Catastrophic Injuries

Thursday, March 20, 2014 | 0

Dean Sziraki was employed in his family’s paving business when his world came crashing in on May 14, 1991. That day, while in the course of his work, he was injured in a one-car accident that resulted in catastrophic brain and spinal-cord injuries.

He spent the next 16 years as a quadriplegic and in a near-vegetative state in hospitals and long-term-care facilities. This is the story of his workers’ compensation claim.

After his accident, the Ohio Bureau of Workers’ Compensation allowed his initial claim for multiple trauma and spinal-cord injuries. The Bureau paid for his medical and nursing-home expenses, and it required periodic medical updates on his condition.

In 1998, Dean’s mother, Marilyn – his only next of kin – applied on his behalf for permanent total disability benefits. He was entitled to those benefits because he had lost the use of his arms and legs. (The law provides for 225 weeks of compensation for the loss of each arm and 200 weeks for the loss of each leg, for a total of 850 weeks.) In April 2002, the Industrial Commission of Ohio – which handles such matters – granted the benefits. They were to begin on March 20, 2002.

On June 7, 2002, the Bureau notified Marilyn that Dean was eligible to begin receiving the benefits but that payments would be withheld until it received either a power of attorney or evidence of a court-ordered guardian for Dean.

Nearly four years later, in 2006, the Bureau wrote to Marilyn and her attorney; there was still no guardian, and no payments had been made. The letter asked Marilyn to respond within 30 days; if she didn’t, the Bureau would refer the matter to the attorney general to file a suggestion of incompetency for Dean with the probate court.

Marilyn never responded, but the Bureau never referred the matter to the attorney general.

On January 8, 2007, Dean passed away. He had no surviving spouse and no dependents. Marilyn, as administrator of his estate, filed an appeal because Dean’s death benefits didn’t include benefits for the loss of his four extremities.

In response, the Industrial Commission awarded compensation for 850 weeks, but due to the law’s two-year limit on retroactive payment, the Commission limited the amount payable to 104 weeks – the amount that Dean would have been able to receive had he filed for compensation on the date of his death.

The estate filed a complaint for a writ with the court of appeals to award the full 850 weeks. It also asserted that the Bureau had abused its discretion when it failed to award the benefits without an application from Dean.

The court of appeals denied the writ, finding that the Bureau did not abuse its discretion by imposing a formal application requirement. After that, the case came before us – the Ohio Supreme Court.

By a 4-3 vote, our court affirmed the court of appeals’ decision. The majority concluded that the Bureau had no clear legal duty to award benefits to Dean during his lifetime in the absence of an application.

Chief Justice Maureen O’Connor, Justice William M. O’Neill, and I cast the dissenting votes. “Given the context of this case,” Chief Justice O’Connor wrote in her dissent, “I would hold that the court of appeals’ decision affirming the Bureau’s failure to award benefits during Dean’s lifetime was arbitrary, unreasonable, and unconscionable.”

Because the Bureau required periodic medical updates of Dean’s condition, it knew that he was medically eligible for an award for the loss of use of both arms and legs. It also knew that Dean was unable so seek benefits on his own behalf or solicit help for that purpose. And it knew that he had no guardian or other representative acting for him.

It wasn’t until 2006 that the Bureau finally wrote to Marilyn about its inability to pay the benefits that were already awarded because there was no guardian. In that letter, the Bureau stated that if Marilyn failed to respond, it intended to refer the matter to the attorney general.

Marilyn didn’t respond, but the Bureau took no action to pursue a guardianship for Dean, even though it clearly knew he was entitled to additional benefits that he wasn’t receiving and that he would never receive them unless someone acted on his behalf.

The majority didn’t dispute these facts, but nevertheless affirmed the court of appeals’ judgment. The majority emphasized that the pertinent law contemplates the need for an application. However, the law does not require an application.

Given that the Bureau had the authority to act in the absence of an application, given its full knowledge that Dean was too disabled to seek benefits on his own and given its assertion that it would refer the case to the attorney general if Marilyn didn’t act, we dissented. We would have held that the Bureau had a clear legal duty to act by either exercising its discretion to confer benefits in the absence of an application or to pursue the referral to the attorney general so that a guardian could be appointed.

The Bureau knew that it had awarded some benefits to a worker whose quadriplegia and inability to communicate rendered him incapable of pursuing his own interests, and that he was entitled to more benefits if given the proper guardian. The Bureau also knew that it had the discretion to award those benefits even without the application.

As an arm of the state, the Bureau had a duty to act to pursue a referral of Dean’s case to the attorney general to secure the proper guardianship, given that it knew Marilyn had not done so.

Rather than reinforcing the Bureau’s dereliction of its duty by affirming this judgment, we would have reversed the court of appeals’ judgment, and ordered the award of the 850 weeks of benefits – not to benefit Dean’s relatives, but to ensure that the welfare of future participants in the workers' compensation system will not be jeopardized by the system’s inaction in the face of a clear duty.

The case referred to is State ex rel. Estate of Sziraki v. Admr., Bur. Of Workers' Comp., 137 Ohio St.3d 201, 2013-Ohio-4007. Case No. 2011-0799. Decided Sept. 18, 2013. Opinion Per Curiam.

Paul E. Pfeifer is a justice on the Ohio Supreme Court. This column was reprinted from his weekly newspaper column.