Court Opinion

ID: 9784791
Source: CourtListenerOpinion
Date Created: 2023-08-30 20:54:00.730281+00
Date Added: 2024-06-11T07:35:59.291802
License: Public Domain

Judge GRAHAM
dissenting.
I respectfully dissent because I believe that § 8-40-201(19)(b), C.R.S.2004, requires that a claimant’s average weekly wage (AWW) be increased only where the claimant has “continued” the employer’s coverage at his own cost. That statute states that “[t]he term ‘wages’ shall include the amount of the employee’s cost of continuing the employer’s group health insurance plan and, upon termination of the continuation, the employee’s cost of conversion to a similar or lesser insurance plan” (emphasis added). This language contemplates that the employee must continue the coverage, which necessarily assumes that the employee must actually purchase the coverage.
I reach this conclusion, in part, because of Midboe v. Industrial Claim Appeals Office, 88 P.3d 643 (Colo.App.2003), which concluded that the specialized terms “continuing” and “conversion” presuppose the actual payment for continued coverage:
Based upon the specialized meaning of these terms, we construe § 8-40-201(19)(b) to mean that a claimant’s AWW includes the cost of health insurance only when a claimant has “continued” the employer’s coverage at his or her own cost pursuant to COBRA or § 10-16-108, and thereafter, when that coverage ends and the claimant has converted to other coverage.
Midboe v. Industrial Claim Appeals Office, supra, 88 P.3d at 646.
COBRA provisions permit an employee to convert a policy only if the employee has been continuously insured under a group policy or the group policy has been terminated. Section 10 — 16—108(1)(e)(1), C.R.S.2004. Because these provisions are part of the same statutory scheme and relate to the same subject, they should be construed in pari materia with the AWW provisions. See Colorado State Board of Medical Examiners v. Jorgensen, 198 Colo. 275, 599 P.2d 869 (1979). I therefore find support in the COBRA provisions for the principle that an employee must actually continue and pay for coverage before the cost of that coverage may become a component of the AWW.
Finally, I rely upon the legislative declaration in § 8-40-102(1), C.R.S.2004, which states the intent that the Workers’ Compensation Act of Colorado be interpreted so as to assure quick and efficient delivery of benefits “at a reasonable cost to employers.” In calculating AWW, it seems more reasonable to base that wage upon real costs actually incurred by the employee. In my view, the most reasonable cost to the employer is the cost based upon actual paid coverage.
Humane Society v. Industrial Claim Appeals Office, 26 P.3d 546 (Colo.App.2001), relied upon by the majority for the proposition that cost means the list price as opposed to the paid price, is distinguishable. The division in that case only addressed the question of whether the AWW should combine the cost of health insurance paid by the employer with the claimant employee’s personal contribution to the health insurance premium prior to termination.
In reaching the conclusion that the AWW should include both contributions, the division in Humane Society relied upon Schelly v. Industrial Claim Appeals Office, 961 P.2d 547 (Colo.App.1997), where the claimant converted her health insurance to Medicare benefits. The claimant in Schelly argued that her AWW should include the cost of the health care paid by her employer at the time of her injury, which cost was higher than the cost for her conversion to Medicare. The Schelly division rejected the claimant’s argument and stated that § 8-40-201(19)(b) “provides that it is the cost to claimant of converting to a similar or lesser plan, not the employer’s cost of health insurance at the time of the injury, that is to be included in the average weekly wage.” Schelly v. Indus*896trial Claim Appeals Office, supra, 961 P.2d at 549 (emphasis added).
Humane Society and Schelly do not reject the proposition that the actual cost incurred by the claimant should be the component added to the AWW. Where the claimant chooses not to incur that cost (as in this case), the AWW should not be adjusted to include the hypothetical cost.