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IN THE SUPREME COURT OF OHIO

STATE OF OHIO, ex. rel.ANITA L. GEORGE936 Dartmouth Ave. S.W.Canton, Ohio 44710330-949-5799

Relator,

vs

STEVEN BUEHRER,Administrator, Bureau of Workers' Compensation30 West Spring StreetColumbus, Ohio 43215

and

OHIO BUREAU of WORKERS' COMPENSATION30 West Spring StreetColunabus, Ohio 43215

andINDUSTRIAL COMMISSION of ORIO

andCROWN CORK & SEAL CO., INC.,One Crown WayPhiladelphia, PA 19154

andK. K.S. G. & ASSOCIATES, INC.Kenny, Keister, Stehlik, Georgic67 E. Wilson Bridge Road, Suite 201

Respondents,

CASE NO:

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ORIGINAL ACTION INMANDAMUS,PEREMPTORY WRITOR ALTERNATEWRIT

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MANDAMUS COMPLAINT OF RELATOR, ANITA L. GEORGEFOR PREMPTORY WRIT OR ALTERNATE WRIT

VINCENT' T. LOMBARDOSenior Assistant Attorney GeneralWorkers' Compensation Section615 W. Superior Avenue 1 ltl' FloorCleveland, Ohio 44113(216) 787-3030

HEJAN 0 6 Z015

MIKE DEWINEAttorney General of Ohio30 East Broad St. 14"' FloorColumbus, Ohio 43215

BUREAU OF WORKERS' COMPENSATION

CLERK OF COURTSUPREME COl1RT OF OHIO

JIJRISDICTION

Now comes Relator, Anita L. George and for her Complaint states:

1. Jurisdiction lies with this Court pursuant to O.R.C. Chapter 2731. A mandamus is a writ

issued in the name of the state to an inferior tribunal commanding the performance of an act

which the law specially enjoins as a duty resulting from an office.

2. Pursuant to O.R.C 4121.27 the Supreme Court has jurisdiction to review, vacate, set aside,

revise, correct, amend, or annul any order of the Bureau of Workers' Compensation. The writ

of mandamus shall lie from the Supreme Court to the bureau in a.ll proper cases.

3. On May 13, 2009, Judge Forchione of Court of Common Pleas, Stark County, stated in the

Judgment Entry, that Plaintiff, Anita L. George has not yet filed a Writ of Mandamus in this

case (App. A).

4. On November 2, 2009, Court of Appeals Fifth District, Stark County, Ohio, stated in the

Opinion, that the proper remedy available to Appellant is a Mandamus action (App. B).

5. On November 25, 2009 Relator, Anita L. George filed an Appeal and Memorandum with the

Ohio Supreme Court (App. C).

6. The claims in this matter arise from Relator's clear legal rights and Respondents, Ohio

Bureau of Workers Compensation and the Ohio Industrial Commission's legal duties

regarding a Lump Sum Settlement that does not conform to O.R.C. 4123.65, Ohio Bureau of

Workers' Compensation application for approval of final settlement (App. D).

7. Relator has no plain or adequate remedy at law to appeal a forged and fraudulent Lump Sum

Settlement of the Respondents, Bureau of Work-ers Compensation of Ohio, and to correct an

unfair and gross miscarriage of justice of the settlement. Given Respondents, Bureau of

Workers' Compensation and the Industrial Commission's legal duties and Relator's right and

lack of remedy, a petition for a Writ of Mandamus or Alternate Writ is appropriate.

PARTIES

8. Relator, Anita L. George is a citizen of the United States, who resides at 936 Dartmouth Ave.

S.W., Canton, county of Stark, and state of Ohio.

9. Respondent, Bureau of Workers Compensation (B.W.C.) is the state of Ohio government

agency located at 30 West Spring Street, Columbus, Ohio. The Bureau of Worker's

Compensation provides workers compensation insurance for employers and employees. The

Bureau of Worker's Compensation provides medical and compensation benefits for work

related injuries, diseases, and deaths. The Bureau of Worker's Compensation is responsible

for making initial claim and diagnosis determinations.

10. Respondent, Ohio Industrial Commission is a state agency that hears appeals of decisions

made on workers compensation claims and those of the Ohio Bureau of Workers

Compensation. The Industrial Commission is located at 30 West Spring Street, Columbus,

Ohio. The Commission is headed by three members. Those members set the policies for the

Commission hearing officers to follow in deciding appeals of Bureau of Worker's

Compensation decisions. District Hearing Officers (D.H.O.) hear the first level of appeals.

Their decisions can be appealed to Staff Hearing Officers (S.H.O.). The Commission

members have discretion to hear appeals of S.H.O. decisions.

11. Respondent, Steve Buehrer is the Administrator of Ohio Bureau of Workers Compensation at

30 West Spring Street Columbus, Ohio. The Administrator shall serve as representative of

the state insurance fund and award compensation, and make payments on all non-contested

claims. The Administrator shall establish a legal section within the B.W.C., to provide legal

advice and assistance to the administrator and the administrator's staff as to claims procedure

and policy, and other legal issues. The Bureau of Workers' Compensation legal section shall

act as attorney for the state fund.

12. Respondent, Crown Cork & Seal is a manufacturing company and corporation with one of its

factories located at 700 16th Street Massillon, Ohio. It is one of the world's premier

manufactures of packaging materials.

13. Respondent, Mike DeWine is the Attorney General of the state of Ohio and his office is

located at 30 E. Broad St. 14th Floor, Columbus, Ohio. The Attorney General shall be the

legal advisor of the Bureau of Workers' Compensation board of directors and the

compensation council.

INTRODUCTION

14. This original mandamus action is brought in the name of the State of Ohio by Relator, Anita

L. George, who is petitioning this Court for a Peremptory Writ or an Alternative Writ of

Mandamus directing Respondents, Ohio Bureau of Workers' Compensation, Administrator,

Steve Bueluer, Ohio Industrial Commission and Crow-n Cork and Seal Co. Inc. to comply

with their legal obligations, pursuant to the O.R.C. 4123.65 rules of application for approval

of final settlement on a Bureau of Workers' Compensation claim.

15. Relator, Anita L. George, filed this original action seeking issuance of a Writ or an Alternate

Writ of Mandamus to (1) compel Respondent, Industrial Commission of Ohio, to vacate its

January 12, 2009 Order; (2) compel Respondent, Industrial Commission and Respondent,

Ohio Bureau of Workers' Compensation to grant Relator, Anita L. George's August 1, 2008

Motion, for the Bureau of Workers' Compensation to set aside and vacate the Lump Sum

Settlement Order of June 13, 2006; and compel the Industrial Commission and the Bureau of

Workers' Compensation to reinstate her Workers' Compensation claim No: 03-397458

16. On August 4, 2003, Relator, Anita George was injured in the course and scope of her

employment at Crown Cork and Seal Co. Inc., 700 16th Street, Massillon, Ohio 44646. Ms.

George's claim was allowed for Bilateral Carpal Tunnel Syndrome on both wrists; Trigger

Finger Left Thumb; Trigger Finger Right Fifth Finger; Trigger Finger Right Second Finger;

Trigger Finger Left Second Finger; Trigger Finger Left Fifth Finger; Trigger Finger Right

Third Finger; Bilateral Wrist Strain on both wrists; Bilateral Ulnar Collateral Ligament Strain

on both elbows (App. E).

17. Claimant, Anita L. George was unable to return to her former job after the injury because it

requires packaging and heavy lifting with two hands and she was no longer able to do this

due to the injuries on both wrist, both elbows, and three fingers on the right hand and three

fingers on the left hand.

18. This inability to return to Relator's former job is found to show a disability that exceeds the

normal handicap requirements of O.R.C. 4123.58 Compensation for Total Disability,

resulting from the lost, or lost the use of both arms, or both feet or both legs, or both eyes, or

any two thereof.

19. Anita L. George's claim was settled for $35,000 pursuant to a Lump sum Settlement Order

dated June 13, 2006 (App. D). Relator was not represented by counsel and did not know that

the Settlement Order with the forged initials L. M., and this was not the authorized signature

of the Staff I-Tearing Officer (S.H.O.) who is supposed to review it. This fraudulent action of

a

Respondent, Bureau of Worker's Compensation Industrial Commission contains evidence of

fraud, a clear mistake of law, and error by the inferior administrative agent or subordinate

hearing office, of such character that remedial action would clearly follow, Industrial

Commission, Resolution R08-1-01 November 1, 2008 and R05-1-02 September 1, 2005. On

August 1, 2008, Ms. George moved the Bureau of Workers' Compensation to set aside and

vacate the Lump Sum Settlement Order. Ms. George's Motion was denied at all levels of the

Industrial Commission hearing process.

20. Relator, Anita L. George requests the Ohio Bureau of Workers' Compensation claim No: 03-

397458 to be re-activated and the forged signature, L.M. on the Settlement Agreement

effectuated June 13, 2006 to be invalid and void pursuant to O.R.C. 412165 (A).

