Articles Posted in Workers’ Compensation Benefits

Workers’ compensation was created in order to provide benefits to employees who have been injured on the job. However, Boston workers’ compensation has limitations as well.

Our experienced Boston injury attorneys can help inform you of your rights in your workers’ compensation case. Understanding your rights can help you get the benefits and medical care you are entitled to.

A recent case was heard in Minnesota that discusses the law that governs the employer liability for medical treatment an injured employee receives. Schatz v. Interfaith Care Center, No. A11-1171 (Minn. S.Ct. Apr. 11, 2012). Schatz (plaintiff) worked as a realtor for Interfaith Care Center (Interfaith) and was a resident of Minnesota. While working in Minnesota, the plaintiff severely injured her shoulder. Although she received medical treatment in Minnesota, she decided to relocate out of state to Wyoming. She sought treatment for her shoulder from a medical provider in Wyoming. This medical care provider conducted two surgeries on the plaintiff’s shoulder, which were a direct result of the work-related injuries plaintiff sustained. This Wyoming medical provider submitted the bills for shoulder surgery and treatment to the Interfaith WC insurer, New Hampshire Insurance Company (insurance company).

Upon receipt of the coverage requests, the insurance company sent the medical provider the amount consistent with the Wyoming WC statutes. The amount sent to the provider did not equal the cost of the treatment which left the plaintiff owing the provider money. Plaintiff entered a WC “medical request for payment” with the insurance company to have the remaining balance covered. The insurance company denied her request; thus, leading to the case at hand.

Plaintiff argued that because the state statute says that an injured employee should not be held liable for medical costs associated with a work-related injury, she should not have to pay the outstanding balance. Additionally, plaintiff supported her argument with the contention that because she was injured in Minnesota, this Minnesota law had to be upheld.

The insurance company argued that Minnesota law does apply but it pointed to a different Minnesota law. The insurance company defended itself by arguing that it was not responsible for the additional payments because of the Minnesota statute discussing the employer’s liability for medical treatment costs. This statute says that where an employee is injured in one state and receives medical treatment in another, the employer’s liability for medical treatment costs is limited to the amount stipulated by the state where the medical treatment is obtained. See Minnesota Statute §176.136.

Plaintiff countered this argument by stating that there was a conflict between the Minnesota state WC statutes that rendered the result unconstitutional.

The court looks to the facts of this case and analyses the statute. The statutes in question were both unambiguous and clear as to their intent and meaning. Where an employee suffers a work related injury, the employer is legally responsible for “furnishing” an injured employee with the reasonable costs associated with the employee’s medical care. Additionally, there is the above referenced Minnesota statute that limits the amount the employer has to pay for out of state treatment by imposing the statute of the state of treatment. However, the court found that the statutes did not conflict as they addressed two different issues.

The court found for Interfaith, and the plaintiff was denied the additional coverage she requested.
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If you are a civil service member who has been injured on the job in Boston, you may be confused about the benefits you are entitled to. Our experienced Boston workers’ compensation attorneys understand your confusion and we can help guide you through the process.

A recent case came out of Rhode Island dealing with the confusion surrounding workers’ compensation cases. Casale v. City of Cranston, No. 2010-162-Appeal (R.I. S.Ct. Apr. 4, 2012). This case involves a firefighter named James Casale (Casale or plaintiff) who was injured in a collision while he was driving to the site of an emergency. Plaintiff was employed as a firefighter and fire-truck driver for the City of Cranston (Cranston or city).

On the date of the collision the party who was at fault for the accident was driving his vehicle negligently and because of this negligence the plaintiff and the at-fault driver collided. This negligent driver was uninsured at the time of the collision.

Because of this accident, the plaintiff suffered severe injuries. Plaintiff was unable to perform his job related activities for a significant period of time. When a firefighter or civil service member is injured while on the job, the government employer is responsible for providing compensation. This compensation for injuries sustained while on the job is often referred to as injured-on-duty (IOD) benefits. Consistent with the state statutes governing IOD benefits, the city awarded plaintiff benefits greater than $50,000.

Although the plaintiff had received the benefits from the City, he proceeded to enter a claim with his insurance company (Amica) for uninsured motorist (UM) benefits. Consistent with the contractual duties of Amica, it paid the plaintiff the difference between the policy limit of $100,000 and the amount plaintiff received in IOD benefits from the city. This insurance claim is what caused the dispute between the city and the plaintiff.

UM is a type of coverage that is offered through your automobile insurance carrier. In many states this type of coverage is required, although that requirement is not in every state. When you purchase UM, your insurance company agrees to stand in the shoes of an at-fault uninsured driver who causes an accident with you. This is sometimes seen as a third-party liability because the insurance company is not a party to the collision.

Once the city discovered that the plaintiff received these UM benefits from Amica, the city argued that it was entitled to a reimbursement for the amount the city had paid in IOD benefits. The city looked to the state statute governing liability of third parties for damages. The purpose of this statute is to prevent an injured party from collecting double the amount of benefits. The city argued that the insurance company should stand in the shoes of the liable party and because of this; the city should not have had to pay IOD benefits.

Plaintiff countered this by arguing that he was not collecting double the benefits, in fact he only received the total of $100,000. Plaintiff had not collected double what he was entitled to because the insurance company decreased the amount of IOD benefits he had received from the UM policy limits.

The lower court originally heard this case and held on behalf of the plaintiff. The Rhode Island Supreme court upheld this lower court decision and because the plaintiff had not collected double the damages, the city was not entitled to reimbursement.

This case illustrates how critical it is to understand the benefits you are entitled to before you apply for benefits.
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