There are so many rules surrounding workers’ compensation in North Carolina. Having an experienced Carolina workers’ compensation attorney advocating for you can give you the peace of mind to concentrate on your health.
A recent Sixth Circuit case discusses the legal interest workers have in receiving workers’ compensation (WC) benefits. Brown et al., v. Cassens Transport Co. et al., No. 10-2334 (6th Cir. Apr. 6, 2012). This case involved several Cassens Transport (Cassens) employees (plaintiffs) who were injured while acting within the scope of their employment.
Cassens was a self-insured company. It hired Crawford as a claims adjuster responsible for managing the company’s outstanding WC claims. As a general practice at Cassens, all injured employees were to obtain a medical evaluation by Dr. Margules (Margules). Cassens was systematically paying Margules over a period of years to evaluate injured Cassens employees and testify against these employees in WC claim disputes.
Upon evaluating the plaintiffs in this case, Margules issued medical evaluation reports to Cassens. These reports indicated that each of the plaintiffs suffered minor injuries. Based on the medical facts articulated in the reports, Cassens denied all of the plaintiff’s WC claims. Plaintiff’s provided additional evidence to be considered, however, this evidence was ignored. Thus, there was significant dispute between the plaintiffs and Cassens surrounding the denial of these WC claims.
Plaintiffs argued that Margules was not sufficiently qualified to make these medical evaluations. Margules was not an orthopedic expert and because most job-related injuries were orthopedic in nature, the evaluating physician should have been an orthopedic expert. Additionally, plaintiffs argued that the medical reports were false and that Margules did not give an accurate assessment of the plaintiffs’ injuries. Furthermore, the plaintiffs argued that because Cassens was paying Margules continuously for years, the fraudulent medical evaluations were solicited by Cassens.
Because of the reasons listed above, plaintiff’s filed suit against Cassens, Crawford and Margules. Plaintiffs argued that this scheming between the parties was illegal and therefore entitled them to monetary relief. The main argument was that the defendants had violated the Racketeer Influenced and Corrupt Organizations Act (RICO).
RICO is an act that was created to punish people who are engaged in unlawful activities that affect interstate or foreign commerce. The activities specified in Article 18 of the United States Code as indictable are considered to be racketeering activities under RICO.
When someone is found guilty of violating RICO, they are forced to pay triple the amount of damages.
Most states have adopted statutes surrounding WC. These statutes provide benefits to those who are injured in job-related activities. When an employee is injured on the job, the employer is responsible for providing benefits consistent with the injuries sustained. The employer usually has fourteen days from the date of notice of injury, before the benefits must be paid.
The trial court that originally heard this case, found that the plaintiff’s had failed to prove the important elements of their case. Because the plaintiffs did not prove that they relied on the medical evaluations, the trial court dismissed plaintiff’s claims. The plaintiffs appealed this decision leading them to the circuit court and this decision.
The circuit court reversed the decision of the trial court and remanded the case back to the lower court with specific instructions. Workers’ compensation benefits are considered property. Any fraudulent activity surrounding the receipt of these benefits is considered a violation of the RICO. Therefore, because it could reasonably be argued that the defendants were involved in fraudulent medical evaluations, the lower court should re-hear the case.
Knowing what laws can provide you with the relief you need, is the job of a well qualified attorney.
Contact the Carolina workers’ compensation attorneys at Lee Law Offices, P.A. for legal advice regarding your case and your rights. We are a dedicated law firm that is here to help to protect the rights of injured workers and their families. Call today to schedule a free and confidential appointment. Call 1-800-887-1965.