Court: Supreme Court of Delaware; March 3, 1987; Delaware; State Supreme Court
John R. McCaman, the claimant-appellant, is appealing the Superior Court's ruling that his 1982 petition for disability compensation related to a 1973 work injury is barred by the statute of limitations outlined in 19 Del. C. 2361. The Chief Justice affirmed the Superior Court's decision, determining the claim was time barred. McCaman, a police officer, sustained a wrist injury on April 14, 1973, while arresting a suspect. He reported the injury promptly, received treatment, and was classified for light duty without missing work. The County’s safety engineer confirmed the injury was work-related, and the County’s nurse filed a workers' compensation report, resulting in Aetna Life and Casualty Company paying for medical services.
Two and a half years later, McCaman re-injured his wrist on October 31, 1975. Following worsening conditions, he underwent surgery in June 1976, after which the new carrier, Home Insurance Company, provided temporary total disability benefits. His condition deteriorated, leading to additional surgeries, with an agreement for total disability compensation finalized in October 1980. A third unsuccessful surgery occurred in 1981.
In April 1982, McCaman sought additional compensation, leading the Board to assess his disability as twenty percent, split between the 1973 and 1975 injuries. However, the Board only awarded fifteen percent, ruling that the earlier payment of medical expenses from 1973 was a "minor bill" and did not invoke the 'last payment' provision that would extend the statute of limitations. Subsequently, the Superior Court remanded the case for the Board to determine whether the original carrier's payment of the 1973 medical bill was made under compulsion, referencing two precedential cases. A hearing was held where testimony was provided by a claims account supervisor from the carrier involved at the time of the payment.
The representative testified that the company processed 'medicals only' claims without investigation, believing that paying a medical bill without work loss did not imply compensability. Because the case involved no time lost, the bill was paid by an administrative person without input from a claims specialist. The carrier maintained it was not obligated to pay until a formal agreement was signed. The Board credited the representative's testimony and concluded that the carrier did not feel compelled to pay the $24.75 bill. It reaffirmed that without a formal or implied agreement, the 1982 claim related to a 1973 accident was barred by a two-year statute of limitations.
The Superior Court upheld the Board's denial of the five percent award related to the 1973 accident but disagreed on the rationale, arguing that the carrier’s policy to pay medical bills for work-related injuries indicated a sense of compulsion when it paid for the Claimant’s 1973 examination. The court concluded that this created an agreement, tolling the statute until five years post-payment. However, it ultimately determined that the 'last payment' provision did not benefit the Claimant, as his 1982 petition was filed nine years after the last payment for the 1973 injury.
In this appeal, the Claimant argued for affirmation of the Superior Court’s ruling regarding the 'last payment' provision and claimed that agreements from 1976 and 1980 further extended the statute of limitations, making the 1982 filing timely. The court upheld the Board's finding that the medical payment was not made under compulsion as per applicable case law. Consequently, the two-year statute of limitations was applicable, barring claims from the 1973 injury as of 1975, regardless of any agreements from 1976 and 1980. The evolution of Delaware’s statute of limitations for compensation claims shows that mere payment of medical expenses does not toll the statute. The historical context indicates that Delaware’s statute is stricter than most jurisdictions, requiring an agreement or timely appeal to avoid barring claims.
The amendment defined compensation to encompass 'surgical, medical and hospital services, medicines and supplies.' Relying on this, the Board determined that medical benefits constituted compensation sufficient to toll the statute of limitations. However, the Superior Court reversed this ruling, stating that the amendment was not applicable since it was enacted after the relevant events. The court acknowledged that if the amendment retroactively established medical services as compensation, it would significantly alter existing law. In response to the Board's interpretation, the General Assembly amended the Act in 1927 to clarify the 'last payment' provision. The new law stipulated that only payments made under a Board-approved agreement or award, along with a proper receipt filed with the Board, would toll the statute of limitations. Consequently, merely providing medical services could not trigger this provision.
