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A.I.M. Mut. Ins. Co. v. Workers' Comp. Trust Fund

COMMONWEALTH OF MASSACHUSETTS APPEALS COURT
Apr 3, 2012
11-P-1041 (Mass. Apr. 3, 2012)

Opinion

11-P-1041

04-03-2012

A.I.M. MUTUAL INSURANCE COMPANY v. WORKERS' COMPENSATION TRUST FUND.


NOTICE: Decisions issued by the Appeals Court pursuant to its rule 1:28 are primarily addressed to the parties and, therefore, may not fully address the facts of the case or the panel's decisional rationale. Moreover, rule 1:28 decisions are not circulated to the entire court and, therefore, represent only the views of the panel that decided the case. A summary decision pursuant to rule 1:28, issued after February 25, 2008, may be cited for its persuasive value but, because of the limitations noted above, not as binding precedent.

MEMORANDUM AND ORDER PURSUANT TO RULE 1:28

The insurer appeals from an adverse decision of the reviewing board of the Department of Industrial Accidents (DIA), reversing the administrative judge's allowance of reimbursement of medical expenses from the Workers' Compensation Trust Fund (trust fund) pursuant to G. L. c. 152, § 37. The trust fund opposed the petition for reimbursement of benefits, averring that the two-year statute of limitations set forth in § 37 barred the insurer from being reimbursed for any medical benefits incurred more than two years prior to the November 14, 2008, filing of the petition. (September 3, 2003, marked the first day after the 104 week waiting period had expired, and November 14, 2006, marked two years prior to the filing of the petition.) The administrative judge allowed the insurer's claim for reimbursement during said period, and after review, the reviewing board reversed.

In allowing the insurer's claim, the administrative judge relied on Cosgrove v. Penacock Place, No. 02-J-614 (2005), a decision of the single justice, holding that § 37 places no additional time restrictions on reimbursement under § 30(after the 104 week waiting period). The insurer's reliance here on the decision of the administrative judge, who in turn liberally interpreted the rationale of a single justice decision, is misplaced. As the reviewing board observed, Cosgrove does not address the limitations period of the statute or the issues before us.

The facts before us are as follows: The insurer paid the employee G. L. c. 152, § 34, total incapacity benefits from September 5, 2001, to August 30, 2004, and G. L. c. 152, § 35, partial incapacity benefits from August 31, 2004, to November 12, 2006. On November 13, 2006, the DIA approved a G. L. c. 152, § 48, lump sum settlement, yielding a net sum of $111,936 to the employee on his claim for permanent and total incapacity benefits, representing more than seven years of such benefits. The insurer filed its petition for reimbursement on November 14, 2008, seeking seventy-five percent of $159,674.40, the employee's net proceeds from the lump sum settlement and all medical benefits paid after the 104 week waiting period, beginning on September 3, 2003.

As the parties have resolved all other reimbursement issues, both parties agree that the sole issue on appeal is whether the two-year statute of limitations under § 37 applies to a request for reimbursement of medical benefits accrued more than two years before the filing of the petition. Notwithstanding the plain language of the statute, the insurer contends § 37 does not bar recovery of medical expenses incurred after the initial waiting period, but more than two years before the date of filing the petition, while it does bar recovery of other benefits under the enumerated sections. Relying on both a straightforward reading of the statute and the legislative intent, the trust fund argues the two-year statute of limitation applies to all benefits recovered under § 37, including medical benefits arising more than two years before the filing of the petition. We agree.

Amended in 1991, § 37 imposes a straightforward, two-year limitations period for the filing of a petition for reimbursement of benefits paid: 'Any petition for reimbursement under this section shall be filed no later than two years from the date on which the benefit payment for which the reimbursement request is being filed was made.' G. L. c. 152, § 37, as amended by St. 1991, c. 398, § 71. The statute lists the benefit payments for which an insurer is entitled to be reimbursed as including 'all compensation due under sections thirty-one, thirty-two, thirty-three, thirty-four A, thirty-six A, and, where benefits are due under any of such sections, section thirty.' Ibid. Section thirty is the provision governing medical payments. Section thirty medical payments are specifically referenced as benefit payments for which an insurer may seek reimbursement, so long as indemnity benefits were received pursuant to an enumerated provision; the limitation provision applies to a 'benefit payment for which the reimbursement request . . . was made.'

There is no language in the limitation provision that indicates any intent to exclude medical benefits from the statute of limitations. Concluding similarly, the reviewing board reversed the administrative judge's decision. Given the substantial deference we must give to an agency's interpretation of the statute which it is responsible to administer, we discern no error. Gateley's Case, 415 Mass. 397, 399 (1993). See also, Alves's Case, 451 Mass. 171, 177 (2008)(appellate court will not substitute its judgment for that of administrative agency if agency's interpretation is reasonable).

Decision of reviewing board affirmed.

By the Court (Cypher, Smith & Fecteau, JJ.),


Summaries of

A.I.M. Mut. Ins. Co. v. Workers' Comp. Trust Fund

COMMONWEALTH OF MASSACHUSETTS APPEALS COURT
Apr 3, 2012
11-P-1041 (Mass. Apr. 3, 2012)
Case details for

A.I.M. Mut. Ins. Co. v. Workers' Comp. Trust Fund

Case Details

Full title:A.I.M. MUTUAL INSURANCE COMPANY v. WORKERS' COMPENSATION TRUST FUND.

Court:COMMONWEALTH OF MASSACHUSETTS APPEALS COURT

Date published: Apr 3, 2012

Citations

11-P-1041 (Mass. Apr. 3, 2012)