Articles by Georges Legrand

Punitive Damages Awarded Against a Jones Act Seaman

In what is believed to be a case of first impression, a jury in federal court in Illinois has awarded punitive damages against a Jones Act seaman and in favor of his employer, after the seaman pursued what was found to be a fraudulent claim.  In Phillips v. Hunter Marine Transport, Inc., United States District Court for the Southern District of Illinois, Case No. 09-cv-0997-SCW (decision rendered 9/26/12), Forest Phillips, a deckhand, brought suit against his employer, Hunter Marine, under the Jones Act and the General Maritime Law, for personal injuries allegedly sustained in March 2009.  When he reported for his 28 day work hitch, he signed a boarding report in which he denied having any physical or mental condition that might impair his ability to perform his job duties.  After boarding the vessel, Phillips claims that he was injured while attempting to walk a kink out of a wire when a co-employee handled the wire and caused it to spin out of Phillips’ hand, striking him in the forearm or upper arm.  Phillips continued to work but submitted an accident report to the company the following day.  He was provided medical treatment but returned to the vessel on light duty and when he departed the vessel two days later, he stated on a departure form that it was a “scheduled relief”.  Phillips ultimately underwent surgery for a cervical disc herniation.  Hunter Marine paid maintenance, cure and supplemental wages for approximately 7 months, at a total cost of approximately $92,000.00.

Ultimately, another deckhand reported that Phillips had told him that, prior to his alleged onboard injury, he had hurt his arm and shoulder while working on his car at home and was going to get the company to pay for it; that he had falsely claimed to have been struck by a wire during his alleged accident; and even attempted to bribe the deckhand so that he would support Phillips’ story.  Upon obtaining this information, the employer terminated all benefits and Phillips filed suit.

Hunter Marine filed a counter claim against Phillps seeking recovery of all monies it had paid, along with punitive damages, due to material misrepresentation and fraud.  Hunter Marine requested a jury trial and the court ultimately bifurcated the claims and allowed the counter claim to be tried to a jury first.  The jury found that Phillips had concealed or misrepresented information when he completed the boarding form and when he reported the on-the-job accident; that his concealment and misrepresentation was material to the employer’s decision allowing him to work and/or to pay benefits; that the concealment or misrepresentation was made with the intent to deceive; that the employer would not have paid benefits if they were aware of the concealment and/or misrepresentation; that the employer had been damaged; and that Phillips was liable for punitive damages of $5,000.00.

In addition to the testimony obtained from the co-workers, there was also evidence that the plaintiff had multiple prior convictions for crimes involving deceit and dishonesty, such as forging checks and providing false information concerning his identity to a police officer.  After the jury returned a verdict in favor of Hunter Marine on the counter claims, the federal magistrate, who was considering Phillips’ claims against his employer, ruled in favor of the employer, dismissing all claims.  This decision illustrates the potentially helpful nature of boarding and departure forms and an extension of remedies for punitive damages.

Collateral Source Rule Does Not Apply to Cure Expenses; Attorney’s Fee Claim Reversed

It is well established under the General Maritime Law that a seaman who becomes injured or ill while in the service of the vessel is entitled to receive maintenance and cure benefits until he reaches maximum medical improvement.  Cure is the right to receive reasonable, bona fide and necessary medical services, causally related to the injury or illness.  As a result, it has been a common practice with Jones Act employers and/or their underwriters to have cure expenses audited and, where appropriate, reduced to a “reasonable and necessary” amount.

In Manderson v. Chet Morrison Contractors, Inc. (“CMC”), which was decided by the United States Fifth Circuit Court of Appeals in January 2012, Manderson, who worked for the defendant as an engineer aboard a dive vessel, left the vessel abruptly and was hospitalized for ulcerative colitis, diabetes and a liver condition.  He never returned to work.

Following his illness, Manderson received extensive medical treatment and submitted his bills to his health insurer.  However, he ultimately filed a lawsuit against his employer under the Jones Act and the General Maritime Law.  His lawsuit sought, among other things, the full amount of the medical bills that he had incurred, which totaled approximately $170,000.00.  His health insurer, based upon either audits or fee agreements in place with medical providers, had paid about $70,000.00 in medical expenses, which had been accepted by the medical providers as full payment.

This case was tried to a judge in the United States District Court for the Western District of Louisiana and the judge awarded the full amount of the medical expenses in damages, along with attorney’s fees of $110,950.00 for the alleged arbitrary and capricious failure to pay maintenance and cure.

In awarding the full amount of cure expenses, the district court applied the collateral-source rule, which bars a tortfeasor from reducing the amount of damages owed to a plaintiff by the amount of recovery the plaintiff receives from other sources of compensation that are independent of or collateral to the tortfeasor.  Most states, including Louisiana, apply the collateral-source rule.

On appeal, holding that this appeared to be an issue of first impression, the Fifth Circuit reversed and held that the seaman was only entitled to recover the discounted amount paid by his health insurer and not the full amount of his medical bills.  In doing so, the court recognized that a seaman’s entitlement to maintenance and cure was an implied term of his employment contract and was not predicated on any fault or negligence of the employer.  As such, the Fifth Circuit concluded that the collateral-source rule should not be strictly applied and reduced the cure award by about $100,000.00.

In reversing the award for attorney’s fees for the alleged arbitrary and capricious failure to pay maintenance and cure benefits, the Fifth Circuit recognized that the district court had awarded attorney’s fees without any underlying findings.  At trial, CMC  presented evidence that Manderson had experienced similar flare-ups of his colitis before working for CMC; that he had applied for short term and long term disability and claimed that his colitis was not work related, before filing a suit for maintenance and cure; that Manderson had failed to reveal some of his pre-existing history; and that he never filed any injury report in connection with the incident.  Furthermore, once a formal demand for maintenance and cure was made, CMC promptly referred the matter to its underwriters to investigate the claims and the underwriter did so.  Under the circumstances, the Fifth Circuit reversed the award for attorney’s fees, finding that the evidentiary basis for such an award had not been met.

This decision should further support the employer’s right to have cure expenses audited and paid at a reduced rate.  Furthermore, if the seaman wants to use a physician who will not agree to a reduced rate when other competent medical providers are available who will accept the reduced rate, we believe the employer has an extremely strong argument that it only owes those reasonable and related charges at the reduced rate.

Note: this article first appeared in For the Record, a general-information newsletter published quarterly by Mouledoux, Bland, Legrand & Brackett.  For more information about the newsletter, or to sign up for a free e-mail subscription, please visit http://mblb.com/newletterrevised/.