Subsequent amendments to the statute included a 1955 change that extended the agreement period from one to two years and the tolling period from two to five years following the last payment. Under the current statute, claims for personal injury are barred unless compensation is agreed upon within two years post-accident. If payments have been made under an approved agreement, the statute does not take effect until five years after the last payment with a filed receipt. In the notable case Pusey v. Reed (1969), the court ruled that a single medical bill payment did not satisfy the 'last payment' criteria, as it lacked Board approval and a filed receipt. This precedent was upheld in Delaware Association of Police v. Donahue (1972), where the court ruled a claim was time-barred due to the absence of receipts for payments made after a termination agreement.
Delaware's approach to medical payments in workers' compensation cases is characterized as a distinct minority. The court emphasized that any perceived harshness stems from clear legislative intent, and changes to the statute must come from the legislature. In the 1975 case Starun v. All American Engineering Co., the court reversed earlier decisions that dismissed an employee's claim for compensation. The court determined that the employer's continuous medical payments for three years indicated an implied agreement under the statute, despite the lack of a formal agreement filed with the Board. The court ruled that the responsibility to file such agreements primarily lies with the employer or its carrier. In a subsequent case, New Castle County v. Goodman (1983), the court reiterated that payments made under perceived compulsion can signify an implied agreement regarding compensation, even without formal documentation. However, for an implied agreement to be recognized, there must be evidence that the employer felt obliged to make the payments. In the current case, substantial evidence suggested that neither the County nor its insurance carrier felt compelled to pay the Claimant's 1973 medical bill, as the carrier's representative testified that the Claimant had not lost work time due to the injury, indicating no obligation to provide benefits.
Neither the Superior Court nor this Court can overturn the Board's factual findings based on substantial evidence. The Claimant's assertion that the carrier was compelled to pay his treatment bill due to an insurance contract with the County is acknowledged, but evidence indicates that the carrier did not feel compelled under the Act. A contract for benefits not mandated by the Act does not equate to an agreement recognized by the Act. Even if an implied agreement existed between the Claimant and the carrier, it would not qualify as a workmen’s compensation agreement eligible for Board approval, as outlined in 2361(b).
The Board's finding that the carrier did not pay due to compulsion introduces a legal question: whether an employee's lack of missed work at the time of medical expense payment legally implies that the employer did not feel compelled under the Act. Previous cases, such as Starun and Goodman, did not address this specific issue regarding the employer's obligations when the employee had not missed significant work.
According to the statutory 'waiting provision,' 19 Del.C. 2321, no compensation is payable for injuries not incapacitating an employee for three days. The Court has clarified that a claimant must demonstrate three days of incapacity to recover under the Act, and employers are not compelled to make payments until this requirement is met. Thus, payments made when an employee has not missed three days of work do not indicate compulsion under the Act and cannot establish an implied agreement that would affect the statute of limitations provisions in 19 Del.C. 2361(b). Therefore, the decision of the Superior Court is affirmed, and relevant sections of the statute of limitations are referenced. Section 2344 states that any agreement regarding compensation must be filed with the Board to be binding.
Professor Larson’s treatise, referenced in the Donahue decision, asserts that most jurisdictions consider medical payments as tolling the statute of limitations, based on the premise that such benefits imply an acceptance of liability under compensation law, aligning with the last payment clause policy. This trend highlights the severity of Delaware's statutory provisions for claimants, particularly given the carrier's valid reliance on the claimant's lack of missed work. Delaware's "waiting period" provision, 19 DeLC. 2321, stipulates no compensation for injuries not resulting in at least three days of incapacity, with payments commencing on the fourth day. Precedents from the Pusey and Donahue decisions support this interpretation. It wasn't until the Starun decision in 1975 that the court recognized medical payments as potentially creating an implied obligation for employers or their carriers to provide compensation. The payment in question occurred in 1973, and while the Goodman decision reformulated the Starun test regarding employer or carrier actions under compulsion, it was meant to uphold the Starun rule and should be understood with reference to the more specific language of the earlier ruling.
