Government’s Right

Government’s Right to Reimbursement from Employer/Carriers in Workers’ Compensation Claims

On October 11, 2011, Judge Doumar sitting in the Federal District Court for the Eastern District of Virginia rendered a decision in the United States of America v. Chartis Insurance Agency, et al. that the Government had the right to pursue an employer/carrier for reimbursement of medical care, plus interest, furnished to a claimant which was recoverable from the employer/employer’s workers’ compensation insurance carrier for benefits paid to or on behalf of an injured worker.

Claimant, James Thompson, was retired from the United States Air Force. He was involved in a compensable workers’ compensation injury when he slipped, fell and fractured his left arm. Thompson received medical care at Langley Air Force Base Hospital following his work injury. Thompson entered into a settlement agreement with his employer and employer’s workers’ compensation carrier which resolved his rights to indemnity and future medical care and treatment. Claimant and his employer were aware of the United States’ claim for reimbursement for medical care provided to the claimant but the United States was not made aware of any settlement negotiations, nor were their rights or interests addressed in the settlement agreements submitted to, and approved by, the Virginia Workers’ Compensation Commission.

Judge Doumar found that the United States had an interest in recovering the amount of expenses incurred in the treatment of the claimant for his work related injuries. Judge Doumar’s decision struck the carrier’s Motion to Dismiss and allowed the United States to pursue their action against the employer and carrier for reimbursement of medical expenses incurred. Chartis resolved their dispute with the Government once its Motion to Dismiss was denied.

Judge Doumar’s decision makes two points apparent. First, that the United States will be pursuing reimbursement for medical care and treatment in those cases where the Government through its medical facilities has paid for medical care and treatment in a compensable workers’ compensation claim. (If the claim is not accepted as compensable I believe it would be incumbent upon the Government to establish in Federal Court that there was a work related injury, or that the medical care and treatment was reasonable, necessary and related to the work accident.) Second, that the Government does have standing to pursue employers and carriers for reimbursement of their lien.

Please be sure in all workers’ compensation claims where a claimant has received medical care and treatment at a Government healthcare facility that the lien is repaid, or taken into consideration in the settlement documents to eliminate potential future exposure on the part of the employer and carrier. This problem is particularly true here in the Tidewater area where a large number of retired military reside.

Please do not hesitate to contact Marilyn N. Harvey at 757-466-0464 or by email should you have any questions regarding this decision or workers’ compensation questions.

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