21. The Ohio Supreme Court has recently and clearly stated that all the requirements specifically

enumerated in O.R.C. 4123.65 must be strictly adhered to before a Settlement of a Workers'

Compensation claim can legally be effectuated. In the instant case, the requirements have not

been met. Therefore, no valid Settlement has taken place in this claim.

22. O.R.C. 4123.65 (D) requires that the Settlement Agreement be sent to the Bureau of Workers

Compensation Industrial Commission, who shall send such to a Staff Hearing Officer

(S.H.O.) and the Staff Hearing Officer shall determine whether the Settlement Agreement is

or is not a gross miscarriage of justice.

23. In this case there are forged initials L.M. that is not a signature of an Ohio Industrial

Commission Staff Hearing Officer that was written in the stamped section, LUMP SUM

SETTLEMENT REVIEWED BY, Industrial Commission (I.C.). Staff Hearing Officer

(S.H.O.). There was no Staff Hearing Officer with the initials L.M., who was employed with

the Ohio Bureau of Workers' Compensation in the year of 2006 at the Canton office in Stark

County.

2-4: -T-heCounselfor Respondents; Senior Assistant Attorney General, Vincent T. Lombardo did

not identify the employee who signed the initials L. M. and he did not address the issue of the

assignment of error in the Appellee's Brief in the Court of Appeals Fifth Appellate District. It

was acknowledged by Staff Hearing Officer (S.H.O.) Gary J. Frame on October 24. 2008,

"There is no evidence that the Industrial Commission, Staff Hearing Officer reviewed the

Settlement Agreement" (App. F). The documented references verifying these statements will

be included with the Memorandum in Support of the Peremptory Writ or Alternative Writ of

Mandamus.

25. The Relator was unrepresented by counsel and the Lump Sum Settlement Agreenient is

unfair and a gross miscarriage of injustice compared to the Reserve of $174,790.00 and

maximum value of $212,500.00 on the Evaluation Form that evaluates the Settlement

Agreement. The evidence shows that the claimant will likely suffer lifelong medical

problems due to the serious injuries sustained on the account of these industrial injuries.

26. Relator's claim number 03-397458 was allowed for 354.0 Bilateral Carpal Tunnel Syndrome

(left& right wrists), Trigger Finger Left Thumb, Trigger Finger Right Fifth Finger, Trigger

Finger Right Second Finger, Trigger Finger Left Second Finger, Trigger Finger left Fifth

Finger, Trigger Finger Right Third Finger, Bilateral Wrist Strain (left& right), and Bilateral

Ulnar Collateral Ligament Strain (left& right elbow).

27, However all of the Relator's allowed conditions were not included in the lump sum

settlement evaluation form and the settlement application. The Bureau of Worker's

Compensation Rule 4123-3-34 (C) states that each Settlement application shall include a list

A

of the claim numbers and all of the body parts effected in all claims by the claimant. The

Lump Sum Settlement Evaluation Form in the Diagnosis and Injury Status section does not

list all of the Relator's injured body parts that are supposed to be evaluated for the Lump

Sum Settlement of the Relator's claim number 03-397458.

28. The Evaluation Form only lists 354.0 Carpal Tunnel Syndrome (single), 727.03 Trigger

Finger (single), 841.1. Ulnar Collateral Ligament Stain (single) and 842.0 Wrist Strain

(single). However, Relator, Anita L. George's injured body parts were Carpal Tunnel

(bilateral), six Trigger Fingers, Ulnar Collateral Ligament Strain (bilateral), and Wrist Strain

(bilateral) and the correct allowed diagnoses were omitted from the settlement evaluation

form.

29. It is impossible for a Settlement Agreement to be valid when it does not list all of Relator's

injured body parts on the Settlement Evaluation Form that should justify the allowed lump

sum settlement amount. There was no review from a Staff Hearing Officer, in spite of a

fraudulent stamp that falsifies the approval of the settlement, with the initials, L.M on the

front page of the Settlement Agreement.

30. Therefore the Bureau of Workers Compensation is guilty of O.R.C. 2912.12 Tampering With

Evidence (A) No person knowing that an official proceeding or investigation is in progress,

or is about to be or likely to be instituted, shall do any of the following: (1) Alter, destroy,

conceal or remove any record, document, or thing, with purpose to impair its value or

availability as evidence in such proceeding or investigation.

31. Relator, Anita L. George filed this Mandamus action stating that Industrial Commission

abused its discretion. Relator moves this Court to "vacate the previous Settlement Agreement

7

and continue jurisdiction to allow the proper fair and legal settlement that justifies the

evaluation of all of the injured worker, Anita L. George's body parts.

STATEMENT OF CASE

32. Now comes, Relator, Anita L. George requesting a Writ of Mandainus or an Alternate Writ

pursuant to O.R.C. 2731.02. This is an original action in Mandamus in which Relator, the

worker compensation claimant seeks an order (1) to compel the Respondent, Industrial

Commission to vacate its January 12, 2009 Order, (2) compel the Commission and

Respondent, Ohio Bureau of Workers Compensation to grant Relator's August I, 2008

Motion requesting the B.W.C. to set aside and vacate the Lump Sum Settlement Order dated

June 13, 2006, (3) compel the Commission and the B.W.C. to reinstate Relator's Workers

Compensation Claim No. 03-397458. The Relator has exhausted all other administrative

remedies.

33. The Ohio Supreme Court has been enacting in its requirement that the terms of O.R.C.

4123.65, to be strictly followed to either consummate or void the settlement of a worker's

compensation claim. In this instant case all of the requirements have not been met. A

Workers Compensation Settlement Agreement is void where it fails to strictly comply with

the requirement of O.R.C. 4123.65.

34. O.R. C. 4123.65 (A) implies that a state fund employer or the employee of such and an

employer may file an application with the Administrator of Workers' Compensation for

approval of a final settlement of a claim under this chapter. The application "Shall include

the Settlement Agreement, to be signed by the claimant and employer, and clearly set forth

the circumstances by reason of which the proposed settlement is deemed desirable". O.R.C.

R

4123.65 requires that the settlement agreement be sent to the Commission, who shall send

such to a Staff Hearing Officer (S.H.O.), and the S.H.O. shall determine within the time

limitations specified in division (c) of this section, whether the Settlement Agreement is or is

not a gross miscarriage of justice.

35. On October 24, 2008 the B.W.C., Staff Hearing Officer, Gary J. Frame denied Ms. George's

Motion dated August 1, 2008, requesting the Bureau of Workers' Compensation, Industrial

Commission to vacate the Settlement Agreement. Mr. Frame stated that by the Order dated

06/13/2006 the Administrator approved the Settlement Agreement between the parties in the

claim (App. F).

36. Mr. Frame concluded that, "There is no evidence that the Industrial Commission reviewed

the Administrator's 06/13/2006 Order". The Ohio Revised Code 4123.65 (D) indicates that if

a Staff Hearing Officer fails to act within 30 days of the date of the Administrator's Order the

Settlement Agreement is approved by operation of law. However, Mr. Frame did not

acknowledge or identify the B.W.C., Industrial Commission employee, who forged the

initialed signature L.M. in the S.H.O., Staff Hearing Officer, LUMP SUM SETTLEMENT

REVIEWED line, on the front page of the Settlement Agreement B.W.C., ORDER.

37. On January 22, 2009 the Industrial Commission denied Ms. George's Motion dated August

1, 2008, requesting the B.W.C. to vacate the Settlement Agreement and Continue Jurisdiction

in her injury claim because there is fraud and forgery in the claim and a clear mistake of law

done by the Bureau of Workers compensation and the Industrial Commission of Ohio (App.

G). The Industrial Commission stated that Ms. George's Motion fails to meet the

requirements of the Industrial Resolution R08-1-01 dated 11-01-2008:

38. To invoke a request for reconsideration shall be considered only in the following cases:

q

• New and changed circumstances have occurred.

• There is evidence of fraud in the claim.

-- • There is a clear mistake of fact in the order from which consideration is sought.

• There is a clear mistake of law in the order from which consideration is sought.

• There is an error by the inferior administrative agent or subordinate hearing officer in the

order.

STATEMENT OF FACTS

39. Relator, Anita L. George was employed at Crown Cork & Seal Inc., where she was injured

during the course of performing work related duties. On August 4, 2003, Relator, Anita L.

George was diagnosed with Carpal Tunnel Syndrome of the right hand and left hand by Dr.

Rakesh Arora. On August 16, 2003 Relator had an electro diagnostic examination by Dr.

Shirali, M.D.

40. On November 25, 2003 Relator had Carpal 'I'unnel surgery on the right wrist, right middle

finger, and right fifth finger. On January 20, 2004 Relator had Carpal Tunnel surgery on the

left wrist, left thumb and left fifth finger. These surgeries were done by Dr. Arora. On

September 17, 2004 Relator had repeat Carpal Tunnel surgery on the right wrist and right

third finger by Dr. Earl Browne at the Cleveland Clinic.

