In Brown v. Perez, a case from United States Court of Appeals for the Tenth Circuit, a group of civilian federal employees filed a lawsuit based upon a claim of unfair administration of the workers’ compensation claims system.
These workers were subject to workers’ compensation system run by an agency that is part of the U.S. Department of Labor. If a worker is injured on the job, or suffers from a work related illness, they are required to go to a to a doctor and get a letter of opinion from that doctor that they are suffering from a qualifying condition. Once this is done, the program agency can have a doctor hired by them review the case and offer a second opinion. If there is a disagreement between the treating physician and the one hired by the workers’ compensation program to provide a second opinion, the agency will have a designated impartial referee review the case, and this person will decide whether or not claimant is entitled to workers’ compensation benefits. The referee typically makes a decision that claimant is not entitled to benefits.
The way these referees are selected is that a computer program selects them from a list of qualified doctors who are within 25 miles from the claimant. They are then asked if they will serve as a referee, and, if they do not want to serve in this capacity, the program looks at an expanded geographical area. The plaintiffs contend that the agency is not really using a random list of doctors, but keeps going with the same few doctors. As a result, they are on a select list of doctors, and they are getting a lot of money for serving as a referee as many times as they do. Since they have a financial incentive to remain on the list, they allegedly find for the denial of benefits, so the agency is happy with their services.
As our Boston workers’ compensation attorneys have seen, whether we dealing with a government agency or a private insurance company, there is often a much greater interest in saving money by denying claims than about making sure disabled workers get the benefits to which they are rightfully entitled. For this reason, the best thing you can do is make sure you have an experienced workers’ compensation attorney on your side that is fighting for your right to a full and appropriate award of disability benefits.
To find out if this is really happening and get proof of their suspicions, they filed this request for records under the Freedom of Information Act (FOIA). The Department of Labor claimed they were exempt from the FOIA process with respect to the referee process and denied to provide the records. At this point, plaintiffs filed a FIOA lawsuit, and the defendant moved to dismiss. The trial court granted this dismissal.
The appellate court felt that that there was a genuine dispute as to a material fact and remanded the case for further proceedings consistent with its opinion.
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Brown v. Perez, August 29, 2016, United States Court of Appeals for the Tenth Circuit
More Blog Entries:
Scope of Employment in Workers’ Compensation Cases, March 29, 2016, Boston Workers’ Compensation Lawyer Blog