Case Title: State ex rel. Russell v. Indus. Comm.

Citation: 1998-Ohio-212

Docket Number: 19960061

State: ohio

Court: Ohio Supreme Court

Date: 1998-08-05T00:00:00Z

Document:
THE STATE EX REL. RUSSELL v. INDUSTRIAL COMMISSION OF OHIO ET AL. 
[Cite as State ex rel. Russell v. Indus. Comm. (1998), ___ Ohio St.3d ___.] 
Workers’ compensation — Appropriate date on which to terminate disputed 
temporary total disability compensation on the basis of maximum medical 
improvement — Industrial Commission may not declare an overpayment for 
payments received by the claimant, when. 
The appropriate date on which to terminate disputed temporary total disability 
compensation on the basis of maximum medical improvement is the date of 
the termination hearing, and the commission may not declare an 
overpayment for payments received by the claimant before that date. 
(No. 96-61 — Submitted March 24, 1998 — Decided August 5, 1998.) 
IN MANDAMUS and PROHIBITION. 
 
On August 13, 1992, relator-claimant, Herbert G. Russell, received an injury 
in the course of, and arising out of, his employment as a firefighter/paramedic with 
respondents, Coventry Township Trustees.  Claimant’s workers’ compensation 
claim was allowed for “lumbar strain,” and he received temporary total disability 
(“TTD”) compensation until May 8, 1994, when compensation was terminated 
upon a finding of permanence. 
 
On October 24, 1994, a district hearing officer allowed the claim for the 
condition of “dysthymia, DSM III secondary type,” and TTD compensation was 
resumed.  Compensation continued to be paid based on the reports of claimant’s 
treating physician, James L. Helmuth, Ph.D., who opined that claimant had not 
reached maximum medical improvement (“MMI”) and remained temporarily and 
totally disabled. 
 
At the behest of respondent, Ohio Bureau of Workers’ Compensation, 
claimant was examined by a psychologist, Alan D. Gilbertson, Ph.D.  On March 
 
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23, 1995, Dr. Gilbertson issued a report opining that claimant had reached MMI.  
Based on this report, the bureau filed a request for formal hearing with respondent, 
Industrial Commission of Ohio, to terminate claimant’s TTD compensation. 
 
On July 24, 1995, a district hearing officer heard the matter and ordered as 
follows: 
 
“The District Hearing Officer finds, based on [the] report of Dr. Gilbertson, 
that claimant reached maximum medical improvement as of 3-23-95, the date on 
which Dr. Gilbertson performed a medical examination or medical review of the 
claimant. 
 
“The District Hearing Officer further finds that the claimant’s temporary 
total disability compensation shall be and is hereby terminated as of 3-23-95, the 
date of the medical examination or medical review. 
 
“The District Hearing Officer defers ruling on the issue of overpayment and 
recoupment under 4123.511(J) O.R.C. pending the final disposition of the Motion 
to Show Cause in State, ex rel. Crabtree v. Bureau of Workers’ Compensation. 
 
“The determination of termination of temporary total disability 
compensation by reason of maximum medical improvement is a final order.  
However, the issue of overpayment and recoupability of overpayment is not a final 
order.” 
 
This order was administratively affirmed. 
 
In identical orders dated December 18, 1995 and February 19, 1996, an 
overpayment was declared.  These orders read: 
 
“Pursuant to * * * State of Ohio ex rel. Roger D. Crabtree, Relator v. Ohio 
Bureau of Workers’ Compensation * * * and pursuant to Resolution No. R95-1-14 
* * * which * * * reinstated in toto Resolution No. R95-1-02, this Hearing Officer 
finds an overpayment of temporary total disability compensation in this case. 
 
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“ * * * [A]n overpayment is declared from the date of termination of 
temporary total disability compensation as established previously by a Hearing 
Officer, to the date on which the Bureau of Workers’ Compensation or self-
insured employer paid temporary total disability compensation.  Further, this 
overpayment is to be recouped by the Bureau of Workers’ Compensation or the 
self-insured employer pursuant to the provisions of Sections 4123.511(J) of the 
Ohio Revised Code as set forth in Resolution No. R95-1-02 and Policy Statement 
and Guideline Memorandum No. C.8 of the Hearing Officer Manual. 
 