41. On March 22, 2004 Dr. Shirali performed additional electro diagnostic testing on Ms.

George's hands. Dr. Shirali diagnosed Ms. George with progressive additional nerve damage

on the right hand and mild nerve damage on the left hand.

42. On June 24, 2004 Ms. George was injured while taking a Functional Capacity Test. On

December 16, 2004 Ms. George received an additional allowance for the injury. The added

injuries were bilateral wrist strain and bilateral ulnar collateral elbow strain (App. H).

1 CD

43. Ms. George continued to have treatment and physical therapy for her work related injuries

throughout the years. She received pain management therapy from different health care

centers.

44. On November 10, 2005 the B.W.C. ordered a medical examination by Dr. Paul Martin, who

diagnosed Ms. George as Maximum Medical Improvement (M.M.I.). The definition of this

medical condition addresses the issue that there will likely not be any future medical

improvements in Relator's occupational injuries. Relator, Anita L George does have some

physical restrictions that consist of lifting no more than 10 pounds on an occasional basis,

avoidance of frequent or repetitive grasping or gripping and avoidance of frequent or

repetitive pushing or pulling activities with either elbows.

45. The total Indemnity in this claim is 51,015.96 for Temporary Total Compensation and the

total Medical paid 45,806.04, which is a total of 96,822.00.

46. Relator, Anita L. George's Temporary Total Compensation check was stopped. Shortly

afterwards Ms. George received a letter from her employer's third party administrator and the

claim was settled for 35,000. Ms. George was not represented by legal counsel and she was

not aware of the Contract Laws of Ohio.

47. On May 12, 2006, Relator's Employer Crown Cork & Seal's third party administrator

executed a C-240 Settlement Application form, requesting that the 03-397458 claim be

settled and Ms. George received a settlement of 35,000: On May 15, 2006 the employer

executed its portion of the Settlement Application (App. I).

48. On May 15, 2006 the B.W.C. executed a C-241 Amended Settlement Agreement and Release

form and the employer's signature was not obtained and Relator did not explain the reason

for the settlement on the Amended Settlement Agreement and Release form (App. J).

11

49. After the Bureau of Workers Compensation reviewed the Settlement Agreement, an Order

was sent to all parties to gain the required signatures of the legal authorities that are

- mandatory fora Lump Sum Settlement. On the front page of the Lump Sum Settlement

B.W.C. Order, dated 6-20-06, there are initials L.M. that falsely stated that it was reviewed

by the (I.C.) Industrial Commission, (S.H.O.) Staff Hearing Officer (App. D).

50. There are no records of the Industrial Commission Staff Hearing Officer (S.H.O) ever

reviewing the Settlement Agreement. There are no records or evidence that proves that the

S.H.O. found the Settlement Agreement to be fair or clearly unfair and a gross miscarriage of

justice. O.R.C. 4123.65(D) requires that an Industrial Commission Staff Hearing Officer

review settlements and determine whether the "Settlement Agreement is or not a gross

miscarriage of justice".

51. On August 1, 2008 Anita L. George filed a Motion to vacate the June 13, 2006 Settlement

Agreement and Continue Jurisdiction on her claim No. 03-397458.

52. On October 24, Ms. George had a hearing with Industrial Commission Staff Hearing Officer,

Gary Frame and he denied Relator's request for the Industrial Commission to exercise its

continuing jurisdiction pursuant to Ohio Revised Code 4123.52, which provides that the

jurisdiction of the Industrial Commission over each case is continuing and the Industrial

Commission may make such modification or change with respect to former findings or

respect thereto. Mr. Gary Frame stated that the claimant has not presented sufficient

persuasive evidence to demonstrate (a) new and changed circumstances, (b) fraud, (c) clear

mistake of fact, (d) clear mistake of law, or (e) error by an inferior tribunal in the execution

and processing of the Settlement Agreement as stated in the guidelines of reconsideration's

R08-1-01 dated 11/01/2008.

1 7

53. On the Order dated 10-24-2008, Staff Hearing Officer Gary Frame verified Relator's claim

that the signature, L.M. on the line reserved for the Staff Hearing Officer (S.H.O.) was

fraud, by stating "There is no evidence or record of the Industrial Commission reviewing the

Settlement Order". This statement alone establishes fraud, clear mistake of fact, clear mistake

of law, and error by an inferior tribunal. However the settlement has been fraudulently

altered by someone other than the legal authorized personal in order to make seem as if it had

actually been reviewed by an Industrial Commission Staff Hearing Officer.

54. Staff Hearing Officer, Gary Frame continues to avoid and acknowledge the fact that someone

other than a legal authorized Staff Hearing Officer signed a Settlement Agreement contract.

The Industrial Commission has not addressed the issue and acknowledged the name and title

of the employee who signed the initials L.M.

55. On January 22, 2009 the members of the Industrial Commission denied Ms. George's request

for reconsideration. The members of the Industrial Commission stated that the request fails to

meet the criteria of Industrial Commission RO8-1-01 (App. G).

56. On March 20, 2009 Ms. George filed a Notice of Appeal in the Stark County Court of

Common Pleas, assigned Case No. 2009CV01123.

57. On June 12, 2009 Ms. George filed an appeal with the Ohio Fifth District Court of Appeals,

assigned Case No. 2009CA00146.

58. The Court of Common Pleas and the Fifth District Court of Appeals stated that Realtor, Anita

L. George has not filed a petition for a Writ of Mandamus in this case. The lower Courts

stated that the proper remedy to Ms. George is a Mandamus action.

59. On. November 25, 2009 Ms. George perfected the appeal with this honorable Court, Case No:

09-2144.

1q

CLAIMS FOR RELIEF

ONE: TAMPERING WITH CLAIM FILE DOCUMENTS

60. The above-described conduct of Respondent, Ohio Bureau of Workers Compensation

constituted tampering with documents, State of Ohio Industrial Commission Policy

Statements and Guidelines. All Hearing Officers are to be aware of the provisions of O.R.C.

2921.12 which is captioned "Tampering with Evidence":

61. No person, knowing that an official proceeding or investigation is in progress, or is about to

be or likely to be instituted, shall do any of the following: Alter, destroy, conceal, or remove

any record, document, or thing, with purpose to impair its value or availability as evidence in

such proceeding or investigation.

62. Ms. George's B.W.C. Settlement Agreement Order June 13, 2006 is voidable by law because

of the forged initials of L.M. in the section, LLTIVIl' SUM SETTLEMENT REVIEWED BY

I.C., with the false representation of a Staff Hearing Officer (S.H.O.). The B.W.C. and the

Industrial Commission fails to identify the Ohio Bureau of Workers' employee who signed

the fraudulent documents of a Settlement Agreement.

63. There was no authorized Staff Hearing Officer (S.H.O.) with the initials L.M. who was

employed with the B.W.C. Industrial Commission, Canton office when the Settlement

Agreement was executed.

TWO: A WORKERS COMPENSATION SETTLEMENT AGREEMENT IS VOIDABLE

WHERE IT FAILS TO STRICTLY COMPLY WITH THE REQUIItEMENTS OF R.C.

4123.65

14

64. The Ohio Supreme Court has recently and clearly stated that all the requirements specifically

enumerated in R.C. 4123.65 must be strictly adhered to before a Settlement of a Workers'

Compensation claim can legally be effectuated.

65. Respondent, Ohio Bureau of Workers' Compensation Settlement Agreement does not meet

the requirements in R.C. 4123.65 because of forged and unauthorized initials of someone

other than an Industrial Commission Staff Hearing Officer.

66. Memo 03, O.R.C. 4123.65 (D) requires that an Industrial Commission Staff Hearing Officer

review Settlements and determine whether the "Settlement Agreement is or is not a gross

miscarriage of justice." In this case the signature of the Staff Hearing Officer was forged on

the Settlement Agreement Order.

67. O.R. C. 4123.65 states that the Staff Hearing Officer review shall include documentation for

the basis of the Settlement. In the October 24, 2008 Order, Staff Hearing Officer, Gary

Frame stated "there is no evidence that the Industrial Commission reviewed the

Administrator's Settlement 6/13/2006 Order". Therefore the Settlement Agreement was

forged by someone with the initials L.M. who was not authorized to sign as a Staff Hearing

Officer (S.H.O.)

68. In the instant Case, the requirements of R.C. 4123.65 have not been met. Therefore, no valid

settlement has taken place in Relator Anita L. George's Bureau of Worker's Compensation

Claim No: 03-397458.

69. Relator, Anita L. George merely wants her Settlement Agreement vacated so that she can

increase the amount of compensation she originally received.

THREE: FORGERY IS A CRIMINAL OFFENSE O.R.C. REVISED CODE 2914.31 (A)

(1) & (C):

11;

70. Respondent, Bureau of Workers' Compensation committed forgery when one of their

employees who was not an authorized Industrial Commission Staff Hearing Officer (S.H.O.),

-- signed the-initials L.M. in the LUMP SUM SETTLEMENT REVIEWED BY I.C. S.H.O.

section dated, 6-20-06. This section was found on the front page of the BWC ORDER.

