Opinion ID: 1918602
Heading Depth: 2
Heading Rank: 3

Heading: Gibson, Procise, and Lavoie

Text: [¶ 15] In their arguments the parties have relied on a trio of cases involving suits against employers and/or insurers by employees whose receipt of workers' compensation benefits was delayed, reduced, or denied and in which we have arrived at differing results. The first is Gibson v. Nat'l Ben Franklin Ins. Co., 387 A.2d 220, 223 (Me.1978), where we held that an insurer who wrongfully withheld workers' compensation benefits was not immune from liability in tort to the injured employee. We found that the case did not arise out of the employment relationship but out of [the employee's] relationship to the insurance carrier after her basic remedies as an injured employee had been settled through procedures provided by the Act. Id. at 222. [¶ 16] In Procise v. Elec. Mut. Liab. Ins. Co., 494 A.2d 1375, 1382 (Me.1985), however, we held that an insurer was immune from a suit for fraud, bad faith, and other claims in which the employee's basic contention was that he was wrongfully denied workers' compensation benefits. Procise claimed that his employer had persuaded him to apply for disability benefits instead of workers' compensation benefits and to state that his injury was not caused by a work accident. Id. at 1378. When he later applied for workers' compensation benefits, he settled his claim. Id. In his tort action he asserted that he had been denied workers' compensation benefits to which he was entitled by the actions of his employer, its insurer, and their agents. Id. at 1378-79. We noted that the Workers' Compensation Act contains a procedure to set aside a settlement agreement when there is a mistake of fact or fraud, but that Procise had not taken advantage of that procedure. Id. at 1382. We distinguished Gibson by stating that Gibson's claim arose not from her employment but from her relationship with the insurer after her workers' compensation claim had been settled, whereas Procise's claims arose from the initial handling of his workers' compensation claim. [5] Id. at 1382-83. [¶ 17] In Lavoie v. Gervais, 1998 ME 158, ¶ 11, 713 A.2d 335, 337, we held that an employer and its insurer were immune from suit where the employee alleged that he had been denied workers' compensation benefits because of fraud committed during the workers' compensation proceedings. Lavoie contended that the defendants and others had conspired to hide the true identity of the employer. Id. ¶ 5, 713 A.2d at 336. We held that the Act itself contains the exclusive remedy for fraud occurring during the course of the proceedings for benefits. Id. ¶ 13, 713 A.2d at 338; see 39-A M.R.S.A. § 321 (Pamph. 2000). We cited Procise for the proposition that when the tort action is based on a claim of wrongful denial of workers' compensation benefits, the Workers' compensation Act provides the exclusive remedy. Lavoie, 1998 ME 158, ¶ 13, 713 A.2d at 338. [¶ 18] We need not attempt to harmonize these cases, because they differ significantly from the instant case. [6] The injuries alleged in the three cases arose from the denial or delay of workers' compensation benefits. Hawkes, unlike the three plaintiffs in Gibson, Procise, and Lavoie, is not claiming that he is entitled to more workers' compensation benefits or that his receipt of benefits was interfered with or delayed. He does not complain about his benefits; he does not contend that they were delayed, denied, or reduced because of the actions of the tortfeasors. This is in sharp contrast to the gravamen of the complaints in Gibson, Procise, and Lavoie. For this reason, the holdings of Gibson, Procise, and Lavoie are inapplicable to this case. [7]