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May 23, 2019 Article

Maine WC Alert: Latest Appellate Division Rulings on Health Insurance Payments, Social Security Benefits

Maine Workers' Comp Alert

The Maine Workers' Comp Appellate Division recently issued rulings in the cases of Rich v. Maine Turnpike Authority and Butler v. City of Portland.

Health Insurance Payments Made by Self-Insured Employer for Health Insurance Purposes Do Not Constitute Payments Under the Act Sufficient to Toll Statute of Limitations

In Rich v. Maine Turnpike Authority (App. Div. 19-17, May 15, 2019), the Appellate Division affirmed the administrative law judge’s (ALJ) finding that certain payments made by the Maine Turnpike Authority’s (MTA) medical insurance program for treatment did not toll the statute of limitations. “[W]e conclude that payments made “under [the Workers’ Compensation] Act” do not include health insurance payments, even if the employer is self-insured for health insurance because the language in section 95 plainly contemplates workers’ compensation payments; payments made by the MTA’s health insurance program were not made pursuant to requirements of the Workers’ Compensation Act; and MTA’s liability under its self-insured health insurance program was entirely independent from whatever liability it incurred under the Act. Consequently, the health insurance payments in 2006 and 2007 did not serve to restart the limitations period for the 1979 work injury.” The decision involved the interpretation of former section 95 (applicable to dates of injury prior to January 1, 1993). The tolling doctrine also applies to dates of injury on or after January 1, 1993 (section 306).

Employer Entitled to Coordinate Old-Age Social Security Benefits Even If the Employer Did Not Pay into the Social Security System on the Employee’s Behalf

In Butler v. City of Portland (App. Div. 19-16, May 14, 2019), the Appellate Division affirmed the ALJ’s finding that the City of Portland was entitled to coordinate partial incapacity benefit with social security benefits received even though the City had not paid into the social security system on the employee’s behalf. The decision involved the interpretation of former section 62-B (which applies to dates of injury prior to January 1, 1993). Section 95 was replaced by section 221, which applies to dates of injury on or after January 1, 1993.

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