Case Title: KLEIN v IND WH ASSOCIATED GROCER

Citation: 

Docket Number: 

State: montana

Court: Montana Supreme Court

Date: 1975-07-21T00:00:00Z

Document:
No, 12902 I N T H E S U P R E M E C O U R T OF THE STATE O F MONTANA 1975 ABE KLEIN, Claimant and Respondent, INDEPENDENT W H O L E S A L E ASSOCIATED GROCERS, and STATE INSURANCE FUND, Defendants and Appellants. Appeal from: D i s t r i c t Court of the Thirteenth J u d i c i a l D i s t r i c t , Honorable Robert Wilson, Judge presiding, Counsel of Record : For Appellants : Harris, Jackson and Utick, Helena, Montana Andrew J, Utick argued, Helena, Montana For Respondent : F i l l n e r and Snyder, Billings, Montana Charles E. Snyder argued, Billings, Montana - Submitted: April 7, 1975 , j l v i % i975 Decided : Filed : JiJI 8 2 - - - Mr. Justice Wesley Castles delivered the Opinion of the Court. This is an appeal from a judgment entered in the district court, Yellowstone County, reversing a decision of the Workmen's Compensation Division and entering judgment for payment of workmen's compensation benefits. After a hearing before the Workmen's Compensation Division (hereinafter referred to as the Division) on September 12, 1973, wherein claimant Abe Klein sought workmen's compensation based upon his claim filed with the Division some three years and seven months after the date of his accident, the Division found claimant entitled to compensation; set the award; and then denied the com- pensation for failure to submit his claim within the statutory one year period set forth in section 92-601, R.C.M. 1947. The district court reversed the Division's order and awarded compensation at the rate of 62 1/2% of the claimant's wage loss up to a statutory maximum of $46 per week and remanded the case to the Division for a determination of claimant's actual wage loss. On or about June 23, 1967, while in the employ of Independ- ent Wholesale Associated Grocers as a mechanic, claimant suffered an on the job injury. The employer was insured under Plan I11 of the Montana Workmen's Compensation Act, the insurer was the State Insurance Fund. Claimant has an eleventh grade education. His work experience is in the area of heavy duty mechanics and evidence at the hearing revealed claimant is now unable to do this type of work. After his injury claimant continued to work at his job as a mechanic, losing only two or three days of work, until his employment was terminated on February 28, 1970. The Division received a t i t s o f f i c e i n Helena, four days following t h e accident, the attending physician's f i r s t report sent i n by D r . Gary V. Dols, a chiropractor, describing claimant's in- 11 jury a s a lumbar s a c r a l s t r a i n " and giving the date and d e t a i l s of the accident. D r . Dols a l s o sent i n periodic medical reports and medical b i l l s . A f i l e number was assigned t o claimant's case. D r . Dols indicated claimant would lose three t o f i v e days of work and there would be no permanent d i s a b i l i t y . Within 30 days of the accident t h e Division a l s o received t h e employer's f i r s t report of injury i n greater d e t a i l with respect t o the type of accident and injury and t h e wages earned by claimant a t the time of t h e accident. O n October 30, 1967, the Division sent t h i s l e t t e r t o claimant : "October 30, 1967 "Re: Accident --- 8944-C-52--Abe Klein "Abe Klein 1204 Hamey Drive Billings, Montana "Dear Sir: "Notice has been given t h a t you have had an injury covered by t h e Workmen's Compensation Act. I f t h i s i s t r u e , you may protect your r i g h t s by using t h e enclosed blank t o make a claim f o r com- pensation. "PLEASE F O L L O W THESE INSTRUCTIONS CAREFULLY. Write plainly with ink o r typewriter. Give the f a c t s with p a r t i c u l a r care t o describe the accident i t s e l f f u l l y . S t a t e exactly t h e days physically disabled and the amount of wages--in figures--lost f o r each of these days. Be sure t o enter the birthdates (month,day, year) of dependent children, sign t h e claim and show your correct mailing address. The law provides t h a t you must f i l e your claim within ONE YEAR a f t e r t h e accidental injury. Failure t o do so w i l l bar you from receiving compensation. Under the law, you a r e e n t i t l e d t o