Clifton Jackson v. Sedgwick Claims Management Servs.

CourtCourt of Appeals for the Sixth Circuit
DecidedSeptember 24, 2013
Docket10-1453
StatusPublished

This text of Clifton Jackson v. Sedgwick Claims Management Servs. (Clifton Jackson v. Sedgwick Claims Management Servs.) is published on Counsel Stack Legal Research, covering Court of Appeals for the Sixth Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Clifton Jackson v. Sedgwick Claims Management Servs., (6th Cir. 2013).

Opinion

RECOMMENDED FOR FULL-TEXT PUBLICATION Pursuant to Sixth Circuit I.O.P. 32.1(b) File Name: 13a0282p.06

UNITED STATES COURT OF APPEALS FOR THE SIXTH CIRCUIT _________________

X - CLIFTON E. JACKSON; CHRISTOPHER M. - SCHARNITZKE, on behalf of themselves and all other persons similarly situated, - Plaintiffs-Appellants, - No. 10-1453

, > - - v.

SEDGWICK CLAIMS MANAGEMENT SERVICES, -- INC.; COCA-COLA ENTERPRISES, INC., foreign - - - corporations; DR. PAUL DROUILLARD, jointly

Defendants-Appellees. - and severally, N

On Appeal from the United States District Court for the Eastern District of Michigan at Detroit. No. 09-11529—Nancy G. Edmunds, District Judge. Argued: June 12, 2013 Decided and Filed: September 24, 2013 Before: BATCHELDER, Chief Judge; GUY, BOGGS, MOORE, COLE, CLAY, GIBBONS, ROGERS, SUTTON, COOK, McKEAGUE, GRIFFIN, KETHLEDGE, WHITE, STRANCH, and DONALD, Circuit Judges.* _________________ COUNSEL ARGUED: Marshall D. Lasser, MARSHALL LASSER, P.C., Southfield, Michigan, for Appellants. Kathleen H. Klaus, MADDIN HAUSER WARTELL, ROTH & HELLER, P.C., Southfield, Michigan, Matthew F. Leitman, MILLER, CANFIELD, PADDOCK AND STONE, P.L.C., Troy, Michigan, Daniel B. Tukel, BUTZEL LONG, Detroit, Michigan, for Appellees. ON BRIEF: Marshall D. Lasser, MARSHALL LASSER, P.C., Southfield, Michigan, Jeffrey T. Stewart, SEIKALY & STEWART, P.C., Farmington Hills, Michigan, for Appellants. Kathleen H. Klaus, MADDIN HAUSER WARTELL, ROTH & HELLER, P.C., Southfield, Michigan, Matthew F. Leitman, Thomas W. Cranmer, MILLER, CANFIELD, PADDOCK AND STONE, P.L.C., Troy,

* The Honorable Boyce F. Martin, Jr., who was a member of the en banc court who heard this case, retired on August 16, 2013, and did not participate in the decision.

1 No. 10-1453 Jackson, et al. v. Sedgwick, et al. Page 2

Michigan, Daniel B. Tukel, BUTZEL LONG, Detroit, Michigan, Michael F. Smith, THE SMITH APPELLATE LAW FIRM, Washington, D.C., for Appellees. Mark F. Horning, Jeffrey M. Theodore, STEPTOE & JOHNSON LLP, Washington, D.C., Allison M. Zieve, PUBLIC CITIZEN LITIGATION GROUP, Washington, D.C., Charles A. Rothfeld, Brian J. Wong, MAYER BROWN LLP, Washington, D.C., for Amici Curiae.

GIBBONS, J., delivered the opinion of the court, in which BATCHELDER, C. J., GUY, BOGGS, ROGERS, SUTTON, COOK, McKEAGUE, GRIFFIN, and KETHLEDGE, JJ., joined. CLAY, J. (pp. 20-23), delivered a separate opinion concurring in the judgment only. MOORE, J. (pp. 24-40), delivered a separate dissenting opinion, in which COLE, WHITE, STRANCH, and DONALD, JJ., joined. _________________

