Source: https://law.justia.com/cases/california/supreme-court/3d/2/1001.html
Timestamp: 2020-08-11 19:05:32
Document Index: 83866926

Matched Legal Cases: ['§ 3700', '§ 5400', 'art 2', '§ 4650', 'art 2', '§ 4600', '§ 3751', '§ 4909']

City Etc. of San Francisco v. Workmen's Comp. App. Bd. :: :: Supreme Court of California Decisions :: California Case Law :: California Law :: US Law :: Justia
Justia › US Law › Case Law › California Case Law › Cal. 3d › Volume 2 › City Etc. of San Francisco v. Workmen's Comp. App. Bd.
Claimants, a fireman and two police officers, sustained industrial injuries arising out of and in the course of their employment for the City and County of San Francisco. Each received a disability payment from the city pursuant to the city charter. In each case the payments were made by the city retirement board after an administrative hearing at which medical evidence was presented as to the extent of the injuries, the need for treatment, and the inability of the employee to continue his regular duties because of the work-related injury. Each was paid full salary during the period of temporary disability; each received medical treatment; each subsequently received a disability retirement allowance or pension based on these work-related injuries. The city charter establishes a comprehensive system for the payment of disability and retirement benefits, recognizes and provides for ascertainment of the city's liability to its employees under the Workmen's Compensation and Safety Act and for payment thereof from tax monies, and makes other compensation provisions for injured employees as well as retirement benefits for length of service. The basic question presented is the nature of the payments made by the city to these [2 Cal. 3d 1007] claimants at or immediately prior to the time their claims were filed with the appeals board.
William G. Paul was born in 1925; sustained injuries on February 8, 1954, and on July 30, 1962; and last received medical treatment for the 1954 injury in April 1960 and for the 1962 injury in March 1965. He was retired for disability on January 24, 1965, fn. 2 and has received a retirement disability pension ever since. On December 7, 1967, he applied for the first time to the appeals board alleging a disagreement with the city regarding his claim for temporary and permanent disability indemnity, reimbursement for self-procured medical expenses, and medical treatment. The city had refused his request for further medical treatment, relying on the bar of the statute of limitations. The referee found that the claims were not barred, that Paul was in need of further medical treatment, that the city should provide such treatment and that it should reimburse him for self-procured medical care. The referee also found that the city was estopped [2 Cal. 3d 1008] from raising the defense of limitations. The appeals board granted reconsideration, struck the finding on estoppel, and otherwise affirmed and adopted the findings and decision.
Neither the fact of injury nor the city's liability therefor under the state act is in dispute. Security for payment of compensation due under the state act may be satisfied by the employer becoming insured or by being permissibly self-insured (§ 3700). The city is permissibly self-insured. The act does not require that claimants must file with the state board. It does, however, provide specific periods of limitation within which such claims may be filed (§§ 5400-5412). Section 5404 provides that unless compensation is paid within the time limited for the institution of proceedings [2 Cal. 3d 1009] for its collection, the right to institute such proceedings is barred. Section 5405 provides that the period within which proceedings may be commenced is one year from "(a) The date of injury; or (b) The expiration of any period covered by payment under Article 3 of Chapter 2 of Part 2 of this division [§§ 4650-4663, disability payments]; or (c) The date of last furnishing of any benefits provided for in Article 2 of Chapter 2 of Part 2 of this division [§§ 4600-4605, medical and hospital benefits]." Section 5409 provides that the running of the period of limitations so prescribed is an affirmative defense which may be waived.