hospital and medical benefits and i f you lose wages, compensation payable every two weeks. For further information you may write t o t h e Board a t any time, I I Very t r u l y yours, I t /s / Margaret Condon Secretary. I1 A Form 54 was enclosed, t h e form used by the Division f o r the employee t o make a claim f o r compensation. Claimant on December 28, 1967, on the back of t h e l e t t e r sent by the Division, responded t o the Division: 11 Gentlemen: I was off work 4 days due t o accident mentioned. I f I ' m applicable f o r Compensation please n o t i f y , & I w i l l . f i l l out form received. h hank you, "/s/ Abe Klein 1204 Karney D r . F i l e #8944-C-52. In response t o claimant's l e t t e r of December 28, 1967, the Division sent t h i s correspondence t o claimant: "January 9, 1968 "Re: Accident 8944-C-52 - Abe Klein "Mr. Abe Klein 1204 Harney Drive Billings, Montana e ear M r . Klein: I I Regarding your recent note i n response t o our mailing of a claim f o r Compensation f o r your completion you should be advised t h a t was merely sent t o you f o r protection i n the event t h a t you may incur l a t e r problems a s a r e s u l t of your June 23 injury. A s you a r e aware D r . Dols has referred you t o D r . Perry Berg and indicated i n reports t o us t h a t he f e e l s t h a t you may have a disc involvement which could eventually cause d i s a b i l i t y and we therefore f e e l t h a t you should complete t h i s form a t your convenience and return although no compensation benefits would be due a t t h i s time. "If you desire any further c l a r i f i c a t i o n i n t h i s regard I suggest you c a l l our Field Representative who l i v e s i n Billings, M r . Harold Winfield. I' The l e t t e r was signed by J. J. Carden, Claims Manager f o r the Division. Claimant did not f i l l i n Form 54. H e did, however, contact M r . Winfield, who v i s i t e d t h e claimant on May 14, 1968, and authorized a 30 day treatment period with D r . Dols. Subsequently, on o r about June 15, 1968, about eight days before the expiration of t h e claim f i l i n g period, M r . Winfield again contacted claimant and gave him another Form 54 and explained t h a t such form had t o be f i l e d within one year of the accident. He cautioned claimant t h a t the f i l i n g period was about t o expire; and advised claimant t o f i l e the form i n order t o protect h i s r i g h t t o compensation i n t h e event h i s con- d i t i o n worsened. O n January 19, 1971, claimant f i l e d f o r compensation. The S t a t e Insurance Fund paid medical benefits t o t a l i n g $174, which represents a l l medical b i l l s submitted on the claim which were incurred within three years of the accident. O n September 12, 1973, hearing was held t o determine claimant's r i g h t t o compensation. O n January 21, 1974, the Division adopted findings of f a c t and conclusions of law t h a t established the claimant suffered a compensable "lumbar s a c r a l strain1'; t h a t due t o h i s wage loss claimant was e n t i t l e d t o maximum temporary benefits of 62 112% of h i s wages o r a s t a t u t o r y maximum of $46 per week, and permanent p a r t i a l d i s a b i l i t y compensation benefits of 62 112% of h i s wage l o s s , o r a s t a t u t o r y maximum of $36 per week under the applicable amendment i n e f f e c t a t t h e time of h i s acci- dent. The Division further found t h a t claimant f a i l e d t o f i l e a claim f o r compensation, Form 54, within the statutory period of one year a s required by section 92-601, R.C.M. 1947. From those findings of f a c t , the Division concluded: "That the claimant, Abe Klein, f a i l e d t o submit a Claim f o r Compensation, form #54, within t h e s t a t u t o r y one year period a s commanded by section 92-601 and f o r t h i s reason, h i s claim must be and i s hereby denied. I 1 O n claimant's appeal t o the d i s t r i c t court the matter was submitted on t h e t r a n s c r i p t from the Division and no new evi- dence was offered. O n September 27, 1974, the d i s t r i c t court entered i t s findings of f a c t and conclusions of law, reversing the workmen's Compensation Division. In i t s conclusions of law, the d i s t r i c t court said: "1, The l e t t e r of claimant dated December 18, 