“This order is a final administrative order, and is therefore not appealable or 
subject to reconsideration.” 
 
This cause is now before the court as an original action in mandamus and 
prohibition. 
__________________ 
 
Stewart Jaffy & Associates Co., L.P.A., Stewart R. Jaffy and Marc J. Jaffy, 
for relator. 
 
Maureen O’Connor, Summit County Prosecuting Attorney, and James W. 
Armstrong, Assistant Prosecuting Attorney, for respondents Coventry Township 
Trustees. 
 
Betty D. Montgomery, Attorney General, Dennis L. Hufstader and William 
A. Thorman III, Assistant Attorneys General, for respondents Industrial 
Commission and Bureau of Workers’ Compensation. 
 
Scott, Scriven & Wahoff, William J. Wahoff, Richard Goldberg and Timothy 
E. Cowans, urging denial of the writs for amicus curiae, Ohio Council of Retail 
Merchants. 
 
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Bricker & Eckler, Charles D. Smith and Elizabeth A. Preston, urging denial 
of the writs for amici curiae, Ohio Chapter of the National Federation of 
Independent Business and Ohio Farm Bureau Federation. 
 
Vorys, Sater, Seymour & Pease, Robert A. Minor and Robin R. Obetz, 
urging denial of the writs for amici curiae, Ohio Manufacturers’ Association and 
Ohio Self-Insurers’ Association. 
 
Millisor & Nobil and Preston J. Garvin, urging denial of the writs for 
amicus curiae, Ohio Chamber of Commerce. 
 
Squire, Sanders & Dempsey, Steven M. Loewengart and Michael Soto, 
urging denial of the writs for amicus curiae, Council of Smaller Enterprises. 
 
Stewart Jaffy & Associates Co., L.P.A., Stewart R. Jaffy and Marc J. Jaffy, 
urging issuance of the writs for amicus curiae, Ohio AFL-CIO. 
 
Gallon & Takacs Co., L.P.A., and Theodore A. Bowman, urging issuance of 
the writs for amicus curiae, Ohio Academy of Trial Lawyers. 
__________________ 
 
ALICE ROBIE RESNICK, J.  At issue is Resolution R95-1-02, adopted by the 
commission on February 9, 1995 and applied in this case, which directs 
commission hearing officers to terminate TTD compensation as of the date MMI 
was diagnosed by the nonattending physician, and to declare an overpayment for 
any compensation paid subsequent to that date.  For the reasons that follow, this 
resolution cannot stand.  We hold that the appropriate date on which to terminate 
disputed TTD compensation on the basis of maximum medical improvement is the 
date of the termination hearing, and the commission may not declare an 
overpayment for payments received by the claimant before that date. 
 
This court has unwaveringly held (1) that continuing TTD compensation 
may not be terminated prior to a hearing before a commission hearing officer so 
 
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long as claimant’s attending physician continues to certify TTD, (2) that the 
hearing officer may not terminate the claimant’s TTD retroactive to a date prior to 
the date of the hearing, (3) that claimant is entitled to all compensation paid to the 
date of the hearing, and (4) that any eventual discounting of the attending 
physician’s reports certifying TTD does not transform those payments into a 
recoupable overpayment.  State ex rel. MTD Products, Inc. v. Indus. Comm. 
(1996), 76 Ohio St.3d 593, 669 N.E.2d 846; State ex rel. Crabtree v. Ohio Bur. of 
Workers’ Comp. (1994), 71 Ohio St.3d 504, 644 N.E.2d 361; AT & T 
Technologies, Inc. v. Indus. Comm. (1993), 68 Ohio St.3d 55, 623 N.E.2d 63; 
State ex rel. Jeep Corp. v. Indus. Comm. (1991), 62 Ohio St.3d 64, 577 N.E.2d 
1095; State ex rel. McGinnis v. Indus. Comm. (1991), 58 Ohio St.3d 81, 568 
N.E.2d 665; State ex rel. Youghiogheny & Ohio Coal Co. v. Kohler (1990), 55 
Ohio St.3d 109, 564 N.E.2d 76. 
 
