eNotes: Workers’ Compensation – March 2022 – Maryland

SIGNIFICANT CASE SUMMARY

MD CASE SUMMARY

Westfield Ins. Co. v. Gilliam
In the Court of Appeals of Maryland
Filed: February 8, 2022

The statutory offset against underinsured motorist benefits is the amount actually paid to a healthcare provider, not the amount billed by the provider

Background

Claimant was rear-ended in an automobile accident while driving a vehicle provided by his employer. Claimant’s healthcare providers billed a total of $243,399.33 for services related to the accident. Claimant ultimately filed a workers’ compensation claim, and the carrier paid $118,369.15 pursuant to the Commission’s Fee Guide. The providers accepted this latter figure in full satisfaction for their services.

The carrier asserted a statutory lien against any benefits Claimant might receive from the other driver. After accepting $10,000 from the other driver’s insurer, Claimant filed suit to recover under the UIM portion of the policy. The UIM carrier removed to federal court (which applied Maryland law). Claimant argued that the deduction should only be the amounts actually paid, while the carrier argued that the $243,399.33 initially billed should be deducted from the UIM recovery. The Court submitted the issue as a certified question of law to Maryland’s Court of Appeals, the state’s highest court.

Holding

The Court of Appeals held that “only the amount that the workers’ compensation insurer actually paid for medical expenses is part of the statutory offset against underinsured motorist benefits.” Therefore, the difference between the fair and reasonable value of the health care services provided to Gilliam and the amount actually paid by the WC insurer would not offset Gilliam’s UIM recovery.

Questions about this case can be directed to Ruth Jacobs at (443) 641-0573 or rjacobs@tthlaw.com.