1967, signed by claimant and not requiring oath, presented t h e 'claim' of claimant t o the division within the meaning of R.C.M. 1947, Section 92-418. "2. Even i f t h e Division did not consider the December 28, 1967 l e t t e r a 'claim', the division knowing t h e extent of claimant's injury, had the duty t o f u l l y advise the claimant and t o see t o it t h a t claimant's r i g h t s were protected; t h i s was particularly t r u e when the Division had n o t i f i e d claimant t h a t he could complete the form 54 a t h i s convenience and t h a t he was not e n t i t l e d t o compensation a t t h a t time. That claimant did not under- stand, o r was not f u l l y advised, of the importance o r purpose of t h e form 54 i s obvious from t h e f a c t t h a t he did not complete one. By f a i l i n g t o protect claimant's r i g h t s under the law, the Division i s equitably estopped from l a t e r denying compensation t o claimant. I 1 The Division appeals from the d i s t r i c t c o u r t ' s judgment. The only i s s u e before t h i s Court i s whether o r not claimant's l e t t e r t o the Division, dated December 28, 1967, c o n s t i t u t e s a claim within the meaning of section 92-601, R.C.M. 1947, before amendment i n 1973. W e find t h a t it does not. Upon appeal, the presumption i s t h a t the Division decided t h e case correctly. Moffett v. Bozeman Canning Co., 95 Mont. 347, 26 P.2d 973. The d i s t r i c t court i s j u s t i f i e d i n reversing the findings of the Division only where there e x i s t s a c l e a r preponderance of the evidence against t h e ~ i v i s i o n ' s findings. Meznarich v. Republic Coal Co., 101 Mont. 78, 53 P.2d 82; Beatty v. Wellman Power M o n t . and Gas, Inc., 812792, opinion handed down July 8, 1975, Section 92-601 is a notice s t a t u t e which then provided: 11 In case of personal injury o r death, a l l claims s h a l l be forever barred unless presented i n writing under oath t o the employer, t h e insurer, o r the board a s t h e case may be, within twelve months from the date of the happening of the accident, e i t h e r by t h e claimant o r someone l e g a l l y authorized t o a c t f o r him i n h i s behalf." Section 92-117, R.C.M. 1947, provides t h a t t h e Division s h a l l p r i n t the forms necessary f o r t h e administration of the Workmen's Compensation Act. Rule 10 of the Rules of Procedure of the Division provides t h a t every claim f o r compensation s h a l l be i n i - t i a t e d by f i l i n g of Form 54. The f a c t t h a t claimant f a i l e d t o properly complete and f i l e Form 54 i s not i n dispute. This he f a i l e d t o do a f t e r he was given no l e s s than three such Form 54's and was asked by the Division t o complete t h e form each time, Claimant argues t h a t h i s l e t t t e r dated December 28, 1967, was s u f f i c i e n t notice within the requirements of section 92-601. With t h a t argument t h i s Court cannot agree. Claimant s p e c i f i c a l l y s t a t e s i n h i s l e t t e r : "If I 'm applicable f o r Compensation, please notify, & I w i l l f i l l out form received. 11 Obviously, claimant did not intend h i s l e t t e r t o be h i s n o t i c e f o r claim, f o r i f he had so regarded it, he would not have made reference t o f i l l i n g out a Form 54. B y s t a t i n g t h a t i f he was "applicable" he would f i l l out the form received, he obviously understood the proper procedure t o follow. Claimant argues t h e Workmen's Compensation Act must be interpreted l i b e r a l l y , c i t i n g Murphy v. Anaconda Company, 133 Mont. 198, 321 P.2d 1094, and other cases. There i s no question but t h a t t h e Act must be l i b e r a l l y interpreted. W e cannot, however, l i b e r a l l y construe a s t a t u t e t o the point of repealing it. When no e f f o r t was made by claimant t o comply with the s t a t u t e , i t w i l l not do t o have claimant turn around and attempt t o get i n under the gun by having t h i s Court l i b e r a l l y construe t h e s t a t u t e i n h i s favor. Claimant argues further t h a t the Division i s equitably estopped from denying h i s claim. W e find no merit i n t h a t argument. The Division did everything i n i t s power t o get claimant t o comply with the s t a t u t e , short of completing