STF na Mídia - MyClipp

Business Insurance/ ­- Article, Dom, 15 de Abril de 2012
CLIPPING INTERNACIONAL (Supreme Court)
Workers denied comp benefits can sue for
RICO violations
CINCINNATI—An appeals court ruling that allows
injured workers to sue their former employer for
alleged racketeering could have a chilling effect on
how employers and third­-party administrators decide
workers compensation claims, observers say.
A panel of the 6th U.S. Circuit Court of Appeals ruled
2­-1 in Paul Brown et al. vs. Cassens Transport Co. et
al. that several Michigan transportation workers can
sue Edwardsville, Ill.­-based Cassens Transport Co.
and Atlanta­-based third­-party administrator Crawford &
Co. for allegedly violating the Racketeer Influenced
and Corrupt Organizations Act after their workers
comp claims were denied or settled.
However, an attorney for the auto transportation
company and the TPA said the defendants will seek a
rehearing of the ruling by the full 6th Circuit.
The workers allege that Cassens, which is self­-insured,
conspired with the TPA and Dr. Saul Margules, a
Michigan physician who evaluated and often testified
against injured Cassens workers.
The plaintiffs allege that the defendants"
communications among themselves constituted mail
and wire fraud under RICO and furthered the
conspiracy that included using “fraudulent medical
reports” and ignoring medical evidence to deny or limit
benefits.
In its April 6 decision, the appeals court said
Michigan"s exclusive remedy workers comp provisions
do not bar the workers from alleging that Cassens and
Crawford committed RICO violations—which are
separate from the workers" injury claims.
“A federal civil RICO claim and a state claim for
workers compensation are legally distinct, even though
they share factual underpinnings,” the majority ruled.
In a dissenting opinion, Judge Julia Smith Gibbons
said RICO laws shouldn"t apply because the workers
didn"t suffer damage to “business or property” as
required by RICO regulations.
Marshall Lasser, a Southfield, Mich.­-based attorney
who represents the former Cassens workers and is
litigating other similar cases, said such suits will help
injured workers receive benefits that were unjustly
denied.
“I"ve alleged that these employers and the insurance
companies or the third­-party administrators know that
these doctors lie,” Mr. Lasser said.
In another suit he filed alleging RICO violations in
Michigan workers comp decisions, Christine Jackson
et al. vs. Sedgwick Claims Management Services Inc.
et al., former employees of Atlanta­-based Coca­-Cola
Enterprises Inc. allege that the company and TPA
conspired with Dr. Paul Drouillard to deny or terminate
their claims. Argued last summer in the 6th Circuit, the
case still is awaiting a decision.
Cases such as those filed by Mr. Lasser could
undermine insurers" and employers" ability to
effectively manage medical treatment and benefit
payments for injured workers, said Bruce Wood,
Washington­-based associate general counsel and
director of workers compensation for the American
Insurance Assn.
“What the cases essentially do is use the cover of
RICO—a federal civil and criminal statute—to
undermine and to subvert a state"s workers
compensation system,” Mr. Wood said.
Denis Juge, an insurance defense attorney in Metairie,
La., contends that RICO litigation in workers comp
cases could result in a flood of such suits and hurt
employers" ability to defend themselves against
disputed claims, because doctors could fear being
named in RICO suits.
“If you allow the suits in the other states, you"re going
to find it very difficult as a defense attorney to get a
physician willing to give a second medical opinion,”
said Mr. Juge, a director at law firm Juge, Napolitano,
Guilbeau, Ruli, Frieman & Whiteley L.L.C.
Janet Lanyon, an attorney for Cassens and Crawford,
said her clients later this month plan to seek an en
banc rehearing of the Brown ruling. Cassens, Crawford
and Dr. Margules deny the workers" claims, said Ms.
Lanyon, a shareholder with Troy, Mich.­-based Dean &
Fulkerson P.C.
Brown vs. Cassens has been in the courts for years.
The 6th Circuit initially affirmed a federal judge"s 2005
dismissal of the plaintiffs" RICO claims. But the U.S.
Supreme Court vacated the 6th Circuit"s ruling in
2008 and remanded the case, citing precedent in a
separate RICO lawsuit.
The 6th Circuit allowed the workers" RICO claims to
move forward in a subsequent 2008 decision, but the
U.S. District Court for the Eastern District of Michigan
dismissed it again in 2010 citing the state"s exclusive
remedy provisions concerning workers comp.
“I believe that the case presents novel issues of law,”
Ms. Lanyon said. “So I think anytime a court is
presented with something where there isn"t a lot of
precedent, the possibility of having differing views is
greater.”
RICO lawsuits in workers comp could open the door
for more litigation and delay injured workers receiving
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