Court Opinion

ID: 9458252
Source: CourtListenerOpinion
Date Created: 2023-08-04 20:46:23.575527+00
Date Added: 2024-06-11T17:35:41.348160
License: Public Domain

AINSWORTH, Circuit Judge
(concurring in part and dissenting in part):
I concur in the reversal of the lower court’s judgment relative to denial of further medical benefits but dissent from the affirmance of the judgment below insofar as it enjoined the enforcement of the compensation provisions of the Deputy Commissioner’s order of June 5, 1970.
*1117The majority opinion holds that the compensation claim of the longshoreman, Moses Lewis, Jr., is time barred by the provisions of 33 U.S.C. § 922, a provision of the Longshoremen’s and Harbor Workers’ Compensation Act. The decision we reach here is far-reaching, for not only is Moses Lewis, Jr.’s claim time barred, but if the principle announced by the majority prevails, many additional longshoremen’s claims (“many hundreds, if not thousands,” Dy.Com. brief, p. 20) will also be barr.ed. The end result will be to “set aside the agency interpretation of 40 years” (Dy.Com. brief, p. 20).
The longshoreman herein filed his claim for compensation informally by writing a letter several months after he was injured, and within one year thereof, to the Deputy Commissioner making claim for resumption of compensation payments. A formal claim on Form US-203 was not made but the Deputy Commissioner accepted the letter as the longshoreman’s claim and gave notice of it to the insurer and claimant and set a date for a prehearing conference. Neither the claimant nor the insurer thereafter pressed for a formal adjudication thereof or for a formal compensation order, and voluntary payments were made from time to time by the insurer to the claimant.
I agree with the agency construction of the Act that the longshoreman’s timely filed initial claim under 33 U.S.C. § 913(a) remains pending and open until a final determination by a deputy commissioner under 33 U.S.C. § 919(a); and that provisions of 33 U.S.C. § 922 permitting modification of awards, if applied for within one year of the last payment of compensation with or without an award, applies only to eases where a determination has been made by a deputy commissioner. No such determination was ever made prior to the present decision of the Deputy Commissioner before us for review. There were recommendations or informal approval by the Claims Examiner but they were not those of a deputy commissioner. See Agency Regulations §§ 01.11 and 31.8; 33 U.S.C. § 919(c). Thus the majority’s citation of Section 922 as a bar to the longshoreman’s claim is erroneous under the circumstances.
I attach as an appendix to this dissent a letter dated August 6, 1971 by the Bureau’s highest officer for Longshoremen’s Act matters relative to the Bureau’s interpretations of the Act on the matters involved in this case. The adverse consequences of the majority ruling which rejects an agency interpretation of many years’ standing are clearly delineated in the letter.
APPENDIX
U. S. DEPARTMENT OF LABOR EMPLOYMENT STANDARDS ADMINISTRATION
Bureau of Employees’ Compensation
Washington, D. C. 20211
August 6, 1971
[EMBLEM]
File No. 100-1523
Leavenworth Colby, Esq.
Special Assistant to the Attorney General
Department of Justice Washington, D. C. 20530
Dear Mr. Colby:
This letter replies to your request for the Bureau’s views as to the assertions of the appellee insurance carrier in their brief in the Moses Lewis case. These concern the effect of § 01.11 and § 31.8 of the Regulations respecting “informal adjudicatory processes” and the application of the modification provisions of § 22 of the Act in cases where payments of compensation have been made without the deputy commissioner having made a determination under § 19(a) of the Act as to the claimant’s condition or any other fact. You further ask how the carrier’s assertions, if accepted, will affect the administration of the Act.
Basically the carrier’s two assertions are directed toward the same end, namely, that injured workers should be required to file successive additional claims when*1118ever the carrier begins and stops voluntary payments of compensation, even though the worker has already filed within one year of injury his original claim as required by § 13(a) of the Act, which claim has never been finally determined by the deputy commissioner as required by § 19. This is so, the carrier says, because (1) any agreement of the parties for voluntary payments, if not rejected by a claims examiner, is an “informal adjudication” under the terms of § 01.11 and § 31.8 of the Regulations and because, in any case, (2) the statute of limitations on modifications of awards under § 22 of the Act requires re-filing a claim each time the carrier begins and stops voluntary payments even where no agreement for payment was recommended.