the form i t s e l f , which it i s not required t o do. Claimant argues the l e t t e r from M r . Carden s t a t i n g claimant could complete t h e form a t h i s l e i s u r e misled claimant i n t o believing there was no r e a l hurry i n completing the form. If M r . Carden's l e t t e r had been the only communication be- tween claimant and the Division, t k r e might be some b a s i s t o t h a t argument. However, i n l i g h t of the f a c t claimant received a notice from t h e Division explaining the year deadline, and i n l i g h t of the f a c t t h a t M r . Winfield personally warned claimant t h a t h i s time f o r f i l i n g was running out, there i s j u s t no foundation t o support t h a t argument. The judgment of the d i s t r i c t court i s reversed. Justice \ W e Concur: 6 Hon. E. Gardner Brownlee, D i s t r i c t Judge, s i t t i n g f o r Chief J u s t i c e James T. Harrison. M r . J u s t i c e Gene B. ~ a l ~ dissenting: I dissent, The general overriding reason f o r a notice s t a t u t e , such a s t h e one i n question here, i s t o prevent i n j u s t i c e . That is t o prevent the f i l i n g of s t a l e o r fraudulent claims f a r removed from the time of t h e claimed injury so a s t o put t h e employer o r insurer i n an untenable position t o defend o r in- vestigate. Secondarily, there must a l s o be r u l e s and orderly procedure and f i n a l i t y i n a l l matters, The r e s u l t reached by the majority here produces a harsh and unjust r e s u l t upon a claimant with an undisputed, honest claim which produced a severe d i s a b i l i t y . Section 92-601, R.C.M. 1947, i s a notice s t a t u t e which then provided: I I In case of personal injury o r death, a l l claims s h a l l be forever barred unless presented i n writing under oath t o t h e employer, the insurer, o r t h e board, a s t h e case may be, within twelve months from the date of t h e happening of t h e accident, e i t h e r by the claimant o r someone legally authorized t o a c t f o r him i n h i s behalf." The Division argues it has the r i g h t under section 92- 117, R.C,M. 1947, t o determine which forms a r e t o be used t o promote the e f f i c i e n t administration of the Workmen's Compensation Act. Rule 10 of t h e Rules of Procedure of the Division pro- vides, i n p a r t , t h a t "Every claim f o r compensation s h a l l be i n i - I I t i a t e d by f i l i n g of form 54, claim f o r compensation. Therefore, i t argues, the only valid claim form is Form No. 54, claim f o r compensat,ion o r a communication of similar content. There i s no doubt the i d e a l s i t u a t i o n f o r the Division would be t o have every form f i l l e d out properly with the correct information, dated, signed, and f i l e d on time. But r e a l i s t i c - a l l y t h i s can not always be done. Forms a r e a constant source of confusion. The entitlement of "Form 54" is a source of con- fusion i n t h a t i t i s t i t l e d "Claim f o r omp pens at ion", although section 92-601 requires t h a t a claim be f i l l e d out within a year of the accident, before many injured persons a r e aware t h e i r injury e n t i t l e s them t o compensation, such a s t h e instant case. FJorkmenls compensation deals with many individuals i n a l l walks of l i f e ; not a l l a r e sophisticated, nor are a l l highly educated, The Montana legislature has mandated, and t h i s Court has held, that the Workmen's Compensation Act must be liberally construed i n favor of the claimant. Section 92-838, R.C.M. 1947; Grief v. Industrial Accident Fund, 108 Mont, 519, 526, 93 P.2d. 961; Murphy v. Anaconda Company, 133 Mont, 198, 321 P.2d 1094, 1097. Section 92-601, R.C.M. 1947, does not s t a t e that Form 54 must be submitted t o the Division. It merely requires that a claim i n writing be made under oath. This Court i n Chisholm v. Voca- tional School for G i r l s , 103 Mont. 503, 507, 64 P.2d 838, held that the techinical requirement of the notice t o be given under oath i s not required. Therefore, the only requirement of section 92- 601 is that written notice be given. Here, claimant wrote t o the Division i n reply t o a l e t t e r from the Division about h i s accident. H e acknowledged that he had been injured; that he had been off work; and, i f "applicable" for