Opinion
W.C. No. 4-155-231
February 13, 1998
FINAL ORDER
The respondents seek review of a final order of Administrative Law Judge Erickson (ALJ), which held that, despite the claimant's making of false statements to procure temporary disability benefits, she did not forfeit her right to ongoing medical benefits. We affirm.
The ALJ found that the claimant suffered compensable physical and emotional injuries when she was attacked at work on November 30, 1992. After payment of temporary disability benefits, the matter went to a hearing concerning the claimant's entitlement to permanent disability benefits and ongoing medical benefits under Grover v. Industrial Commission, 759 P.2d 705 (Colo. 1988). On July 26, 1995, an order was entered awarding the claimant permanent disability benefits and Grover medical benefits to pay for future psychiatric treatment.
Subsequently, the claimant pled guilty to willfully making a false statement or representation which was material to the claim for temporary disability benefits. Relying on § 8-43-402, C.R.S. 1997, the respondents filed a Final Admission of Liability purporting to terminate the claimant's right to the Grover medical benefits. The claimant then sought a hearing concerning the propriety of the respondents' termination of medical benefits.
The ALJ found that the claimant needs ongoing psychiatric treatment to relieve the effects of the industrial injury. Moreover, the ALJ concluded § 8-43-402 does not operate to terminate the claimant's right to medical benefits. Relying on Wild West Radio, Inc. v. Industrial Claim Appeals Office, 886 P.2d 304 (Colo.App. 1994), the ALJ held that "medical benefits" do not constitute "compensation" for purposes of the forfeiture provision of § 8-43-402.
On review, the respondents contend that the ALJ erred in his interpretation of § 8-43-402. The respondents argue that the "plain meaning" of § 8-43-402 is that the claimant must forfeit "all right" to "compensation" based on her conviction for making a false statement. Moreover, the respondents point out that, in Swerdfeger v. Swerdfeger, 793 P.2d 618 (Colo.App. 1990), the Court of Appeals stated that the terms "benefits," "compensation," and "award" are used interchangeably, and that no great significance should be placed on the distinction between "medical benefits" and "compensation." We disagree.
Section 8-43-402 provides as follows:
"If, for the purpose of obtaining any order, benefit, award, compensation, or payment under the provisions of articles 40 to 47 of this title, either for self-gain or for the benefit of any other person, anyone willfully makes a false statement or representation material to the claim, such person commits a class 5 felony and shall be punished as provided in section 18-1-105, C.R.S., and shall forfeit all right to compensation under said articles upon conviction of such offense."
We agree with the respondents that the purpose of statutory construction is to effectuate the legislative intent, and that the best guide to legislative intent is the plain language of the statute. Snyder Oil Co. v. Embree, 862 P.2d 259 (Colo. 1993). However, to the extent the statutory language contains ambiguities, it is proper to resort to other rules of statutory construction. Henderson v. RSI, Inc., 824 P.2d 91 (Colo.App. 1991).
The question in this case is whether the term "compensation," as it is used in the last sentence of § 8-43-402, contemplates only indemnity benefits, or also contemplates "medical benefits." We note that the first sentence of § 8-43-402 mentions not only "compensation," but also orders, benefits, awards, and other payments under the Workers' Compensation Act (Act). Thus, the statute is ambiguous concerning whether the word "compensation," as used in the sentence concerning forfeiture, is meant to encompass all of the types of benefits and payments listed in the first sentence.
Unfortunately, the case law is less than clear concerning whether or not the term "compensation" encompasses all types of benefits, including "medical benefits." One line of cases, exemplified by Padilla v. Industrial Commission, 696 P.2d 273 (Colo. 1985), endorses the view that the Act generally makes no meaningful distinction between "compensation" and "benefits." In Padilla, the court was asked to determine whether a full and final settlement could be reopened under former provisions of the Act. The court cited various provisions of the statute, mostly involving death benefits, where the terms "compensation" and "benefits" appear to be used interchangeably.
Subsequently, in Swerdfeger v. Swerdfeger, supra, the Court of Appeals expressly held that payment of medical benefits constituted payment of "compensation" for purposes of the reopening provisions. In a similar vein, American Express v. Industrial Commission, 712 P.2d 1132 (Colo.App. 1985), held that there is no distinction between medical benefits and "compensation disability benefits" for purposes of determining the finality of an order under § 8-43-301(2), C.R.S. 1997.
Conversely, an equally well-established body of authority suggests that "compensation" and "medical benefits" are not synonymous under other provisions of the Act. In Wild West Radio, Inc. v. Industrial Claim Appeals Office, supra, the Court of Appeals held that medical benefits are not "compensation" for purposes of the intoxication penalty found at § 8-42-112(1)(c), C.R.S. 1997. The Wild West court held that Swerdfeger is limited to cases involving the reopening statutes. Moreover, the court concluded that, in view of the remedial objectives of the Act, it is inappropriate to reduce medical benefits in order to deter employee misconduct. Finally, the court concluded that it would be improper to reduce payments to medical providers based on the claimant's misconduct.
