Court Rejects Insurer’s Bid for Second Injury Fund Reimbursement
- The New Hampshire Supreme Court reversed a Compensation Appeals Board decision that had granted ESIS, Inc., the former workers’ compensation insurer for BAE Systems, Inc., reimbursement from the state’s Special Fund for Second Injuries for benefits paid to an employee who suffered a work-related back injury.
- To qualify for reimbursement, state law requires an insurer to prove by written records or affidavit that the employer knew of an employee’s permanent physical or mental impairment at the time of hire; the insurer relied on a federal “Voluntary Self-Identification of Disability” form the employee had checked indicating “Yes, I have a disability, or have had one in the past.”
- The court found that language insufficient, ruling the phrase “have had one in the past” could just as easily mean the condition had already been resolved, meaning the form failed to demonstrate the employer knew of a presently existing, permanent impairment at the time of hiring as the statute requires.
- The court rejected the insurer’s argument that BAE shouldn’t be penalized for using a federally designed form as intended, clarifying that the form’s federal purpose was irrelevant since it simply didn’t meet New Hampshire’s specific statutory knowledge requirement, and remanded the case for further proceedings.
Court Tosses Medical Provider’s Suit Against Medicare Set-Aside Administrator
- A Louisiana federal district court dismissed with prejudice a lawsuit by Louisiana Pain Specialists, LLC against Ametros Financial Corp., a Medicare set-aside administrator, over allegations that Ametros underpaid medical providers treating patients whose workers’ compensation settlements were funded into MSA accounts.
- LPS argued Ametros should pay providers at workers’ compensation fee schedule rates, since those rates were used to calculate how much money funded each patient’s MSA account, but the court found LPS failed to cite any statute or regulation requiring reimbursement at the higher workers’ compensation rate rather than the Medicare rate Ametros actually paid.
- The court also rejected LPS’s argument that Ametros had a contractual obligation to pay at workers’ comp fee schedule rates, finding no privity of contract existed between the two parties since Ametros’ only contractual relationships were with the individual patients whose MSA accounts it administered, not with LPS directly.
- Because the court found LPS’s petition failed due to a lack of viable legal causes of action rather than insufficient factual detail, it denied LPS leave to amend and file a revised complaint.
Bill Would Cement Real Estate Agents’ Independent Contractor Status
- A bipartisan House bill, H.R. 3495, would exclude qualified real estate agents and direct sellers from the Fair Labor Standards Act’s definition of “employee,” aligning federal labor law with how the tax code has classified agents as independent contractors since 1982.
- Introduced by Rep. Kevin Kiley (I-Calif.) and Rep. Henry Cuellar (D-Texas), the bill has 31 cosponsors and has advanced through the House Committee on Education and Workforce, and is now awaiting full House consideration.
- The National Association of Realtors supports the bill, noting 89% of its members are already classified as independent contractors, and says the change would reduce regulatory confusion. Because independent contractors generally aren’t covered by workers’ compensation, agents who remain classified this way would continue relying on self-purchased coverage rather than employer-provided workers’ comp or benefits.