This summary was computer-generated without any editorial revision. It is not official, has not been checked for accuracy, and is NOT citable.
Facts
A worker employed as a courier was injured in an automobile accident caused by an uninsured motorist while performing his job duties. The worker sustained two lumbar disk herniations, resulting in disability. He received workers' compensation benefits and uninsured motorist benefits from two separate insurance policies, one of which was paid for by his employer. The employer sought reimbursement for the workers' compensation benefits paid, arguing that the worker's recovery from the uninsured motorist benefits constituted duplicative compensation (paras 2-4).
Procedural History
- Workers' Compensation Judge (WCJ): Held that the employer was entitled to dollar-for-dollar reimbursement for workers' compensation benefits paid and a credit against future payments. Determined the worker's permanent partial disability rating was equal to his impairment rating because he returned to work at a wage equal to or greater than his pre-injury wage. Denied the worker's petition for attorney's fees and sanctions (para 4).
- Court of Appeals: Reversed the WCJ's decision on reimbursement, holding that the employer was entitled only to reimbursement for duplicative recovery. Affirmed the WCJ's determination that the worker waived his challenge to the wage rate determination. Declined to address the attorney's fees issue (para 5).
Parties' Submissions
- Employer-Insurer (SED/USF&G): Argued that they were entitled to dollar-for-dollar reimbursement for workers' compensation benefits paid under Section 52-5-17(C) because the worker received uninsured motorist benefits from a policy paid for by the employer. Claimed that the Gutierrez element-by-element analysis was inapplicable to this case (paras 9-10).
- Worker: Contended that the employer was entitled only to reimbursement for duplicative recovery, as determined through an element-by-element analysis. Argued that the WCJ's determination that he returned to work at a wage equal to or greater than his pre-injury wage was unsupported by evidence. Also sought reconsideration of the denial of attorney's fees (paras 5, 17, 23).
Legal Issues
- Whether the employer is entitled to dollar-for-dollar reimbursement for workers' compensation benefits paid or only for duplicative recovery under Section 52-5-17(C).
- Whether the worker waived his challenge to the determination that he returned to work at a wage equal to or greater than his pre-injury wage.
- Whether the WCJ's findings of fact support the conclusion that the worker returned to work at a wage equal to or greater than his pre-injury wage.
- Whether the denial of the worker's attorney's fees should be reconsidered.
Disposition
- The employer is entitled only to reimbursement for duplicative recovery, determined through an element-by-element analysis (paras 8, 10).
- The worker waived his challenge to the wage rate determination by failing to cite supporting evidence (para 18).
- The WCJ's findings of fact do not support the conclusion that the worker returned to work at a wage equal to or greater than his pre-injury wage, and the compensation order is vacated (paras 20-22).
- The issue of attorney's fees is remanded for reconsideration (para 23).
Reasons
Per Pamela B. Minzner, Chief Justice (Baca, Franchini, Serna, and Maes JJ. concurring):
Reimbursement for Duplicative Recovery: The Court affirmed that the purpose of Section 52-5-17 is to prevent double recovery by workers. The Gutierrez element-by-element analysis applies to determine the amount of duplicative recovery, even for uninsured motorist benefits under Section 52-5-17(C). A dollar-for-dollar reimbursement would conflict with the aims of the uninsured motorist statute, which seeks to place injured parties in the same position they would have been in had the tortfeasor been insured (paras 6-16).
Waiver of Wage Rate Challenge: The worker failed to comply with Rule 12-213(A)(3) by not citing evidence supporting his challenge to the wage rate determination. The Court of Appeals correctly deemed the challenge waived (paras 17-18).
Findings on Wage Rate: The WCJ's findings of fact regarding the worker's pre-injury and post-injury earnings do not support the conclusion that he returned to work at a wage equal to or greater than his pre-injury wage. The Court vacated the compensation order and remanded the matter for entry of amended findings and conclusions (paras 19-22).
Attorney's Fees: The denial of attorney's fees was tied to the WCJ's determination of reimbursement. The Court remanded the issue for reconsideration after recalculating the employer's right to reimbursement and considering the efforts of the worker's attorney on appeal (para 23).