Thomas v. Logue, Admr. of Ohio Bur. of Workers' Comp.Thomas v. Logue, Admr. of Ohio Bur. of Workers' Comp.
DECISION
Rendered on May 12, 2022
On brief: Garson Johnson LLC, James A. DeRoche, and Jeffrey D. Johnson; Weisman, Kennedy & Berris Co., L.P.A., R. Eric Kennedy, and Daniel P. Goetz; Ciano Goldwasser, LLP, and Andrew S. Goldwasser, for appellant. Argued: James A. DeRoche.
On brief: Brennan, Manna & Diamond, LLC, Robert A. Hager, Justin M. Alaburda, and Daniel J. Rudary; Dave Yost, Attorney General, and Timothy M. Miller, for appellee. Argued: Daniel J. Rudary.
APPEAL from the Court of Claims of Ohio
DORRIAN, J.
{¶ 1} Plaintiff-appellant, Lamar Thomas, appeals the June 28, 2021 decision and judgment entry of the Court of Claims of Ohio finding defendant-appellee, Ohio Bureau of Workers’ Compensation (“BWC“), was entitled to judgment as a matter of law and granting BWC‘s motion for judgment on the pleadings. For the following reasons, we reverse.
{¶ 2} On March 4, 2021, appellant filed a complaint in the Court of Claims asserting claims for equitable restitution and unjust enrichment in addition to seeking declaratory and injunctive relief. In his complaint, appellant allеged that on September 5, 2013, he was injured in the course and scope of his employment in an automobile accident. Appellant filed a claim for workers’ compensation benefits, and such claim was allowed by BWC for cervical and lumbar sprain. According to appellant, his injury was caused by the negligence of a third party, and appellant pursued a separate claim against such party.
{¶ 3} As a result of his injury, appellant sought medical treatment from a physician and received physical therapy. Appellant‘s physician, Dr. Adam Friedman, authored a report opining that, as a result of the accident, appellant sustained a lumbar sprain and substantially aggravated pre-existing degenerative disc disease as well as pre-existing spondylothesis. On June 14, 2014, appellant filed a request with BWC for an additional allowance for the conditions in Dr. Friedman‘s report.
{¶ 4} In response to appellant‘s request for additional allowances, BWC referred the claim to an independent medical examiner, Dr. Gerald Yosowitz, who reviewed appellant‘s medical records and opined that the additional conditions identified by Dr. Friedman were degenerative and unrelated to the injury sustained by appellant in the automobile acсident. Based on Dr. Yosowitz‘s review, BWC referred appellant‘s claim to the Industrial Commission of Ohio (“commission“).1 In front of the commission, BWC argued the commission should deny appellant‘s request for additional allowances.2 On January 16, 2015, the commission hearing officer disallowed the claim for the requested additional conditions based on Dr. Yosowitz‘s report. On February 26, 2015, a second commission hearing officer denied appellant‘s appeal of the January 16, 2015 commission decision. On March 20, 2015, the commission refused appellant‘s appeal. As a result,
{¶ 5} Appellant further alleged that following the settlement of his third-party claim, BWC asserted a right of subrogation in the amount of $6,044.36 from appellant‘s settlement pursuant to
{¶ 6} On April 30, 2021, BWC filed an answer. On May 3, 2021, BWC filed a motion for judgment on the pleadings pursuant to
II. Assignment of Error
{¶ 7} Appellant appeals and presents thе following sole assignment of error for our review:
The trial court erroneously interpreted “subrogation interest” [
R.C. 4123.93(D) ] to include administrative costs that neither the injured worker nor the statutory subrogee could recover from a liable third party.
III. Assignment of Error—Interpretation of R.C. 4123.93(D)
{¶ 8} In his assignment of error, appellant asserts the court erred by granting judgment on the pleadings in favor of BWC because it incorrectly interpreted the statutory definition of the term “subrogation interest” under
A. Motion for Judgment on the Pleadings Under Civ.R. 12(C)
{¶ 9} Pursuant to
B. Subrogation Under Ohio Workers’ Compensation Law
{¶ 10}
(A) “Claimant” means a person who is eligible to receive compensation, medical benefits, or death benefits under this chapter or Chapter 4121., 4127., or 4131. of the Revised Code.