In its effort to defend Resolution R95-1-02, the commission attempts to 
distinguish the above-cited cases, most notably AT & T and McGinnis.  The 
commission argues that our decision in AT & T did not address the issue of the 
termination date for TTD benefits due to MMI, and does not preclude it from 
establishing the termination date as the date MMI was diagnosed by the 
nonattending physician.  We cannot fathom how the commission could reach such 
a conclusion. 
 
In MTD Products, we specifically explained that “in AT & T, we held that 
pursuant to former R.C. 4123.56, where an attending physician’s reports support 
TTD, a self-insured employer who successfully challenges the attending 
physician’s reports is not entitled to a termination of TTD retroactive to the date 
MMI was diagnosed by the nonattending physician.”  Id., 76 Ohio St.3d at 595-
596, 669 N.E.2d at 848.  Indeed, even the dissent in AT & T recognized that “[t]he 
 
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majority holds that when the attending physician’s report supports compensation 
for temporary total disability * * *, the termination date for TTD benefits paid by 
self-insured employers is the date on which the district hearing officer orders the 
payments terminated.”  Id., 68 Ohio St.3d at 58, 623 N.E.2d at 65 (Wright, J., 
dissenting).1 
 
The commission also argues that although this court in McGinnis “did 
examine the issue of the effect of denying an award before the hearing date, * * * 
McGinnis [was decided under] former R.C. 4123.56, which did not contain the 
provisions in current R.C. 4123.56 requiring denial of temporary total 
compensation for the period when the claimant reaches maximum medical 
improvement * * * [and] prior to the enactment of Ohio Adm.Code 4121-3-32 and 
R.C. 4123.511(J) which specifically provide for withholding against future 
awards.”  Thus, the commission concludes, “unlike the period governed by 
McGinnis, the Industrial Commission and the courts now have direct and specific 
statutory and administrative code authority which requires the Industrial 
Commission to declare an overpayment, and which requires the Bureau of 
Workers’ Compensation or the self-insured employer to withhold the overpayment 
in the manner provided by the statute.”  (Emphasis sic.) 
 
In deference to the commission, we will construe this argument as not being 
limited to McGinnis, since even without McGinnis, AT & T and MTD Products 
would still invalidate Resolution R95-1-02.  However, of the six cases cited 
above, all except Crabtree (which the commission would distinguish) were 
decided under former R.C. 4123.56 (138 Ohio Laws, Part I, 1893-1894) and 
without regard to Ohio Adm.Code 4121-3-32(B)(2)(d) or R.C. 4123.511(J).  If the 
commission is correct in its assertion that these provisions changed the law in this 
 
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area, then the issue now before us would have to be reevaluated in light of the 
change. 
 
The problem with the commission’s argument, however, is that it assumes 
too much.  No relevant change in the law has been effected by these provisions 
that would call into question the continuing vitality of our previous decisions.  
While the August 22, 1986 amendments to former R.C. 4123.56 added the 
language that payment shall not be made for the period “when the employee has 
reached the maximum medical improvement,” this language added nothing that we 
had not already construed to be part of former R.C. 4123.56.  141 Ohio Laws, Part 
I, 766. 
 
As early as 1982, we construed former R.C. 4123.56 to require that TTD 
compensation terminate when the claimant’s temporary disability has become 
permanent.  State ex rel. Ramirez v. Indus. Comm. (1982), 69 Ohio St.2d 630, 23 
O.O.3d 518, 433 N.E.2d 586.  Our decision in AT & T specifically adhered to this 
construction of former R.C. 4123.56, and, in Jeep Corp., 62 Ohio St.3d at 66, 577 
N.E.2d at 1097, we rejected the commission’s argument to the contrary.  The 1986 
amendments did not change our construction of R.C. 4123.56, but codified it.  
Thus, there is no basis on which to decide the issue differently today. 
 
