Court: $1M coverage for Conn. fire victim families
Headline Legal News
Families suing the operator of a Hartford nursing home where 16 patients died in a 2003 fire suffered a setback Monday, when the Connecticut Supreme Court ruled that the home's insurance coverage was $1 million instead of the $10 million claimed by the victims' relatives.
The justices' 3-2 decision reversed a lower court judge's interpretation of Greenwood Health Center's insurance policy in favor of the families. The high court instead found in favor of Boston-based Lexington Insurance Co., a subsidiary of American International Group Inc.
"It just seems completely inadequate," Van Starkweather, an attorney for one victim's family, said about the lower coverage figure. "I'm disappointed. It was a close decision. Three justices went with AIG. Two justices went with the victims."
A lawyer for Lexington Insurance declined to comment Monday.
The fire at Greenwood Health Center on Feb. 26, 2003, broke out after psychiatric patient Leslie Andino set her bed on fire while flicking a cigarette lighter. Officials at the time said it was the 10th deadliest nursing home fire in U.S. history. Andino was charged with 16 counts of arson murder, but was found incompetent to stand trial and committed to a psychiatric hospital.
Relatives of 13 of the 16 victims sued the nursing home's operator for cash damages, saying it failed to adequately supervise Andino. Hartford Superior Court Judge Marshall K. Berger Jr. ruled in 2009 that Greenwood's insurance policy with Lexington provided $250,000 in coverage for each plaintiff and the policy's maximum coverage was $10 million.
But Lexington Insurance appealed Berger's decision, saying that the $10 million was the total coverage for all seven nursing homes run by Greenwood's operator and that each home was insured up to $1 million.
In a decision written by Chief Justice Chase T. Rogers, the Supreme Court's majority found that each plaintiff actually was eligible for up to $500,000 from the insurance policy if they won their lawsuit, but that the policy's total coverage was limited to $1 million.
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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.