This demand of the carrier for multiple re-filing of claims is untenable and unworkable. It would require every injured worker, to prevent forfeiture of his timely-filed claim before it was ever determined by the deputy commissioner under § 19, to re-file his claim at least once each year unless the carrier had never paid compensation at all. Such a requirement would result in an excessive multiplication of paper work in the district offices and would require greatly increased administrative handling of cases to assure claimants the protection of their rights under the Act.
Under § 01.11 and § 31.8 such informal agreements are plainly neither “informal adjudications" nor “settlements". They are not determinations by the deputy commissioner, but merely agreements by ,the parties as to their appraisal of the then existing factual situation of the claimant, to which the claims examiner has seen no reason to object. The carrier’s contrary contention would place the Regulations in clear violation of § 13 and § 19 of the Act.
Authority for the informal adjudicatory processes to which Regulation § 01.11 refers (i. e., adjudication of claims without formal hearing) is found solely in § 19(c) of the Act and not elsewhere. The deputy commissioner, although no formal hearings are held, must still, under the Act “determine all questions in respect of such claim” and “by order reject the claim or make an award.” Contrary to the carrier’s assertions claims examiners have no authority whatsoever to make “adjudications”, informal or otherwise. In § 31.12 the Regulations accordingly prescribe that, whether formally or informally, “orders adjudicating claims for compensation” shall be so designated, shall conform to numerous other explicit requirements, and shall be served personally or by registered mail upon the claimant, the employer and the insurance carrier.
These requirements of § 01.11 and § 31.-12 of the Regulations are complemented by § 31.8 and § 31.15. Section 31.8 prescribes the procedure for pre-hearing agreements of the parties,, leading either to informal adjudications under § 01.11 of the Regulations and § 19(c) of the Act, or to interlocutory agreements upon recommendations which lead to voluntary payments by the carrier for a certain period without any such “informal adjudication”, thus leaving the matter for later determination by the deputy commissioner under § 19 of the Act. To prevent any misunderstanding, § 31.15 of the Regulations expressly prescribes that “during the pendency of a compensation case” formal orders shall not be made “with respect to interlocutory matters” in the course of proceedings on a claim and § 31.8 further prescribes that the parties should be told that such agreements, although recommended, cannot be determinations or decisions of the deputy commissioner as required by § 19 of the Act.
The procedure followed by the Bureau does not result in an “informal adjudication” of the claim, as described in § 01.-11 of the Regulations and § 19(c) of the Act until the deputy commissioner has determined “all questions in respect of such claim” and has filed and served a compensation order. The action of the parties and the claims examiners cannot be considered an agreement of settlement to waive or release claimant’s *1119rights, but is merely an interlocutory agreement as to certain facts assumed to exist at the time. It is merely an interlocutory step in a pending case, which was begun by the filing of “a claim”, and will be finally concluded only by a determination by the deputy commissioner and the filing of “a compensation order” after informal or formal adjudication under § 19(c) of the Act and § 01.11 and § 31.12 of the Regulations. Informal adjudication cannot be made by approval of agreed settlements by the interested parties in the sense in which the carrier uses the term. Informal and formal adjudications of claims both require, in compliance with § 19 of the Act, that the deputy commissioner “determine all questions in respect of such claim” and file and serve a compensation order. Permanently binding settlements, as contrasted with interlocutory agreements, are expressly prohibited by § 15(b) and § 16 of the Act, except with Secretarial approval, and then only to the limited extent prescribed explicitly in 20 C.F.R. § 31.26. The carrier is in error in comparing the power of a claims examiner to that of a district judge in a Jones Act action for damages, for not even the deputy commissioner may make a final award for full damages for all past and future pain and suffering, loss of wages and consequential damages. Compensation is only a scheme for providing injured workmen medical care and subsistence payments. No adjudication under compensation acts is final in the sense to which the carrier refers. All determinations are subject to modification: forever, as to the carrier; for one year after the final payment after a deputy commissioner’s award as to the injured worker.
