Court: Court of Appeals of Arizona; June 19, 1984; Arizona; State Appellate Court
In the case of NCR Corporation and National Union Fire Insurance v. Industrial Commission of Arizona, the Arizona Court of Appeals reviewed an Industrial Commission award that vacated a termination notice due to its invalidity. The primary issue was whether a benefits carrier could terminate compensation based on a claimant's lack of response to a "twenty-day" letter, despite uncontradicted medical evidence of permanent impairment. The court affirmed the administrative law judge's decision that the carrier could not terminate benefits under these circumstances.
The claimant, Mercie Plowman, suffered a work-related foot injury in August 1980 and was treated by Dr. Joseph S. Gimbel, who later indicated she had a 5% permanent impairment. Although she initially returned to work, her condition deteriorated, and she did not attend a follow-up appointment in July 1981. In December 1981, she received a "twenty-day" letter asking for updates on her medical treatment, which she did not answer. Consequently, a notice was issued in January 1982 terminating her temporary compensation without acknowledging her permanent impairment. The claimant did not protest this notice within the required ninety days.
In June 1982, after hiring an attorney, she sought to reopen her claim, which was denied, prompting a hearing where she argued her condition had worsened. However, procedural issues arose regarding the acknowledgment of her protest against the termination notice, as it was not officially recorded during the hearings. Ultimately, the court upheld the decision to vacate the termination notice, reiterating that benefits cannot be ended based solely on a claimant's failure to respond to correspondence when medical impairment is evident.
The administrative law judge vacated the termination notice issued by the employer and carrier regarding the applicant's claim. The primary issue was whether the applicant could reopen her claim due to new or additional disability. The applicant filed a second request for hearing, asserting that the January 7, 1982 Notice of Claim Status contradicted Dr. Moczynski's July 3, 1981 medical report, which indicated the applicant was medically stationary but had a 5% impairment of her right foot. The judge concluded that the Notice was void because it was directly contradicted by Dr. Moczynski's report, referencing the case of Roseberry v. Industrial Commission, which allows for exceptions to the res judicata effect of unprotested notices when they are invalid. Although the applicant did not seek medical care for about a year following the Notice, the judge found that Dr. Moczynski's report affirmed the applicant's permanent impairment, thus rendering the Notice null and void. The applicant is entitled to further benefits, which will be determined through an administrative process, and it was supported by evidence that she should receive additional medical benefits from July to October 1982. The employer and carrier contested the judge's ruling, arguing that the termination notice was based on the claimant's lack of response to a prior communication rather than Dr. Moczynski's report. They cited cases indicating that medical evidence is not the sole basis for claim termination, asserting that alternative justifications must be present.
A claimant's abandonment of a claim can justify its closure, as established in Minghelli v. Industrial Commission. In this case, the claimant left Arizona without approval and did not contact the Industrial Commission or the carrier for five years. A "twenty-day" letter sent to the claimant six months after the carrier received a medical report from Dr. Moczynski could have supported a claim termination due to non-response. However, the report indicated permanent impairment, placing this case in a specific legal context that prevents the termination notice from being valid, as it was ambiguous regarding the permanent impairment issue. The hearing judge correctly ruled the termination notice void. The employer's and carrier's reliance on Nelson v. Industrial Commission was unfounded, as that case involved different circumstances where medical evidence did not contradict the termination notice, whereas here, the evidence strongly contradicted it.
The employer and carrier also raised three additional issues:
1. They claimed lack of proper notice for the hearing on the claimant's protest against the termination notice, but they had received statutory notice and did not object to the proceedings.
2. They requested Dr. Moczynski's testimony, which was not necessary as the administrative law judge did not assess the claimant's medical condition at this stage.
3. They argued there was insufficient evidence for reopening, but since the termination notice was void, the reopening petition was dismissed.
Ultimately, the administrative law judge's conclusion that the termination notice was void was affirmed.