71. Forgery is defined as the making or altering of a false writing with intent to defraud. This act

is related to the crime of uttering a forged instrument defined to be offering as genuine an

instrument that may be the subject of forgery and is false with intent to defraud.

72. Forgery is the act or legal offense of imitation or counterfeiting documents, signatures, work

of art, etc. to deceive. Forgery imitation, copy, imposture, cheat, fake, fabrication, fraud, or

phony is a crime. Anyone who commits forgery is guilty of a felony offense.

FOUR: U. R C. 2913.48 WORKERS' COMPENSATION FRAUD

73. Respondent, Ohio Bureau of Workers' Compensation, Industrial Commission committed

fraud when one of their employees who was not an authorized Staff Hearing Officer (S.H.O.)

signed the initials L.M. in the LUMP SUM SETTLEMENT REVIEWED BY I.C. S.H.O.

section dated 6-20-06.

74. (A) No person with purpose to defraud or knowing that the person is facilitating a fraud, shall

do any of the following:

(3) Alter, falsify, destroy, conceal, or remove any record or document that is

necessary to fully establish the validity of any claim filed with or necessary to

establish the nature and validity of all goods and services for which reimbursement or

payment was received or is requested from, the Bureau of Workers' Compensation, or

self-insuring employer.

19

CONCLUSION

75. There is no question that mandamus is an appropriate remedy to reverse the decision of the

Court of Common Pleas and Court of Appeals, Fifth Appellate District of Stark County to (1)

compel Respondent, Industrial Commission and Respondent Ohio Bureau of Worker's

Compensation to grant Relator, Anita L. George's August 1, 2008 Motion for the Bureau of

Workers' Compensation to set aside and vacate the Lump Sum Settlement Order of June 13,

2006; and compel the Industrial Commission and the Bureau of Workers' Compensation to

reinstate Ms. George's Workers' Compensation Claim No: 03-397458.

76. In conclusion, Relator Anita L. George's Settlement Agreement is voidable as a matter of

law. The June 13, 2006 Settlement failed to comply with the requirements of O.R.C.

4123.65. Further, there is evidence of fraud in the claim, clear mistake of fact in the order,

clear mistake of law, and error by the inferior administrative agent or subordinate hearing

office committed by the Ohio Bureau of Workers' Compensation Industrial because of the

forged initials L. M. on the front page of the B. W. C. Settlement Order. This person was not

authorized to do so and there are no documents supporting the evidence of the findings of the

employee, L. M. to have ever reviewed the settlement agreement.

77. What makes this case particular is that the settlement was entered into and approved by the

Bureau of Workers' Compensation.

17

PRAYER FOR RELIEF

78. Wherefore Relator, Anita L. George asks this Honorable Court to reverse the decision of the

Court of Common Pleas and Court of Appeals in Stark County, Ohio Fifth Appellate District

to issue an Order in Mandamus which (1) compels the Commission to vacate its October 24,

2008 Order, and (2) compels the Commission and the Bureau of Workers Compensation to

grant Ms. George's August 1, 2008 administrative Motion for the Bureau of Workers'

Compensation to set aside and vacate the Lump Sum Settlement Agreement Order of June

13, 2006; and (3) compels the Commission and the Bureau of Workers Compensation to

reinstate Ms. George's Workers Compensation Claim 03-397458. Relator asks the Court for

non-attorney fees and expenses. Relator also request such other relief as this Court deems fit

and just.

Respectfully submitted,

J

4Gt G eorge936 Dartmouth Ave. S.W.Canton, Ohio 44710(330) 949-5799

1R

IN THE SUPREME COURT OF OHIO

State Of Ohio, ex. rel.Anita L. George, CASE NO:

Relator,

vs

Steve Buehrer, Administrator,Bureau of Workers'Compensation, IndustrialCommission, Crown Cork &Seal Co. Inc., et. al.

AFFIDAVIT OF RELATOR,ANITA L.GEORGE

Respondents,

AFFIDAVIT OF ANITA L. GEORGE

I, Anita L. George, Relator being duly sworn accordingly to law say that I am 63 years of

age and have personal knowledge of the following facts:

1. That Relator was injured in the course of her employnient, at Crown, Cork & Seal Co.

Inc., 700 16th Street S. E., Massillon, Ohio and was diagnosed with industrial injuries

on August 4, 2003 by Dr. Rakesh Arora.

2. That Relator was allowed in the Bureau of Workers' Compensation (B.W.C.) claim

number 03-397458, for Bilateral Carpal Tunnel Syndrome, Trigger Finger Left

Thumb, Trigger Finger Right Fifth Finger, Trigger Finger Right Second Finger,

Trigger Finger Left Second Finger, Trigger Finger Left Fifth Finger, Trigger Finger

Right Third Finger, Bilateral Wrist Strain, and Bilateral Ulnar Collateral Ligament

Strain on both elbows.

^

3. That the medical evidence shows that Relator will suffer lifelong medical problems

due to the serious injuries she sustained on account of the industrial accident at her

employer Crown Cork & Seal Co. Inc.

4. That the total Indemnity paid in Relator's claim was $51,015.96 for Temporary Total

Compensation and the total Medical paid was $45,806.04, a total of $96,822.00.

5. That the Relator was unrepresented by counsel at the time she signed the Settlement

agreement.

6. That Relator's claim was settled for $35,000.

7. That Relator's Lump Sum Settlement Agreement Order of claim on 6-20-2006 was

not reviewed and signed by a Bureau of Workers' Compensation, Staff Hearing

Officer that is a requirement of O.R.C. 4123.65 to validate a settlement contract.

8. That the initials L.M. are not the legal signatures of any authorized Bureau of

Workers' Compensation Industrial Commission, Staff Hearing Officer (S.H.O.).

9. That Respondent, Bureau of Workers' Compensation did not acknowledge or present

any document that identifies the employee who signed the initials L. M. on the front

page of a legal document,

10. That in the Court of Appeals, in the Brief of Respondent, Bureau of Worker's

Compensation counsel, Vincent T. Lombardo did not acknowledge or address the

issue in the section, LUMP SUM SETTLEMENT REVIEWED BY I.C. SHO: L. M.

DATE: 6-20-06, that is on the front page of the B.W.C. ORDER, Settlement

Agreement.

11. That Respondent, Bureau of Workers' Compensation Staff Hearing, Officer Gary

Frame, stated in the Order dated October 24, 2008, "There is no evidence that the

1

Industrial Commission Staff Hearing officer reviewed the Administrator's 06-13-

2006 Settlement Order", therefore this is evidence of fraud, error, and mistake in the

claim, by Respondents, Bureau of Workers' Compensation.

12. That Relator's Settlement was a gross miscarriage of justice and unfair.

13. That the Respondent, Bureau of Workers' Compensation Lump Sum Settlement

Evaluation Form does not list all of the injured body parts of Relator's diagnosis and

injury status that is allowed and included in Mrs. George's injury claim.

14. That the Reserve value on the claim is $174,479.00 and the Maximum Value is

$212,500.00.

15. That there is no plain and adequate remedy in the ordinary course of law and Relator

has exhausted all administrative remedies, Judgment Order of B.W.C. October 24,

2008 and January 22, 2009, Stark County Court of Common Pleas Judgment Entry

May 13, 2009, Stark County Fifth Appellate District Court of Appeals Opinion

Novembei- 2, 2009, Ohio Supreme Court Judgment Entry, February 10, 2009.

Anita L. George

SWORN TO AND SUBSCRIBED before me this 16 day of December, 2014.

Jody L. MltWNotary Public, Statg of

my Commmssfon ExplnsJuty 05,2017

NOTARY PUBLIC

54 a

IN THE COURT OF COMMON PLEAS

STARK COUNTY, OHIO

ANITA LEE GEORGE

PLAINTIFF(S),

VS.

ADMINISTRATOR, BUREAU OFWORKERS' COMPENSATION, et al.

DEFENDANT(S).

)))))))))))

R`iPyiL400

.$T^I<`CQUIV^ ON ^

09K^,^ 1 3 AM H: 45

CASE NO. 2009 CV 01123

JUDGE FORCHIONE

JUDGMENT ENTRY

This matter is before the Court upon Defendant-Adminstrator's Motion to

Dismiss for Lack of Subject Matter Jurisdiction filed on April 14, 2009. Plaintiff filed a

Response on April 23, 2009.

On June 13, 2006, Plaintiff settled elaim No. 03-397458. The $35,000.00 settlement

consisted of $5,000.00 for prescription drugs and $30,000.00 for medical benefits, less an

overpayment of $165.25. Plaintiff filed a Motion to Vacate the Settlement Agreement.

The Hearing Officer denied Plaintiff's motion to vacate and the Industrial Commission

issued an Order on January 12, 2009, refusing to vacate the settlement award.