(B) “Statutory subrogee” means the administrator of workers’ compensation, a self-insuring employer, or an employer that contracts for the direct payment of medical services pursuant to division (P) of section 4121.44 of the Revised Code.
(C) “Third party” means an individual, private insurer, public or private entity, or public or private program that is or may be liable to make payments to a рerson without regard to any statutory duty contained in this chapter or Chapter 4121., 4127., or 4131. of the Revised Code.
(D) “Subrogation interest” includes past, present, and estimated future payments of compensation, medical benefits, rehabilitation costs, or death benefits, and any other costs or expenses paid to or on behalf of the claimant by the statutory subrogee pursuant to this chapter or Chapter 4121., 4127., or 4131. of the Revised Code.
C. Interpretation of R.C. 4123.93(D)
{¶ 11} This case presents a question of statutory interpretation regarding the scope of the statutory subrogee‘s subrogation interest as that term is defined under
{¶ 12} Statutory interpretation presents a question of law subject to a de novo standard of review. Natl. Lime & Stone at ¶ 14, citing Ceccarelli v. Levin, 127 Ohio St.3d 231, 2010-Ohio-5681, ¶ 8; State ex rel. Peregrine Health Servs. of Columbus, L.L.C. v. Sears, 10th Dist. No. 18AP-16, 2020-Ohio-3426, ¶ 23. The Supreme Court of Ohio has held that courts ” ‘must give due deference to an administrative interpretation formulated by an agency that has accumulated substantial expertise, and to which the General Assembly has delegated the responsibility of implementing the legislative command.’ ” Bernard v. Unemp. Comp. Rev. Comm., 136 Ohio St.3d 264, 2013-Ohio-3121, ¶ 12, quoting Swallow v. Indus. Comm., 36 Ohio St.3d 55, 57 (1988). If the statute in question ” ‘is silent or ambiguous with respect to the specific issue, the question
{¶ 13} Appellant contends BWC impropеrly included its administrative costs in calculating its subrogation interest. Specifically, appellant argues that BWC improperly included the cost of Dr. Yosowitz‘s record review and report as part of the medical bills in its subrogation interest following the settlement of appellant‘s third-party claim. BWC responds that Dr. Yosowitz‘s report should be included in its subrogation interest because it was a cost or expense paid “on behalf of” appellant as that term is used in
{¶ 14} The court, construing the meaning of “costs or expenses” and “on behalf of” under
{¶ 16} Merriam-Webster‘s Collegiate Dictionary defines “on behalf of” both as “in the interest of” and “as a representative of.” Merriam-Webster‘s Collegiate Dictionary 110 (11th Ed.2014).7 Similarly, the New Oxford American Dictionary defines “on behalf of” to mean: (1) “in the interests of a person, group, or principle“; (2) “as a representative of“; and (3) “on the part of; done by.” New Oxford American Dictionary 150 (3d Ed.2010). The American Heritage Dictionary of the English Language defines “on behalf of” both as “[f]or the benefit of; in the interest of,” and “[a]s the agent of; on the part of.” The American Heritage Dictionary of the English Language 162 (5th Ed.2018). Webster‘s Third New
{¶ 17} BWC argues that its subrogation interest includes the payment to Dr. Yosowitz for his record review and report because such payment was made on behalf of appellant. BWC supports this by arguing that appellant voluntarily initiated the request for additional allowances and, therefore, BWC was acting “to determine the propriety of [appellant‘s] request” by ordering the record review and report. (BWC‘s Brief at 24.) As a result, BWC argues that the cоst or expense of the medical record review and report was
{¶ 18} Appellant alleged in his complaint that he filed his claim for additional allowances after consulting his doctor, undergoing an evaluation, and providing support for his claim in the form of his doctor‘s medical report. BWC‘s actions upon receiving the claim were in its ministerial capacity through its review аnd processing of the claim by authorizing Dr. Yosowitz‘s review of appellant‘s medical records. In making its argument, BWC correctly notes that the workers’ compensation process is designed as a nonadversarial system. See State ex rel. Ohio AFL-CIO v. Ohio Bur. of Workers’ Comp., 97 Ohio St.3d 504, 2002-Ohio-6717, ¶ 49 (stating that the “workers’ compensation system is designed to avoid the adversarial character of the civil justice system“). However, the nonadversarial nature of the claim review process does not mean that BWC‘s actions are undertaken as the representative of or for the benefit of the claimant. Rather, BWC‘s operations in reviewing claims, including, as here, requests for additional allowances, are in the nature of its ministerial or administrative function. This crucial distinction is supported by BWC‘s own statements.
