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Garcia v. Uninsured Employers' Fund

Court of Workers Compensation of Montana

June 16, 1998

STEPHEN T. GARCIA Petitioner
v.
UNINSURED EMPLOYERS' FUND/JULIE MANIACI Respondent/Insurer for PROFESSIONAL HEALTH PLANNING Employer.,

          Submitted: April 23, 1998

          FINDINGS OF FACT, CONCLUSIONS OF LAW AND JUDGMENT

          MIKE McCARTER JUDGE.

         Summary: An employer challenged the determination of the Uninsured Employers' Fund that an office manager injured in an automobile accident over the lunch hour was acting within the course and scope of employment. Employee claimed she was running an errand specifically authorized by the employer.

         Held: After carefully considering the conflicting testimony of the employee and employer, the WCC is unable to make the subjective judgment whether one was more credible than the other. The Court thus turned to the question of burden of proof, finding that where an uninsured employer files a petition to challenge a UEF determination, the petition is in the nature of an action for declaratory judgment. The burden of proof is thus properly placed on the UEF, which would bear that burden if it commenced its own action to obtain reimbursement from the employer. Thus, the WCC held the UEF is not entitled to indemnification from the employer.

         Topics:

Proof: Burden of Proof: Generally. Where an uninsured employer files a petition in the WCC to challenge the UEF's determination that a claimant is entitled to benefits and that it must reimburse the UEF, the action is in the nature of an action for declaratory judgment and the burden of proof is properly with the UEF, which would have that burden if it sought to collect reimbursement from petitioner. [Note: Although the WCC decision was affirmed on appeal in Garcia v. Uninsured Employers' Fund, 1999 MT 35N, an unpublished, nonciteable opinion, the Supreme Court did not reach the issue of burden of proof.]
Witnesses: Credibility. After carefully considering the conflicting testimony of two witnesses, the WCC was unable to make the subjective judgment whether one was more credible than the other and decided the case based on its determination of the burden of proof.

         ¶1 This matter was tried on April 23, 1998 in Bozeman, Montana. The petitioner, Stephen T. Garcia, was present and was represented by Mr. William Dean Blackaby. The Uninsured Employers' Fund was represented by Mr. Robert J. Campbell. Ms Julie Maniaci Brennan was present and represented herself.

         ¶2 Exhibits: Exhibits 1 through 18 were admitted without objection.

         ¶3 Witnesses: Stephen T. Garcia, Julie Maniaci Brennan, Charles Edquest and Bernadette Rice testified at trial. The parties also submitted depositions of Charles Edquest, Julie Maniaci, Bernadette Rice, Merle Bouma, D.C., and Curt Kurtz, M.D. for the Court's consideration.

         ¶4 Issues: The parties state the issues as follows:

1. Was the claimant acting in the course and scope of her employment when she was involved in a motor vehicle accident on November 10, 1995?
2. Has the UEF met its obligation under 39-71-502 and 39-71-503(1) by paying only "proper" benefits, managing medical and indemnity benefits appropriately and operated in "good faith" in managing the claim?

(Pre-trial Order at 3.)

         ¶5 Having considered the testimony at trial, the demeanor and credibility of the witnesses, the exhibits, the depositions submitted for the Court's consideration, and the arguments of the parties, the Court makes the following:

         FINDINGS OF FACT

         ¶6 Stephen T. Garcia (Garcia) is an independent agent for group health benefits plans. Since 1991 he has based his business in Bozeman, Montana.

         ¶7 On November 1, 1995, Julie Maniaci (Maniaci) began working for Garcia. (Maniaci has since remarried and changed her last name to Brennan. She is also referred to as Julie T. Murphy and Julie Foster in the exhibits. Her changes of name are the result of remarriages.)

         ¶8 Maniaci's job title was office manager and her duties included answering the telephones, filing, bookkeeping, and general management of the office. She worked 8:00 a.m. to 5:00 p.m., with one hour for lunch. She was paid for 40 hours a week, so she was not paid during her lunch hour.

         ¶9 On Friday, November 10, 1995, Maniaci left Garcia's office at approximately noon. She drove to Wendy's and had lunch. Lunch consumed approximately half an hour. Maniaci then reentered her car and within two blocks of Wendy's was involved in a car accident.

         ¶10 Although she did not immediately seek medical care, claimant was shaken up in the accident. She returned to Garcia's office to work the afternoon but left work a half hour early.

         ¶11 On Monday, November 13, 1995, Maniaci sought medical care from her family physician, Dr. Curt Kurtz. (Ex. 10 at 2.) She reported the accident to him and complained of left-side pain in the neck and thoracic region with radiating pain into her left shoulder. Dr. Kurtz diagnosed cervical and thoracic strain. (Id.)

         ¶12 On November 13, 1995, Maniaci also obtained massage therapy for "lumbar & cervical discomfort - for sprain." (Ex. 12.) She received additional massage therapy on November 15, 1995.

         ¶13 Maniaci did not work Monday or Tuesday, November 13 and 14, 1995. She returned to work November 15 and worked for approximately another month. She was then off work for more than a year and a half.

         ¶14 One or two weeks after the auto accident, Maniaci decided to pursue a workers' compensation claim with regard to her accident. She learned that Garcia did not have workers' compensation insurance and filed a claim with the UEF. The UEF accepted liability for the claim.

         ¶15 The UEF paid Maniaci temporary total disability benefits from December 19, 1995 through June 8, 1997. On June 8, 1997, claimant returned to work with another employer.

         ¶16 Since the accident, claimant has been treated by Dr. Kurtz, two chiropractors, a ...


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