On November 18, 2015, the Second Circuit Court of Appeal upheld a Workers’ Compensation Judge’s (WCJ) decision finding that the employer was entitled to a statutory offset on supplemental earnings benefits (SEBs) owed to the claimant for long-term disability (LTD) payments where the employer paid the entirety of the premiums on the policy. Claimant, Shelia Hill, worked as a dialysis technician for Employer, Fresenius Medical Care NA, when she was diagnosed with bilateral carpal tunnel syndrome (CTS). Claimant underwent CTS surgery and was subsequently diagnosed with degenerative joint disease of the left basilar joint. Following a records review finding that the basilar joint condition was unrelated to her employment and that Claimant could return to modified work, Employer denied that the basilar thumb arthritis was related to her employment. Claimant proceeded to undergo surgery for that condition under her private insurance.
Soon after the surgery, Employer terminated Claimant’s temporary total disability (TTD) benefits and Claimant began receiving LTD benefits under a policy entirely funded by FMC. Following a trial, the WCJ found that Claimant had failed to prove a causal connection between her basilar joint arthritis and employment. Claimant was awarded SEBs from the date TTD was terminated and Employer was entitled to an offset pursuant to La. R.S. 23:1225 based on the employer-funded LTD benefits received by Claimant. Claimant moved for a new trial which was granted. Additional proceedings were held but the WCJ concluded that as long as Claimant received LTD benefits, or was ordered to or agreed to reimburse the payments, Employer was entitled to a corresponding offset. Claimant appealed. On Appeal, the Second Circuit noted that Section 1225 is a wage-loss benefit coordination statute. “When an employee receives, in addition to workers’ compensation benefits, the benefits under another (non-workers’ compensation) disability plan funded by the employer, the employer is entitled to a credit for the benefits received by the employee from the separate plan.” The judgment of the WCJ was affirmed.
Hill v. Fresenius Medical Care NA