compensation he would l i k e to be notified. The Division was f u l l y aware that an accident had occurred and the d e t a i l s of the accident by virtue of the employer and medical contacts s e t forth heretofore. Y e t , i n answer t o claimant's request for advice, the Division manager advised that claimant was not e l i g i b l e for a claim a t present, but that he should f i l l out form 54 a t h i s convenience. The Division should have known that claimant did not fully understand the importance of f i l i n g form 54, because he had failed t o do so. Under such circumstances it must a c t t o protect claimant's rights by helping him complete the form, i f necessary. B y f a i l i n g so t o do the Division i s estopped from denying claimant h i s claim, for having failed t o f i l e a particular form, I f there was any necessary information desired by the Division not contained i n claimant's l e t t e r , the physician's report, and the employer's report, a l l of which the Division had i n i t s f i l e s , M r . Winfield, the f i e l d agent f o r the Division, could have e a s i l y acquired it on one of h i s several v i s i t s with claimant. Winfield t e s t i f i e d t h a t when claims have inadequate information, it i s customary f o r him t o further investigate. This is not t o say t h a t the requirements of t h e Division o r the s t a t u t e s can be ignored nor t h a t t h e Division must f i l e the required form f o r claimants i n a l l cases. In Yurkovich v. I n d u s t r i a l Accident Board, 132 Mont. 77, 314 P.2d 866, t h i s Court held t h a t i t was not the duty of the Board t o go out and s o l i c i t claims and each case must be determined on i t s own f a c t s , circum- stances and the law applicable. Y e t , it i s the duty of the Board t o f u l l y advise the injured workman when he comes t o the Board and asks f o r information. The Court f u r t h e r held t h a t t h i s placed the Board i n a position of t r u s t and it was obligated t o investigate on i t s own, i f necessary, t o determine entitlement t o compensation by t h e injured workman. Failure t o do so i n Yurkovich resulted i n the Court denying t h e Board, by estoppel, the benefit of the s t a t u t e of limitations. Here, the Division argues t h e claimant was not misled, a s i s required t o invoke equitable estoppel, and c i t e s numerous cases wherein an insurance company, a doctor, a company lawyer, a c i t y c l e r k and mayor a c t i v e l y misinformed the injured workman and estoppel resulted and would urge t h i s f a c t u a l s i t u a t i o n a s a condition precedent t o invoking the doctrine. It r e c i t e s language from Ricks v. Teslow Consolidated, 162 Mont. 469, 512 P.2d 1304, t o support i t s position. W e agree with t h e law as s t a t e d i n Ricks . It merely r e s t a t e s t h a t t h e doctrine w i l l be applied i f there have been affirmative a c t s which prevent t h e claimant from f i l i n g o r lead him t o believe he need not do so. The f a c t s here s t i l l must control t h e r e s u l t reached i n t h e present cause. The language of Levo v. General-Shea-Morrison, 128 Mont. 570, 576, 280 P.2d 1086, c i t e d t o the Court by the Division, i s p a r t i c u l a r l y appropriate: ¸Ÿ he doctrine of equitable estoppel i s a f l e x i b l e one, founded i n equity and good conscience; i t s object is t o prevent a party from taking an uncon- scionable advantage of h i s own wrong while a s s e r t i n g h i s s t r i c t l e g a l r i g h t . Seemingly the only s t r i c t legal r i g h t t h a t we a r e asked t o adhere t o i s the s t a t u t e which was passed solely f o r the benefit of the employer and t h e insurance c a r r i e r , i . e . , the Statute of Limitations. * J ; "J; A J ; Certainly, i f there i s any circumstance wherein the doctrine of equitable estoppel should be extended, it i s i n matters concerning an injured workman, where the l a w i t s e l f says t h a t t h e Workmen's Compensation Act s h a l l be construed l i b e r a l l y . I I The judgment of the d i s t r i c t court should be affirmed. - d d % - - I - " - - - - - - - - - - Justice. / L v i r . J u s t i c e Frank I. Haswell dissenting: I dissent and concur i n the foregoing dissent of M r . J u s t i c e Gene B. Daly. Justice.