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MEMORANDUM - July 22, 1996

Supreme Court Affirms CRB Decision about Payment for Injured Workers' Medical Care


TO: Attorneys, CT Medical Societies, Insurance Carriers, Medical Practitioners, PPO Organizations, Self-Insured Employers, State Agency WC Liaisons, Unions, WC Advisory Board, WC Legal & Medical Advisory Panels, WC Commissioners
FROM: Jesse M. Frankl, Chairman
DATE: July 22, 1996
RE: Supreme Court Affirms CRB Decision about Payment for Injured Workers' Medical Care


The Connecticut Supreme Court recently issued a decision in the case of Figueroa v. C & S Ball Bearing, 237 Conn. 1 (1996), which unanimously affirmed an earlier Compensation Review Board (CRB) decision on the matter [see, Baigert v. Fosdick Corp., 13 Conn. Workers' Comp. Rev. Op. 78, 1784 CRB-8-93-7 (Jan. 20, 1995)].

The plaintiff in the case, the Veterans Memorial Medical Center (VMMC), sought compensation for medical services it had provided to a number of individuals who were alleged to have been injured in the course of their employment, but who had not filed claims under the Workers' Compensation Act. The VMMC notified the individuals' respective employers concerning the medical services it had provided, including in the notifications bills for those services. When a number of bills remained unpaid, the VMMC requested several informal hearings before the Workers' Compensation Commission, which were initially scheduled, but were later postponed indefinitely by the Commission Chairman. The VMMC then consolidated its outstanding claims and appealed them to the CRB.

On January 20, 1995, the CRB issued a written decision in which it dismissed the VMMC's appeal for lack of subject matter jurisdiction, holding that the Commission "lack[ed] no claim was asserted by the alleged employees of their right to [workers' compensation] benefits." It further concluded that, "a medical provider [does not have] standing before this commission in the absence of a claim by an injured employee or his dependent(s) for benefits under [the act]. Without, at the very least, an underlying assertion by a claimant to an entitlement of workers' compensation benefits, there is no basis upon which a commissioner would inquire as to the medical services provided."

The VMMC then appealed the case to the Appellate Court, and the case was subsequently transferred to the Supreme Court. The Court agreed, in part, with the CRB's reasoning and affirmed its decision.

Writing for the Court, Justice Berdon explained in his opinion that the Workers' Compensation Commission is a tribunal of limited jurisdiction, whose jurisdiction must first be invoked before the agency may act upon a matter presented to it. He also noted that once the issue of jurisdiction of a court or agency is raised, it must be disposed of before proceeding further with the case, and stated that, "Under the act, before the commission has jurisdiction to hold a hearing to determine whether a party is entitled to compensation, a written notice of claim must be filed . . . or one of the statutory jurisdictional alternatives must be satisfied."1 In none of the cases involved in the earlier CRB appeal had the employee in question submitted a claim for workers' compensation benefits, so the jurisdiction of the Commission to hear the case had not been established.

The question facing the Court was, therefore, whether a medical provider may furnish the requisite notice on behalf of the employee in order to initiate a workers' compensation claim. Berdon noted that, "It is a basic tenet of statutory construction that the intent of the legislature is to be found not in an isolated phrase or sentence but, rather, from the statutory scheme as a whole." He concluded that, "Although the statute does not explicitly state that an 'employee' shall provide the notice of claim, it is clear from a reading of the act that employees, not medical providers or other third parties, have standing to initiate a claim."

Justice Berdon stated that, "The act was specifically designed to benefit injured employees" and that, "In at least two ways, the statutory scheme reflects this intention and requires that the injured employee invoke the commission's jurisdiction by furnishing the required notice if he wishes to take advantage of the act."2 In view of the purpose of the Workers' Compensation Act and the legislative scheme, the Court concluded that a medical provider does NOT have statutory authority to furnish the notice required of an employee to invoke the jurisdiction of the Commission by giving notice on behalf of an employee.

The plaintiff also made a claim that as a medical provider, it independently has standing to initiate a claim under the Workers' Compensation Act. Although the VMMC cited no statutory authority to support this claim, it did cite several CRB decisions. However, the Court found that the decisions cited by the VMMC do NOT hold that a medical provider has an independent basis for standing to initiate a claim under the act.

The Court summarized its main findings regarding the plaintiff's arguments: "The filing of a workers' compensation claim is not required by law for every injury an employee may sustain while at work. An injured employee has the option of taking advantage of the act.3 Rather than filing a claim, an employee may want to pay for his treatment personally or have it paid through other means. If an employee decides not to utilize the act, however, he exposes himself to liability for the services performed by a medical provider. A medical provider, however, does NOT have standing to invoke the jurisdiction of the commission by giving notice on behalf of the employee or by independently filing a claim."

1 Pursuant to Section 31-294c(c) of the Workers' Compensation Act, the Commission may acquire jurisdiction if, within the applicable period of time, any one of the following three jurisdictional alternatives has been met: (1) there has been a hearing or a written request for a hearing or an assignment for a hearing; (2) a voluntary agreement has been submitted within the applicable period; or (3) the employer has furnished the employee, for the respective work-related injury, with medical or surgical care as provided in Section 31-294d of the Workers' Compensation Act. BACK TO TEXT

2 First, Section 31-294b of the Workers' Compensation Act focuses directly on the employee by requiring him to report the nature of his injury to his employer. Second, Section 31-294c provides that only the dependents or legal representatives of a deceased employee may initiate a claim on an employee's behalf. BACK TO TEXT

3 A footnote within the Court's decision states that "Should an employee decide to forgo the benefits offered under the act, the employee is still limited to the legal recoveries permitted under the act. See General Statutes §§31-284 and 31-293a." BACK TO TEXT