Bailey v. City of Lewiston

Name

Insurance Company

Date Decided

July 20, 2017

Panel Members

File Size

82 KB

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Summary from the Troubh Heisler Attorneys

Judge Goodnough established in a 2007 decree that Bailey had reached MMI from his 2001 respiratory injury that resulted in 32% PI, and it allowed ongoing partial incapacity benefits. In 2013 the City filed another petition to determine PI and introduced an updated medical exam showing that Bailey’s PI had decreased to 0%. Judge Goodnough granted the petition, found that the PI had changed to 0%, and terminated weekly benefits due to the durational limit. On appeal the Appellate Division reversed, holding that the 2007 determination of MMI was final and that the PI rating could not be reduced. The Court agreed to hear the City's appeal but then affirmed the Appellate Division’s decision.

Using unexpectedly sweeping language, the Court ruled that, in the absence of mistake of fact, fraud, or newly discovered evidence, "the workers' compensation statute provides no opportunity for a re-determination of a hearing officer's or ALJ's findings regarding permanent impairment or MMI." The Court further ruled that the "change of circumstances" analysis that applies to petitions seeking a change in weekly benefit levels "does not apply to a permanent impairment finding."

The Court noted that the statutory purpose of a PI determination is "to create a dichotomy of injured workers," whereby one class is potentially eligible for lifetime benefits and the other class is restricted to durationally-limited benefits. The Court then stated, "If a party were able to disturb a permanent impairment finding so as to either terminate an employee's eligibility to receive ongoing benefits or award such eligibility after it had already been denied, the statute would be completely circumvented and the provisions creating the temporal dichotomy rendered superfluous."

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