Supreme Court rules for nursing home patient’s family
Supreme Court News
The Supreme Court on Thursday ruled for the family of a nursing home resident with dementia that had sued over his care, declining to use the case to broadly limit the right to sue government workers.
The man’s family went to court alleging that he was given drugs to keep him easier to manage in violation of his rights. The justices had been asked to use his case to limit the ability of people to use a federal law to sue for civil rights violations. That outcome could have left tens of millions of people participating in federal programs, including Medicare and Medicaid, without an avenue to go to court to enforce their rights.
The Supreme Court has previously said that a section of federal law — “Section 1983” — broadly gives people the right to sue state and local governments when their employees violate rights created by any federal statute.
The court by a 7-2 vote reiterated that Thursday, with Justice Ketanji Brown Jackson writing that Section 1983 “can presumptively be used to enforce unambiguously conferred federal individual rights.” Both liberal and conservative justices joined her majority opinion while conservative Justices Clarence Thomas and Samuel Alito dissented.
The court had been asked to say that when Congress creates a federal spending program — giving states money to provide services such as Medicare and Medicaid — they shouldn’t face lawsuits from individuals under Section 1983. The court rejected that invitation.
The specific case the justices heard involves the interaction of Section 1983 and the Federal Nursing Home Reform Act, a 1987 law that outlines requirements for nursing homes that accept federal Medicare and Medicaid funds. The court was being asked to answer whether a person can use Section 1983 to go to court with claims their rights under the nursing home act are violated. The answer is yes, the court said.
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Workers’ Compensation Subrogation of Administrative Fees and Costs
When a worker covered by workers’ compensation makes a claim against a third party, the workers’ compensation insurance retains the right to subrogate against any recovery from that third party for all benefits paid to or on behalf of a claimant injured at work. When subrogating for more than basic medical and indemnity benefits, the Texas workers’ compensation subrogation statute provides that “the net amount recovered by a claimant in a third‑party action shall be used to reimburse the carrier for benefits, including medical benefits that have been paid for the compensable injury.” TX Labor Code § 417.002.
In fact, all 50 states provide for similar subrogation. However, none of them precisely outlines which payments or costs paid by a compensation carrier constitute “compensation” and can be recovered. The result is industry-wide confusion and an ongoing debate and argument with claimants’ attorneys over what can and can’t be included in a carrier’s lien for recovery purposes.
In addition to medical expenses, death benefits, funeral costs and/or indemnity benefits for lost wages and loss of earning capacity resulting from a compensable injury, workers’ compensation insurance carriers also expend considerable dollars for case management costs, medical bill audit fees, rehabilitation benefits, nurse case worker fees, and other similar fees. They also incur other expenses in conjunction with the handling and adjusting of workers’ compensation claims. Workers’ compensation carriers typically assert, of course, that, they are entitled to reimbursement for such expenditures when it recovers its workers’ compensation lien. Injured workers and their attorneys disagree.