Court: Connecticut Appellate Court; January 27, 1998; Connecticut; State Appellate Court
Mansfield Construction Company and Zurich-American Insurance Group appeal a workers’ compensation review board decision affirming a commissioner’s denial of their motion to modify compensation benefits under General Statutes § 31-315. The plaintiff, employed part-time by Mansfield in 1986, was injured in an accident while following employer instructions. Mansfield reported the incident to Zurich, which computed a compensation rate of $166.67 weekly, initiating payments in February 1987 that lasted six and a half years without a formal agreement. Zurich stopped payments on June 26, 1993, without filing a form 43 notice of contest, and failed to pay for necessary home modifications and medical expenses.
The commissioner found all charges reasonable, confirmed the injury was compensable, and ruled that no evidence demonstrated a mutual mistake regarding the compensation rate. Consequently, he ordered continued payments of $166.67 per week, plus cost-of-living adjustments, until a formal notice to discontinue payments was approved. He also mandated reimbursement for medical bills and home modifications, along with statutory interest and attorney's fees.
The defendants challenge the board's affirmation of the compensability finding, the home modification award, the no mutual mistake ruling, and the motion denial. The court affirms the board's decision, noting the jurisdiction of the workers’ compensation commissioner was established due to the provision of medical care within one year of the accident, despite the absence of a written notice of claim. The findings corroborated that Zurich provided necessary medical care, satisfying jurisdictional requirements.
An employer’s provision of medical treatment indicates awareness of an employee's injury, which may establish grounds for a compensation claim, as outlined in Gesmundo v. Bush. If an employer's representative sends an employee to a physician, this counts as furnishing medical treatment, regardless of payment. In this case, while no explicit finding was made that the plaintiff's son directed the plaintiff to seek treatment, it is acknowledged that Mansfield furnished such treatment and was aware of the injury shortly after the accident. The presumption of jurisdiction supports the court's authority in this matter, particularly since the defendants did not contest jurisdiction.
The Workers’ Compensation Act is interpreted broadly in favor of employees, aiming to fulfill its beneficial purpose. Zurich’s long-term payment of medical bills qualifies as furnishing medical treatment, thereby granting the commission jurisdiction under the medical treatment exception to § 31-294c (c). The standard of review indicates that the commissioner’s conclusions are upheld unless there is a misapplication of law or unreasonable inferences drawn from the facts.
The defendants' argument that the board incorrectly affirmed the commissioner’s acceptance of the claim fails, as the board noted that Admin. Reg. 31-296-n2 permits employers to make payments without prejudice while notifying the claimant and commissioner. However, no Form 43 was filed in this case, which is required for such claims.
Zurich ceased designating claimant payments as made without prejudice in February 1987 and continued these payments for years, indicating acceptance of the claim's compensability. The commissioner found sufficient evidence to support this conclusion, asserting that Zurich waived its right to contest liability through its actions. Waiver is defined as the voluntary relinquishment of a known right, and it can be inferred from conduct inconsistent with the intention to retain that right. The board upheld the commissioner's decision, rejecting the defendants' argument that they should not pay for certain services and home improvements, as Zurich had agreed to these payments, and the defendants did not challenge their reasonableness or the commissioner’s findings.
Additionally, the defendants contended that the board improperly affirmed the commissioner’s denial of their motion to modify based on a mutual mistake regarding the compensation rate. However, the commissioner found insufficient credible evidence from Zurich to support this claim, leading to the conclusion that the board appropriately upheld the commissioner's decision. The workers’ compensation review board's decision is affirmed, with other judges concurring, and the commissioner’s findings and award are the basis for the defendants’ petition for review.
General Statutes § 31-315 stipulates that any compensation awards or voluntary agreements made under the chapter, as well as transfers of liability to the Second Injury Fund, are subject to modification upon request by either party or the custodian of the Fund, if there is evidence of changes in the employee's incapacity, dependency measures, or other relevant conditions. The compensation commissioner has the authority to modify awards similarly to how a court can modify judgments and retains jurisdiction over claims throughout the compensation period.
A hearing will be scheduled to address attorney’s fees, interest, and review medical treatments and bills, with the decision being final for appeal purposes. Determining the modification of the current award will involve evaluating the medical treatments and bills, and unresolved issues regarding counsel fees do not affect the finality of the decision.
The parties are required to submit supplemental briefs addressing whether the commission had subject matter jurisdiction over the claim, including whether a written notice of claim was filed under General Statutes (Rev. to 1985) § 31-294, and if so, whether the case should be remanded for a formal finding regarding the notice. Additionally, questions arise about which tribunal is authorized to make necessary fact-based determinations and whether the Appellate Court has the authority to remand the case for those purposes. General Statutes § 31-294c (a) specifies the time limits for filing notices of claim for compensation related to accidents or occupational diseases, outlining a one-year deadline from the accident date or a three-year deadline from the first symptom manifestation, with specific provisions for claims related to death.
A notice of claim for compensation must be submitted to the employer or a commissioner, detailing the date and location of the accident, the nature of the resulting injury, or the date of the first symptom of an occupational disease along with the employee's name and address. According to General Statutes § 31-294c (c), failure to provide such notice does not preclude legal proceedings if a hearing or written request for a hearing occurred within one year of the accident or three years from the disease's first symptom, or if a voluntary agreement or medical care was provided within those timeframes. Any defects in the notice do not bar proceedings unless the employer can demonstrate ignorance of the injury facts and prejudice resulting from the notice's inaccuracies. In such cases, the employer may receive an allowance proportional to the demonstrated prejudice. The defendants have raised a third issue regarding whether a mutual mistake of fact occurred concerning compensability. The appeal focused solely on whether the commissioner accurately determined that no mutual mistake existed about the compensation rate, not on liability. Issues not briefed by the defendants are considered abandoned, as established in State v. Samaha.
