MS Court Affirms Denial of Quadriplegic’s Settlement Agreement
A Mississippi appellate court affirmed a decision by the state’s Workers’ Compensation Commission that denied—without a hearing—an injured worker’s petition to settle and close out the medical portion of his claim [Himeliz v. Hog Slat, 2021 Miss. App. LEXIS 264 (June 22, 2021). Noting that the Commission’s rules did not require a hearing, either by the Commissioner who initially denied the worker’s petition, or by the full Commission itself, the appellate court held it was in no position to second-guess the Commission’s determination, which had been entered after a full review of the circumstances of the case. The worker, whose injuries rendered him a quadriplegic, had been working in the United States pursuant to a work visa at the time of his accident.
Background
After multiple surgeries, Himeliz—a Mexican citizen—had some limited mobility in his hands. He could operate a specially equipped motorized wheelchair, but was clearly permanently, totally disabled. It was undisputed that he would require medical attention for the rest of his life. His visa expired sometime after his accident, and he is not entitled to any government benefits. Himeliz received a lump-sum payment for all disability benefits to which he was entitled by law. Subsequently, he and his employer voluntarily participated in mediation and agreed to a settlement that would close out the medical portion of his claim.
Commissioner Denies Settlement Petition
The parties submitted a petition for approval of a settlement agreement to the Mississippi Commission for approval. The proposed agreement included a structure plan and a structured settlement. No hearing on the matter was requested, and none was held. In February 2020, the proposed settlement was denied by Commissioner Aldridge based on the criteria set out in Mississippi Workers’ Compensation Commission Procedural Rule 2.15; presumably because she did not believe it was in Himeliz’s best interest.
Full Commission Agrees With Commissioner
In spite of the fact that the Commission’s rules provided no mechanism allowing for the review of the Commissioner’s decision, the parties filed a joint emergency petition for review. In due course, the full Commission denied the petition, indicating in its order that settlement approval was discretionary and that there was no rule that contemplated review by the full Commission of a proposed settlement that had been denied by a Commissioner. Nevertheless, the full Commission went on to analyze the proposed settlement—again without a hearing. After its analysis, the full Commission held that the proposed settlement was not in Himeliz’s best interest based on Rule 2.15.
Himeliz appealed, arguing in pertinent part that Commissioner Aldridge’s denial of the settlement was erroneous because no hearing was held and that upon denial of the settlement, there should have been a hearing before the full Commission. Himeliz’s former employer, Hog Slat Inc., joined in the appeal also alleging as error that the full Commission’s decision was not supported by substantial evidence.
Court of Appeals
Initially, the court of appeals noted that Miss. Code Ann. § 7103-61(1)(Rev. 2011) granted the Commission the power to write and enforce its own rules comformable to law that might be necessary to enable the Commission to discharge its duties. The court noted that Rule 2.15 states in relevant part:
In every case of compromise settlement, the proposed settlement will be explored and medical reports will be examined to determine if the amount of the proposed settlement appears fair and reasonable. The Commission or Administrative Judge shall not approve the settlement if it is:
a. not accurately reported,
b. not completely understood by the claimant, or
c. not in the best interest of the claimant.
The Commission or Administrative Judge will approve the settlement if:
a. the underlying facts, terms, and amount of the settlement are accurately reported,
b. claimant understands the settlement’s import and effect, and
c. the settlement is in claimant’s best interest.
No Hearing Required
The court stressed that Rule 2.15 did not require a hearing by a Commissioner, the full Commission, or an administrative judge in order for a settlement to be approved or denied. Only unrepresented claimants are required to be interviewed by the Commission prior to settlement approval. The court also pointed to Miss. Code Ann. § 71-3-29, which provides that commutation and lump sum settlement payments are to be governed by rules of the commission, and are not to be made except when determined to be in the best interest of the injured worker or his dependents, with the Commission having final authority in such questions. The court observed that the parties had cited no authority that required a hearing in this instance. The court specifically noted that Himeliz’s petition did not contain a request for a hearing.
No Duty to Conduct Independent Research
The court continued that there was every indication that the Commission had thoroughly reviewed the petition, exhibits, and medical records on file. The court said the Commission had no duty to conduct independent research, particularly when, as here, the claimant was represented by counsel. The court also noted that while the petition prepared by counsel for Himeliz set forth the details of the proposed settlement, it contained only one cursory statement about it being in Himeliz’s best interest: “Claimant avers that it would be in [his] best interest that this compromise settlement be approved.” The court speculated that Himeliz might have furthered his cause by giving the Commission specific reasons that he believed the settlement was in his best interest.
No Mechanism for Reversal
The court continued that even if it believed the best course of action would have been to conduct a hearing in order to give Himeliz the opportunity to show why the settlement was in his best interest, there was no legal mechanism that would enable the court to reverse the Commission in order to require it to adhere to a procedural rule that did not exist. Accordingly, the court found that the Commissioner was not mandated to hold a hearing prior to her denial of the proposed settlement, nor did she err in failing to do so. Likewise, the full Commission’s denial of the settlement was based on substantial evidence, and it did not err in rendering a decision without holding a hearing.
Denial Based upon Substantial Evidence
The court noted that in its denial, the Commission had expressed concern that the settlement agreement’s life-care plan provided only for “the best case scenario” for Himeliz. Specifically, in the three years since Himeliz’s injury he had required three surgeries, but the life-care plan did not include costs for potential future surgery despite the fact that one of Himeliz’s physicians said that he was at an increased risk for recurrence of pressure ulcers and the need for surgery to treat them. The Commission also noted that the settlement offer provided less than $200,000 per year for predicted future medical expenses, while expenses for the previous three years had averaged $1,000,000 per year.
The court observed as well that the Commission also had reservations about Himeliz’s support system—citing his family’s unreliability and his need for twenty-four hour care. Further complicating matters was the fact that English is not Himeliz’s primary language and he needs an interpreter to communicate with his care providers. Although the employer had been paying for an interpreter, the life-care plan would discontinue this service after a year of English lessons. Since the original injury, Himeliz has sustained a traumatic brain injury, and there was no indication that he was capable of learning English beyond his current level. The court noted other less important, but still relevant, evidence considered by the Commission that supported its decision.
Based on the foregoing, the court concluded that the Commission did not commit error in failing to conduct a hearing. Additionally, substantial evidence existed for the denial of the proposed agreement.