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Discounted Medicaid payment can't be recovered through comp benefits: Court


NEW ORLEANS—Medicaid's discounted medical expense payment for a deceased refinery worker exposed to benzene, “extinguished” the claimant's ability to recover workers compensation benefits from his employer, Louisiana's Supreme Court ruled.

The court's split decision in Jerry Wayne Benoit vs. Turner Industries Group L.L.C. addresses a workers comp claim filed by Mr. Benoit, who developed acute myeloid leukemia during his 27 years of working for Turner due to exposure to benzene and other chemicals.

Mr. Benoit died in 2007, a year after filing his claim, which was pursued by his spouse after his death, court records state.

The Louisiana Office of Workers' Compensation found that the claimant's AML was related to benzene exposure while working for Turner. It awarded him $625,168 in medical expenses.

In May 2011, a state court of appeal affirmed the judgment.

On appeal by Turner, the Louisiana Supreme Court considered whether the Office of Workers' Compensation erred in awarding the amount of medical expenses to the claimant.

Mr. Benoit qualified for a Medicaid program, which paid $203,124 of the $625,168 billed by his medical providers. The difference between an amount charged by providers and Medicaid's payment cap is referred to as a "write-off.”

The high court's majority ruled that the Office of Workers' Compensation erred in awarding the claimant medical expenses for the $203,124 paid by Medicaid.

“We find the direct payment of $203,124 in medical expenses by Medicaid extinguished any claim the claimant may have had to recover these amounts from Turner,” the majority said.

The majority also said the claimant was not entitled to recover the $422,043 write-off.

It would amount to an improper windfall “if he was allowed to recover for medical expenses which have been reduced by health care providers as a result of their contractual arrangements with Medicaid,” the majority opinion states.

The court reversed the court of appeal decision, which had affirmed the Office of Workers' Compensation judgment.

But two dissenting justices said, among other arguments, that the majority's opinion allowed the employer to escape its obligations.