CRB Case Annotations re: Section 31-293

Claimant received settlement in third-party action, and respondent insurer was entitled to credit of $33,562.63 against future benefits. Compensation for temporary partial disability benefits was presently terminated. Claimant then underwent surgery on cervical spine. Respondents initially declined to accept liability, and after finally doing so over a year later, declined to offset medical costs in order to shorten moratorium. Instead, insurer applied full value of credit against award of cervical spine permanency benefits. Trier found that, pursuant to Pokorny v. Getta’s Garage, 219 Conn. 439 (1991), credit could not be reduced by neck surgery payments that had been made by claimant’s group health carrier, and that had not been repaid to group insurer by respondents. CRB affirmed. Claimant’s strategy for reducing moratorium assumed that group health insurer could be made to assume ultimate liability for neck surgery. Insurer possesses reimbursement rights under § 31-299(a) and § 38a-470 against employer or insurer when it pays benefits pursuant to health insurance policy for medical treatment later shown to be related to compensable injury. Under Pokorny, issues regarding obligations to pay for such bills lie between respondents and medical insurance carrier. If all parties avail selves of rights, no one party would be left with a windfall. See, Bilodeau, § 31-300; also cited at Bilodeau, § 31-299a.

Trier found that respondent’s failure to strictly adhere to § 31-293’s provisions was due to its reliance on representations of claimant’s counsel, and held that respondent continued to have rights to a credit against third-party proceeds. CRB affirmed. Factual grounds existed to establish basis for respondent’s belief that counsel was keeping it apprised of third-party action. As claimant had already paid respondent over $50,000 as reimbursement for lien, respondent had reason to expect that the remainder of its credit/moratorium right would also be honored. See Longo v. Leibovitz, 3464 CRB-3-96-11 (Jan 15, 1998), infra. Employer retains continuing right to credit for present worth of probable future payments, either known or unknown, to extent that there are excess proceeds from third party recovery. CRB also held that respondent was not entitled to take credit for an amount that claimant collected pursuant to an underinsured motorist policy owned by the company whose vehicle he was driving at the time of his automobile accident, following Matteo v. Alvarez, 53 Conn. App. 452, 454-55 (1999). See Schreck, § 31-300, § 31-301 appeal procedure. Prior decision at Schreck, 3322 CRB-7-96-4 (Sept. 23, 1997) (dismissal order), rev’d, 51 Conn. App. 92 (1998), rev’d on different grounds, 250 Conn. 592 (1999), appeal reinstated, 3322 CBR-7-96-4 (July 21, 2000), § 31-301 appeal procedure.

Motion for Reconsideration granted February 14, 2000. Board affirmed trial commissioner’s decision that the Fund was entitled to a credit for the claimant widow’s settlement of a third party suit, and that said credit applied to the widow’s recovery for wrongful death but not to her recovery for loss of consortium. CRB discussed claim for loss of consortium and policy of preventing double recovery. Additionally, board found that trier erroneously failed to allow credit under § 31-293 for wrongful death recovery which was paid to children, as the children were to be recipients of benefits under § 31-306. In support of her Motion for Reconsideration, the claimant argued that the entire wrongful death recovery allocated to the children is not appropriately a credit because the children’s interest will soon terminate under § 31-306(5). The board agreed with the claimant’s argument that the trial commissioner upon remand should reconsider the credit, taking into account the children’s entire wrongful death recovery.

Trier found that respondents were entitled to credit for future compensation benefits against claimant’s portion of third-party settlement. Claimant argued that language of release between respondents and third-party defendants waived right to reimbursement. CRB affirmed. Release was drafted for signature of civil suit defendants, not claimant, and its language did not necessarily waive entitlement to an offset.

No error in commissioner’s finding that the claimant did not prove that the amount of the respondents’ moratorium should be reduced because a third party settlement was made on account of wife’s loss of consortium claim rather than claimant’s lawsuit for personal injuries. Much of claimant’s argument was addressed in a prior CRB decision, and panel refused to readdress those matters.

