Five Recent Cases You Should Know About (3/25/2011)

Five Recent Cases You Should Know About (3/25/2011)

Larson's Spotlight on Preferred Provider Organization, Exclusive Remedy, Physician Testimony, Temporary Partial Disability, and Jurisdiction. 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.

IL: Court Strikes Down Class Certification in PPO Case Filed Against Insurers

An Illinois appellate court has dismissed a class action filed by members of a preferred provider organization against insurers that had challenged the right of the insurer to take discounts for medical care provided to workers' compensation claimants under the terms of the PPO agreement.  According to the plaintiffs, the defendant carriers discounted bills from the plaintiffs without steering patients to the plaintiffs by offering financial incentives to their insureds for utilizing the plaintiffs as their provider.  Under the plaintiffs' theory, since insurance companies in the context of workers compensation could not provide financial incentives to patients to steer them toward a network provider, and the use of financial incentives is the only true method of steering patients, the defendant carriers were not entitled to take PPO discounts on bills for workers' compensation patients submitted by network providers such as the plaintiffs.  The trial court granted plaintiffs' motion for a class certification but the appellate court found that the plaintiffs had not shown an actionable claim under any legal theory. 

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 Ill. App. LEXIS 207. 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.

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MT: Mother's Wrongful Death Action Barred By Exclusivity In Spite of Small $3,000 Death Benefits for Non-Dependent Parents

The payment of $3,000 to a non-dependent parent upon the death of her son was a sufficient quid pro quo to bar a wrongful death action filed by that parent against the employer following the son's work-related death, held the Supreme Court of Montana in a split decision recently.  The court was not persuaded that since she could receive no wage loss benefits under the workers' compensation law, she should not be barred from recovery in tort; the legislature had logically directed that wage loss benefits be paid to those who needed them, and paid only a small amount to persons who did not.

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 Mont. LEXIS 48. 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, § 101.03.

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MT: Physician's License Expires, But Not His Expertise

That a physician's license to practice medicine within the state had expired at the time of a medical examination (the physician's practice was actually in an adjacent state where he maintained appropriate credentials) did not render his opinion any less credible, held the Supreme Court of Montana recently.  The court also indicated that it was within the discretion of the Workers' Compensation Court to give more weight to the opinion of the "expired" physician in spite of the fact that the expert's opinion was contradicted by the injured worker's treating physician.

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 Mont. LEXIS 45. 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, § 130.05.

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VA: Injured Worker's Choice of Part-Time Light-Duty Position Nixes Temporary Partial Disability Benefits

Where a light-duty position was not available with the injured worker's employer and the worker instead took a part-time job with another employer that provided 34 hours of work each week, it was not appropriate for the Workers' Compensation Commission to enter an award for temporary partial disability benefits; the worker had a duty to mitigate his wage loss to the full extent of the hours he had worked before the injury, held a Virginia appellate court recently.

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 Va. App. LEXIS 92. 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, § 85.03.

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CA: Trial Court Has Continued Jurisdiction to Award Costs After It Finds Case Barred By Exclusive Remedy Defense

A California appellate court recently held that where a defendant obtained a judgment of dismissal in a personal injury case because it was successful in proving that the injuries alleged by plaintiff were within the exclusive jurisdiction of the workers' compensation system, the trial court had jurisdiction to award costs to defendant as the prevailing party pursuant to Code Civ. Proc., § 1032.  The trial court granted plaintiff's motion to strike defendant's memorandum of costs following the trial court's decision that the matter was barred by exclusivity, concluding that it lacked jurisdiction to move forward.  The appellate court disagreed.  At least in the context of the case where exclusivity had been raised as an affirmative defense and the case was decided against the plaintiff on that issue, the trial court retained jurisdiction to award costs to the prevailing party.

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 Cal. App. LEXIS 306. 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, § 100.01.

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

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