{¶ 19} As previously noted, BWC states that in ordering Dr. Yosowitz‘s record review and report, it was acting “to determine the propriety of [appellant‘s] request.” (Emphasis added.) (BWC‘s Brief at 24.) BWC states that Dr. Yosowitz‘s medical review “was necessary to evaluate whether [appellant] was entitled to participate in the workers’ compensation fund for the additional allowances.” (Emphasis added.) (BWC‘s Brief at 22.) In order “[t]o assist in this determination,” BWC relied on its authority under
{¶ 20} BWC states that its “mission” is “to ensure that a claimant is fully and fairly compensated to the extent he or she is entitled to be—no more and no less.” (Emphasis sic.) (BWC‘s Brief at 27.) Citing another provision of Ohio‘s workers’ compensation statutes, BWC acknowledges that its “role” in this process is to serve “as steward and fiduciary of the State Insurance Fund.” (BWC‘s Brief at 25, citing
{¶ 21} Next, BWC argues that “any” is a term that expands the scope of costs or expenses to include ” ‘all’ costs or expenses of ‘whatever kind’ that were paid ‘to or on behalf of the claimant.” (BWC‘s Brief at 19.) While it is true that the term “any” expansively qualifies the types of costs or expenses within the scope of subrogation interest under
{¶ 23} Second, significant factual differences distinguish Roma, the case which originated the language in McManus cited by BWC, from the present matter. In Roma, the court considered the question of whether an appeal from an order of the commission to the Mahoning County Common Pleas Court was timely because the claimant did not receive actual notice of the commission‘s order denying compensation for the claimant‘s injury. Because the claimant‘s attorney withdrew from representation and the record reflected that the claimant did not have actual notice of the commission‘s denial, which was sent to the claimant‘s former attorney, the court found the claimant‘s appeal to the common pleas court was timely. In so finding, the court noted that “the principles and objects sought to be attained by the Workmen‘s Compensation Act” included “obviat[ing] the necessity of claimants dealing with the board through agents, representatives or attorneys.” Roma at 252. The court found that by “voluntarily submit[ting] to the decision of the Board of
{¶ 24} Thus, we cannot agree that including the cost of a record review and report performed by mandate of BWC in furtherance of BWC‘s administrative mission of discerning the merits of appellant‘s request for additional allowances comports with the common sense meaning of the phrase “on behalf of.” Indeed, this interpretation strains the natural and most obvious reading of the statute‘s language. See Stolz at ¶ 9, citing Ohio Neighborhood Fin., Inc. v. Scott, 139 Ohio St.3d 536, 2014-Ohio-2440, ¶ 22 (stating in the context of applying an unambiguous statute that “a court must give effect to the natural and most obvious import of a statute‘s language, avoiding any subtle or forced constructions“). Appellant did not request or authorize the services of Dr. Yosowitz; nor was BWC acting as appellant‘s representative by requesting the record review to further its ministerial function. Applying the common meaning of the express terms of the statute to the undisputed facts of this case leads to a straightforward, unambiguous result—BWC‘s administrative costs are not encompassed by the definition of subrogation interest. As a result, the Court of Claims erred in finding Dr. Yosowitz‘s medical review and report was properly included in BWC‘s subrogation interest.
