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Injured worker must reimburse health, not comp, insurer


A pet food manufacturer employee who was injured in a wreck in 2015 while traveling between facilities on a motorcycle will need to reimburse his health plan costs plus interest with proceeds from a negligence lawsuit filed against the driver that hit him, an appeals court in Wisconsin ruled Wednesday.

William C. Brown, who worked for Gardner Pet Group Inc., declined workers compensation coverage, claiming he was not working at the time of his bike ride despite being on the clock and on the same road he took when he traveled between work sites, and went instead through his health insurer to cover $482,099.61 for his “significant injuries,” according to documents in William C. Brown and Beth A. Brown v. Muskego Norway School District Group Health Plan, filed in the Wisconsin Court of Appeals in Waukesha.

Five days after the accident, Gardner Pet Group submitted a claim to the Wisconsin Department of Workforce Development’s Worker’s Compensation Division, indicating that Mr. Brown was “driving from one work location to another” when the accident occurred, according to court documents.

Travelers Property Casualty Co. of America, Gardner Pet Group’s workers comp insurer, determined that Mr. Brown’s claim was compensable. When Mr. Brown discovered the claim had been filed, he refused the workers comp checks he received from Travelers and instructed Gardner Pet Group to withdraw the claim, arguing that he was not working at the time of his accident, documents state.

Meanwhile, Muskego Norway School District Group Health Plan, Mr. Brown’s health insurer, also investigated whether it owed coverage and sent a standard questionnaire to Mr. Brown in 2016, which included the question, “Was treatment required as the result of a work related Injury or Illness,” and the box was marked, “No.” Relying on the questionnaire, the health plan covered Mr. Brown’s medical care and treatment.

Mr. Brown filed a negligence suit in 2016 against the driver and insurer of the vehicle that hit him, naming the health plan as a subrogated party for the health care payments that it made and Travelers in the event it made payments.

In 2017, the health plan filed an amended answer and counterclaim seeking a declaration under state law that it “was not obligated to pay any claims arising from the accident pursuant to the Plan language as Brown was covered by worker’s compensation benefits.”

A Wisconsin circuit court agreed and granted the health plan’s motion for summary judgment and entered a judgment in the amount of $514,551.28, which was $32,451.67 over the costs of care, which included attorney’s fees and interest, against Mr. Brown, who filed this appeal, according to documents.

The appeals court affirmed the judgment in the health plan’s favor, ruling that the plan should not have covered any costs related to a work accident. The court dismissed $245.13 in reimbursements for mileage driven by attorneys, which is not permissible under law.


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