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Coulombe v. Anthem Blue Cross/Blue Shield of Maine11/1/2002
Reporter of Decisions
Argued: October 10, 2002
Anthem Blue Cross/Blue Shield of Maine, Inc., appeals from a decision of a hearing officer of the Workers' Compensation Board granting the employee's petition for award and awarding partial incapacity benefits. Anthem challenges the hearing officer's interpretation of Board Rule chapter 1, § 5(3)(A), which permits the inclusion of fringe benefits in the employee's post-injury wages “to the same extent” that fringe benefits are included in the pre-injury wages. Me. W.C.B Rule ch.1, § 5(3)(A). Because the Board Rule represents a clarification of an ambiguity in the governing statute and does not exceed the scope of the Board's rulemaking authority, we affirm.
I. CASE HISTORY
Alice J. Coulombe suffered a work-related injury in May 1999, while employed by Blue Cross/Blue Shield of Maine. She returned to work in August 2000. Coulombe found post-injury work with a different employer, Maine Medical Center for Cancer (MMCC), in October 2000. She left that employment in November 2000, for family medical care reasons, returning to work for MMCC in June 2001.
Coulombe filed a petition for award of partial incapacity benefits in August 2001. The parties agreed that Coulombe's pre-injury average weekly wage was $571.00 with an additional $121.97 in fringe benefits. The parties also agreed that her current weekly earnings at MMCC are $460 with an additional $188.81 in fringe benefits. The hearing officer granted Coulombe's petition for partial incapacity benefits.
The law, 39-A M.R.S.A. § 102(4)(H) (2001), requires the inclusion of noncontinuing fringe benefits in the calculation of the employee's pre-injury wage in many circumstances. See Beaulieu v. Me. Med. Ctr., 675 A.2d 110, 111 (Me. 1996). The law does not directly address calculation of fringe benefits in computing the post-injury average weekly wage. Board Rule chapter 1, § 5(3)(A), addresses calculation of fringe benefits in the post-injury average weekly wage as follows: “The fringe benefit package of any subsequent employers must be included in the computation of the employee's post-injury earnings to the same extent that it is included in the employee's pre-injury average weekly wage.” Me. W.C.B. Rule ch. 1, § 5(3)A (emphasis added).
Although Coulombe had higher fringe benefits in her post-injury employment than in her pre-injury employment, the hearing officer interpreted Rule 5(3)(A) to mean that because the employee had $121.97 in pre-injury fringe benefits, Coulombe's fringe benefits in her post-injury employment would also be calculated at $121.97 a week in determining her entitlement to partial incapacity benefits.
The hearing officer computed Coulombe's pre-injury earnings by adding Coulombe's pre-injury wage and her fringe benefits ($571 + $121.97 = $692.97). Using the Board's Weekly Benefit Table, 80% of the after-tax average weekly pre-injury wage is $450.02.
Adding the current post-injury earnings and fringe benefits results in a post-injury wage of $581.97 ($460 + $121.97). Using the Weekly Benefit Table, 80% of the after-tax weekly post-injury wage is $387.34. Calculating the benefit for this period results in a weekly benefit of $62.68 ($450.02 - $387.34). If all of Coulombe's post-injury employment fringe benefits were included in the calculation, her weekly benefit would be reduced to approximately $24.
Anthem filed a motion for further findings of fact. The hearing officer issued further findings of fact, but did not alter the calculation. We granted Anthem's petition for appellate review pursuant to 39-A M.R.S.A. § 322 (2001) and M.R. App. P. 23.
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