Court: No workers' comp in drunk dockworker case
Recent Cases
A federal appeals court says an Oregon longshoreman who got drunk on the job, urinated while standing on a dock and then fell 6 feet onto concrete should not get workers' compensation benefits for his injuries.
Gary Schwirse drank at least nine beers and half-pint of whiskey on Jan. 8, 2006. While standing on a dock, he urinated and fell over a railing. At the hospital, he registered a blood-alcohol level of 0.25 percent.
Schwirse sued for workers' compensation benefits and at first was victorious, when an administrative law judge ruled that workplace hazards had been a factor in his fall. But the judge later reversed his ruling when Schwirse backed off a claim that he tripped over an orange cone.
The worker appealed it to U.S. District Court, where he lost, and the case landed in the 9th U.S. Circuit Court of Appeals, which denied a petition for a review of claims this week. The court said his injuries were due solely to intoxication and his employers could not be held responsible.
Schwirse later tried to argue that the very concrete onto which he fell, and not his intoxication, was responsible for his injuries. That argument also lost.
Ninth Circuit Court of Appeals judge N. Randy Smith wrote in the opinion that if intoxication was the reason for the fall, then intoxication was also the reason for the injury.
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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.