Opinion
No. 1836 C.D. 2012
04-25-2013
Cambria County, Petitioner v. Unemployment Compensation Board of Review, Respondent
BEFORE: HONORABLE BONNIE BRIGANCE LEADBETTER, Judge HONORABLE ROBERT SIMPSON, Judge HONORABLE JAMES GARDNER COLINS, Senior Judge
OPINION NOT REPORTED
MEMORANDUM OPINION BY JUDGE SIMPSON
Cambria County (Employer) petitions for review of an order of the Unemployment Compensation Board of Review (Board) that determined Rose Patterson (Claimant) eligible for unemployment compensation (UC) benefits. Employer asserts Claimant is ineligible pursuant to Section 402(e) of the Unemployment Compensation Law (Law) (regarding willful misconduct). Specifically, it contends Claimant allegedly committed insurance fraud by claiming her purported common law spouse on her health care coverage form when she initially enrolled in 1996. Upon review, we affirm.
Act of December 5, 1936, Second Ex. Sess., P.L. (1937) 2897, as amended, 43 P.S. §802(e).
Claimant worked for Employer as a corrections officer for 18 years until her discharge in 2012. Employer excluded common law marriages from its definition of spouse for purposes of employee health care coverage. Employer discharged Claimant for purportedly misrepresenting the father of her children, Bryon Latterner, Sr. (Latterner), as her spouse when completing her initial health coverage enrollment form in 1996. As proof of her misconduct, Employer cited inconsistencies between that initial enrollment form and forms Claimant completed in 2009 when Employer switched insurers, which reflected she had no spouse.
Claimant applied for benefits, which the local service center denied under Section 402(e) of the Law. Claimant appealed. During the hearing before a referee, Claimant (represented by counsel), Latterner, and their daughters testified. Employer also submitted the testimony of its human resources manager. The referee granted benefits, finding Employer did not maintain a policy excluding common law married spouses from coverage. Employer appealed to the Board.
The Board rendered its own findings and conclusions, deeming Claimant eligible for benefits. The Board made the following pertinent findings (with emphasis added):
3. [Claimant] alleges that she was told she could place the father of her children on the health care form because they had lived together for 10 to 12 years[,] so she did.
4. The particular enrollment application [Claimant] acknowledged submitting dated July 15, 1996, to [Employer] apprises [her] 'any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance or statement of claim containing any material false information, or conceals for the purpose of misleading concerning any fact material thereto commits a fraudulent insurance act which is a crime and subjects such person to criminal and civil penalties.'
5. In 2008, Employer changed their [sic] healthcare provider from Blue Cross/Blue Shield to UPMC and did not require employees such as [Claimant] to complete a new enrollment application for the change in healthcare provider.
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7. The comparable coverage verification form worksheet placed [Claimant] on notice that the amount of the employee co-pay was different depending on the coverage selected, from single, two persons, parent/child(ren), or family, with family being the most expensive.
8. The worksheet does not define what two-person or family coverage encompasses.
9. The certificate of group health plan coverage [Claimant] provided [Employer's] human resource department, which is dated April 20, 2010, referencing a Bryon Latterner[] ... reflects date coverage ended: 3/31/2012.
10. [Claimant] and [Latterner] resided together from 1982 through approximately 2008, when they separated.
11. From January 18, 1983 until May 17, 1993, [Claimant] and [Latterner] gave birth to three children, a son and two daughters, [who] were raised by them in the same household through 2008.
12. Their primary residence ...was held jointly by [Latterner] and [Claimant].
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17. [Claimant] believed that she had removed [Latterner from health coverage] via phone call to an employer human resource representative because they were no longer together.
18. At that time, [Employer's] representatives, including the human resource manager, consistently requested [Claimant] provide a divorce decree to substantiate the marriage had ended
to enable [Employer] to remove her purported former spouse, [Latterner], from health coverage.Bd. Op., 9/6/12, Findings of Fact (F.F.) Nos. 3-5, 7-12, 17, 18, 21, 22.
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21. Due to the inconsistencies between the initial enrollment form [Claimant] provided in 1996, when enrolling [Latterner] as a spouse and [Claimant's] completion of comparable coverage verification forms commencing annually in January 2009 reflecting either that she had no spousal option or was single, [Employer] made a decision to sever [Claimant's] employment relationship citing unacceptable conduct in providing that information to obtain coverage for [Latterner], the father of their three children and then later identifying herself as single ....
22. [Claimant] did not deliberately misrepresent the father of her children as her spouse.
Claimant's son's name is also Bryon Latterner.
Based on these findings, the Board determined Employer did not meet its burden of establishing a policy, of which Claimant was aware, and a violation of that policy. Specifically, while finding him credible, the Board noted Employer's human resources manager could not "provide evidence or first-hand testimony of how Claimant would have been apprised of the County practice to exclude common law marriages from the definition of spouse when enrolling for health coverage." Bd. Op. at 4. The Board reasoned that in the event Claimant and Latterner had a common law marriage, she completed the correct enrollment form in 1996. Although the Board did not find a common law marriage existed, it concluded Claimant reasonably believed Latterner, the father of her children, could be considered her spouse for purposes of obtaining medical coverage with Employer. As Claimant acted in good faith, the Board determined she did not commit willful misconduct.
Employer petitions for review. Employer challenges the Board's findings as unsupported by substantial evidence. Employer also contends Claimant knowingly made a false representation when she claimed Latterner as her spouse on her initial health insurance application.
Our review is limited to determining whether the necessary findings of fact were supported by substantial evidence, whether errors of law were committed, or whether constitutional rights were violated. Spence v. Unemployment Comp. Bd. of Review, 29 A.3d 117 (Pa. Cmwlth. 2011).
