Five Recent Workers’ Comp Cases You Should Know About (10/7/2011) – Workers Comp Denied Where Claimant Was Chased At High Speed and Shot By Co-worker's Friend

Larson's Spotlight on Unilateral Termination of Benefits, Going and Coming Rule, Pre-Authorization of Medical Care, Settlement Proceeds Not Subject to Lien, Date of Development of Injury. 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.

MD: Friend of Co-Worker Follows Claimant in High-Speed Auto "Chase," Then Shoots Him; Court Says No Recovery Because, Among Other Things, Claim Barred by "Going and Coming Rule"

A Maryland appellate court recently affirmed a decision of a circuit court that had reversed an award of workers' compensation benefits to hotel worker who was shot and rendered a paraplegic by a friend of a co-worker with whom claimant had an argument over several supply carts being utilized for a hotel banquet.  The evidence tended to show that claimant and the co-worker argued and that the claimant touched the co-worker on the hand, at which point the co-worker called a friend, telling him to get his "thing," and come "take care of" the claimant.  The "friend" got his gun, drove to the hotel, and then accosted claimant, who'd been told by the supervisor (in light of the loud argument between the two workers) to go on home since his shift was almost over.  As the claimant left in his vehicle, he was chased for some 13 miles at high speeds by the co-worker's friend.  When the vehicles finally stopped, the assailant shot and seriously wounded claimant.  In spite of the work-related origin of the argument between the claimant and the co-worker, the court held that claimant's injuries were not covered by the Act because the assault that caused them was not "directed" against him in the course of his employment.  Citing various sections of Larson's Workers' Compensation Law, the court held that the injuries did not arise of the employment.  And, in an unusual application of the rule, the court also held that under the going and coming rule, claimant's injuries were not compensable.

FREE VERSION: Access the case on lexisONE free case law. Click on tab for Free Case Law. Click on the radio button for Search by Citation. Enter this citation: 2011 Md. App. LEXIS 140. Then click on the red button Search for Free. Note: If you haven't registered for free at lexisONE, you will be prompted to do so in order to access the free case law.

FULLY FEATURED VERSION: Lexis.com subscribers can read the fully featured case here. See generally Larson's Workers' Compensation Law, §§ 8.01, 13.01.

LA: Court Affirms $16,000 in Penalties and Fees for Unilateral Termination of Benefits and Adds $4,000 More of Its Own

A Louisiana appellate court recently upheld a decision of the state Office of Workers' Compensation that had awarded $8,000 in penalties and $8,000 in attorney's fees to claimant whose workers' compensation benefits were unilaterally terminated by an insurer.  Finding the termination to be arbitrary and capricious, and adding an additional award of $4,000 in attorney's fees, the appellate court observed that the carrier ceased benefits based upon a single newspaper report that in a drug bust, the claimant had charged after and assaulted one or more members of the police team that entered his house to serve a search warrant.  The carrier apparently reasoned that if claimant was able to assault a police officer and deal drugs, he was physically and mentally capable of driving a log truck, his former employment.  Noting as well that a claimant could not forfeit his or her rights to compensation based upon an arrest-the charges were later reduced to simple marijuana possession and claimant received one-year probation-the court found that claimant had done nothing to warrant a forfeiture of future benefits.

FREE VERSION: Access the case on lexisONE free case law. Click on tab for Free Case Law. Click on the radio button for Search by Citation. Enter this citation: 2011 La. App. LEXIS 1109. Then click on the red button Search for Free. Note: If you haven't registered for free at lexisONE, you will be prompted to do so in order to access the free case law.

FULLY FEATURED VERSION: Lexis.com subscribers can read the fully featured case here. See generally Larson's Workers' Compensation Law, §§ 131.03, 135.02.

GA: 5-Day Response Rule Regarding Pre-Authorization of Medical Care Does Not Shift Burden of Proof to Employer/Carrier

Affirming a decision of the state Court of Appeals, but on different grounds, the Supreme Court of Georgia recently sanctioned Rule 205 of the State Board of Workers' Compensation, which imposes a five-day deadline for carriers and self-insurers to respond to a request for pre-authorization of medical care, such as surgery.  The Court of Appeals had declined to order payment of surgical benefits in the case, in spite of the delay in responding to the request, because it held the Board exceeded its authority in promulgating the Rule.  Agreeing with the employer, the Court of Appeals had held that the effect of the rule was to shift improperly the burden of proof of compensability to the employer.  The high court disagreed with the reasoning of the Court of Appeals.  It held that Rule 205 does not mandate that an employer's failure to respond within five days results in the employer's obligation, as a matter of law, to pay for such medical treatment regardless of whether the underlying injury is work-related.  The wording of the rule clearly indicated that the treatment or test must be related to the compensable injury.   Since the claimant had to show compensability, the Rule shifted no burden.  The court added parenthetically that this was not to say, however, that an insurer/self-insurer was not subject to any sanction for failing to respond to a physician's request for preauthorization within the five day time frame in Rule 205.  Civil penalties and attorney's fees might be appropriate.

FREE VERSION: Access the case on lexisONE free case law. Click on tab for Free Case Law. Click on the radio button for Search by Citation. Enter this citation: 2011 Ga. LEXIS 705. Then click on the red button Search for Free. Note: If you haven't registered for free at lexisONE, you will be prompted to do so in order to access the free case law.

FULLY FEATURED VERSION: Lexis.com subscribers can read the fully featured case here. See generally Larson's Workers' Compensation Law, § 94.02.  

MA: Settlement Proceeds Appropriately Allocated to Loss of Consortium and to Decedent's Pain and Suffering are Not Subject to Lien Related to Employer/Carrier's Subrogation Rights

Affirming a decision of a trial court, a Massachusetts appellate court recently agreed that loss of consortium suffered by family members and conscious pain and suffering on the part of the deceased worker were not compensable injuries under the state's workers' compensation statute and, therefore, in a third party civil action brought by the spouse or personal representative of the deceased worker, settlement amounts appropriately attributed to those injuries were not subject to the employer or carrier's lien for workers' compensation benefits paid.

FREE VERSION: Access the case on lexisONE free case law. Click on tab for Free Case Law. Click on the radio button for Search by Citation. Enter this citation: 2011 Mass. App. LEXIS 1244. Then click on the red button Search for Free. Note: If you haven't registered for free at lexisONE, you will be prompted to do so in order to access the free case law.

FULLY FEATURED VERSION: Lexis.com subscribers can read the fully featured case here. See generally Larson's Workers' Compensation Law, §§ 117.05, 117.06.

LA: Worker's Claim For Injury Resulting From Exposure to Hazardous Chemicals Found Time-Barred

An employee's workers' compensation claim for injury resulting from exposure to hazardous chemicals in his work as a tank-cleaner was barred by La. Rev. Stat. Ann. § 23:1209(A)(3) because, once his doctor indicated to him that his condition was work-related, he had one year from the date of the development of his injury to file, and he failed to do so.

FREE VERSION: Access the case on lexisONE free case law. Click on tab for Free Case Law. Click on the radio button for Search by Citation. Enter this citation: 2011 La. App. LEXIS 1124. Then click on the red button Search for Free. Note: If you haven't registered for free at lexisONE, you will be prompted to do so in order to access the free case law.

FULLY FEATURED VERSION: Lexis.com subscribers can read the fully featured case here. See generally Larson's Workers' Compensation Law, § 126.05.

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

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