The administrative effect of the carrier’s view that recommendations of claims examiners, despite the contrary requirement of § 19 of the Act, should constitute “informal adjudicatory processes” would be far-reaching. It would destroy the existing interlocutory claim procedures by which all but a few claims are amicably disposed of without either informal or formal adjudication. If such recommendations were to constitute final adjudicatory action, however informal, they would be subject, under the Administrative Procedure Act, 5 U.S.C. 551(6) and (7); 702-706, to the requirement of a record containing substantial evidence and to judicial review in any “applicable form of action.” For such review proceedings no limitation period is prescribed. Claimants would be able to assert many years later that there was no substantial evidence before the examiner and that they were overreached by carriers. This would be destructive of the Act’s self-executing principle and the procedures prescribed in § 01.11 and § 31.12 of the Regulations. It would, moreover, place review of the vast majority of all litigated compensation cases outside the provisions of § 921 of the Act.
The contention of the carrier, that where cases are closed or reclosed as inactive without adjudication by a final order of a deputy commissioner they have been finally adjudicated, would be in clear violation of § 01.11(a) of the Regulations and § 19(a) of the Act. The annual reports of the Bureau show that in each year some 100,000 cases are “closed” or “reclosed” without proceeding to such final adjudication. These unadjudicated cases are only closed in the sense that the files are retired as inactive. Unadjudicated claims remain pending, subject to reopening,- until they have been finally determined and adjudicated by a deputy commissioner as required by § 19 of the Act.
The carrier’s second assertion is that the provisions of § 22 of the Act for modification of awards apply to every case where there has been any voluntary payment of compensation, whether or not there is a changed condition or mistake in the deputy commissioner’s determination. This, the carrier asserts, requires every employee to file an additional claim within one year after any stoppage of voluntary payments although the employee already has on file a timely original claim, still pending un*1120determined by the deputy commissioner. This assertion of the carrier disregards the plain terms of the first sentence of § 22 which restrict modification to only eases involving changed condition or mistake in a “determination of fact by the deputy commissioner.”
The terms of § 22 thus refer back to § 19(a), which grants to the deputy commissioner exclusive “full power and authority to determine all questions” in respect of claims. For § 22 to apply, therefore, there must have first been either an informal or formal determination and adjudication by the deputy commissioner within the meaning of § 19(c). Absent such a previous determination by the deputy commissioner (not by a claims examiner), § 22 has nothing upon which to operate. There is nothing for “modification”. The one-year statute of limitations on the power to modify cannot be translated into an addition to § 13(a) of a requirement that multiple claims must be filed by the employee each time voluntary payments are stopped.
The Act does not contemplate the filing and consideration of a succession of claims to be renewed after each stoppage of voluntary payments. It provides in § 14 that compensation shall be paid “periodically” and “promptly” in place of wages, and requires the employer to notify the deputy commissioner if payments are stopped, clearly indicating that “a claim” once filed shall cover all disabilities and eventualities until the case is finally acted upon. It provides in § 13(a) and § 19(a) for the filing of “a claim for compensation”, which one claim, once filed, covers all consequences of the injury reported until that one claim is finally adjudicated. Were this not so, an award could be made only for that period of disability which preceded the date of each successive claim filed; employees would then be required to file a new claim for each week of disability. If they did not re-file at least once each year their pending, timely claim would be forfeited.
The foregoing is contrary to the terms of the Act. Once filed, a claim remains pending until finally acted upon. Section 14(h) requires the deputy commissioner, if the claim is controverted or payment stopped, to take such action as will protect the fights of the parties. Section 19(c) requires him to hold a hearing if requested. But whether acting under § 14(h) or § 19(c), only the deputy commissioner, and' not a claims examiner, is given by § 19(a) “full power and authority to hear and determine all questions” concerning the claim. Only he must “by order reject the claim or make an award”, and without his determination there is nothing susceptible of modification under § 22 any more than of judicial review under § 21(b).
The effect on the administration of the Act, if the carrier’s view were to be accepted and each stoppage of voluntary payments would require the employee to file an additional claim notwithstanding he already has a timely filed claim remaining unadjudicated, would be administratively unworkable. Under such a view an employer could after a short period discontinue voluntary payments on a timely filed claim, give the disabled workman light employment for a year or more following the date of last payment of compensation, and then discharge him. The worker’s right to compensation would then be forever barred because of the limitations in § 22, even though there was pending a timely filed but unadjudicated claim for compensation.
In short, the assertions of the carrier are in clear contradiction of the Bureau’s Regulations and the terms of the Act, and would destroy the purposes of the Act and its administration.
Sincerely,
(Signed) JOHN E. STOCKER
JOHN E. STOCKER
Assistant Director
Office of Longshoremen’s and Harbor Workers’ Compensation