In her. Complaint, Plaintiff moves this Court to "vacate the previous Settlement

and Continue Jurisdiction to allow the proper and legal Settlement that justifies the

evaluation of all of the injured workers body parts and inju.ries."

Defendant argues that this Court does not have jurisdiction to hear Plaintiff's

complaint because the Industrial Commission's decision not to vacate the settlement

ENTERED^

Tr= f

does not involve Plaintiff's right to participate in the Ohio Workers' Compensation

Insurance Fund.

Plaintiff states that the settlement is unfair and a gross miscarriage of justice and

cites State ex ret. Wise v..Ryan (2008),118 Ohio St.3d 68, in support of her position.

A party can appeal a decision by the Industrial Commission only when a

claimant's right to participate in the Fund is involved. A!ftates v. Lorain (1992), 63 Ohio

St.3d 22. Further, the Fifth District found that under R.C. § 4123.512, a claimant may

only appeal an order of the Industrial Commission involving a claimant's right to

participate in the Workers' Compensation Fund, not decisions involving a claimant's

extent of disability. Hazelwoad v. Mei1er, Inc., 2001 WL 456416 (Ohio Appl 5 Dist.),

unreported. Thus, the only appealable decision by the Industrial Comniission is the

decision to grant, deny or terminate the employee's continued participation in the

Workers' Compensation Fund. Id.

Q.R.C. § 4123.65(A) allows workers' compensation claims to be administratively

settled by the Bureau of Workers' Compensation. In addition, O.R.C. § 4123.65(F)

provides that decisions regarding settlements made according to R.C. § 4123.65 are not

appealable under R.C. § 4123.511 and R.C. § 4123.512.

The Court finds the case cited by Plaintiff, State ex rei. Wise, to be inapplicable to

the instant case because the Plaintiff in the Wise case filed suit requesting a writ of

2

, . a ^b

2 ., ls

mandamus against the Industrial Commission. Plaintiff has not filed a petition for a

writ of mandamus in this case.

Therefore, this Court does not have jurisdiction to hear Plaintiff's appeal.

Accordingly, it is ORDERED, ADJUDGED and DECREED that Defendant's

Motion to Dismiss for Lack of Subject Matter Jurisdiction is GRANTED.

IT IS SO ORDERED.

NOTICE TO THE CLERK -- FINAL APPEALABLE ORDER

The Clerk of Courts shall serve upon all parties not in default for failure to appearnotice and a copy of the judgment and its date of entry upon the journal. Said noticeand copy shall be sent within three days of entering the judgment upon the journal.The Clerk shall serve the parties in a manner prescribed by Civ. 5(B) and note theservice in the appearance docket.

FORCHIONE, JUDGE

3

COURT OF APPEALSSTARK COUNTY, OHIO

FIFTH APPELLATE DISTRICT

ANITA LEE GEORGE, PR^'J SE JUDGES:Hon. Sheila G. Farmer, P.J.

Plaintiff-Appellant Hon. William B. Hoffman, J.Hon. Patricia A. Delaney, J.

-vs-

ADMiN[STRATOR, OHIO BUREAUOF WORKERS' CflMPENSATlON

and

CROWN CORK & SEAL CO., INC.

and

K K S G & ASSOCIATES, INC.

Defendants-Appellees

CHARACTER OF PROCEEDING

JUDGMENT:

®ATE„C^F J.U^GI11^fENT.E.N.TRY:

APPEARANCES:

For Plaintiff-Appellant

ANITA LEE GEORGE, PRO SE3420 Westview Avenue, NWApt. 3Canton, OH 44709

..._.:,s

Case Ncr. 20©9CA0-01 .46

OP1N IC}N

^ ,..-.,F,^ ^^; •^.,,. :

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^^ _...^'...:.^

Appeal from the Court of Common Pleas,Case No. 2009CV01 123

Affirmed

For Defendant-Appellee

VINCENT T. LOMBARDOState Office Building11 th Floor615 West Superior AvenueCleveland, OH 441 1 3-1 899

-Exbik4 8 .

Stark County, Case No. 2009CA00146 2

Farmer, P.J.

{If1} On June 13, 2006, appel3ant, Anita Lee George, settled her workers'

compensation claim against her employer, Crown Cork & Seal USA, Inc., with appellee,

the Bureau of Workers' Compensation, for $35,000. On August 1, 2008, appellant filed

a motion with the Industrial Commission to vacate the settlement. A Staff Hearing

Officer, - Gary Frame, denied the motion on -October - 24, 2008: Appellant sought

reconsideration which was denied on January 12, 2009.

{1f2l On March 20, 2009, appellant filed an appeal to the Court of Common

Pleas of Stark County, Ohio. On April 15, 2009, appellee filed a motion to dismiss for

lack of subject matter jurisdiction. By judgment entry filed May 13, 2009, the trial court

granted the motion and dismissed appe[lant's appeal.

{131 Appellant filed an appeal and this matter is now before this court for

consideration. Assignments of error are as follows:

{1j4} "THE TRIAL COURT COMMITTED PREJUDICIAL ERROR WHEN IT

GRANTED THE APPELLEE, BWC'S MOTION TO DISMISS WITHOUT FIRST

HOLDING AN EVIDENTIARY HEARING ON THE QUESTION OF WHETHER THE

-... .- JUNE 13, 2006-1NORKER'S COMPENSATION SETTLEIMENT-AGREEfViENT _NAC3`

BEEN PROPERLY ENTERED INTO UNDER O.R.C. 4123.65."

11

{115} "THE TRIAL COURT COMMITTED PREJUDICIAL ERROR IN FINDING

THAT IT LACKED SUBJECT MATTER JURISDICTION PURSUANT TO O.R.C.

^a .. .

Stark County, Case No. 2009CA00146 3

4123.65 (F) WHEN THE SETTLEMENT AGREEMENT ENTERED 1NTO BY THE

PARTIES DID NOT MEET THE STRICT REQUIREMENTS OF O.R.C. 4123.65."

III

116} "THE TRIAL COURT COMMITTED PREJUDICIAL ERROR IN FAILING

TO GRANT SUMMARY JUDGMENT IN FAVOR OF APPELLANT WHEN THERE

EXISTED NQ GENIJINE ISSUES OF MATERIAL FACT IN DISPUTE CONCERNING

THE LEGALITY OF THE JUNE 13, 2006 SETTLEMENT AGREEMENT AND THAT

THE STAFF HEARING OFFtCER' S(S.H.O.) SIGNATURE WAS FORGED, VIOLATING

BWC'S TAMPERING WITH CLAIM FILE DOCUMENTS, MEMO S4."

11

{1[7} Appellant claims the trial court erred in determining it lacked subject

matter jurisdictiort over her request to vacate her prior settlement agreement. We

disagree.

{JS} Appellant originally settled her right to receive benefits via an agreement

that she now challenges as fraudulent. See, Settiement Agreement and Application for

Approval of Settlement Agreement attached to Appellant's Brief as Plaintiff Exhibit I.

119} Pursuant to R.C. 4123.65(D), a copy of a€inal settlement shall

immediately be sent to "the industrial commission who shall assign the matter to a staff

hearing officer. The staff hearing officer shall determine, within the time limitations

specified in division (C) of this section, whether the settlement agreement is or is not a

gross miscarriage of justice."

{¶10} Appellant argues the purported signature of "L.M.," representing a Staff

Hearing Officer who reviewed the settlement agreement, was a forgery. See, BWC

Stark County, Case No. 2009CA00146 4

Order attached to Appeliant's Brief as Plaintiff Exhibit M. Appellant - makes this -

argument because Mr. Frame, the Staff Hearing Officer who denied her claim to vacate

the settlement, noted "[t]here is no evidence that the Industrial Commission reviewed

the Administrator's 06113f2006 order." See, Record of Proceedings attached to

Appellant's Brief as Plaintiff Exhibit N. Therefore, appellant argues the BWC Order was

altered to make it seem as if it had been reviewed.

{¶li} We note R.C. 4123.65(D) states, "[i]f the staff hearing officer determines

that the settlement agreement is not clearly unfair or fails to act within those time limits,

the sett[ement agreement is approved."

{$12} As cited supra, the matter was heard by the Industrial Commission and

denied. The action of the Industria! Commission was not about appellant's right to

participate, but was about appellant's request to vacate the prior settlement agreement.

{^13} R.C. 4123.512 governs appeals of workers' compensation claims, and

confers limited jurisdiction over a Court of Common Pleas:

11(14} "(A) The claimant or the employer may appeal an order of the industrial

commission made under division (E) of section 4123.511 of the Revised Code in any

injury or occupational disease case, other than a decision as to the extent of disability to._ ..___,. .._. ._. _..._......,_.._...___._._-...._..: _. :_._.___ .._.

the court of cornmon pleas of the county in which the injury was inflicted or in which the

contract of employment was made if the injury occurred outside the state, or in which

the contract of employment was made if the exposure occurred outside the state. If no

common pleas court has jurisdiction for the purposes of an appeal by the use of the

jurisdictional requirements described in this division, the appellant may use the venue

provisions in the Rules of Civil Procedure to vest jurisdiction in a court.""

