Larson’s Spotlight on Recent Cases: Court Dismisses Injured Workers' Tort Action Against Carrier for Five-Month Delay in Medical Benefits

Larson's Spotlight on Bad Faith Insurance Tactics, Benefits During Incarceration, Borrowing Employer, and Injury and Causation. Larson's surveys the latest case developments that you need to know about. Thomas A. Robinson, the staff writer for Larson's Workers' Compensation Law, has compiled the list below.

TX: Injured Workers' Tort Action Against Carrier and Others for Five-Month Delay in Medical Benefits Was Appropriately Dismissed

A Texas appellate court recently affirmed the dismissal of a tort claim filed against a workers' compensation carrier, another defendant (Southwest) that had provided administrative services, and a physician alleging that the trio were liable for damages under common-law bad faith, statutory bad faith, and fraud theories associated with the carrier's delay of five months in paying benefits to the plaintiff-worker.  Citing the recent decision of the Texas Supreme Court in Texas Mutual Insurance Co. v. Ruttiger, 2012 Tex. LEXIS 501 (Tex. June 22, 2012), the appellate court held that the regulatory scheme set out in the Workers' Compensation Act (the Act), as amended in 1989, precluded the injured worker's causes of action regarding the manner in which the carrier had handled the processing of his workers' compensation claim.  The court, citing and quoting Ruttiger, noted that the 1989 amendments to the Act contained significant changes, including reforms to the dispute resolution process, and that the Act prescribed detailed, Division-supervised, time-compressed processes for carriers to handle claims and for dispute resolution. It had multiple, sometimes redundant but sometimes additive, penalty and sanction provisions for enforcing compliance with its requirements. Allowing a separate cause of action in tort would be inconsistent with the Act.

See Carpenter v. Southwest Medical Examination Servs., Inc., 2012 Tex. App. LEXIS 5879 (July 19, 2012).

See generally Larson's Workers' Compensation Law, §§ 104.05, 114.04.

MA: Court Ordered Alcohol Treatment Program is Not "Incarceration;" Employee Need Not Repay Benefits Received During Treatment Period

A Massachusetts appellate court recently affirmed a finding by the state's Industrial Accident Reviewing Board requiring an injured employee to repay the employer the benefits he received while he was actually incarcerated in jail, but not those he received while committed to a court-ordered alcohol treatment program. This was not "incarceration" for the purposes of Mass. Gen. Laws ch. 152, § 8(2)(j). The court found the board's interpretation of § 8(2)(j) reasonable.

See MacDonnell's Case, 2012 Mass. App. LEXIS 223 (July 19, 2012).

See generally Larson's Workers' Compensation Law, § 64.03.

IL: Administrator May Not Sue Borrowing Employer for Fatal Injuries Sustained by Husband

An Illinois appellate court recently affirmed a trial court's determination that a worker who sustained fatal injuries while repairing a garage door at a Toyota dealership was a borrowed employee and the administrator of his estate could not proceed in tort against the dealership because of the exclusive remedy of the state's workers' compensation law. The decedent had been hired by an affiliated corporation, which operated a Chevrolet dealership. The various corporations had common ownership and it appeared the decedent did work as needed at each of the corporate entitles that were controlled by the Grossinger family. The appellate court indicated that the borrowing employer had the right to control the duties of the decedent. Since the decedent was a borrowed employee, the tort action was barred by exclusivity.

See Prodanic v. Grossinger City Autocorp, Inc., 2012 Ill. App. LEXIS 593 (July 19, 2012).

See generally Larson's Workers' Compensation Law, § 111.03.

MT: Causation Requires Showing of "More Probable Than Not" and Must Be Shown by "Objective Medical Findings"

The Supreme Court of Montana recently affirmed a denial of benefits to an employee who claimed he sustained cervical injuries under rather bizarre circumstances-he attempted to dislodge metal from a baling machine by using a chain attached to a pickup truck.  In the process his neck snapped back when the truck abruptly stopped, the force of the effort to dislodge lifting the truck off the ground.  Clarifying the burden of proof in workers' compensation claims, the court indicated that the claimant's burden to establish an accident, an injury or aggravation of a preexisting condition, and a causal connection between the accident and the injury/aggravation is "more probable than not." Furthermore, in meeting that burden, the employee must establish injury and causation by objective medical findings.  The employee had not shown by a preponderance of objective medical evidence that he was entitled to temporary total disability benefits.

See Ford v. Sentry Casualty Co., 2012 MT 156, 2012 Mont LEXIS 205 (July 24, 2012).

See generally Larson's Workers' Compensation Law, § 46.03. 

Source: Larson's Workers' Compensation Law, the nation's leading authority on workers' compensation law.

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