In In the Matter of 4-K Marine, No. 18-30348 (5th Cir. Jan. 30, 2019) the U.S. Fifth Circuit held that the owner of a stationary, “innocent” vessel is not entitled to reimbursement of the medical expenses of an employee who fraudulently claimed his preexisting injuries resulted from an allision. In June 2015, the M/V TOMMY, owned and operated by Enterprise Marine, was pushing a flotilla of barges on the Mississippi River when it allided with the MISS ELIZABETH, a stationary tug with barges owned and operated by CBR. Individuals aboard the MISS ELIZABETH, including Prince McKinley, alleged they were injured in the allision. CBR promptly commenced maintenance and cure payments to McKinley.
After suit was filed, CBR filed a counter-claim against Enterprise Marine for reimbursement of the amounts it paid to McKinley for medical expenses, because generally, an at-fault third party must reimburse a Jones Act employer for maintenance and cure paid to its Jones Act employee. CBR paid, and Enterprise Marine reimbursed, $23,000 in maintenance and $5,000 in cure to McKinley. CBR also agreed to pay for McKinley’s back surgery, but Enterprise Marine reviewed McKinley’s medical history and refused to reimburse those expenses, arguing the condition was not a result of the allision.
After a bench trial, the district court determined that McKinley injured his knee in the allision, but his back problems predated the accident and were unaffected by the allision. Further, the court held that McKinley fraudulently withheld material issues about his pre-existing medical conditions and medications before and after the incident. The district court held that CBR had no obligation to pay for McKinley’s back surgery, and Enterprise Marine had no obligation to reimburse CBR for the back surgery.
CBR appealed to the U.S. Fifth Circuit arguing that maritime principles compelled Enterprise Marine to reimburse CBR for McKinley’s back surgery regardless of McKinley’s fraud. The U.S. Fifth Circuit explained that a third-party must reimburse maintenance and cure payments only where its negligence caused or contributed to the need for maintenance and cure. Because McKinley’s back condition did not result from the allision, Enterprise Marine did cause or contribute to the need for maintenance and cure for that particular medical problem. Accordingly, Enterprise Marine did not owe reimbursement to CBR for McKinley’s back surgery.
The Fifth Circuit recognized the practical problems faced by CBR. It noted that the decision to cover McKinley’s back surgery had to be made early, and CBR was presented with what initially appeared to be a plausible claim for cure. Further, the denial of such claim could have exposed CBR to punitive damages. But the Court noted that CBR had options. An employer need not immediately commence maintenance and cure payments upon request. Further, an employer is only liable for compensatory damages if it “unreasonably rejects the claim” after an investigation, and punitive damages “only for behavior that is egregious”. Finally, CBR had the right to deny payment if, which was ultimately determined, McKinley intentionally misrepresented or concealed material facts, the disclosure of which was desired by CBR.
The U.S. Fifth Circuit’s opinion in In the Matter of 4-K Marine details the harsh realities facing Jones Act employers. Employers must quickly investigate maintenance and cure claims to determine their legal rights. Act too slowly, and the employer may face compensatory or punitive damages. Act too quickly, and an employer may pay for unnecessary medical expenses and not be able to recoup them.