U.S. Supreme Court Addresses Wrongful Conduct by Workers' Compensation Carriers
On December 7, the U.S. Supreme Court denied a petition seeking to reverse the 6th Circuit decision in Cassens Transport Co. v. Brown. That 6th Circuit decision allowed several injured workers to pursue Federal Racketeer Influenced and Corrupt Organizations Act (RICO) claims against their employer and its workers' compensation adjustor.
RICO makes it a Federal crime to engage in interstate commerce through a pattern of "racketeering activity." Racketeering activity includes such wrongful conduct as witness tampering, mail fraud and wire fraud. RICO also allows individuals injured by such activity to sue for damages. In Cassens, the plaintiffs were injured workers who had submitted workers' compensation claims. They alleged that their employer and its workers' compensation adjustor had then engaged in false or fraudulent communications in an effort to obtain false medical opinions that would be used wrongly to deny their claims.
What is the significance of this 6th Federal Circuit decision? The 6th Circuit does not geographically include Alabama. However, in Alabama, the employer and its workers' compensation carrier control the medical process. They pick the physician who can provide medical care. They then often employ case nurses who attend appointments and meet privately with that physician to discuss the patient. They can also review requests for medical care by the physician through an administrative process that is largely one-sided in their favor. The pressure on the chosen physician by the carrier is often enormous.
I continue to believe that most people in this process are truly motivated by a desire to help injured workers receive the medical care they need to recover. We all benefit when workers obtain complete medical care. Yet, a small minority of those involved in the system don't share this goal. In my practice, I have seen first-hand the additional damage these "bad apples" can inflict on an already injured worker and his family. Recently, in one case, I discovered that a case nurse falsely told the treating physician that my client was addicted to drugs. In another recent case, the physician received false employment information which implied that my client was refusing to seek employment.
Alabama's Workers' Compensation Act justly protects employers and their insurance carriers from liability due to simple errors or oversights. However, intentional misconduct should not be protected. I am hopeful that this new decision will halt some of the worst practices in our system.
It's amazing what sort of dealings these companies can come up with to try and save money.
It's almost like a detective case sometimes trying to figure out who was planted where and to do what.
On September 27, 2010, the Federal District Court in Michigan dismissed this case. This is the third occasion when the local District Court has negatively reviewed the case. In its Order, the District Court held that Michigan's workers' compensation laws provide the exclusive remedy for a denial of benefits. Will the plaintiff appeal the District Court again? On his blog today, Jon Gelman addressed this recent decision. See, http://workers-compensation.blogspot.com/2010/10/rico-case-dismissed-by-trial-court.html