Refusal To Pay Benefits Based On Dispute Between Carriers Warrants Penalties

Ruling: The Appellate Court of Illinois, 1st District affirmed the Circuit court’s judgment confirming the Commission.  The Commission properly found a carpet installer’s injury compensable and awarded penalties and attorney’s fees for the employer’s unreasonable and vexatious conduct in denying temporary total disability and medical  benefits.

What it means:  A dispute over liability between two carriers does not justify the denial of benefits clearly owed to a claimant.

Summary: The claimant, a carpet installer, injured his left elbow ina work accident on October 1, 2000.  He suffered a second work accident on February 6, 2002, again injuring the left elbow.  The Commission found the claimant’s condition was attributable to the February accident, as such accident was an independent intervening cause breaking the chain of causation between the October injury and the ensuing disability.  In addition, TTD and medical expenses, the Commission awarded penalties and attorney’s fees, reasoning that a dispute over liability between two carriers does not justify the denial of benefits clearly owed to the claimant. The appellate court affirmed, as the Commission’s decision was not against the manifest weight of the evidence.

In addressing the issue of an intervening accident, the court noted that the claimant’s immediate and frequent treatment following the February injury demonstrated that his injury was aggravated by the February accident, especially in light of the delay in treatment and infrequent medical visits following the October accident.   Also, following the February accident, the claimant complained about the pain in his arm more often and reported new and different symptoms.

As for the award of penalties and attorney’s fees, the court found its prior decision in Bunnow v. Industrial Commission instructive. In Bunnow, two employers disputed liability, each contending the claimant was an employee of the other. However, neither employer contested that the claimant suffered severe injuries from a work-related accident.  The appellate court affirmed an award of penalties and attorney’s fees. Ultimate liability of an employer was clear and the only dispute was over who was responsible for paying the claimant benefits. Similarly, in the instant case, the employer’s liability was clear.  The only dispute was over which insurance carrier was responsible for paying benefits.  Accordingly, the Commission’s award based on unreasonable or vexatious delay was not against the manifest weight of the evidence.