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Robinson v. Montana State Fund

Court of Workers Compensation of Montana

April 6, 2018

JANIE L. ROBINSON Petitioner
v.
MONTANA STATE FUND Respondent/Insurer.

         Summary: Respondent moved for summary judgment on Petitioner's two causes of action. First, Respondent argues it can take the Social Security offset from Petitioner's PTD benefits under § 39-71-702(4), MCA, because Petitioner is receiving PTD benefits and SSDI benefits because of her two industrial injuries. Second, Respondent argues it did not violate Petitioner's due process rights when it took the offset and began recouping an alleged overpayment before she had the opportunity for a hearing. Petitioner cross-moved for summary judgment. First, she argues that Respondent cannot take the offset because the statute states that the insurer can take the offset only when SSDI benefits are awarded "because of the injury, " which Petitioner interprets as applying only when the claimant has one industrial injury. Second, Petitioner argues that Respondent violated her right to due process by taking the offset and recouping an overpayment before she had the opportunity for a hearing and that she is entitled to "such damages as are just for the violation of her right to due process."

         Held: Respondent is entitled to summary judgment on Petitioner's offset claim. Section 39-71-702(4), MCA, covers situations in which a claimant is receiving PTD benefits and SSDI benefits because of two industrial injuries under the rule of statutory construction providing that the "singular includes the plural." This interpretation also upholds the legislative intent of the offset statute. Petitioner's due process claim, in which the only remedy she seeks is damages, is dismissed because this Court does not have subject matter jurisdiction over tort claims.

          Submitted: October 21, 2016

         ORDER AND JUDGMENT GRANTING RESPONDENT'S MOTION FOR SUMMARY JUDGMENT AS TO PETITIONER'S OFFSET CLAIM, DENYING PETITIONER'S CROSS MOTION FOR SUMMARY JUDGMENT AS TO PETITIONER'S OFFSET CLAIM, AND DISMISSING PETITIONER'S DUE PROCESS CLAIM FOR LACK OF SUBJECT MATTER JURISDICTION

          DAVID M. SANDLER, JUDGE

         ¶ 1 Petitioner Janie L. Robinson petitioned this Court for a ruling that Respondent Montana State Fund (State Fund) is not entitled to take the Social Security offset from her permanent total disability (PTD) benefits under § 39-71-702(4), MCA. Robinson also alleges that State Fund violated her right to due process when it took the offset and reduced her PTD benefits by $40 per week to recoup an alleged overpayment before she had the opportunity for a hearing and asks this Court to award her damages. State Fund moved for summary judgment, arguing it is entitled to take the offset and it did not violate Robinson's right to due process. Robinson opposes State Fund's motion and has cross-moved for summary judgment.

         ISSUES

         ¶ 2 The following issues are before this Court:

Issue One: Is State Fund entitled to take the Social Security offset from Robinson's PTD benefits under § 39-71-702(4), MCA?
Issue Two: By offsetting Robinson's PTD benefits before Robinson had the opportunity for a hearing, did State Fund violate her right to due process under Article II, Section 17 of the Montana Constitution, thereby entitling her to damages?

         UNDISPUTED FACTS

         ¶ 3 Robinson suffered two industrial accidents while working for South Peak Angus Ranch, which State Fund insured at all times relevant to this case. On July 4, 1996, Robinson suffered a brain injury due to heat stroke. As a result of this injury, Robinson has been treated for cognitive difficulties, depression, anxiety, panic disorder, posttraumatic stress disorder, and chronic migraine headaches. On March 19, 2004, Robinson suffered a low-back injury.

         ¶ 4 State Fund accepted liability for both injuries.

         ¶ 5 On March 29, 2006, State Fund determined that Robinson was permanently totally disabled and began paying her PTD benefits.

         ¶ 6 On December 28, 2011, Robinson applied for Social Security benefits, asserting that she had been unable to work since March 19, 2004, the date of her low-back injury.

         ¶ 7 On January 30, 2014, the Social Security Administration determined that Robinson was disabled and entitled to Social Security Disability Insurance (SSDI) benefits, effective December 1, 2010. The Administrative Law Judge cited the effects of both Robinson's brain injury and her low-back injury as the disabling conditions. The Decision from the Social Security Administration states, in relevant part:

3. The medical evidence in the record establishes that the claimant has the following medically determinable severe impairments: a history of a traumatic brain injury resulting in a cognitive disorder NOS and a posttraumatic stress disorder; a mood disorder due to general medical condition; a panic disorder with agoraphobia; a depressive disorder NOS; an anxiety disorder NOS; and pain disorder with both psychological factors and medical condition. The claimant also has a combination of physical impairments that have affected her ability to work since her alleged onset date, including chronic migraine headaches and a degenerative back impairment with chronic low back pain.[1]

         ¶ 8 On July 17, 2014, State Fund learned that the Social Security Administration had determined that Robinson was disabled and entitled to SSDI benefits.

         ¶9 On July 31, 2014, State Fund notified Robinson that it was entitled to take the offset from her PTD benefits in the amount of $65.13 per week and that, starting July 29, 2014, it would take the offset. State Fund also advised Robinson that because it had been entitled to take the offset from her PTD benefits paid since December 1, 2010, it had overpaid her PTD benefits, and asserted that it was entitled to recoup the overpayment.

         ¶ 10 On August 29, 2014, Robinson asserted that State Fund was not entitled to take the offset under § 39-71-702(4), MCA. In a letter to the claims examiner, Robinson's attorney stated:

Ms. Robinson has suffered two workers' compensation injuries, not one. Both of those injuries combined to render her totally disabled for Social Security purposes. However, the statute refers to "the injury." How in your calculations do you, if at all, accommodate the fact that this offset statute may not apply to Ms. Robinson because of the fact that she suffered two workers' compensation injuries, not one?

         ¶ 11 In response, State Fund reaffirmed its position that it was entitled to take the offset and recoup the overpayment. In a letter to Robinson's attorney dated October 2, ...


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