CASE NO. 696 CRD-1-88-2Workers’ Compensation Commission
SEPTEMBER 15, 1989
The claimant was represented by David E. Johnson, Esq., Johnson McLaughlin.
The respondent-employer was represented by John F. Nagle, Esq., Leone, Throwe, Teller, and Nagle.
The respondent-insurer was represented at the trial level by Lucas Strunk, Esq., Pomeranz, Drayton Stabnick. However respondent-insurer did not participate in oral argument.
This Petition for Review from the February 3, 1988 Finding and Award of the Commissioner at Large Acting for the First District was heard April 28, 1989 before a Compensation Review Division panel consisting of the Commission Chairman, John Arcudi, and Commissioners Frank Verrilli and A. Thomas White Jr.
OPINION
JOHN ARCUDI, CHAIRMAN.
At issue in this appeal is the 1982 legislation, P.A. 82-398, now included in Sec. 31-284b.[1] Claimant had an August 4, 1983 compensable injury to his left upper extremity for which the employer’s carrier paid benefits, including a 65.48 week specific disability benefit beginning June 10, 1985. While at work for this employer claimant was covered in a group medical plan for which the employer and employee each paid one half the premiums. This arrangement continued after the 1983 injury until December 31, 1985. At that time the group insurer was changed from Guardian Life to New York Life. Apparently there was also an expansion of the benefits package. This caused a threefold increase in monthly premiums. Claimant refused to pay the increase in his proportionate share beginning January 1, 1986.
During the period that claimant was receiving disability benefits he and his family incurred medical expenses which would have been covered under the group plan in effect on August 4, 1983, the date of the injury. The trial commissioner’s February 3, 1988 decision ruled that the employer had to make the employee whole for those medical expenses incurred since the employer’s obligation under Sec. 31-284b was to give the employee equivalent coverage to that existing at the time of the injury.
On appeal the respondent contends that its 31-284b
obligation was extinguished when the employee refused to pay one half the new monthly premium beginning January 1, 1986. Although not stated in those precise words, the commissioner’s ruling that the employer failed “to observe the requirements of Section 31-284b since January 1, 1986,” Finding, Paragraph 8, necessarily includes a finding that the new medical insurance package provided after January 1, 1986 was not “equivalent” coverage to that existing August 4, 1983. Such a factual conclusion seems obvious. This tribunal cannot disagree.
Claimant’s appeal concerns $2,806.55 in medical expenses incurred before December 31, 1985. The commissioner found that the employer had provided coverage through that date and had therefore fulfilled its Sec. 31-284b obligation until then. The remaining dispute over the unpaid expenses was then over an interpretation of the group insurance policy. The ruling below was that our limited jurisdiction does not permit us to pass on that contractual question. We agree. Besides the group insurance carrier was not a party before the commissioner.
The Finding and Award is affirmed and the appeals are dismissed.
Commissioners Frank Verrilli and A. Thomas White Jr. concur.