Worker's Comp Claims as Civil RICO Claims
NCLC has filed twice in this Racketeer Influenced and Corrupt Organizations Act (“RICO”) case involving employees who sought workers’ compensation benefits under Michigan law after their claims were denied by the employer’s third-party administrator (“TPA”). The employees filed suit against their employer, the TPA, and the doctor who evaluated their injuries alleging that the defendants had conspired to fraudulently deny their claims.
In its original filing, NCLC urged the Sixth Circuit to dismiss the Racketeer Influenced and Corrupt Organizations Act (RICO) claims of plaintiffs attempting to circumvent the administrative process for obtaining workers' compensation benefits. NCLC argued that federal case law prohibits the use of RICO to resolve disputes that are entrusted to the exclusive jurisdiction of a regulatory agency. Workers' compensation disputes are a complex matter better left for expert administrative agencies, such as the Michigan Bureau of Workers' Compensation. NCLC warned that the misuse of RICO would undermine Michigan's regime for regulating workers' compensation awards.
The 6th Circuit Court of Appeals held that RICO should be read broadly and interpreted liberally and allowed the claim to move forward. NCLC then filed a second brief, urging the Court to grant rehearing en banc. NCLC argued that the decision conflicts with other circuit-level authority, would make RICO an avenue to evade worker’s compensation system that States have successfully run for generations, and would make workplace injuries a subject of federal litigation.
The 6th Circuit Court of Appeals held that RICO should be read broadly and interpreted liberally and allowed the claim to move forward.