Section 172 of the city charter provides that the benefit provisions of the workmen's compensation laws included in the Labor Code as they affect the benefits provided for, or payable to, or on account of, officers and employees, shall be administered exclusively by the retirement board, and that the latter shall determine whether the city, through the retirement system, shall assume the risks in whole or in part with the state compensation insurance fund. It also provides that "Whenever any member of the fire or police department ... is incapacitated for the performance of his duties by reason of any bodily injury received in or illness caused by the performance of his duty, as determined by the retirement board, he shall become entitled, regardless of his period of service with the city, as fixed by the charter, while so disabled, for a period or periods not exceeding twelve months in the aggregate, with respect to any one injury or illness. Said disability benefit shall be reduced in the manner fixed by the board of supervisors by the amount of any benefits other than medical benefits payable to such person under the Labor Code concurrently with said disability benefit, and because of the injury or illness resulting in said disability. Such disability benefits as are paid in the absence of payment of any benefits other than medical benefits under the workmen's compensation laws included in said Labor Code, shall be considered as in lieu of such benefits, payable to such person under the said Code concurrently with said disability benefits, and shall be in satisfaction and discharge of the obligations of the city and county to pay such benefits under the Labor Code. Medical treatment which may become necessary to relieve or cure said members from the effects of the injury or illness shall be furnished by the city and county, in the same manner that such treatment is furnished under said Labor Code, but without first requiring continuing awards of such treatment by the ... [appeals board] relating to impairments of permanent or of extended and uncertain duration. fn. 4 The provisions of this paragraph shall be administered exclusively by the retirement board and the city and county shall pay to the retirement system during each fiscal year an amount equal to the total disability benefits paid by said [2 Cal. 3d 1010] system during that year...." [1] By reference to the workmen's compensation laws in the Labor Code the charter impliedly refers to all of its provisions, including the limitations stated in section 5405 of that code.
[2] Compensation and pension systems, private or public, are to be encouraged for the benefit and protection of employees. If there is any conflict between the compensation provisions made by the employer and those made by the state law, the latter must prevail. (Healy v. Industrial Acc. Com., 41 Cal. 2d 118, 122 [258 P.2d 1[.) [3] It is the policy of the state law that compensation injuries be swiftly recognized and payments commenced and that medical care and hospitalization be speedily furnished and claims settled without litigation. (Royal Indem. Co. v. Industrial Acc. Com., 239 Cal. App. 2d 917 [49 Cal. Rptr. 224].) The charter here purports to provide for both the city's liability under the state act and other benefits.
[4, 5] Payments of workmen's compensation and of retirement benefits are based upon entirely different principles. The former is compulsory under state law; the latter is voluntary and is subject to contractual arrangement between the employer and employee. The former must be entirely subsidized by city tax monies where the employer is a city (City of Los Angeles v. Industrial Acc. Com. (Fraide) 63 Cal. 2d 242 [46 Cal. Rptr. 97, 404 P.2d 801]) or by the employer himself, through insurance or otherwise, where the employer is not a public body. Retirement pensions are considered to be an element of contractual compensation earned by the employee (Abbott v. City of Los Angeles, 50 Cal. 2d 438, 455 [326 P.2d 484]) and may include employee contributions.
Payment of workmen's compensation liability, as required by the state act, and payment of compensation benefits over and beyond the liability imposed by the state are also distinguishable. The source of each, in this instance, is tax monies; but the motive and obligation of the city is distinct. An employer may pay more than he is required to pay for disability compensation under the state act. Section 3750 of the Labor Code specifically provides that "Nothing in this division shall affect ... (d) The right to provide by mutual or other insurance, or by arrangement with his employees, or otherwise, for the payment to such employees ... of sick, accident, or death benefits, in addition to the compensation provided for by this division." The employer may not exact or receive from an employee any contributions or make or take any deductions from his earnings, directly or indirectly, to cover the whole or any part of the cost of compensation under the state act (§ 3751). The additional benefits, as well as the primary benefits, conferred upon the injured employee by the city charter are paid from tax funds. The voluntary payment from tax monies for these [2 Cal. 3d 1011] additional benefits is probably justified by the peculiarly hazardous character of the work of a fireman or policeman. [6] The charter specifically provides, in section 172, that "Such disability benefits as are paid in the absence of payment of any benefits other than medical benefits under the workmen's compensation laws included in said Labor Code, shall be considered as in lieu of such benefits, payable to such person under the said Code concurrently with said disability benefits, and shall be in satisfaction and discharge of the obligations of the city and county to pay such benefits under the Labor Code." This section was obviously intended to provide that any payments made to an injured employee by the city should first be applied in satisfaction of its liability under the Labor Code.