R.C. 4123.511(J) was enacted as part of Am.Sub.H.B. No. 107, effective 
October 20, 1993.  145 Ohio Laws, Part II, 2990, 3152-3153.  As the commission 
correctly states, R.C. 4123.511(J) supersedes Ohio Adm.Code 4121-3-32(B)(2)(d).  
However, R.C. 4123.511(J) simply provides for withholding future payments to 
recoup an overpayment when a claimant is found to have received compensation 
to which he was not entitled.  The question of claimant’s entitlement to receive 
ongoing TTD compensation until a hearing officer rules otherwise is governed by 
R.C. 4123.56, not 4123.511(J).  To say that under R.C. 4123.511(J) a claimant 
 
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must repay compensation to which he or she was not entitled begs the question of 
whether claimant was entitled in the first place to receive such compensation. 
 
In this case, claimant was receiving ongoing TTD compensation pursuant to 
a prior order, and continued to submit proof of TTD from his attending physician.  
This fulfills all conditions precedent to the payment of compensation and 
establishes claimant’s entitlement to all payments at the time they were received, 
despite the existence of contrary evidence.  MTD Products, 76 Ohio St.3d at 595, 
669 N.E.2d at 848; Crabtree, 71 Ohio St.3d at 508, 644 N.E.2d at 365; AT & T, 68 
Ohio St.3d at 57-58, 623 N.E.2d at 65; Jeep Corp., 62 Ohio St.3d at 66, 577 
N.E.2d at 1097; McGinnis, 58 Ohio St.3d at 83, 568 N.E.2d at 667.  A termination 
order does not negate the previous order pursuant to which compensation has been 
paid; it does not, and could not, change the eligibility requirements for the 
payment of compensation.  Simply put, this is not a situation to which R.C. 
4123.511(J) applies. 
 
The dissent argues that “[t]he language of R.C. 4123.56(A) conflicts with 
the majority’s position,” placing emphasis on the phrase “however[,] payment 
shall not be made for the period in which any employee has * * * reached the 
maximum medical improvement.”  The dissent is confused. 
 
This language relates to the issue of unilateral termination and applies “only 
when there is no dispute as to whether the employee has reached maximum 
medical improvement.”  Crabtree, 71 Ohio St.3d at 509-510, 644 N.E.2d at 366.  
Otherwise, “payments shall be for a duration based upon the medical reports of the 
attending physician.  If the employer disputes the attending physician’s report, 
payments may be terminated only upon application and hearing by a district 
hearing officer * * *.”  R.C. 4123.56(A).  As Justice Cook pointed out in MTD 
Products, 76 Ohio St.3d at 595-596, 669 N.E.2d at 848, the employer who 
 
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successfully challenges the attending physician’s report is not entitled to a 
termination of TTD compensation retroactive to the date MMI was diagnosed by 
the nonattending physician. 
 
The dissent also argues that R.C. 4123.511(J) “demonstrates a legislative 
expectation that compensation will be repaid by claimants who do not meet the 
eligibility criteria.  [In]eligibility is the key to the right to recoupment.  The 
payment of continued benefits pending a hearing to determine eligibility does not 
equate with eligibility.”  Again the dissent is confused. 
 
The claimant is entitled to continuing TTD payments until they are 
terminated at hearing precisely because he has fulfilled the eligibility 
requirements.  “[T]he bureau must pay TTD compensation if all conditions 
precedent are met.  Thus, if the commission order makes payment contingent on 
proof of disability and the claimant tenders such evidence, the bureau must 
continue compensation regardless of the existence of contrary evidence.”  
(Emphasis sic.)  Crabtree, 71 Ohio St.3d at 508, 644 N.E.2d at 365.  In this case, 
TTD compensation was previously awarded and the claimant continued to offer 
proof of TTD from his attending physician.  This fulfills all the “eligibility 
criteria” for the payment of compensation and establishes claimant’s entitlement to 
all payments received. 
 
