Federal case alleging violation of RICO Act reinstated

Michigan workers compensation lawyer explains the significance of the Sixth Circuit opinion in the matter of Brown v. Cassens Transp. Co.

Great news from the Sixth Circuit Court of Appeals! The case of Brown v. Cassens Transp. Co. has been reinstated and remanded for further proceedings. This means that the plaintiffs will finally have their day in court!

The plaintiffs, who were allegedly injured while working for Cassens Transport Company, sought workers compensation benefits.  Crawford & Company, the third-party administrator, denied benefits. In response, the plaintiffs filed a complaint in the United States District Court for the Eastern District of Michigan, alleging that the denials were fraudulent and violated the Racketeer Influenced and Corrupt Organizations Act (RICO).

According to the complaint, Cassens Transport Company and Crawford & Company solicited fraudulent medical reports from various IME physicians in order to deny benefits. The plaintiffs assert that other medical evidence that supported their claims was ignored.

This case could have a profound effect on the world of workers compensation. Not just in Michigan but all around the United States. It opens the door for other people to file suit for denial of workers compensation benefits based upon fraudulent independent medical examinations.

Here is some information about Michigan workers compensation and the RICO Act that you should know about.

Workers Disability Compensation Act (WDCA)

Michigan adopted its first workers compensation law in 1912. It was a compromise between employee and employer interests. Employees gave up the right to sue in civil court in exchange for what are essentially no-fault benefits. It protects both parties in the event of a work-related injury.

Workers compensation is supposed to pay for lost wages, unlimited medical treatment, mileage reimbursement, and vocational rehabilitation. Pain and suffering is not available.

Many employers and insurance companies rely upon independent medical examinations to determine whether a claim is legitimate. Unfortunately, these medical examinations are never really independent.

Insurance companies use the same doctors over and over again because they know what to expect.  It is common for a doctor who performs an independent medical examination to find no evidence of an injury or to conclude that a medical condition is not work-related. Some of these doctors make a career out of testifying for insurance companies and earn hundreds of thousands of dollars per year.

Racketeer Influenced and Corrupt Organizations Act (RICO)

Many people have heard of RICO from watching movies and television shows involving criminal prosecution of the Mafia. What is not commonly known is that RICO can also give rise to a civil cause of action.

RICO makes it unlawful for a person or business to engage in a pattern of racketeering activity. This includes conspiracy to deny valid workers compensation claims based upon fraudulent medical opinions. Treble damages, costs, and attorney fees could all be recoverable.

It is too soon to tell if RICO will be a viable tool to stop employer and insurance company abuse. However, this court decision sends a powerful message. It should also send shivers down the spines of those IME doctors who regularly find nothing wrong with injured workers.

What you can do about your own workers compensation claim

If you feel that your benefits have been unfairly denied, call an experienced workers compensation lawyer. A bad medical opinion can always be challenged in court. The insurance company is betting that you just go away. Prove them wrong!

An experienced workers compensation lawyer can also help you find out about other potential claims. It may turn out that the IME doctor who examined you is already the target of a RICO action and you could have a potential claim. Similar cases that have been filed include Lewis v. Drouillard and Jackson v. Sedgwick Claims Mgmt. Servs., Inc.

Call (855) 221-2667 to speak with one of our workers compensation lawyers in Michigan. We offer free telephone advice and your call is always confidential.

Alex Berman is the founder of Michigan Workers Comp Lawyers. He’s been representing injured and disabled workers exclusively for more than 35 years.  Alex has helped countless people obtain workers compensation benefits and never charges a fee to evaluate a case.

Related information:

Brown v. Cassens Transp. Co.

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