DiCarlo: SJC tells Workers’ Comp Insurers: You Can’t Get What You Don’t Pay For

reza-breakstone-web.jpgBy Reza Breakstone

In a major victory for the rights of injured workers, the Supreme Judicial Court ruled today that pain and suffering damages, to which injured workers are entitled in their accident cases, are not subject to liens from workers’ compensation insurance companies. As a result of the ruling, workers will be able to keep more of their personal injury settlements and verdicts.

Until today, there was confusion over the relationship between workers’ compensation liens and damages paid by a third party to employees for worksite injuries. If an employee gets injured, he or she is entitled to workers’ compensation for lost wages, medical bills, and other specific damages. But workers’ compensation insurance does not pay for pain and suffering damages.

If the worker collects workers’ comp, then successfully sues a third party (not his employer) for those injuries, he or she has a duty to reimburse the insurance carrier up to a point. The mechanism to regulate reimbursement to the insurance company is General Laws c. 152, § 15. The statute provides that an employer can recover its workers’ compensation payments to its employee, if that employee recovers money from a third party.

But, as mentioned above, workers’ compensation pays for lost wages and medical expenses. In a tort lawsuit, an injured party is entitled to more than that, including damages for pain and suffering. In the case where an employee simply recovers lost wages and medical expenses from a third party, there is no dispute that that money is returned to the workers’ compensation insurer in the amount that was paid. Any excess, the employee keeps. But, what about when an employee also gets money for pain and suffering? Does the workers’ compensation insurer get that money back, too?

Today, the SJC said, in no uncertain terms, no. They didn’t quite say “you can’t always get what you want.” But, they did say, you get can’t what you don’t pay for. Workers’ compensation does not pay for pain and suffering. So, if an employee gets a recovery that specifically sets aside damages for pain and suffering, that employee keeps that set-aside amount. Anything else is liable to go back to the workers’ compensation insurer for the amount that was paid (minus its fair proportionate share of attorney’s fees and expenses).

The cases were DiCarlo v. Suffolk Constr. Co., SJC docket no. 11854; Martin v. Angelini Plastering, Inc., SJC docket no. 11853 (both decided February 12, 2016).

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Massachusetts Supreme Judicial Court Denies General Contractor Immunity

Ruling Confirms Rights of Injured Workers to Bring Third Party Claims Against General Contractor after Receiving Workers’ Compensation Insurance

The Supreme Judicial Court (SJC) today affirmed the right of an employee of an uninsured subcontractor to bring third party claims against the general contractor, even if the general contractor has made workers’ compensation payments pursuant to G.L. c. 152, § 18. The case was an important victory for workers injured in construction accidents.

The case arose from an explosion on a residential construction site. The explosion killed a worker and seriously injured his son, who was also working at the site. Both men were employed by Great Green Barrier Co., which did not have workers’ compensation insurance. As a result, pursuant to G.L. c. 152, § 18, the general contractor, Henry C. Becker Custom Building Ltd., was liable for the workers’ compensation obligations. This obligation arises under the policy in Massachusetts that a general contractor is responsible to hire only subcontractors which have workers’ compensation insurance available for their employees.

The defendant argued that the statutory scheme prevented the plaintiffs from making third party claims once they had accepted lump sum workers’ compensation settlements pursuant to G.L. c. 152, § 23, which ordinarily bars workers from maintaining negligence claims against their employers if they have accepted workers’ compensation benefits. While this argument had persuaded the trial court, which granted summary judgment for the defendant, the ruling had been overturned by the Appeals Court. Wentworth v. Henry C. Becker Custom Bldg. Ltd, 76 Mass.App.Ct. 507 (2010).

The SJC granted further appellate review and affirmed the Appeals Court ruling, which reversed the summary judgment for the defendant.

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