Opinion ID: 2639895
Heading Depth: 1
Heading Rank: 3

Heading: Claimant Kent

Text: According to an Award dated November 18, 2002, the parties stipulated to the following facts: 1. [Kent] claims personal injury by accident in Shawnee County, Kansas. 2. [Kent] claims said accidental injury occurred on or about January 22, 1991. 3. Respondent/insurance carrier admit [that Kent] met with personal injury by accident on or about the alleged date of accident. 4. Respondent/insurance carrier admit the relationship of employer-employee existed on the date of the accidental injury. 5. Respondent/insurance carrier admit that the parties are governed by the Kansas Workers Compensation Act. 6. Respondent/insurance [carrier] admit that proper notice of the alleged accident was made. 7. Trinity Universal Insurance Company was the insurance carrier for the respondent on the date of the accidental injury. 8. The parties stipulate that the average weekly wage on January 22, 1991, was $482.65. 9. Medical treatment has been furnished in the total amount of $17,616.00. There is no claim by the claimant for any past due or out of pocket medical reimbursement. 10. Temporary total disability compensation has been made in the amount of $87,848.00 representing 316 weeks at the rate of $278.00 per week. According to the Award, the following four issues, the first three of which were identical to those in Anderson, remained in dispute: 1. Whether claimant's accidental injury arose out of and in the course of his employment with respondent? 2. Whether timely written claim was served? 3. What is the nature and extent of claimant's disability and appropriate compensation, if any? 4. What is the liability of the Kansas Workers Compensation Fund? (Emphasis added.) Under FINDINGS, the ALJ found, among other things, that Kent's claim for compensation should be denied due to his abandonment of his claim, resulting in his failure to prove that his accidental injuries arose out of and in the course of his employment as follows:  Claimant has acknowledged under letter dated July 31, 2001 from his attorney that he is abandoning his claim. This abandonment was confirmed as the result of a pre-hearing settlement conference held on August 1, 2001. As a result of the outcome of that pre-hearing settlement conference counsel for the respondent/ insurance carrier had circulated on two separate occasions, an Agreed Award. Neither of these Agreed Awards was returned for filing as requested and respondent/insurance carrier has now sought issuance of [an] Award confirming the abandonment pursuant to Supreme Court Rule 170. It is therefore found that the claim for compensation should be denied due to claimant's abandonment of his claim resulting in failure to prove that his accidental injuries arose out of and in the course of his employment and that he served timely written claim. (Emphasis added.) Under the heading AWARD, the ALJ concluded: The Court accepts the stipulation of the parties and makes findings consistent with those outlined above. Accordingly, claimant's claim is denied. Like Anderson's ALJ, this one also held: All rights of the parties in this matter have been determined except the respondent/insurance carrier's right to proceed on securing the reimbursement. Trinity Universal then sought reimbursement of its $105,464 from the Director. In a letter dated April 17, 2003, Harness denied reimbursement on two bases: (1) no full hearing had occurred and (2) similar to his rationale regarding Anderson, claimant Kent would not lose his original entitlement merely through a subsequent untimely service of written claim or abandonment. First, it is questionable whether the November 18, 2002, award amounts to a full hearing. This is an award by default, initiated by the respondent, when the claimant was unavailable or unwilling to participate in a regular hearing. The award contains no substantive findings on the compensability issues of injury arising out of and in the course of employment or timely written claim. The award denied benefits simply because the claimant was not there to prove his case. Even if I assumed this was a full hearing, I cannot determine that the claimant was entitled to less than the benefits previously paid. A worker's entitlement to benefits does not depend on the existence of an award. Conversely, a default denial, such as in this case, that does not substantively address any compensability issues, fails to establish that the worker was never entitled to benefits.  (Emphasis added.) The employers and their insurance carriers in both matters then filed petitions for writs of mandamus, asking the trial court to compel reimbursement from the Director under K.S.A. 44-534a. Harness filed motions to dismiss, claiming that the trial court lacked subject matter jurisdiction and that mandamus was improper because plaintiffs were not entitled to the relief requested as a matter of law. As Harness had done in his letters denying the claims for reimbursement, he also alleged that there had not been a full hearing on the Kent claim and there had not been a determination of overpayment on either claim, both of which he asserted were required by K.S.A. 44-534a. Harness was succeeded by Paula Greathouse as Director. After consolidating the two actions, the trial court made findings of fact primarily by adopting the stipulations of the parties before the ALJs. It also added findings of fact in the Anderson claim: 6. The Administrative Law Judge found that Anderson had not timely filed a written claim, and that a timely application for hearing [had] not been made. Anderson's claim was denied. 7. Petitioners requested that Respondent certify the amounts it had voluntarily paid to Anderson, to the Commissioner of Insurance for reimbursement pursuant to K.S.A. 44-534a(b). 8. Respondent has declined to certify said amounts stating that denial of Anderson's claim was the result of an untimely application for hearing and a late written claim, and that there was no finding that Anderson was not entitled to the benefits when paid. 9. The relief Petitioners seek is enforcement of a provision of the Kansas Workers' Compensation Act, specifically, K.S.A. 44-534a. 10. That upon application for reconsideration of the director's denial of certification for reimbursement, the director indicated that if the parties wanted to stipulate that the injuries for which compensation was paid did not arise out of and in the course of employment, and obtain an amended order from the Administrative Law Judge to that effect, then the director would reconsider the application for certification.  (Emphasis added.) For the Kent claim the trial court added the following findings of fact: 6. The Administrative Law Judge denied Kent's claim because he found that Kent had abandoned it, and as a result [1] failed to prove that his accidental injuries arose out of and in the course of his employment, and that [2] he failed to serve a timely written claim. 7. Petitioners requested that Respondent certify the amounts they had paid to, or on behalf of, Kent, to the Commissioner of Insurance for reimbursement pursuant to K.S.A. 44-534a(b). 8. Respondent has declined to certify said amounts stating that denial of the claim was the result of abandonment, and that there was no finding that Kent was not entitled to the benefits when paid. 9. The relief Petitioners seek is enforcement of a provision of the Kansas Workers' Compensation [Act], specifically, K.S.A. 44-534a. (Emphasis added.) The trial court found that it had jurisdiction over mandamus actions, though a writ of mandamus should not issue unless a defendant's legal duty is clear. The court agreed with the Director's argument that K.S.A. 44-534a(b) requires a full hearing, which occurs when an administrative law judge enters an award after a preliminary hearing has been held. Sawyer v. Oldham's Farm Sausage Co., 247 Kan. 327, 333 (1990). The court also held there was no determination that the claimants had been paid more in benefits than those to which they were entitled. It concluded: It is clear that an employer would be entitled to reimbursement if it was determined at a full hearing that the injured worker was not entitled to receive benefits. However, there is nothing present in case law or statutory interpretation/ language that suggests reimbursement is appropriate when a full hearing has not been held. Additionally, there has been no determination that Petitioners paid more in benefits than the claimants were entitled to. Since Petitioners have failed to establish that the requirements of K.S.A. 44-534a(b) have been met, the Court cannot compel Respondent to certify a claim for reimbursement  her legal duty to do so is not clear. Therefore, Petitioners are not entitled to mandamus relief as a matter of law.