Name

Anita Farrell v. MaineGeneral Health

Insurance Company

MaineGeneral Health Assoc.

Date Decided

March 6, 2023

Panel Members

Elizabeth Elwin

David Hirtle

Katherine Gatti Rooks

Categories

Tags

File Size

141 KB

Summary from the Troubh Heisler Attorneys

Anita Farrell v. MaineGeneral Health (attached)- Where MaineGeneral’s most recent benefit payment on a 1997 injury was made in 2009, treatment thereafter was paid by Medicare and employee did not file petition until 2020, employee’s claim was barred by the 6 year statute of limitations set forth in 39-A M.R.S.A. 306(2). In Farrell v. MaineGeneral Health, Dec. No. 23-05, Ms. Farrell injured her neck, back and right shoulder in 1997. Benefits were awarded and paid under 2005 and 2008 decrees. Following the 2008 decree MaineGeneral controverted medical treatment expense in 2008 and 2010. Following the 2010 Notice of Controversy the WCB Troubleshooter wrote Ms. Farrell a letter confirming that she did not intend to pursue the claim at that time and advising her that the 6 year statute of limitations begins to run as of the date of the last payment.

In 2020 Ms. Farrell filed a Petition for Award. At the 2021 hearing MaineGeneral submitted an affidavit stating that no benefit payments were made since 2009. The ALJ denied the petition, determining the claim was barred by the 6 year statute of limitations. Ms. Farrell appealed, raising among other claims of error that the ALJ erred by not finding that payments made by Medicare for injury related treatment after 2009 tolled the statute of limitations. The Appellate Division affirmed. In Charest v. Hydraulic Hose & Assemblies, LLC, 2021 ME 17, the Law Court held that where the employer’s weekly benefit obligation was completely offset by social security retirement benefits, the social security retirement payments are considered primary payments on the workers’ compensation claim and toll the statute. The Appellate Division distinguished Charest on the grounds that the employer in that case had an obligation to make the weekly benefit payments whereas in this case MaineGeneral was under no obligation to make the medical payments. The Medicare payments were not a substitute for medical payments MaineGeneral was otherwise obligated to make.

Ms. Farrell also argued that because she received medical treatment after 2009 from health care providers associated with MaineGeneral, those treatments should be treated as medical payments under sec. 306(2)(A), where certain medical treatment through healthcare providers paid by or under contract with the employer tolls the statute of limitations. The Appellate Division rejected this argument because Ms. Farrell did not present evidence that these health care providers were employed by or under contract with MaineGeneral.