However, the dissent argues that although the claimant may have been 
“eligible to receive payments” made after the date of the nonattending physician’s 
report, R.C. 4123.511(J) should apply to allow a determination that the claimant is 
“ineligible to retain those payments.”  (Emphasis sic.)  Yet the dissent does not 
question our decisions in AT & T and MTD Products prohibiting the termination 
of TTD retroactive to the date of the nonattending physician’s report.  In actuality, 
therefore, the dissent’s argument translates to the absurd proposition that the 
 
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district hearing officer may declare a recoupable overpayment from the date of the 
nonattending physician’s report even though he or she is prohibited from 
terminating compensation retroactive to that date. 
 
The dissent, therefore, lacks statutory support for its position.  In addition, 
the dissent has been unable to cite even the slightest dictum from any case to 
support its view.  Instead, the dissent incredibly argues that “[t]he majority relies 
on a single case — State ex rel. McGinnis * * *, a case which we ought to 
reconsider because the cases it relies upon do not justify the decision.” 
 
According to the dissent, the court in McGinnis “relied on the standard 
articulated in State ex rel. Martin v. Connor (1984), 9 Ohio St.3d 213, 9 OBR 523, 
459 N.E.2d 889.”  In Martin, the court compared Indus. Comm. v. Dell (1922), 
104 Ohio St. 389, 135 N.E. 669, with State ex rel. Weimer v. Indus. Comm. (1980), 
62 Ohio St.2d 159, 16 O.O.3d 174, 404 N.E.2d 149, and essentially concluded that 
payments made under a mistake of fact cannot be recouped where the parties had a 
good faith belief that claimant was entitled to the payments at the time they were 
made.  Id., 9 Ohio St.3d at 214, 9 OBR at 525, 459 N.E.2d at 891.  The dissent 
argues that because Dell was not a recoupment case, Martin was wrongly decided, 
and that “in applying Martin, McGinnis only perpetuated an earlier standard that is 
legally unsound and fiscally untenable.” 
 
In the first place, it is pure fantasy to suggest that we have relied “on a 
single case — State ex rel. McGinnis.”  Indeed, as we stated above, “[i]n deference 
to the commission, we will construe this argument as not being limited to 
McGinnis, since even without McGinnis, AT & T and MTD Products would still 
invalidate Resolution R95-1-02.”  Thus, even if the dissent’s attack on McGinnis 
had merit, it would not produce the result the dissent seeks. 
 
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In any event, the dissent’s argument, which has not been raised by the 
commission, the bureau, the claimant’s employer, or any of their supporting amici, 
is entirely without merit.  In McGinnis, claimant was receiving continuing TTD 
compensation based on the reports of his attending physician, who certified his 
inability to return to his former position of employment.  Claimant’s employer 
filed a motion to terminate, which was granted on January 18, 1984.  In the order, 
the commission’s hearing officer had terminated TTD compensation retroactive to 
September 30, 1982.  Subsequently, the hearing officer declared an overpayment 
from September 30, 1982 to February 7, 1984 and permitted the employer to offset 
the payments made against any future compensation awarded to claimant.  The 
court of appeals granted a writ of mandamus in favor of claimant, after finding that 
no overpayment had occurred. 
 
In arguing the merits of its recoupment request, the employer in McGinnis 
relied heavily on State ex rel. DeLong v. Indus. Comm. (1988), 40 Ohio St.3d 345, 
533 N.E.2d 729.  In DeLong, an employer appealed a district hearing officer’s 
award of TTD compensation.  Pursuant to former R.C. 4123.515, that appeal 
stayed the payment of compensation pending a regional board hearing, but 
claimant’s employer mistakenly paid compensation during the pendency of that 
hearing.  We upheld the employer’s right to recoupment in DeLong because, in 
light of R.C. 4123.515’s stay on payment, it was unlikely that claimant had had a 
good faith belief that he was entitled to the funds at the time payments were made. 
 