{¶ 25} We notе appellant also argues that the court erred in failing to consider potential conflict between the parties’ differing interpretations of the definition of subrogation interest and other provisions of workers’ compensation law. Although analysis of other statutory code provisions is unnecessary given our resolution of the question under
{¶ 26} The Supreme Court has stated the following with regard to potentially conflicting statutory provisions:
First, all statutes which relate to the same general subject matter must be read in pari materia. And, in reading such statutes in pari materia, and construing them together, this court must give such a reasonable construction as to give the proper force and effect to each and all such statutes. The interpretation and applicatiоn of statutes must be viewed in a manner to carry out the legislative intent of the sections. All provisions of the Revised Code bearing upon the same subject matter should be construed harmoniously. This court in the interpretation of related and co-existing statutes must harmonize and give full application to all such statutes unless they are irreconcilable and in hopeless conflict.
(Internal citations omitted.) Johnson‘s Markets, Inc. v. New Carlisle Dept. of Health, 58 Ohio St.3d 28, 35 (1991). Thus, “[t]he statutory-construction canon of in pari materia instructs that statutes relating to the same subject ‘be construed together, so that inconsistencies in one statute may be resolved by looking at [the] other statute on the same subject.’ ” State v. Smith, ___ Ohio St.3d ___, 2022-Ohio-274, ¶ 30, quoting Black‘s Law Dictionary 911 (10th Ed.2014). See Thomas v. Freeman, 79 Ohio St.3d 221, 225 (1997) (stating that the “maxim of in pari materia indicates that acts will be given full meaning and effect if they can be reconciled“); State v. Pribble, 158 Ohio St.3d 490, 2019-Ohio-4808, ¶ 12, quoting State v. Moaning, 76 Ohio St.3d 126, 128 (1996) (” ‘It is a well-settled rule of statutory interpretation that statutory provisions be construed together and the Revised Code be read as an interrelated body of law.’ “); Meyers v. Hadsell Chem. Processing, L.L.C., 10th Dist. No. 18AP-387, 2019-Ohio-2982, ¶ 34.
The administrator of workers’ compensation or the industrial commission may require any employee claiming the right to receive compensation to submit to a medical examination, vocational evaluation, or vocational questionnaire at any time, and from time to time, at a place reasonably convenient for the employee, and as provided by the rules of the commission or the administrator of workers’ compensation. A claimant required by the commission or administrator to submit to a medical examination or vocational evaluation, at a point outside of the place of permanent or temporary residence of the claimant, as provided in this section, is entitled to have paid to the claimant by the bureau of workers’ compensation the necessary and actual expenses on account of the attendance for the medical examination or vocational evaluation after approval of the expense statement by the bureau.
Thus, in the process of reviewing a claimant‘s claim, BWC may require the claimant to submit to a medical examination pursuant to
{¶ 28}
The administrative costs of the industrial commission, the bureau of workers’ compensation board of directors, and the bureau of workers’ compensation shall be those costs and expenses that are incident to the discharge of the duties and performance of the activities of the industrial commission, the board, and the bureau under this chapter and [other listed workers’ compensation statutes], and all such costs shall be borne by the state and by other employers amenable to this chapter * * *.
Thus, under
{¶ 29} From the foregoing, it is clear that, in the processing of a claim for benefits, BWC has the authority to refer such claim for investigation, as was done in this case when BWC sought Dr. Yosowitz‘s opinion of appellant‘s medical records. The fact that this procedure occurs in the processing of an application for benefits, renders this procedure “incident to the discharge of the duties and performance of the activities” of the BWC.
{¶ 30} Accordingly, we sustain appellant‘s sole assignment of error.
IV. Conclusion
{¶ 31} Having sustained appellant‘s sole assignment of error, we reverse the June 28, 2021 decision and judgment entry of the Court of Claims of Ohio and remand this matter to that court for further proceedings consistent with law and this decision.
Judgment reversed and cause remanded.
KLATT and MENTEL, JJ., concur.