The board affirmed the trial commissioner’s conclusion that the insurer did not forfeit its right to reimbursement pursuant to § 31-293. Where the claimant specifically negotiated with the insurer regarding reimbursement from a $100,000.00 settlement, it would not be reasonable to expect that insurer to file its own cause of action against the third party tortfeasor when the claimant’s attorney had agreed that the insurer had a right to reimbursement from said settlement. A reasonable inference is that the insurer’s failure to strictly adhere to the provisions of § 31-293 resulted from its reliance on the agreement which was signed by the claimant.

Trial commissioner ruled that respondents were entitled to offset against widow’s benefits any amounts recovered by claimant as a result of third party claims against asbestos manufacturers. Held: § 52-572r(c) was in effect on the date of the injury (12/14/90), and Krampetz v. Uniroyal Chemical, 11 Conn. Workers’ Comp. Rev. Op. 293, 1367 CRD-5-92-1 (December 8, 1993), held that that statute prohibits an employer from having a lien on any judgment received in a product liability claim, or a corresponding right of subrogation. No reason to overrule that doctrine here. Also, no evidence was offered regarding the parties’ compliance with the requirements of § 31-293.

Second injury fund need not receive notice before liability accrues for benefits. See, Petraroia, § 31-352 for complete discussion of case.

Libby v. Goodwin Pontiac, 13 Conn. Workers’ Comp. Rev. Op. 182, 1637 CRB-2-93-2 (March 21, 1995), aff’d, 42 Conn. App. 200 (1996), aff’d, 241 Conn. 170 (1997).

Employer accepted injury as compensable; subsequently, claimant reached settlement with third party tortfeasor. Respondents were not involved in settlement, were not promised money from recovery, and did not file suit against third party under § 31-293. Held, employer forfeited right to reimbursement by failing to enforce its rights as prescribed by statute.

Schiano v. Bliss Exterminating, 13 Conn. Workers’ Comp. Rev. Op. 45, 1341 CRD-4-91-11, 1852 CRB-4-93-9 (December 7, 1994), aff’d, 57 Conn App. 406 (2000).

Where claimant recovers an amount in a third party action that is less than an employer’s lien, the employer may still take credit for the amount of the settlement against future payments due to the claimant. Testimony supported commissioner’s finding that Second Injury Fund and claimant agreed to a “moratorium” amounting to a credit rather than a postponement of benefits, which is consistent with § 31-293. No authorization in statute for commissioner to enforce credit against permanent partial disability benefits rather than temporary total disability benefits, however. Commissioner improperly found that moratorium applied to entire recovery made by claimant and his wife without first determining how much, if any, of the settlement was received for loss of consortium claim. Statute does not extend to settlements for consortium claims. Remanded. See also, Schiano, § 31-301. Appeal procedure. See subsequent Schiano, 3315 CRB-4-96-4 (May 16, 1997), § 31-301 Appeal procedure, and 4104 CRB-4-99-8 (Feb. 21, 2001), rev’d, 260 Conn. 21 (2002), § 31-278, § 31-303, and cited at § 31-300.

Casman v. Lego Systems, 12 Conn. Workers’ Comp. Rev. Op. 178, 1520 CRB-3-92-10 (May 2, 1994).

Claimant is bound by the rules which govern proceedings within the workers’ compensation act where employer intervenes in third party tort claim in superior court. Both actions proceed independent of each other. See also, Casman, § 31-294f.

Mulligan v. N.C.H. Corporation, 12 Conn. Workers’ Comp. Rev. Op. 223, 1499 CRB-7-92-8 (March 22, 1994).

Although respondent employer timely intervened in a third party action and that action was settled, employer must file a Form 36 and obtain commissioner approval before discontinuing benefits. See, Mulligan v. Hall, 32 Conn. App. 203 (1993). See also, Mulligan, § 31-296.

Kramptez v. Uniroyal Chemical, 11 Conn. Workers’ Comp. Rev. Op. 293, 1367 CRD-5-92-1 (December 8, 1993).