In McGinnis, we rejected the employer’s recoupment request, finding its 
reliance on DeLong to be misplaced.  We held that pursuant to former R.C. 
4123.56, “so long as claimant’s physician did not release him to return to his 
former position, appellant was statutorily required to pay temporary total disability 
compensation until a commission hearing officer held otherwise.  This eventually 
 
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occurred on January 18, 1984.  In view of appellant’s duty, claimant was entitled 
to the funds.  DeLong and Weimer are thus distinguishable.”  Id., 58 Ohio St.3d at 
83, 568 N.E.2d at 667. 
 
However, in distinguishing DeLong and Weimer, we did not rely on the 
standard articulated in Martin.  Martin is nowhere cited in the majority opinion in 
McGinnis, and at no time did we attempt to justify McGinnis’s entitlement to TTD 
compensation on the basis of such a standard.  We did not make a determination 
that McGinnis’s compensation payments were made under a mistake of fact or 
inquire into the parties’ belief at the time payments were made.  To the contrary, 
the payments made to McGinnis were statutorily required and not made under a 
mistake of fact at all. McGinnis is simply not a mistake-of-fact case, and this is 
what distinguishes it from DeLong, Weimer, or Martin.  Thus, even if Martin is 
legally infirm, such an infirmity would not affect the viability of McGinnis. 
 
Since, like McGinnis, the instant case has nothing whatsoever to do with the 
recoupability of payments made under a mistake of fact, there is no reason to 
revisit Martin.  However, our refusal to defend Martin and its progeny is based 
solely on the fact that those cases are irrelevant under the present circumstances, 
and should in no way be construed as casting doubt on Martin’s continued 
viability. 
 
Since Resolution R95-1-02 was passed without statutory authority, and 
since claimant has a clear legal right to those funds that the commission has 
declared an overpayment, the writs of mandamus and prohibition are hereby 
granted. 
Writs granted. 
 
DOUGLAS, F.E. SWEENEY and PFEIFER, JJ., concur. 
 
LUNDBERG STRATTON, J., concurs separately. 
 
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MOYER, C.J., and COOK, J., dissent. 
FOOTNOTE: 
1. 
In AT & T, as with all our previous cases on this issue except for Crabtree, 
the claimant was an employee of a self-insured employer.  The claimant in the 
present case is a State Fund employee.  The commission does not argue that self-
insured cases in this area do not apply to State Fund claims, and indeed relies on 
that portion of R.C. 4123.56(A) that begins, “In the case of a self-insuring 
employer.”  We agree that the provisions of R.C. 4123.56 governing the 
termination of TTD payments apply to the bureau in State Fund claims as well as 
to self-insuring employers.  In Crabtree, we analyzed the State Fund claimant’s 
entitlement to a termination hearing, and to reinstatement of his TTD 
compensation while determination is pending, under the self-insuring-employer 
provision of R.C. 4123.56(A).  As pointed out by Justice Douglas, such uniformity 
of application is required by R.C. 4121.31(C).  Id., 71 Ohio St.3d at 510-511, 644 
N.E.2d at 367 (Douglas, J., concurring). 
__________________ 
 
LUNDBERG STRATTON, J., concurring.  There are four situations where 
temporary total disability compensation is terminated.  It is not payable when the 
claimant (1) has returned to work, (2) is medically able to return to the former 
position of employment, (3) has declined suitable alternate employment, or  (4) 
has attained permanency of the disability.  R.C. 4123.56(A);  State ex rel. Ramirez 
v. Indus. Comm. (1982), 69 Ohio St.2d 630, 23 O.O.3d 518, 433 N.E.2d 586;  
Vulcan Materials Co. v. Indus. Comm. (1986), 25 Ohio St.3d 31, 25 OBR 26, 494 
N.E.2d 1125.  Because the majority’s opinion narrowly addresses only those 
situations where there is conflicting medical evidence concerning the claimant’s 
maximum medical improvement, I agree that, so long as the claimant’s attending 
 
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physician continues to certify the claimant as temporarily and totally disabled, 
TTD compensation should continue until a termination order is rendered. 
 
