 104, 144 A.3d 530 (2016); and is codified in the Workers’ Compensation Act (act),
This appeal does not involve any dispute as to the underlying facts found by the commissioner. Rather, it concerns the proper interpretation of
I
On appeal, the defendant claims that the board improperly determined that the defendant was precluded from contesting the extent of the plaintiff‘s injuries.8 It argues that the plaintiff‘s failure to submit medical bills or a request for payment to the defendant within the twenty-eight day statutory period rendered it impossible for the defendant to comply with the predicаtes of
In resolving that issue of statutory construction, we are mindful that
As its title indicates,
We begin with the language of the statute in question. Section 31-294c (b) contains several related provisions that govern an employer‘s obligation to respond to a properly filed notice of claim for compensation. It provides in relevant part: “Whenever liability to pay compensation is contested by the employer, he shall file with the сommissioner, on or before the twenty-eighth day after he has received a written notice of claim,9 a notice in accord with a form prescribed by the chairman of the Workers’ Compensation Commission stating that the right to compensation is contested, the name of the claimant, the name of the employer, the date of the alleged injury or death and the specific grounds on which the right to compensation is contested. The employer shall send a copy of the notice to the employee in accordance with section 31-321. If the employer . . . fails to file the notice contesting liability on or before the twenty-eighth day after he has received the written notice of claim, the employer shall commence payment of compensation for such injury or death on or before the twenty-eighth day after he has received the written notice of claim, but the employer may contest the employee‘s right to receive compensation on any grounds or the extent of his disability within one year from the receipt of the written notice of claim, provided the employer shall not be required to commence payment of compensation when the written notice of claim has not been properly served in accordance with section 31-321 or when the written notice of claim fails to include a warning that (1) the employer, if he has commenced payment for the alleged injury or death on or before the twenty-eighth day after receiving a written notice of claim, shall be precluded
It is well established that, “in interpreting [statutory language], we do not write on a clean slate, but are bound by . . . previous judicial interpretations of this language and the purpose of the statute.” New England Road, Inc. v. Planning & Zoning Commission, 308 Conn. 180, 186, 61 A.3d 505 (2013). On several occasions, the appellate courts of this state have construed the various provisions of
In the seminal case of Harpaz v. Laidlaw Transit, Inc., 286 Conn. 102, 942 A.2d 396 (2008), our Supreme Court detailed the contours of the preclusion scheme contained in
The issue presented in Harpaz was “whether an employer that is deemed ‘conclusively presumed to have accepted the compensability of the alleged injury’ under . . .
In Donahue v. Veridiem, Inc., supra, 291 Conn. 545, our Supreme Court described the requirement that an employer either file a notice contesting liability or commence payment on the claim within the twenty-eight day statutory period as predicates to the employer‘s ability to challenge “both the compensability of the injury and the extent of disability.”11 In the present case, it is undisputed
Our Supreme Court previously has determined that
“The test to determine ambiguity is whether the statute, when read in context, is susceptible to more than one reasonable interpretation.” (Internal quotation marks omitted.) Sena v. American Medical Response of Connecticut, Inc., 333 Conn. 30, 46, 213 A.3d 1110 (2019). Because
The plaintiff, by contrast, contends that the inherent nature of the form 30C itself, which is the vehicle by which a claimant provides notice of a claim for compensation, communicated to the defendant that he was seeking рayment of benefits due under the act, including medical expenses.13 The plaintiff thus argues that
We conclude that both interpretations of
The notice of claim requirements of
The legislature further revised
In 1993, the General Assembly “undertook comprehensive reforms to the . . . [a]ct.” Id., 120. Number 93-
At the same time, the legislative history of the 1993 amendment sheds little light on the precise question before us, which concerns the mechanics of the “commence payment” predicate of
The preclusion provision of
Placing the initial burden with the employer also comports with another primary purpose of
In addition, our conclusion that the initial burden with respect to the “commence payment” predicate of
We are mindful that the legislature included a safe harbor provision in
As with all issues of statutory construction, “[o]ur fundamental objective is to ascertain and give effect to the apparent intent of the legislature.” (Internal quotation marks omitted.) Callaghan v. Car Parts International, LLC, 329 Conn. 564, 570, 188 A.3d 691 (2018). Our review of the genealogy and legislative history of
It is undisputed that the plaintiff in the present case fully complied with the notice of claim for compensation requirements contained in
II
Despite its failure to file a responsive answer of any kind during the twenty-eight day statutory period, the defendant maintains that the limited exception to the preclusion provision of
Dubrosky is factually and procedurally distinguishable from the present case. Although the defendant employer in that case failed to file a responsive answer to the plaintiff employee‘s form 30C within the statutory period, it subsequently (1) paid all medical bills submitted to it by the plaintiff‘s physician and (2) affirmatively accepted, at the formal hearing before the commissioner, that an incident involving the plaintiff had occurred. Id., 265-66. At that hearing, the defendant clarified that it only “sought to maintain its ability to contest the extent of the plaintiff‘s disability” due to the impossibility of complying with the “commence payment” predicate of
On appeal, this court concluded otherwise and recognized a narrow exception to the preclusion provision, as previously construed by Harpaz and its progeny. The court concluded “that, under the facts of this case, it was not reasonably practical for the board to require the defendant to have complied with
Unlike the defendant employer in Dubrosky, the defendant here has not accepted liability for the plaintiff‘s injuries. Rather, as both the commissioner and the board emphasized, the defendant filed a belated form 43 in which it denied liability for the plaintiff‘s injuries. See footnote 6 of this opinion. Moreover, at no time has the defendant made payments for the plaintiff‘s medical care, as did the defendant employer in Dubrosky. Put simply, this case is not Dubrosky.
In this appeal, the defendant asks us to extend the limited exception articulated in Dubrosky to situations in which employers (1) dispute both liability and the extent of a claimant‘s injuries,21 and (2) fail to make any payments for the claimant‘s medical care. We refuse to do so. As our Supreme Court has observed, “[i]t is not the court‘s role to acknowledge an exclusion when the legislature painstakingly has created such a complete statute. We consistently have acknowledged that the act is an intricate and comprehensive statutory scheme. . . . The complex nature of the workers’ compensation system requires that policy determinations should be lеft to the legislature, not the judiciary.” (Citations omitted; internal quotation marks omitted.) McCullough v. Swan Engraving, Inc., supra, 320 Conn. 310; see also footnote 18 of this opinion. For that reason, this court expressly has declined “to carve out another exception” to the statutory scheme embodied in
The decision of the Compensation Review Board is affirmed.
In this opinion the other judges concurred.