Stark County, Case No. 2009CA00946 5

{t15} The Supreme Court of Ohio has limited the right of appeal to a Court of

Common Pleas not only on the issue of the right to participate, Afrates v. Lorain (1992),

63 Ohio St.3d 22, but has further restricted appeals under R.C. 4123.512 to questions

of causation between employment and claimed injury or death. State ex re1. Liposchak

v. Industrial Commission of Uhio, 90 Ohio St.3d 276, 20O0-4hio-73.

{I,16) As noted by appellee, it can administratively settle a ciairri pursdant to

R.C. 4123.65(A), but there is no right to appeal a settlement. R.C. 4123.65(F)

specifically states, "[a] settlement entered into under this section is not appealable

under section 4123.511 or 4123.512 of the Revised Code."

{^17} Because of the statutory mandates cited supra, the issue was not

appealable to the Court of Common Pleas. As the Supreme Court of Ohio suggested in

State ex re1. Wise v. Ryan, 118 Ohio St.3d 68, 2008-Ohio-1740, the proper remedy

available to appellant is a mandamus action,

{1118} Assignment of Error If is denied.

1,111

{1(19} These assignments are moot given our ruling on the issue of subject

matter jurisdiction.

Stark County, Case No. 2009GA00146 6

{1I20} The judgment of the Court of Common Pleas of Stark-Gounty, Ohio is

hereby affirmed.

By Farmer, P.J.

Roffman, J. and

Delaney, J. concur.

^`^f

JUDGES

SGF/sg 1016

IN THE SUPREME COURT OF OHIO4,

Anita Lee George

Appellant,

On Appeal from the StarkCounty Court of Appeats,Fifth Appellate District

v$

Administrator, Bureau of WorkersCompensation et. al.

Appelees,

Court of AppealsCase No: 2009-CA-00146

NOTICE OF APPEAL OF APPELLANT ANITA LEE GEORGE

Vincent T. LombardoSenior Assistant Attorn.ey GeneralWorkers Compensation Section.615 W. Superior Avenue I I`h FloorCleveland, Ohio 44113-1899(216) 787-3039

COUiNSEL FOR. APPELLEE, B.W.C.

Crown Cork & Seal, Co. Inc.One Crown WayPhiladelphia, PA 19154

K.K.S.G. & Associates Inc.Kenny, Keister, Stehlik, Georgic67 B. Wilson. Bridge Road, Suite 201Worthington, OH 43215

^^LIPs u 9 R^^^ ^^^^^ ^^ ^1111 1

Notice LAAneal of Appellant Anita Leae GloMe

Appellant Anita Lee George hereby gives notice of appeal to the Supreme Court of Ohio

from the Judgm.ent Entry and Decision of the Stark County Court of Appeals, Fifth Appellate

District entered in Anita Lee George, pro.se. v Administrator, Ohio Bureau of Workers

Compensation and Crown Cork & Seal Co. Inc. and K.K.S.G. & Associates Inc. Case No.

2009CA00146 on November 2, 2009.

This case originated in the Common Pleas Court of Stark County ®luo.

Respectfully subniztted,

Anita Lee eorge3420 Westview Ave. N.W. Apt 3

Canton, Ohio 44709(330) 371-6569

2

PROOF OF SERVICE

A copy of the foregoing was served by regular U.S. zxail, this 23'd day of

November, 2004, to:

Vincent T. LombardoSenior Assistant Attomey GeneralWorkers Compensation Section615 W. Superior Avenue 11'h FloorCleveland, Ohio 44113-1899(216) 787-3039

COUNSEL FOR APPELLE B.W.C.

Crown Cork & Seal, Co. Inc.One Crown WayPhiladelphia, PA 19154

K.K.S.G. & Associates Inc.Kenny, Keister, Stehlik, Georgic67 E. Wilson Bridge Road, Suite 201Worthington, OH 43215

°ta Lee C'seorge, pro se^3420 Westview Ave. N.W. Apt 3Canton, Ohio 44709Telephone: (330) 371-6569

I

^

CANTON 9EALICS OFFICE4Q03RD ST SEC.AJVTCN 4Fi 44702-1102 ^^'

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ANITA L C,`ECRGE3305 BERR?'WWD AS7L' SWC^,YTCN CEI 44706-4909

In[3ared xc3rker :cs.a:^ number:Zn^ury date:C1.^2u.m type :

ANITA L GE}RGE

08 0^^Z^03flcc. Disease

Dear In3ured 4iarxer arid Employer:

The purpose of thza arder is to iSettlement Agreement and AppIxaat{C-240}. and any Amended SettZemethe ab®va-referenced claim(s). Aparties have agreed to a settlLhmmagreement outls,ned below. Ifyou have only 30 da s from ttrisettlement. To wit^drawr youw'rltxng WithiII the 30--@ay peL-further clarificatio:f, pleaseb+e2t3x.

APPRDQ

r

el .. C;P,

Em ^oyer"s namesPolic^ aumber-manua. n

sEAL USA, I:tC.

ciss.on regard.ing your1 9et^ement Agreement

41) previously ^iled iniea ahd negatiat^,on, all

kii1 2171d ttte details of tnzWs^.nd about the settlement,

a2 to withdraar from thethe s^ther pe.rty and ^triC intaave any questions or needims service special2st listed

AGRUMENT

The Adsain.istrator fMs tnat^ Settle:nent Agreement and Applicationfor AppcovaZ of S ti^].ament 1^Seement has been filed in the above-nreferencsci clai ^. ter review of the at►plscation, the . cadrnsniatrator fS ing:

^ pravec! far a lump sum settlement in the amcu4t c^Thea 13. ca °$35`089.00. e^ e allocated as folloars: Ff

Zndemnity 0 c, Q P.r1KediC81-,,, • 70,000.00

PreWq,jVtxon Dr^^ 5,000.00^'

Tti`^ a^qr m̂^nt 'z.s a ful,l anct final settlement of the claim(s) . c¢ c_3

The`^.tOta3..greAd settlement amount is $35,000.00, whioh will De Ln^Q'acW hy^the cvex^pa^ent of $155.25. The amount of your payment as $34,834-'T5.

Issue vaiizant to: GEORGE,AXITg L.

NOTE MEDICARE BENEFICIAR^ESa Any aettlemant amounts allocated forfuture med^.cal services (excluding amounts for prescraption drugs) must beused for aiedi.cal services before ltedx.care wi.il cQrsider pa ymen for.sQrv.^ces for the conditions of the 4^orkers ` compensata.on claim^s) .

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M Taft 1Alilliam E. VabeGrrremcr Jidmrrnstratori=

oilwM+rtteam I-iwewoe'4Me

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ika qft 3,.w a3i^wc.can f^1M10IIWCMEEMENW,

T"ie settlament amount set %vrt3 aDvve, reducec3 by any ovecpayaents, s „be paa3 to V'te injdrsd wcrter 30 days after ttle date of thr.s approval. iftne employee, enploeer, or tAe adYlisfistratQr Vf*WraAts CvftseSlit to thea reement by grovYdj.ng vritten not-,ca to the other two parties w't3u:c the36 day hold $riad or tne L°Ldnstr^Zal Caaoa^a.s9iori of 01u.c disapproves t:tesettlement, ^t atil.2 no longer be valid. TiJ:-,s settlement ,:s nct, appea3..a:;ieunder Oitlo Revised Code section 4123.511 or sectzon 4323.312.

Please be advi5ec1, BWC vili not male az!y pa^eats af var the^ t;^as settlarnent approval for med_cal b^lis or earvicea rbiU has not been resolved to your sat1sfaction, yau siiotzldt.hs.s settlement. Aiso, any payt^ent ma^:e pursuant to ti41s s+agree;^ent s.a au^s5ect to any ar,d a7.l valid child gupport 2n:51

Settlement of any claia{s) sncluded in this agreenient -HWC's statutvey rzg?fts to subrogation r^ecovery. ila ^a finding cf fraud, the ada^f nastr°atcar r^etasns tae r tsettlement agreement and re-coen the cl^azm for an ;averpayment hear3.aq and referraZ for cri^,na,7. pro

PLE}tSS RMW A cGPY OF THIS LL

3QEiDf pCANTflN SERVIC$ OFFICE400 3RD ST SECMTCN 0ff 44702-1102

Cl.aim number: 03-397458

CC:CBOirN CORK & SEAL USA, INC.GOEdFx'L. CORP[3RATxCNICKS43 c A.ssCc.9

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Tbe Industrial Camnbsinn ef Ohio

RECORD OF PROCEEDINGS

Claim Number: 03-397458LT-00-OSIF-Ctlit

PGIV: 20601$1 Anita L. George

ANITA L. GEOROE3305 9ERR.7WQD AVE SWCANTON OH 447 Q6-490g

Date of Diagnosis: 8/04/2003

Claims Heard! 03-397458

,.^..,

^INt^i^GS MAi^.eD _^ 7 £3 ^^6

I.C. '^,ANTON

Risk hiumber : 1376538-0

This claim has been previously allowed for: BILATERAL CARPAL TUNNELS1IhiR43ME; TRIGGER FINGER LEFT THlM; TRIBGER FINGER RIBkff FIFTH FINGER;TRIGGER FINGER RIGHT SECf3FD FINGflt; TRI6BER FINGER LEFT SECOND FINGER;TRIGGER FINGER LEFT FIFTH FIlVGER; TRIGGER FINGER RIGHT THIRI} FIWaEli;BILATERd1L WRIST 57RATN; BILATERAL ULMAR COLLATERAL LIGAMENT STRAIN_OISi1LL{1b(ED; NA,3tIR DE€'RESSIQN SINGLE EPISODE; GENERALIZED AMIETY L}ISRDHi.