The majority’s conclusion does not appear to apply to the claimant who 
satisfies any one of the first three categories that terminate a claimant’s right to 
TTD compensation, or when there is uncontested evidence that the claimant has 
reached MMI.  In those instances, TTD is no longer payable on the date that the 
claimant has indisputably reached MMI and recoupment of overpayment is 
available from the undisputed date of termination. 
 
However, in situations where there is conflicting evidence as to whether or 
when MMI has been attained, the existence of a conflicting report from a 
nonattending physician  is merely evidence to present at the hearing.  AT & T 
Technologies, Inc. v. Indus. Comm. (1993), 68 Ohio St.3d 55, 58, 623 N.E.2d 63, 
65.  The purpose of the administrative hearing is to determine, based upon the 
conflicting reports, whether the claimant has reached MMI.  Until the issue is 
resolved, the claimant remains entitled to receive TTD compensation pursuant to 
the existing order so long as the claimant’s attending physician provides medical 
certification of the continuing disability.  Thus, I concur with the majority’s 
holding that payment of TTD should terminate on the date of the hearing resolving 
the dispute, not the date offered in the conflicting medical report.  Under this 
scenario, recoupment of overpayments is not at issue because, until the 
termination order is issued, the claimant has met all the conditions of, and is 
entitled to, the TTD compensation. 
 
Therefore, to the extent that the majority’s opinion strikes a fair balance 
between the rights of the injured worker and the rights of the employer, I concur. 
__________________ 
 
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COOK, J., dissenting.  The majority opinion effectively permits the 
retention of temporary total disability (“TTD”) compensation by claimants who 
are not temporarily and totally disabled.  I therefore respectfully dissent. 
 
The language of R.C. 4123.56(A) conflicts with the majority’s position.  It 
states: 
 
“[P]ayments shall be for a duration based upon the medical reports of the 
attending physician.  If the employer disputes the attending physician’s report, 
payments may be terminated only upon application and hearing by a district 
hearing officer * * *.  Payments shall continue  pending the determination of the 
matter, however payment shall not be made for the period in which any employee 
has * * * reached the maximum medical improvement.”  (Emphasis added.) 
 
The recoupment provisions of R.C. 4123.511(J), in correlation with the 
above-emphasized language, further undermine the majority’s position. Directed 
at claimants who have been “found to have received compensation to which the 
claimant was not entitled,” R.C. 4123.511(J) demonstrates a legislative 
expectation that compensation will be repaid by claimants who do not meet the 
eligibility criteria.  Non-eligibility is the key to the right to recoupment.  The 
payment of continued benefits pending a hearing to determine eligibility does not 
equate with eligibility.  A claimant may be eligible to receive payments, but later 
determined to be ineligible to retain those payments.  Continuing payments is a 
fair method to accommodate the reality that the system does not permit 
instantaneous hearings. 
 
The majority relies upon a single case — State ex rel. McGinnis v. Indus. 
Comm. (1991), 58 Ohio St.3d 81, 568 N.E.2d 665, a case which we ought to 
reconsider because the cases it relies upon do not justify the decision.  In 
McGinnis, claimant’s ongoing TTD compensation was challenged by his 
 
16
employer, which alleged that as of September 30, 1982, claimant could return to 
his former position of employment.  However, because claimant’s attending 
physician continued to certify an inability to return to work, TTD compensation 
continued until the January 18, 1984 district hearing officer hearing.  At the 
hearing, the district hearing officer (“DHO”) terminated compensation effective 
September 30, 1992.  The DHO specifically discounted the attending physician’s 
reports because he had considered nonallowed conditions.  Later, all TTD 
compensation paid after September 30, 1982 was declared overpaid, prompting 
claimant’s mandamus challenge. 
 
The court of appeals found that the commission abused its discretion in 
assessing an overpayment, and this court affirmed.  This court relied on the 
standard articulated in State ex rel. Martin v. Connor (1984), 9 Ohio St.3d 213, 9 
OBR 523, 459 N.E.2d 889.  There, the court ruled that compensation could be 
recouped from a claimant only where (1) subsequent information revealed the 
claimant was not entitled to the money, and (2) the parties believed at the time of 
payment that the claimant was not so entitled. 
 
