Remedies For Injured Workers Denied Workers Compensation Benefits

Injured workers may pursue civil claims for damages under the federal racketeering law known as RICO (Racketeer Influenced Corrupt Organizations) based on a scheme to wrongfully deny them workers compensation benefits the United States Court of Appeals for the Sixth Circuit, which covers Kentucky, recently ruled in Brown v. Cassens Transport Co., No. 05-2089.  A group of six injured workers claimed that their employer, Cassens Transport Company, the company that administered Cassens's workers compensation claims, Crawford & Company, and a doctor, Saul Margules, "employed mail and wire fraud in a scheme to deny them worker's compensation benefits."  More specifically, the injured workers alleged that "Cassens and Crawford deliberately selected and paid unqualified doctors, including Margules, to give fraudulent medical opinions that would support the denial of worker's compensation benefits, and that defendants ignored other medical evidence in denying them benefits." 

The court ruled that a pattern of racketeering activity could be shown based on the following:

  • the common purpose of reducing "Cassens's payment obligations towards worker's compensation benefits by fraudulently denying worker's compensation benefits to which the employees are lawfully entitled"

  • the common result of denying "worker's compensation benefits to certain Cassen's employees who are entitled to such benefits under Michigan law"

  • common participants including worker's compensation officials at Cassens and Crawford and "Margules, a doctor who the plaintiffs allege, with regard to some of the predicate acts, fraudulently recommended ineligibility of benefits at the request of Cassens and Crawford"
  • common victims in the injured employees eligible for but wrongfully denied worker's compensation benefits

  • similar methods of commission, the fraudulent application of legal standards to wrongfully deny worker's compensation benefits to eligible employees.

The Kentucky Justice Association published an article authored by Robert L. Abell, a Lexington, Kentucky workers compensation lawyer, on this case in its January/February 2009 issue of its publication, The Advocate, "Injured Workers May Pursue Civil RICO Claim Based on Enterprise To Deny Them Workers' Compensation Benefits.