In Racon Construction v. Industrial Claim Appeals Office, 775 P.2d 61 (Colo.App. 1989), the court held that the payment of medical benefits does not establish that the claimant was "successful in his claim for compensation" for purposes of imposing a penalty under the statute currently codified at § 8-43-203(2)(a), C.R.S. 1997. Moreover, in Industrial Commission v. Hammond, 77 Colo. 414, 236 P.2d 1006 (1925), it was held that medical benefits do not constitute compensation for purposes of increasing benefits based on the employer's failure to procure insurance. See § 8-43-408(1), C.R.S. 1997.
Summarizing these cases, the term "compensation" has been broadly construed where the particular statute involves procedural issues such as reopening or finality. Conversely, the term is interpreted narrowly when the statute involves the imposition of a penalty. We must presume that the General Assembly was aware of these judicial distinctions when it enacted § 8-43-402. See United States Fidelity Guaranty, Inc. v. Kourlis, 868 P.2d 1158 (Colo.App. 1994). Consequently, we agree with the ALJ that the last sentence of § 8-43-402 uses the term "compensation" in the strictest sense, and does not include medical benefits.
This conclusion is consistent with precedent governing the interpretation of penal statutes. Where, as here, a civil statute imposes a penalty for misconduct, our courts hold held that the statute should be construed liberally in favor of persons whose interests are affected by the statute. Van Gerpen v. Peterson, 620 P.2d 714 (Colo. 1980); Schrag v. Altman, 767 P.2d 805 (Colo.App. 1988). Construing the forfeiture provision of § 8-43-402 in favor of the claimant supports the result reached by the ALJ.
Finally, we agree with the ALJ's conclusion that Wild West Radio, Inc. v. Industrial Claim Appeals Office, supra, is persuasive authority concerning the interpretation to be given the word "compensation" in the last sentence § 8-43-402. As the Wild West court observed, the Act essentially operates on a nofault concept, and provisions designed to punish and deter wrongdoing should be construed with the nofault principle in mind. Forfeiture of medical benefits based on false statements is inconsistent with the nofault principle. Moreover, as Wild West itself noted, construing the term "compensation" to include medical benefits might well have the effect of punishing a physician who has provided services to the claimant, not the claimant herself.
Finally, we note that the General Assembly is cognizant of using the all-encompassing term "benefits" when the statute concerns a claimant who obtains workers' compensation payments through fraud. Section 8-43-304(2), C.R.S. 1997, which was enacted in 1991, provides as follows:
"Any insurer or self-insured employer may take a credit or offset of previously paid workers' compensation benefits or payments against any further workers' compensation benefits or payments due a worker when the worker admits to having obtained the previously paid benefits or payments through fraud, or a civil judgment or criminal conviction is entered against the worker for having obtained the previously paid benefits through fraud. Benefits or payments obtained through fraud by a worker shall not be included in any data used for rate making or individual employer rating or dividend calculations by any insurer or by the Colorado compensation insurance authority." (Emphasis added.)
Thus, we think it significant that the forfeiture clause of § 8-43-402 uses the narrower term "compensation."
In view of this ruling, we need not consider the claimant's contention that interpretation of § 8-43-402 so as to include her medical benefits would constitute "double jeopardy." In any event, we lack jurisdiction to consider this issue. Kinterknecht v. Industrial Commission, 175 Colo. 60, 485 P.2d 721 (1971).
IT IS THEREFORE ORDERED that the ALJ's order dated March 25, 1997, is affirmed.
INDUSTRIAL CLAIM APPEALS PANEL __________________________________ David Cain __________________________________ Bill WhitacreNOTICE
This Order is final unless an action to modify or vacate the Order is commenced in the Colorado Court of Appeals, 2 East 14th Avenue, Denver, Colorado 80203, by filing a petition to review with the court, with service of a copy of the petition upon the Industrial Claim Appeals Office and all other parties, within twenty (20) days after the date the Order was mailed, pursuant to §§ 8-43-301(10) and 307, C.R.S. 1997.
Copies of this decision were mailed February 13, 1998 to the following parties:
Charlene Wolford, 9024 Vance St., #204, Westminster, CO 80021
Support, Inc., 15591 E. Centretech Pkwy., Aurora, CO 80011-9031
Laurie A. Schoder, Esq., Colorado Compensation Insurance Authority — Interagency Mail
Steven H. Gurwin, Esq., 1777 S. Harrison, #906, Denver, CO 80210-3934 (For Claimant)
John V. FitzSimons, Esq., 3464 S. Willow St., Denver, CO 80231-4566 (For Respondents)
By: ________________________________