Workers Compensation Commission's Determination that Employee had not Committed Fraud Is Appealable

Montgomery County, Maryland v. Valerie J. Willis, No. 3081 (September 2009)

Valerie Willis ("Willis"), a former Montgomery County, Maryland Police Office, obtained compensation benefits for a work related injury. Montgomery County ("the County") filed a "Request for Hearing for Referral to the Maryland Insurance Fraud Division," with the Workers Compensation Commission ("the Commission"). The County claimed that subsequent to the event causing the work related injury, but before workers compensation benefits were awarded, Willis sustained a non-work related injury that she failed to disclose. The Commission held an evidentiary hearing and determined that there was insufficient evidence of fraud and denied the County's request to refer the matter to the Maryland Insurance Fraud Division. The County sought judicial review of the Commission's Order in the Circuit Court for Montgomery County. The Circuit Court held that the Commission's Order was not appealable, on the ground that denial of the request for hearing was not a final substantive disposition of the case. The County appealed the Circuit Court's decision to the Court of Special Appeals of Maryland ("COSA").

MD. CODE ANN., LAB. & EMPL. § 9-737, permits any party to appeal the decision of the Commission, provided that the appeal is filed within 30 days after the date of the mailing of the Commission's Order, by filing a petition for judicial review. The COSA, citing Montgomery County v. Ward, 331 Md. 521, 526 (1993), held that any "decision [that is sought to be appealed], must be a final decision or order in a case rather than an interim order." A "final decision or order", in relation to workers compensation cases, has been defined by case law as one that "determines the issues of law and of fact necessary for a resolution of the problem presented in that particular proceeding and which grants or denies some benefit under the [Workers Compensation] Act." Great American Ins. v. Havenner, 33 Md. App. 326 (1976). Willis argued that the Commission's decision not to refer the matter to the Maryland Insurance Fraud Division was not final decision or order because it did not grant or deny a benefit under the Workers Compensation Act ("the Act").

The COSA held that the Commission's denial of the County's request for a referral to the Maryland Insurance Fraud Division was a final determination as to whether Willis had obtained benefits in violation of the fraud provision of the Act. The Court stated that the fraud provisions of the Act were enacted to discourage fraud and to deter employees from abusing the Act. Therefore, to permit judicial review of the Commission decision based on issue fraud was not counter to the purpose of the Act, regardless of whether the decision involved the grant or denial of benefits.