Valencia v. GEP BTL, LLC

In determining eligibility for "supplemental disability," it is a prerequisite that the complainant to provide verifiable documentation of secondary employment, and there is no investigative obligation on the employer or employer's insurance carrier.

Claimant, Chris Valencia (Valencia), suffered a compensable injury. Valencia had multiple employers at the time of the injury and thus could receive “supplemental disability.” ComPro, the insurer, requested documents to verify Valencia’s wages from his "secondary" employers. ComPro received insufficient information and denied eligibility until Valenica could provide sufficient verification. Valenica provided verification, but there was a hearing on the issue of penalties and attorney fees for lateness in processing the claim. An administrative law judge issued penalties and attorney fees against ComPro for failing to conduct an independent investigation of Valencia’s eligibility for benefits before determining Valencia was ineligible. The Workers Compensation Board (Board) reversed. The Court of Appeals agreed with the Board, stating that ComPro had no affirmative obligation to investigate Valenica’s eligibility and that it is a prerequisite of eligibility that claimant provide verifiable documentation of secondary employment. Remanded on other issues.