The fact that the payments were voluntarily made does not change their character, if no liability under the Labor Code remained extant. It has been held that payments voluntarily made to an injured employee, with knowledge by the employer of the injury and that the employee is not rendering services, are compensation, and not wages or gratuities, for the purpose of determining whether such payments tolled the statute of limitations. (Bulger v. Industrial Acc. Com., 218 Cal. 716 [24 P.2d 796]; Rendleman v. Industrial Acc. Com., 242 Cal. App. 2d 32 [50 Cal. Rptr. 923]; Morrison v. Industrial Acc. Com., 29 Cal. App. 2d 528 [85 P.2d 186]; London Guar. & Acc. Co. v. Industrial Acc. Com., 92 Cal. App. 298 [268 P. 670].) In each of the cited cases payments were made at a time when disability benefits were due, and claims therefor were filed within the time limit (six months then provided by the Labor Code from the receipt of compensation). The fact that the employers in those cases were private employers rather than a city and county, should not and does not change the character of the payment. [9] Here there was an agreement (the charter) between employer and employee regarding the discharge and satisfaction of disability benefits, although the employee was paid full salary while temporarily disabled. Even in the absence of such an agreement, [2 Cal. 3d 1012] payment of full wages by a private employer to an injured workman during a period of temporary total disability discharges the liability of the employer for workmen's compensation. (Herrera v. Workmen's Comp. App. Bd., 71 Cal. 2d 254, 258 [78 Cal. Rptr. 497, 455 P.2d 425].)
[11] The Labor Code does not impinge upon the city's right to reduce its pension payments during the period of time an injured employee is drawing full compensation. The employer may be credited for the amounts so paid. (§ 4909.) The city may claim a credit against its workmen's compensation liability commensurate with its contributions to the compensation or pension fund. (City of Los Angeles v. Industrial Acc. Com. (Fraide) [2 Cal. 3d 1013] supra, 63 Cal. 2d 242.) Here the contribution was 100 percent, and the allowance of credit would be 100 percent.
In a companion case to Fraide, City of Los Angeles v. Industrial Acc. Com. (Dillin) 63 Cal. 2d 255 [46 Cal. Rptr. 105, 404 P.2d 809], the specific issue considered in the opinion was whether the city was estopped by its action to assert the defense of limitations. Necessarily involved therein, however, was the nature of the payments being made to Dillin under the city charter at the time he filed a claim with the state commission in 1962,-- 27 years after the date of injury, and 21 years after the last medical treatment for such injury. The record contained a stipulation by the parties that there was a permanent disability rating of 69 percent attributable to the 1935 injury, equal to 276 weeks at $25 a week or $6,900 plus medico-legal costs. The commission allowed the city a credit of only $25 a week during the period in which the city had paid Dillin full salary, refused to allow it any credit for the disability pension paid thereafter, and awarded lifetime medical treatment. The city petitioned unsuccessfully for a Certificate of Satisfaction and applied for a lien against compensation to the extent due on the day of the filing thereof on the ground that by operation of charter section 182 1/2 the payments previously made constituted compensation to the extent compensation was due. The city urged on appeal that since the ordinance providing for payment constituted an agreement the award ought to have credited the total amount paid during this period against the disability indemnity found due rather than credit only that amount the city would have been required to pay under a commission award of temporary disability indemnity for the same period, and that for the commission to refuse to credit the city with having discharged its liability under the Labor Code was arbitrary and capricious.