In applying Martin, McGinnis reasoned that R.C. 4123.56(A) mandated 
continued TTD compensation in the event of a dispute.  As such, claimant was 
entitled to the funds, and they could not be taken away.  Unfortunately, closer 
review reveals that in applying Martin, McGinnis only perpetuated an earlier 
standard that is legally unsound and fiscally untenable. 
 
Martin involved Disabled Workers’ Relief Fund (“DWRF”) benefits to a 
claimant from 1976 to 1981.  Because the DWRF amount was tied to the amount 
of disability Social Security benefits (“DSS”) received, a subsequent discovery of 
DSS underpayment meant that DWRF had been overpaid.  Efforts by the Bureau 
 
17
of Workers’ Compensation to recover the overpayment via compensation offset 
were opposed in mandamus. 
 
This court permitted the claimant to keep the nine thousand dollar 
overpayment.  To do so, however, it was necessary to distinguish State ex rel. 
Weimer v. Indus. Comm. (1980), 62 Ohio St.2d 159, 16 O.O.3d 174, 404 N.E.2d 
149, which four years earlier had upheld the commission’s recovery of an 
overpayment generated by clerical error. 
 
Martin compared Weimer with an even earlier case — Indus. Comm. v. Dell 
(1922), 104 Ohio St. 389, 135 N.E. 669.  Martin stated that the difference between 
Weimer and Dell was the parties’ good faith belief in compensation entitlement 
when payment occurred.  Martin held that neither the bureau nor the claimant in 
Weimer could have legitimately believed that claimant was entitled to the overpaid 
amount, even when made.  Martin, therefore, relied on Dell — a case which, 
according to the Martin majority, prohibited recoupment from one with an initial 
good faith belief in compensation entitlement. 
 
The problem is that Dell said no such thing.  Dell was a continuing 
jurisdiction case, not a recoupment case.  Dell involved the receipt of death 
benefits by a widow whose decedent also had an undisclosed and undivorced first 
wife.  Dell addressed the commission’s continuing jurisdiction to reopen the issue 
of benefit eligibility and stop payments to the second woman.  Dell never 
discussed the status of payments already made and never stated — expressly or 
impliedly — that the second wife could keep the money.  To the contrary, this 
passage from Dell suggests the opposite: 
 
“The commission should be held to have inherent power to prevent the 
misappropriation or the misapplication of the insurance fund to claimants who are 
afterwards found not to be entitled thereto.  The state insurance fund is in the 
 
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nature of a trust fund and it is the duty of the commission to impartially distribute 
the same among persons entitled thereto and not permit the fund to be depleted or 
become the object of fraud or imposition, and it being clearly their moral and legal 
duty to correct any mistake or fraud or imposition which will result in a 
misapplication or a misappropriation of any part of the fund the law should not be 
so construed, even in case of the ambiguity, neither should the legislature be held 
to have intended to enact any provisions which would hamper in any manner or 
interfere with the members of the commission in their efforts to properly protect 
the fund.”  Id. at 396-397, 135 N.E. at 672. 
 
In attempting to equate Weimer and Dell, Martin created a recoupment 
standard that lacks legal foundation.  This, in turn, discredits McGinnis’s premise.  
Equally important, Dell embodies a pivotal question, that is, why a claimant who 
is not temporarily and totally disabled can be permitted to retain TTD benefits? 
 
The majority’s decision disregards three workers’ compensation tenets: 
Dell’s prohibition against fund misapplication; the prohibition against claimant 
windfalls pronounced in State ex rel. Wireman v. Indus. Comm. (1990), 49 Ohio 
St.3d 286, 551 N.E.2d 1265; and the “some evidence” rule.  In addition, it 
essentially renders meaningless the prerequisites to TTD compensation set down 
in State ex rel. Ramirez v. Indus. Comm. (1982), 69 Ohio St.2d 630, 23 O.O.3d 
518, 433 N.E.2d 586. 
 
For the reasons stated above, I would deny the writs of mandamus and 
prohibition. 
 
MOYER, C.J., concurs in the foregoing dissenting opinion.