Whether a claimant's conduct rises to the level of willful misconduct is a question of law fully reviewable on appeal. Caterpillar, Inc. v. Unemployment Comp. Bd. of Review, 550 Pa. 115, 703 A.2d 452 (1997). "The Board's findings of fact are conclusive on appeal only so long as the record, taken as a whole, contains substantial evidence to support them." Middletown Twp. v. Unemployment Comp. Bd. of Review, 40 A.3d 217, 223 (Pa. Cmwlth. 2012). In determining whether there is substantial evidence to support the Board's findings, this Court must examine the testimony in the light most favorable to the prevailing party, giving that party the benefit of any inferences that can logically and reasonably be drawn from the evidence. Id.
Section 402(e) of the Law provides, "[a]n employe shall be ineligible for compensation for any week ... [i]n which his unemployment is due to his discharge ... from work for willful misconduct connected with his work ...." 43 P.S. §802(e). "Willful misconduct" is "behavior evidencing a wanton or willful disregard of the employer's interests; a deliberate violation of the employer's work rules; a disregard of standards of behavior the employer can rightfully expect from its employee; [or], negligence indicating an intentional disregard of the employer's interest or an employee's duties or obligations." Dep't of Corr. v. Unemployment Comp. Bd. of Review, 943 A.2d 1011, 1015 (Pa. Cmwlth. 2008).
The employer bears the burden of proving a claimant engaged in willful misconduct. Ductmate Indus., Inc. v. Unemployment Comp. Bd. of Review, 949 A.2d 338 (Pa. Cmwlth. 2008). When asserting misconduct due to a violation of a work rule, an employer must establish existence of the rule and its violation. Id. The employer must also "prove that claimant was made aware of the existence of the work rule." Bruce v. Unemployment Comp. Bd. of Review, 2 A.3d 667, 671 (Pa. Cmwlth. 2012). "[A]n inadvertent violation of an employer's rule may not constitute willful misconduct." Eshbach v. Unemployment Comp. Bd. of Review, 855 A.2d 943, 947 (Pa. Cmwlth. 2004).
Here, Employer discharged Claimant for allegedly committing health insurance fraud, in that she knowingly and intentionally made a fraudulent statement on the initial health coverage enrollment form in 1996 by representing Latterner as her spouse when they were not legally married. Reproduced Record (R.R.) at 62a. Employer contends Claimant knowingly violated its long-standing policy against recognizing common law marriage for health insurance purposes. Employer asserts it did not recognize common law marriage when Claimant submitted her initial enrollment form. Employer argues it properly discharged Claimant 16 years after she allegedly knowingly misrepresented her marital status because it only discovered her fraudulent activities then. See Pet'r's Br. at 12.
Employer did not present substantial evidence supporting the existence of a policy against insuring common law spouses. Employer's witness stated he "[did] not have a memo on it but it is past practice" to exclude common law marriage from coverage. Referee's Hearing, 6/20/12, Notes of Testimony (N.T.) at 10; R.R. at 64a. Employer did not have a written policy and did not offer any evidence to substantiate this policy or to prove that it advised Claimant of its stated policy against common law marriage, in 1996.
Employer had no evidence or knowledge as to who gave the initial enrollment form to Claimant. N.T. at 12; R.R. at 66a. Notably, the form was blank where an Employer representative neglected to sign it. F.F. No. 2; N.T. at 11; R.R. at 65a. Therefore, Employer was unable to refute Claimant's testimony that Employer's employee advised her that she could place Latterner on the form. Presuming for sake of argument that Employer had a policy against covering common law spouses, at most, Claimant inadvertently violated it because there is no proof she was made aware of it. Such inadvertence is not a basis for willful misconduct. Eshbach.
The Board found Claimant did not intentionally misrepresent her marital status. F.F. No. 22. The Board found Claimant was advised she could place Latterner on the form as her spouse because they lived together for 10 to 12 years. F.F. No. 3. Employer offered no evidence to refute Claimant's statement or to demonstrate that it apprised Claimant of Employer's alleged practice to exclude common law spouses from coverage. Bd. Op. at 4. Further, the Board found Claimant "could have" believed Latterner was her common law spouse under the circumstances in 1996. Bd. Op. at 6; see also F.F. No. 22. Absent proof of a knowing misrepresentation, Employer did not establish willful misconduct here.
Substantial evidence supports the Board's determination in Claimant's favor. In 1996, Claimant had been living with Latterner in their jointly owned home for 14 years; she and Latterner had three children together and raised them in their joint household. F.F. Nos. 3, 10-12. She considered herself "married" in the common law sense, and the Commonwealth recognized such marriages at the time. Moreover, Claimant reasonably believed she was permitted to so state on the form because Employer's employee told her as much. F.F. No. 3.
Until 2005, this Commonwealth recognized common law marriage. Section 1103 of the Domestic Relations Code, 23 Pa. C.S. §1103 (providing "Nothing in this part shall be deemed or taken to render any common-law marriage otherwise lawful and contracted on or before January 1, 2005, invalid."); see also Lennitt v. Dep't of Corr., 964 A.2d 37 (Pa. Cmwlth. 2008) (Section 1103 did not invalidate any lawfully existing common law marriages). --------
Based on the foregoing reasons, we affirm the Board.
/s/_________
ROBERT SIMPSON, Judge ORDER
AND NOW, this 25th day of April, 2013, the order of the Unemployment Compensation Board of Review is AFFIRMED.
/s/_________
ROBERT SIMPSON, Judge