Civil Immunity under the Workers’ Compensation Act

Today’s post comes from Anthony Lucas at the Jernigan Law Firm.

Civil Immunity under the Workers’ Compensation Act

Under the North Carolina Workers’ Compensation Act, there are a few instances where the Act specifically precludes or limits civil liability for certain actors. Not surprisingly, two of the three listed below are related to reporting actions related to fraud in the workers’ compensation system. The third is related to medical malpractice.

With respect to workers’ compensation fraud, the Act provides civil immunity to any person who in good faith reports information about another person making a false statement or representation of a material fact for the purpose of obtaining or denying any benefit or payment, or assisting another person to obtain any benefit or payment. N.C. Gen. Stat. § 97-88.2. The Act also provides civil immunity to any person who in good faith reports information about a healthcare provider submitting charges for health care not furnished; or fraudulently administering, providing, and attempting to collect for inappropriate or unnecessary treatment or services; or violating the Self-Referrals statute N.C. Gen. Stat. § 97-88.3. In both cases the key to immunity is reporting in “good faith.” Malicious and knowingly false reporting can lead to adverse consequences.

Apart from immunity for reporting fraud, the Act provides employers with civil immunity from damages for malpractice by a doctor the employer furnishes to treat the injured employee. However, the consequences of the doctor’s malpractice is deemed to be part of the workplace injury and workers’ compensation benefits are allowed. N.C. Gen. Stat. § 97-26. In the malpractice situation, since the employer dictates the doctor seen by the employee, should the employer get complete immunity if an employee was forced to see a known incompetent physician who causes harm? With the way this immunity statute is phrased it is likely that a claim under Woodson v. Rowland, 329 N.C. 330, 341 (1991) (civil action allowed when “an employer intentionally engages in misconduct knowing it is substantially certain to cause serious injury or death to employees and an employee is injured or killed by that misconduct”) would be barred. Someone once said, “Immunity breeds abuse,” and any immunity statute should be joined with an escape hatch where abuse occurs.

By |April 2nd, 2018|Fraud, Immunity, Workers' Compensation|Comments Off on Civil Immunity under the Workers’ Compensation Act

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