The Los Angeles city charter, section 182 1/2, provided that if any member of the fire or police department was entitled to pension benefits under the charter and was granted any compensation or award under any general law providing for compensation or indemnity in case of sickness, injury or death arising out of the performance of his duty, then and in that event any payments made pursuant to the charter "shall be construed to be and shall be payments of such compensation or award under such general law, and any payments made under the provisions of this article shall be first applied to payment of such compensation or award and any balance of such payments made pursuant to the provisions of this article shall be pension payments; and it is hereby provided that the pension ... shall be reduced in amount to the difference between the amount of pension provided for in this article and the total amount of such compensation or award granted and paid under such general law until the total amount awarded under such general law shall have been fully paid. After payment [2 Cal. 3d 1014] of the total amount of such compensation or award granted under such general law the payments herein provided for shall continue as pension benefits subject to the provisions of this article." It was held that the statute of limitations barred Dillin's claim unless the city was estopped to assert the statute. This necessarily determined that the pension payments being received by Dillin at the time he applied to the state commission for workmen's compensation benefits were not "compensation" within the meaning of section 3207 and did not toll the statute of limitations prescribed in section 5405. Subsequent to the decision in Dillin, the state commission followed this same reasoning in deciding that the statute of limitations was not tolled by the payment of monthly disability pension where permanent disability due the employee had been satisfied more than a year before the claim was filed. (Hall v. City of Los Angeles, 31 Cal. Comp. Cases 444.) Re-examination of the decision in Dillin does not result in the conclusion that it was inadvertently decided, nor that the payments to the present claimants are of any different nature from those considered in Dillin.
If the city's liability to the claimants under the state act was satisfied and discharged more than a year before these claims were filed with the appeals board, the receipt of disability retirement allowances by the claimants did not toll the statute. [13] The limitations stated in section 5405 are in the alternative and are of equal force. The city must prove that the time has elapsed starting from any and all three of the points designated. (Colonial Ins. Co. v. Industrial Acc. Com., 27 Cal. 2d 437, 441 [164 P.2d 490].) [12b] None of the claims was filed within a year after the date of injury or after the last medical treatment requested or furnished for such injury. Whether the claims were filed within a year after the last payment of "compensation," within the meaning of Labor Code section 3207, will depend upon the permanent rating of claimants, and the cause must be remanded to the board to determine these ratings. [2 Cal. 3d 1015]
Whether this letter constituted a continuing offer of medical services, unrestricted by any period of limitations contained in the Labor Code, or whether Paul reasonably believed that it so provided and relied upon it to his detriment, are questions of fact that should be determined by the appeals board. [14b] Whether the charter provision was reasonably relied upon by Quinn as entitling him to medical treatment for injuries of permanent or extended and uncertain duration without applying to the appeals board or without regard to any period of limitations, is also a question of fact. [2 Cal. 3d 1016]
Sullivan, Acting C. J., Peters, J., Tobriner, J., and Burke, J., concurred. [2 Cal. 3d 1017]
FN 1. Quinn retired under charter section 169(e), which provides that "Any pension payable because of the ... retirement of any such persons shall be reduced in the manner fixed by the board of supervisors, by the amount of any benefits payable to or on account of such person, under the workmen's compensation insurance and safety law of the State of California."
FN 2. Paul retired under charter section 168.1.6, which provides that where an industrial disability retirement allowance is paid by the city and county, that portion of the allowance which is provided by contributions of the city and county "shall be considered as in lieu of any benefits, other than medical benefits payable" to the retired employee under the Labor Code "and shall be in satisfaction and discharge of the obligation of the city and county to pay such benefits."
FN 3. Page retired under charter section 168.1.3, which provides that any member of the police department who becomes incapacitated for the performance of his duty by reason of bodily injury received in performance of his duty, shall be retired and if he is not qualified for service retirement shall receive a retirement allowance equal to 75 percent of the final compensation of said member.
FN 4. Whether this sentence creates an estoppel is hereafter considered.