CRB affirmed trier’s finding that decedent’s date of injury of December 7, 1981 controls whether § 52-572r applies. (Note: § 52-572r(c) was in effect from October 1, 1979 through July 1, 1993). As § 52-572r applies and § 31-293 does not, respondent employer had no right to an offset against any third party product liability recovery. See also, Kramptez, § 52-572r.

Sauer v. The Day Publishing Company, 9 Conn. Workers’ Comp. Rev. Op. 182, 1021 CRD-2-90-5 (August 19, 1991).

Remanded in accordance with Supreme Court’s ruling in Love v. J.P. Stevens & Co., 218 Conn. 46 (1991) and Enquist v. General Datacom, 218 Conn. 19 (1991) whereby the Supreme Court held an employer could receive credit for future compensation payments against a third party tort recovery.

O’Donal v. West Hartford, 10 Conn. Workers’ Comp. Rev. Op. 6, 917 CRD-1-89-9 (April 15, 1991).

Discussion of § 31-293(a) language. § 31-293(a) does not allow reimbursement from a third party damage settlement for § 31-284b benefits paid. Also, even though collective bargaining agreement obligated the town to pay full pay during police officer’s period of disability, statute does not require reimbursement to the town beyond the two thirds wages amount required under chapter 568.

Libertino v. Lerner Laboratories, Inc., 8 Conn. Workers’ Comp. Rev. Op. 152, 838 CRD-8-89-3 (September 21, 1990).

Remanded to determine validity of insurer’s lien. Trial commissioner has jurisdiction under § 31-293 to determine if lien is proper.

Enquist v. General Datacom, 7 Conn. Workers’ Comp. Rev. Op. 8, 623 CRD-7-87 (June 20, 1989), error, remanded, 21 Conn. App. 270 (1990), rev’d, 218 Conn. 19 (1991).

Employer who properly intervenes in a third party suit pursuant to § 31-293 is entitled to reimbursement for workers’ compensation benefits and a credit for future payments. See also, Love v. J.P. Stevens & Co., infra.

Love v. J.P. Stevens & Co., Inc., 6 Conn. Workers’ Comp. Rev. Op. 56, 378 CRD-7-85 (November 10, 1988), rev’d, 21 Conn. App. 9 (1990), rev’d, 218 Conn. 46 (1991).

CRD held trial Commissioner had authority to order credit for future payments made pursuant to Act from third party suit settlement. Note: Appellate Court reversed and held that respondents not entitled to credit as they failed to preserve their right for the present value of future probable payments under § 31-293. Supreme Court reversed ruling of Appellate Court.

Pokorny v. Getta’s Garage, 6 Conn. Workers’ Comp. Rev. Op. 161, 716 CRD-7-88-3 (June 2, 1989), rev’d, 22 Conn. App. 539 (1990), rev’d, 219 Conn. 439 (1991).

CRD disallowed claimant payment of medical expenses paid by private health insurer but for which no lien was filed. See also, Pokorny, § 31-300.

Latham v. Jim & Joe General Contractors, 4 Conn. Workers’ Comp. Rev. Op. 51, 304 CRD-2-84 (April 13, 1987), error, remanded, 16 Conn. App. 138 (1988).

Trial commissioner’s determination that he lacked jurisdiction to decide a Motion for Reimbursement was error. CRD held reimbursement from settlement with third party auto insurer should not be granted as neither the claimant nor the respondent instituted suit. Remanded by Appellate Court.

Conard v. Haggerty Pool Service, 3 Conn. Workers’ Comp. Rev. Op. 96, 174 CRD-7-82 (November 19, 1986).

Where employer pays benefits for surgery stemming from a work related injury and said surgery results in malpractice which necessitates additional surgery, employer is entitled to reimbursement of benefits and a credit against future benefit payouts from third party settlement.

Skitromo v. Meriden Yellow Cab Co., 3 Conn. Workers’ Comp. Rev. Op. 37, 326 CRD 6-84 (February 26, 1986), no error, 204 Conn. 485 (1987).

Where carrier fails to intervene in employee’s third party suit, no right to reimbursement or reduction against future benefits.

CRB Case Annotations re: Section 31-293

Reimbursement and third party suits.