Mark Grubbs v. Paulo Products Company

administrative law judge found that the employee did so by the filing of a Form WC-21, Claim for Compensation. The administrative law judge concluded that because the employee marked the box "Second Injury Fund Only" on the pre-printed Form WC-21, the claim of September 29, 2005, was not a claim against the employer/insurer under the provisions of $\S 287.430$.

For ease of reference, we quote the following passages from the administrative law judge's award:

The statute that allows for the settlement of cases, Mo. Rev. Stat. § 287.390.1 (2000), specifically allows for the compromise of any dispute or claim for compensation..." [emphasis added]. Based on this wording, the legislature intended there to be the ability to settle not only cases with a claim for compensation, but also cases where there are disputes, but no claim.

Claimant next argues that the phrase "a claim" in Section 287.430 means any claim including an "'informal' claim for compensation against an employer-insurer which is settled without filing a formal claim." Claimant argues that the settlement on November 15, 2004 amounts to an informal claim against the Second Injury Fund. This argument runs afoul of the very wording of Section 287.430 .

According to Section 287.430, "[t]he filing of any form, report, receipt, or agreement, other than a claim for compensation, shall not toll the running of the periods of limitation provided in this section." There can be no doubt based on this sentence that the agreement reached on November 15, 2004, does not constitute a claim for the purposes of the statute of limitations. By using "claim for compensation" in this section, I find the legislature was clearly referring to the formal document entitled Claim for Compensation (Form WC-21) that Claimant first filed on September 21, 2005. Therefore, Claimant's argument that he had a year after the settlement of the case against Employer to file a claim against the Second Injury Fund, when a claim was never previously filed, is without merit.

Award p. 9.

The provisions of the Missouri Workers' Compensation Law (Law) and the Division of Workers' Compensation Regulations that bear on our decision are set out below:

Section 287.430 RSMo.

Except for a claim for recovery filed against the second injury fund, no proceedings for compensation under this chapter shall be maintained unless a claim therefor is filed with the division within two years after the date of injury or death, or the last payment made under this chapter on account of the injury or death, except that if the report of the injury or the death is not filed by the employer as required by section 287.380 , the claim for compensation may be filed within three years after the date of injury, death, or last payment made under this chapter on account of the injury or death. The filing of any form, report, receipt, or agreement, other than a claim for compensation, shall not toll the running of the periods of limitation provided in this section. The filing of the report of injury or death three years or more after the date of injury, death, or last payment made under this chapter on account of the injury or death, shall not toll the running of the periods of limitation provided in this section, nor shall such filing reactivate or revive the period of time in which a claim may be filed. A claim against the second injury fund shall be filed within two years after the date of the injury or within one year after a claim is filed against an employer or insurer pursuant to this chapter, whichever is later. In all other respects

the limitations shall be governed by the law of civil actions other than for the recovery of real property, but the appointment of a conservator shall be deemed the termination of the legal disability from minority or disability as defined in chapter 475, RSMo. The statute of limitations contained in this section is one of extinction and not of repose.

Section 287.390.1 RSMo.

Nothing in this chapter shall be construed as preventing the parties to claims hereunder from entering into voluntary agreements in settlement thereof, but no agreement by an employee or his dependents to waive his rights under this chapter shall be valid, nor shall any agreement of settlement or compromise of any dispute or claim for compensation under this chapter be valid until approved by an administrative law judge or the commission, nor shall an administrative law judge or the commission approve any settlement which is not in accordance with the rights of the parties as given in this chapter. No such agreement shall be valid unless made after seven days from the date of the injury or death.

Division regulation 8 CSR 50-2.010(7)

The employee or the employee's dependents may file a Claim for Compensation. In order that the place of setting may be determined, the county in which the accident occurred must be stated on the claim, and if the injury occurred outside of the state of Missouri, the name of the county in which the contract of employment was made must be stated. The claim shall be filed with sufficient copies for the division and each employer and insurer named, and the attorney general in case of a Second Injury Fund claim. The claim must be filed within the time prescribed by sections 287.430 or 287.440, RSMo, for accidental injuries, or section 287.063.3, RSMo, for occupational disease. A claim against the Second Injury Fund must be asserted affirmatively by the claimant and cannot be made by any other party to the claim, on motion or otherwise. Naming the state treasurer as a party is not, in itself, sufficient to make a claim against the fund. Injuries which are claimed to create fund liability must be specifically set forth in the Claim for Compensation.

(A) The filing of a claim initiates a contested case.

(B) A claim against an employer/insurer and the Second Injury Fund are against two (2) separate parties and the assertion of a claim against one is not an assertion of a claim against the other.

The word "claim" appears in several different clauses in $\S 287.430$. For purposes of Chapter 287, what does "claim" mean? What is a "claim for recovery"? What is a "claim for compensation"? What is a "claim against the Second Injury Fund"? These words and phrases are not defined in the Workers' Compensation Law. "It has long been established that a claim for compensation must be direct and unequivocal and must call for some immediate action by the Commission." Clanton v. Teledyne Neosho, 960 S.W.2d 532, 534-535 (Mo. App. 1998), citing Higgins v. Heine Boiler Co., 328 Mo. 493, 41 S.W.2d 565, 572 (Mo. 1931).

Black's Law Dictionary defines "claim" as "[t]he aggregate of operative facts giving rise to a right enforceable by a court." Alternately, Black's defines "claim" as "[a]n interest or remedy recognized at law; the means by which a person can obtain a privilege, possession, or enjoyment of a right or thing; CAUSE OF ACTION." Webster's Dictionary says "claim" means "a demand for compensation, benefits, or payment (as one made in conformity with provisions of the Social Security Act or of a workmen's compensation law...)." "A 'claim' even in the barest of layman's language, includes not only a lawsuit but also a claim settled out of court." Williams v. Barnes Hospital, 736 S.W.2d 33, 38 (Mo. 1987).

The administrative law judge is convinced that the legislature was clearly referring to Form WC-21 when it used the phrase "claim for compensation" in $\S 287.430$. We disagree for several reasons. First, the portion of the statute reading, "no proceeding for compensation under this chapter shall be maintained unless a claim therefore [is] filed," has remained unchanged since the Workmen's Compensation Law was enacted by referendum in 1926. We find it highly improbable that those voting on this language in the 1920s were concerned with a particular form. If they were, they simply could have provided for one as they have in so many other statutes.

Second, if we accept the administrative law judge's conclusion that "claim" as it appears in the Law means the Form WC-21, Claim for Compensation, accepted meanings of many other provisions of the Law are called into question. For example, $\S 287.390 .1$ provides that an administrative law judge can only approve a settlement entered into between "parties to claims." If "claim" means only the WC-21, then an administrative law judge can only approve a settlement entered into between parties to a dispute for which a Form WC-21 has been filed. The settlement between employee and employer/insurer in this case would be invalid because no WC-21 was filed before the administrative law judge approved the settlement. We find no indication in the plain language of the statute to support such a legislative intent.

We are not the first tribunal to ponder the legal significance of the submission of a settlement agreement before any document entitled a "claim for compensation" has been filed:

The filing of the settlement agreement gave the commission jurisdiction of the plaintiff's claim for compensation for injuries ensuing on account of the accident. It was in effect the filing of a claim fo