Opinion ID: 6215893
Heading Depth: 3
Heading Rank: 1

Heading: Text in Context

Text: Under IN §19-513(e), UIM benefits “shall be reduced to the extent that the recipient has recovered benefits under the workers’ compensation laws of a state or the federal government for which the provider of the workers’ compensation benefits has not been reimbursed.” The key phrase in the statute for our purposes is, of course, “workers’ compensation benefits.” In Mr. Gilliam’s view, the phrase is limited to money paid to a workers’ compensation claimant or on the claimant’s behalf. In Westfield’s view, the phrase can include a discount of an expense when the claimant enjoys the discount as a result of the workers’ compensation law. The statutes governing UM/UIM coverage – of which §19-513(e) is part – do not define that phrase. See IN §19-501 et seq. More broadly, the State insurance law does not 23 define “workers’ compensation benefit” specifically or the term “benefit” generally, although the latter word is used throughout the Insurance Article. Nor does the workers’ compensation law itself have an applicable general definition of “benefit,” although that term appears frequently in that statute. See LE §9-101 et seq. In ordinary parlance, the word “benefit” could mean any number of things besides a monetary payment.28 However, statutory interpretation does not occur in the silo of a single word; the context of a word or phrase in a statute, and other language that relates to the word or phrase, is critical to understanding its meaning. Nationstar, 476 Md. at 169. In the context of IN §19-513(e) the offset provided by that statute is against “benefits payable” under UIM coverage (and certain other coverages) – i.e., a sum of money. The “workers’ compensation benefit” that comprises the offset thus must be expressible as a monetary amount for the offset to make sense. Related language in IN §19-513(e) further clarifies the meaning of “workers’ compensation benefit” in two ways. First, the offset applies to “the extent that the recipient has recovered benefits.” IN §19-513(e) (emphasis added). This qualifying language supports a more tangible understanding of the word “benefit” – one that denotes the amount of money already actually paid on behalf of or directly to an injured employee rather than 28 The American Heritage College Dictionary, for example, offers “something that promotes or enhances well-being; an advantage” as a common meaning of “benefit.” See American Heritage College Dictionary (3d ed. 1993) at 127. In terms of law-related uses of the word, a recent edition of Black’s Law Dictionary contains similarly expansive alternative meanings; it includes a definition of “benefit” as an “advantage” or “privilege” as well as “profit or gain” and defines separately almost two dozen phrases including the word. Black’s Law Dictionary (9th ed. 2009) at 178-79. 24 an amount never owed by anyone. See State Farm, 283 Md. at 671-72 (stating that “has recovered” generally refers to something obtained); Parry, 408 Md. at 145 (statute requires UM/UIM insurers to reduce such benefits “by the amount of workers’ compensation benefits paid…”) (emphasis added). Second, the statute refers to benefits “for which the provider of the workers’ compensation benefits has not been reimbursed.” IN §19-513(e) (emphasis added). This clause indicates that the “workers’ compensation benefits” received by the claimant are capable of being reimbursed; reimbursement is accomplished by a repayment of a sum previously received. See TravCo, 430 Md. at 408-11 (a reimbursement affects amount of offset under IN §19-513(e) only after repayment is made). While the Workers’ Compensation Act also does not define “benefit,” the use of the term in that statute supports the same reading. Subtitle 6 of the Act (entitled “Benefits”) identifies the different types of workers’ compensation benefits available to a claimant (e.g., temporary partial disability, temporary total disability, wage reimbursement, death benefits, vocational rehabilitation benefits). See LE §9-601 et seq. Part IX of that subtitle, entitled “Medical Benefits,” protects against unreasonable medical fees charged to WC insurers and employers. As indicated earlier, the Workers’ Compensation Act contemplates that fees paid under that Act are intended to reflect “prevail[ing]” charges in the community for such services and to protect claimants from “unreasonable and excessive charges for health care services.” LE §9-663(b); Queen, 287 Md. at 346. There is no reference in the workers’ compensation law to “write-downs” or discounts of medical bills – much less any characterization of such a thing as a “benefit” 25 under that law. Moreover, it is impossible for Mr. Gilliam to “reimburse” the WC insurer for an amount it never paid – i.e., the $125,030.18 difference between what the health care providers billed and what they accepted as full payment for their services. The face amount of a bill generated by a provider simply has no role under the workers’ compensation law governing medical benefits. The fact that a “reimbursement” cannot occur – even if Mr. Gilliam for some reason decided to make a voluntary payment of that amount to the WC insurer – indicates that it is not a “workers’ compensation benefit” for purposes of IN §19513(e). Westfield’s interpretation of “workers’ compensation benefit” to include a discounted portion of a health care provider’s fee thus does not comport with the statutory scheme.