It is commonplace during the course of an Ohio Workers’ Compensation claim to have the employer request that the employee submit to an Independent Medical Exam, commonly known as an IME. For years there has been statewide (and nationwide) suspicion that the financial relationship that builds between the IME doctor and the employer causes the IME doctor’s reports to be skewed against the injured Ohio worker and in favor of the employer. Now, employees have begun to take matters into their own hands.
In Brown v. Cassens Transport Company, several employees of Cassens sustained work-related injuries and made workers’ compensation claims. Cassens was a self-insured employer and utilized a third-party administrator (TPA) to administer its workers’ compensation claims. Cassens and its TPA arranged to have the five employees examined at an IME by Dr. Saul Margules. Cassens denied the employees’ workers’ compensation claims based on Dr. Margules’ IME reports.
The employees filed a complaint against Cassens, the TPA and Dr. Margules, asserting a RICO (Racketeer Influenced and Corrupt Organization Act) claim. The employees alleged Cassens and its TPA solicited fraudulent medical reports from Dr. Margules, and that Cassens, the TPA and Dr. Margules conspired to fraudulently deny their pending claims to receive workers’ compensation benefits. The plaintiffs argued that Dr. Margules was biased against them because Cassens and its TPA paid him a significant amount of money over the years to prepare favorable IME reports.
The appellate court denied the employer’s motion to dismiss the RICO claims, stating that the plaintiffs’ allegation of personal injuries constituted a property interest. The Court remanded the case to the district court to allow the plaintiffs the opportunity to prove their RICO claim. A similar case was also advanced in the matter of Jackson v. Coca-Cola, which is currently pending in the Sixth Circuit Court of Appeals. The employer in the Cassens case has appealed the Sixth Circuit’s decision to the U.S. Supreme Court which is currently in the process of deciding whether to hear the appeal.
In light of the Cassens decision and Jackson decision, it appears that injured workers have the green light to bring RICO claims against employers upon producing evidence that troubling usage patterns have developed with IME providers or other service providers. Indeed, upon an employee producing evidence of over-utilization of certain providers, the employee may be able to be successful in taking the next step and proving outright collusion, which, frankly, probably happens much more than anyone would like to admit. Employees must keep in mind, however, that the courts have not found that any of the defendants in Cassens or Jackson actually committed a RICO violation. The courts have simply sent the cases back to the trial court level to allow the plaintiffs the opportunity to prove their RICO claims. If you have been injured and are filing claims, contact The Charles E. Boyk Law Offices, LLC.