This matter was heard on 02/14/2006 before District Hearing Officer6ary J. Frame pursuant to the provisions of Ohio Revised Code Section4121.34 and 4123.511 on the following;

F10?IQN filed by Bureau of Workers' Co"ensation on 01109/2006Issue: 1) Request To Terminate Temporary Total

Noticas Were mailed to the °lnjured worker, the employer, their respectiverepresentatives and the Administratar of the Bureau of Workers'Compensation not less than 14 days prior to this date and the followingwere present for the hearing:

APPEARANCE FOR THE INJURED NtORKER: ClaimantAPPEARANCE FOR THE EMPLOYER: CookAPPEARANCE FOR THE ADMINISTRATOR: Marshall

It is the order of the District Hearing Officer that the Bureau of Workers'Cnmpensation's mntion, filed 01I09j2006, is granted to the extent of thisorder.

The District Hearing OffiC2r finds, based on the 11/10/1005 independentmedical examination report of Dr. Martin, that the allowed conditions inthis claim have reached maximum medical inAprovement pursuant to a medicalexamination of the claimant.

The District Hearing Officer further orders that the claimant's temporarytotal compensation shall be and is hereby terminated as of 02/14/2006, thedate of this hearing.

Therefore, the District Hearing Officer finds any temporary totaldisability compensation paid suhsequant to 02/14I20Q6 is an overpayment andshall be recouped pursuant to Section 4123.511 (J) of the Ohfio Revised Code.

This order is placed pursuant to Tndustriat Commissian Resolution R98-1-04.

All relevant evidence in the file was reviewed and considered.

An Appeal from this order may be filed within 14 days of the receipt of theorder. The Appeal may be filed online at www.ohioic.com or the Appeal(IC-12) may be sent to the Industrial Conurission of Ohio,Canttsn District Office, 400 Third Street, S.E., Ste 1, Canton OH 44702.

DHOSFCT2 Page I eh/eh

^

The Induatriai CamnnWAn dOhio

RECORD OF PROCEEDINGS

^

^

Claim Number; 03-397450

Typed 8y: ehDate Typed : 02 / 14!?006i3ate Received: 01/10/2006Notice of Cantested Claim: 41/0912006Findings Mailed:

The partfes and representatives listed below have been sent this record ofproceedings. If Yau are not an authorized representative of either theinjured worker or employer, ptease notify the Industrial t°ommission.

03-397458Anita L. George3305 Berrywood Ave SWGantcn OH 44706-4909

Risk No: 1376538-0Crown Cork & Seal Usa, IncCrown Cork ^ SealDf renza Sandra1 Crown WayPhiladelphia PA 19154-4501

ID No: 1648-80K K S G & Associates67 E Wilson Bridge Rd #201Worthington OF! 43085

IO No: 9994-05**°°8 ►11C, La+w -Canton***Attn: Don Marshall400 3rd Street, 3rd FloorCanton OH 44702

9WC, LAW DIRECTOR

FIN®tNGS MAILED

FE8 16 2006

I.C. CANTOh}

DHOSFCT2 Page 2

lfl ioWa1 appuze iEy Ylgioya

6A6 8nwlea Dm®Sqft

eh/eh

(Page 1 of 3)

03-397458The Industrial Commission of Ohio

RECORD OF PROCEEDINGS

Claim Number: 03-397458LT-oD-OSIF-COV

PCN: 2082771 Anita L. George

Claims Heard: 03-397458

08-809478 - Ref

ANITA L. GEORGE3420 WESTVIEW AVE NW APT 3CANTON OH 44709-2664

Date of Diagnosis: 8/04/2003 Risk Number: 1376538-0

This claim has been previously allowed for: BILATERAL CARPAL TUNNELSYNDROME; TRIGGER FINGER LEFT THUMB; TRIGGER FINGER RIGHT FIFTH FINGER;TRIGGER FINGER RIGHT SECOND FINGER; TRIGGER FINGER LEFT SECOND FINGER;TRIGGER FINGER LEFT FIFTH FINGER; TRIGGER FINGER RIGHT THIRD FINGER;BILATERAL WRIST STRAIN; BILATERAL ULNAR COLLATERAL LIGAMENT STRAIN.

DISALLOW®: MAJOR DEPRESSION SINGLE EPISODE; GENERALIZED ANXIETY DISORDER.

This matter was heard on 10/24/2008 before Staff Hearing OfficerGary J. Frame pursuant to the provisions of Ohio Revised Code Section4121.35(B) and 4123.511(D) on the following:

C-86 Motion filed by Injured Worker on 08/01/2008.Issue: 1) Continuing Jurisdiction To Vacate A Settlement

Notices were mailed to the injured worker, the employer, their respectiverepresentatives and the Administrator of the Bureau of Workers'Compensation not less than 14 days prior to this date, and the followingwere present for the hearing:

APPEARANCE FOR THE INJURED WORKER: Degennaro, ClaimantAPPEARANCE FOR THE EMPLOYER: NoneAPPEARANCE FOR THE ADMINISTRATOR: Kirk, Marshall

It is the order of the Staff Hearing Officer that the Injured Worker'sC-86, filed 08/01/2008, is denied.

On 05/12/2006, the claimant executed a C-240 application requesting thatthis claim be settled for $35,000. The claimant indicated in thatapplication that she was requesting the settlement due to financialproblems and health problems. On 05/15/2006 the employer executed itsportion of the C-240 application indicating that it was in agreement withthe claimant's request to settle the claim for $35,000. On 06/13/2006 theclaimant executed a C-241 (amended settlement agreement and release)specifying that the $35,000 settlement consisted of $5,000 for prescriptiondrugs and $30,000 for medical benefits, less an overpayment of $165.25.The employer's signature was not obtained or required for the amendedsettlement agreement as the amount of the settlement minus the overpaymentwas less than the amount listed in the C-240 application to which theemployer had already agreed.

By order dated 06/13/2006 the Administrator approved the settlementagreement between the parties to the claim. it ere is no evidence that theIndustri al Commi ssi on reviewed the Admi ni strator siTr37Zt3 or er,owever, Oh io Revised o 4123 . bb(D) in tca-es t at i a a earing

Officer fails to act within 30 days of the date of the Administrator'sorder, the settlement agreement is approved by operation of law.

The claimant has now filed a motion requesting that the settlementagreement be declared void and that the settlement be vacated for several

A^` • _

77

(Page 2 of 3 y

03-397458The Industrial Commission of Ohio

RECORD OF PROCEEDINGSClaim Number: 03-397458

reasons. The C-86 cites the claimant's lack of representation by counselat the time the settlement was entered; the claimant's alleged psychiatricillness; an allegation that the amended settlement agreement does notconform with Ohio Revised Code 4123.65(A); and that the settlement "isunfair and a gross miscarriage of justice when compared to reserve."

The claimant's representative relies heavily upon State ex rel Wise vRvan (2008), 118 Ohio St. 3d 68, drawing a parallel between the situationof Mr. Wise and the situation of the claimant. However, the HearingOfficer does not find this analogy to be persuasive. The claimanttestified that she graduated from high school as is able to read, write,and do basic math. Although she was unrepresentedby counsel at the timeof the settlement, the claimant testified that she was originally offered$20,000 by the Administrator to settle her claim. After discussing thismatter with her family, she determined that $20,000 was not sufficient andentered into negotiations with the Administrator that eventually led to anagreement for $35,000. The Hearing Officer finds that these are not theactions of someone who does not understand the settlement process or thevalue of her claim.

In addition, although the claimant has been diagnosed with a depressivedisorder and an anxiety disorder, these conditions have been disallowed inthis claim. More importantly, unlike the facts in ise, the claimant haspresented no evidence from a licensed psychiatrist, psychologist, orphysician indicating that the claimant was incapable of understanding thesettlement process or the consequences of settling her claim. To thecontrary, the claimant testified at the hearing that she "knew my benefitswould be cut off" if she settled her claim.