OPINION _________________

JULIA SMITH GIBBONS, Circuit Judge. Clifton Jackson and Christopher Scharnitzke were employees of Coca-Cola Enterprises, Inc. (“Coca-Cola”) who suffered work-related injuries. They applied for workers’ compensation benefits from Coca-Cola through Sedgwick Claims Management Services (“Sedgwick”), Coca-Cola’s third-party benefit claims administrator. Sedgwick disputed both of their claims and refused to pay benefits. Jackson and Scharnitzke allege that Coca-Cola and Sedgwick “engaged in a fraudulent scheme involving the mail . . . to avoid paying benefits to injured employees,” Jackson v. Segwick Claims Mgmt. Servs., 699 F.3d 466, 473 (6th Cir. 2012), in violation of the Racketeer Influenced and Corrupt Organizations Act (“RICO”), 18 U.S.C. § 1962(c). Accordingly, they sued Coca-Cola, Sedgwick, and Dr. Paul Drouillard—a so-called “cut-off” doctor who allegedly colluded with Coca-Cola and Sedgwick to discontinue Jackson’s benefits—in federal district court pursuant to RICO’s civil- remedy provision. See 18 U.S.C. § 1964(c).1

The district court granted the defendants’ motions to dismiss the complaint pursuant to Federal Rule of Civil Procedure 12(b)(6). A panel of this court reversed in

1 “Any person injured in his business or property by reason of a violation of section 1962 of this chapter may sue therefor in any appropriate United States district court and shall recover threefold the damages he sustains and the cost of the suit, including a reasonable attorney’s fee . . . .” 18 U.S.C. § 1964(c). No. 10-1453 Jackson, et al. v. Sedgwick, et al. Page 3

reliance on Brown v. Cassens Transport Co., 675 F.3d 946 (6th Cir. 2012) (Brown II), which rejected many of the legal arguments the district court relied upon in granting the motion to dismiss. As was true in Brown II, the panel was divided over the proper resolution of the appeal. See Jackson, 699 F.3d at 485–87 (Batchelder, C.J., concurring in the judgment); Brown II, 675 F.3d at 969–74 (Gibbons, J., dissenting). The court granted the defendants’ petition to rehear this case en banc. Because the plaintiffs have not pled an injury to their “business or property” that is compensable under § 1964(c), we overrule Brown II and affirm the district court’s judgment.

I.

We begin by providing some background about Michigan’s workers’ compensation system. “When Michigan adopted the [Workers’ Disability Compensation Act (“WDCA”)], it essentially created a ‘no-fault’ system under which a worker no longer has to establish negligence on the part of the employer but the employer is liable for certain expenses related to an injury suffered on the job without regard to fault.” Brown v. Cassens Transp. Co., 743 F. Supp. 2d 651, 661–62 (E.D. Mich. 2010) (Brown I), rev’d, 675 F.3d 946 (6th Cir. 2012). This design ensures recovery for injured employees while creating greater certainty for employers. Hesse v. Ashland Oil, Inc., 642 N.W.2d 330, 334 (Mich. 2002). The system achieves this goal, in part, because “[t]he right to the recovery of benefits [under the WDCA is] the employee’s exclusive remedy against the employer for a personal injury or occupational disease. The only exception to this exclusive remedy is an intentional tort.” Mich. Comp. Laws § 418.131. If this were not the case, injured employees could circumvent the restrictions the WDCA places on the benefits an injured employee is entitled to receive. See id. §§ 418.301 (wage loss benefits), 418.315 (medical expenses), 418.319 (rehabilitation services).

In exchange for the employer’s promise to pay certain types of benefits and the employee’s promise to forsake other remedies, the workers’ compensation system ensures efficient benefit payments and dispute resolution. “An employee, who receives a personal injury arising out of and in the course of employment by an employer who is subject to this act at the time of the injury, shall be paid” workers compensation benefits No. 10-1453 Jackson, et al. v. Sedgwick, et al. Page 4

according to the statutory scheme once he provides notice of a work-related injury to an employer. Id. § 418.301(1) (emphasis added). Benefits to an injured employee “become due and payable on the fourteenth day after the employer has notice or knowledge of the disability.” Id. § 418.801(1). Failure to pay benefits when owed can lead to the imposition of fines on the employer. Id. § 418.801(2).

If an employer believes an employee is not entitled to benefits, it may dispute the claim. An employer is not obligated to pay benefits or fines when there is an “ongoing dispute” over an employee’s claim, regardless of the merits of the dispute. Id.; see also Warner v. Collavino Bros., 347 N.W.2d 787, 790 (Mich. Ct. App. 1984) (“On its face [the statute] merely requires an ‘ongoing dispute’ and does not distinguish good faith disputes from bad faith or unreasonable disputes.”).

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