It’s not uncommon for employers to switch workers’ compensation insurance carriers periodically. However, this action caused a headache for the courts when it came to a worker who suffered two compensable work-related injuries while working for the same employer, but covered by two different insurance carriers.
The case, Gill v. Brescome Barton, Inc., wound its way recently all the way to the Connecticut Supreme Court.
According to court records, worker suffered a compensable, work-related injury to his left knee back in 1997. At the time of that injury, his employer was insured for workers’ compensation benefits by Company 1.
Five years later, the employee suffered another work-related injury to his right knee. By then, the employer had switched insurance carriers, and the workers’ compensation carrier was Company 2.
The injuries were completely unrelated to each other, and neither carrier disputed its responsibility for the respective injuries incurred at the time they provided coverage to plaintiff’s employer.
A physician recommended worker undergo a bilateral knee surgery, meaning both knees were to be operated on at the same time, a procedure that was not only medically necessary but reasonable.
The insurance companies together agreed Company 2 would cover the cost of the surgery, and Company 1 would then reimburse for half the cost, plus other related expenses.
What the carriers could not come to an agreement about was how to divvy up worker’s temporary total disability benefits, to which he was entitled during recovery, while he was unable to work.
Company 1 at first said it would pay back Company 2 for less than half the relapse rate, but Company 2 didn’t accept this offer. There was a formal hearing over the matter, at which time a workers’ compensation board hearing officer noted that while the two injuries were distinct, either one or the other would render the claimant temporarily totally disabled. They are concurrent of each other, which actually benefits both carriers because they could split the surgical and post-surgical costs, as well as the duplicative disability insurance coverage.
Commissioner thus ordered Company 1 to reimburse Company 2 half of these costs. Company 1 appealed, arguing commissioner lacked authority to make such a determination.
The full board affirmed the commissioner, noting firstly the commissioner could not have ordered both carriers to cover the full cost, as that would amount to double recovery. Further, the award was in line with the previous agreement the carriers had regarding the split of “incidental expenses” – of which post-surgical disability benefits would be one.
Company 1 appealed that ruling to the state supreme court. There, justices ruled that given the unique circumstances of the case, commissioner was within his authority to issue this decision, which was legally sound.
The case shows how insurance companies will fight aggressively in every case to limit liability to whatever extent possible, even for compensable injuries. Although this was primarily a dispute between two insurance companies, workers need to ensure their rights and interests are protected by hiring an experienced workers’ compensation attorney.
For information on Atlanta work injury compensation, contact J. Franklin Burns, P.C., at 1-404-920-4708 .