Attorneys for injured workers continue to attempt to make a federal Racketeering case out of workers’ compensation claims administration, and so far have failed in the 6th and 9th Circuits. Yet they are unrelenting despite lack of success. They have just suffered another legal setback in the 6th Circuit.
The latest case involves Mark Marusza who suffered a serious work-related accident in fall 2011.
He filed a federal civil action claiming that defendant Accident Fund Insurance Company neglected to pay their share of Marusza’s medical bills, which resulted in Medicare paying for a portion of his bills. Accident Fund likewise refused to pay Nancy Gucwa – Marusza’s long-term, live-in girlfriend – for the attendant care she provided.
Marusza and Gucwa alleged in their federal court case that (1) Accident Fund and the defendant physicians defrauded Marusza, Gucwa, and others of benefits, in violation of the Racketeer Influenced and Corrupt Organizations Act; (2) Marusza is entitled to double damages under the Medicare Secondary Payer Act; (3) the defendant doctors tortiously interfered with Marusza’s contractual relationship and/or business expectancy by inducing Accident Fund to deny his benefits; and (4) Accident Fund falsely imprisoned Marusza by requiring him to attend an examination with a neuropsychologist.
The district court dismissed each claim under Federal Rule 12(b)(6) for failure to state a claim. Plaintiffs appealed and the United States Court of Appeals affirmed in the partially published case of Gucwa v. Lawley 2018 U.S. App. LEXIS 942.
The district court found that Marusza lacked standing because his personal injury does not qualify as an injury to “business or property” as contemplated by the RICO statute.
The Court affirmed the dismissal. In Jackson v. Sedgwick Claims Mgmt. Servs., Inc., an en banc panel of this court expressly held that “racketeering activity leading to a loss or diminution of benefits the plaintiff expects to receive under a workers’ compensation scheme does not constitute an injury to ‘business or property’ under RICO.” 731 F.3d 556, 566 (6th Cir. 2013) (en banc).
The district court also dismissed Marusza’s claim under the Medicare Secondary Payer Act because he had not alleged financial harm. The Court of Appeals again affirmed.
Because the Medicare Secondary Payer Act is not a qui tam statute, the financial injury suffered by the government does not confer standing upon other parties. Stalley v. Methodist Healthcare, 517 F.3d 911, 919 (6th Cir. 2008). Private plaintiffs must suffer their own individual harm; for instance, a private plaintiff may allege that they were paid less by Medicare than they would have been paid by the primary payer.