Court of Civil Appeals Upholds Ruling on Medical Causation and Health Insurance Premium Reimbursement
Grund v. American Trim, LLC:
On September 17, 1010, the Alabama Court of Civil Appeals upheld the Cullman Circuit Court’s decision to deny workers’ compensation benefits based on a lack of causation between the employee’s accident and the alleged injury.
The employee claimed that she suffered an on the job injury to her rotator cuff in November of 2006. She further claimed that she suffered a subsequent rotator cuff injury in August of 2007.
At trial it was established that her physician could not determine medical causation because of the lag time between the incident and the treatment. It was further established that she had filed a short term disability application in which she stated that her injury was not work related. The Alabama Court of Civil Appeals found that the lower court’s opinion was proper considering the evidence presented before it and affirmed the decision of the lower court.
As a side note, both the trial and appellate courts ruled that the employee was liable to the employer for the employee’s contribution to her health insurance premiums, which were provided by the employer, while she was on leave. While the trial court relied to contract principals in issuing its ruling, the Court of Civil Appeals relied on the FMLA to uphold the decision to have the employee repay the contributions.
Under the FMLA, an employer is required to maintain group health insurance benefits for an employee who goes on FMLA leave. The employer is able to recover the share that would have been paid by the employee, either through deductions of pay after the employee returns from leave, or through deductions prior to the employee’s absence if the leave is planned. In this case the employee did not return to work after her second injury, so she was liable for the total $7,176.49 that had been paid on her behalf.