Fn addition, unlike the claimant in ise, the claimant did indicate thereason she desired a settlement in the appropriate space in the C-240application. Although the claimant's representative makes much of the factthat this language was not repeated on the C-241application, the HearingOfficer finds that a repetition of this language is unnecessary as theclaimant had already clearly expressed the reasons for seeking a settlementin the C-240 application. Further, the C-241 application does not containa specific place where the claimant is to explain the reason she is seekinga settlement. Although the claimant could include this information in thesection marked "other", it this instance it was unnecessary to do so as theclaimant clearly expressed her reasons for seeking a settlement on theC-240 application.

Finally, as explained by the Administrator's representatives at thehearing, the "reserve" value to which the claimant's representative refershas no relevance to the value of the settlement of a claim, but ratherrelates to future premiums to be paid by the employer.

In essence, the claimant is requesting that the Industrial Commissionexercise its continuing jurisdiction pursuant to Ohio Revised Code 4123,52to readdress the settlement of this claim and make a finding that thesettlement represents a gross miscarriage of justice and is clearly unfair.However, the claimant has not presented sufficient persuasive evidence todemonstrate new and changed circumstances, fraud, clear mistake of fact,clear mistake of law, or error by an inferior tribunal in the execution andprocessing of the settlement agreeinent.

Accordingly, it is the order of the Staff Hearing Officer that theclaimant's request to vacate the settlement agreement in this claim isdenied.

All evidence was reviewed and considered.

An Appeal from this order may be filed within 14 days of the receipt of theorder. The Appeal may be filed online at www.ohioic.com or the Appeal(IC-12) may be sent to the Industrial Commission of Ohio,Canton District Office, 400 Third Street, S.E., Ste 1, Canton OH 44702.

^. . .^.vv

(Page 3 of 3)

03-397458The Industrial Commission of Ohio

RECORD OF PROCEEDINGS

Claim Number: 03-397458

Typed By: vldDate Typed: 10/24/2008

Findings Mailed: 10/29/2008

Gary J. FrameStaff Hearing Officer

Electronically signed byGary T. Frame

The parties and representatives listed below have been sent this record ofproceedings. If you are not an authorized representative of either theinjured worker or employer, please notify the Industrial Commission.

03-397458Anita L. George3420 Westview Ave NW Apt 3Canton OH 44709-2664

Risk Na: 1376538-0Crown Cork & Seal Usa, IncCrown Cork & SealDirenzo Sandra1 Crown WayPhiladelphia PA 19154-4501

ID No: 16835-90Nick Degennaro430 White Pond Dr Ste 300Akron OH 44320-1122

ID No: 1648-80K K S G& Associates67 E Wilson Bridge Rd Ste 201Worthington OH 43085-2338

ID No: 9999-05***BWC, Law -Canton***400 3rd St SE Ste 3Canton OH 44702-1100

BWC, LAW DIRECTOR

NOTE: INJURED WORKERS, EMPLOYERS, AND THEIR AUTHORIZED REPRESENTATIVES MAYREVIEW THEIR ACTIVE CLAIMS INFORMATION THROUGH THE INDUSTRIAL COMMISSION WEBSITE AT www.ohioic.com. ONCE ON THE HOME PAGE OF THE WEB SITE, PLEASE CLICKI.C.O.N. AND FOLLOW THE INSTRUCTIONS FOR OBTAINING A PASSWORD. ONCE YOU HAVEOBTAINED A PASSWORD, YOU SHOULD BE ABLE TO ACCESS YOUR ACTIVE CLAIM(S).

SH01 Page 3 vld/vld

(Pace 1 of 2)

^J̀J-391'4J8

The IIIdIiStT181: Commission of Ohio

RECORD OFPR1J CEiiDI1`) GS

C(aim Number: 03-397458

LT-OD-OS I F-CflVPCN: 2083581 Anita L. George'l

ANITA L. GEORGE3420 WESTVIEW AVE NW APT 3CANTON OF! 44709-2664

Date of Diagnosis: 8/04/2003

Claims Heard: 03-397458

08-8094r - Ref

FINDINGS MAILE9 %

JAN 22 2009

tNDUSTRIAL CO41v}ISSiJWOF OHlO

Risk Number: 1376538-0

Request For Reconsideration filed by Injured Worker on 11/06/2008,issue: 1) Continuing Jurisdiction Pursuant To R.C. 4123.52

2) CONTINUING JURISDICTION TO VACATE A SETTLEMENT

The Injured lJorker's request for reconsideration, filed 11/06/2008, fromthe order issued 10/29/2008, is denied for the reason that the requestfails to meet the criteria of Industrial Commission Resolution R08-1-01dated 1110112008.

Typed By: CA/lwgDate Typed: 01/12/2009

The above findings and order was approved and confirmed by the majority ofthe members.

Gary M. eyTio YES Wiliiam E. hompson YESChairperson Commissioner

/&. eKevin R. Abrams YESCommissioner

A'iTE$TED TO By:

(

E,x ecutive DirectorFindings Mailed: I

ICRECON2 Page 1 lwg/lwg

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??Page 2 of 2)

03-397458The fndastrial Commission of Ohio

RECORD OF PROCEEDINGSClaim Number: 03-397458

The parties and representatives listed below have been sent this record ofproceedings. If you are not an authorized representative of either theinjured worker or employer, pTease notify the industrial Commission.

03-397458Anita L. Georae3420 Westview Ave NW Apt 3Canton OH 44709-2664

Risk No: 1376538-0Crown Cork & Seal Usa, IncCrown Cork & SealDirenzo Sandra1 Crown WayPhiladelphia PA 19154-4501

ID No: 16835-90Nick Degennaro430 White Pond Dr Ste 300Akron OH 44320-1122

ID No: 1648-80K K S G& Associates67 E Wilson Bridge Rd Ste 201Worthington OH 43085-2338

BWC, LAW DIRECTOR

NOTE: INJURED WORKERS, EMPLOYERS, AND THEIR AUTHORIZED REPRESENTATIVES MAYREVIE4! THEIR ACTIVE CLAIMS INFORMATION THROUGH THE INDUSTRIAL COMMISSION WEBSITE AT www.ohioic.com. ONCE ON THE HOME PAGE OF THE WEB SITE, PLEASE CLICKI.C.O.N. AND FOLLOW THE INSTRUCTIONS FOR OBTAINING A PASSWORD. ONCE YOU HAVEDBTAINED A PASSWORD, YOU SHOULD BE ABLE TO ACCESS YOUR ACTIVE CLAIM(S).

ICRECON2 Page 2 lwg/lwg

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The tnhu.staial Commission of Ohio

RECORD OF PROCEEDINGS

Claim Number: 03-397458 Claims Heard: 03-397458LT-OD-OSIF-COV

PCN: 2043241 Anita L. George

ANITA L. GEORGE8705 GRIMES AVE NW APT 4NORTH CANTON OH 44720-9015

Date of Injury: 8/04/2003 Risk Number: 1376538-0

This claim has been previously allowed for: CARPAL TUNNEL SYNDROMEBILATERAL; TRIGGER FINGER LEFT THUMB; TRIGGER FINGER RIGHT THIRD FINGER;TRIGGER FINGER RIGHT FIFTH FINGER; TRIGGER FINGER LEFT SECOND FINGER;TRIGGER FINGER LEFT FIFTH FINGER; TRIGGER FINGER RIGHT THIRD FINGER.

This matter was heard on 12/16/2004 before District Hearing OfficerLinda Kovach pursuant to the provisions of Ohio Revised Code Section4121.34 and 4123.511 on the following:

C-86 Motion filed by Injured Worker on 09/08/2004Issue: 1) Additional Allowance - BILATERAL WRIST STRAIN

2) Additional Allowance - BILATERAL ELBOW STRAIN ( ULNAR COLLATERALLIGAMENT STRAIN)

Notices were mailed to the injured worker, the employer, their respectiverepresentatives and the Administrator of the Bureau of Workers°Compensation not less than 14 days prior to this date and the followingwere present for the hearing:

APPEARANCE FOR THE INJURED WORKER: Klapp, ClaimantAPPEARANCE FOR THE EMPLOYER: HeinzAPPEARANCE FOR THE ADMINISTRATOR: None

It is the order of the District Hearing Officer that the C86, filed09/08/Z004, is granted to the extent of this order.

It is the order of the District Hearing Officer that the claim isadditionally aalowed for the conditions "BILATERAL WRIST STRAIN ANDBILATERAL ULNAR COLLATERAL LIGAMENT STRAIN."

The District Hearing Officer finds that these conditions are a flow throughinjury.

This order is based on the 06/24/2004 office note of Dr. Shirali; the08/26/2004 signed office note of Dr. Bodnar; and the 07/29/2004 MercyMedical Center report.

An Appeal from this order may be filed within 14 days of the receipt of theorder. The Appeal may be filed online at www.ohioic.com or the Appeal(IC-12) may be sent to the Industrial Commission of Ohio,Canton District Office, 400 Third Street, S.E., Ste 1, Canton OH 44702.

Typed By: vld ^Date Typed: 12/16/2004 L ia-dDate Received: 11/13/2004 DistNotice of Contested Claim: 09/08/ 04 ^Findings Mailed:

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