$18M for beating, Stow gets $5.8, Dodgers get $1.6

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in EMS Topics, Firefighter Safety & Health, Law & Justice 1 min ago 0 Comments

Let’s learn about SUBORGATION

David Armstrong’s April 7 article in BloombergBusinessweek looks at what happened since AMR Paramedic Brian Stow was attacked and left severely injured in Dodger’s Stadium after the 2011 Opening Day game with San Francisco. The subhead sums up the situation: “First he was assaulted for wearing the wrong team’s clothes. Then he was sucker-punched by the insurance system.”

Although a Los Angeles Superior Court jury awarded Stow $18 million from the Dodgers and his assailants last year, he has yet to receive any money. And, in a bizarre twist, the Dodgers’ liability insurer, ACE Property and Casualty Insurance Company, stands to net $1.6 million from a side deal in the case.

SUBORGATION

Subrogation refers to the process an insurance company uses to seek reimbursement from the responsible party for a claim it has already paid. Subrogation matters to you if:

You have a covered loss, and
You submit a claim to your insurance company, but
Another party is actually responsible for all or part of the damages (i.e. you have a car accident and the other driver caused the accident, or if damage to your home was caused by a faulty appliance)

Armstrong notes that “A growing body of federal law, including a recent U.S. Supreme Court case, gives insurers power to recoup medical costs caused by a third party—in the face of state laws that specifically prohibit it.”

It gets worse:

All but two states either ban subrogation outright or limit how much insurers can collect. Unfortunately, many employers provide health insurance as an employee benefit under the Employment Retirement Income Security Act, or ERISA, which is a federal law. Congress specifically designed ERISA to supersede any state statutes related to employee benefit plans. More than 90 percent of workers with medical coverage at the largest U.S. corporations are insured this way, according to the Kaiser Family Foundation. Hailed at its passage in 1974 for safeguarding employees’ pension plans, ERISA now helps deny or reduce compensation to workers injured through someone else’s negligence.

When all of the dust settles, Stow should see $5.8M of the $18 million judgement. During the court proceedings an expert estimated Stow will need $30 million.

ACE Casualty Insurance and Property, the insurer for the Dodgers, will see $1.6M from their side deal.

What does this mean to me?

Paramedics and firefighters assume they have full coverage from their employer, labor and individual insurance policies. Each state has a different approach and you should both read your policy and determine what your state/commonwealth has done with prior cases.

Arizona: HotShot denied benefits

Texas: Fort Worth firefighters died while serving their hometown VFD

New Jersey: Township refuses to certify death as line of duty