By Erica Shelley Nelson and Brennen Johnson
In Moore v. Washington State Health Care Authority, the Washington State Supreme Court determined that State employees who were wrongfully denied health care benefits were entitled to the value that the benefits would have cost the State. Although the State argued that it should only be responsible for the out-of-pocket costs that employees paid for healthcare during the time they were denied benefits, the Court determined otherwise. The Court decided that such a method for measuring what the State owed the employees would fail to account for all of the damage that was inflicted on the employees through the denial of benefits.
In 2006, part-time Washington State employees filed a class action lawsuit claiming the State improperly denied them health care benefits. The trial court ruled that the State in fact had violated multiple laws when it failed to provide the health benefits. After the Court determined that the State acted wrongfully and was liable for denying the benefits, the State argued that it should only have to compensate the out-of-pocket costs that the employees paid for medical expenses or for substitute insurance during the time they were denied benefits. Lawyers who also need to bring a case to the supreme court may consider using amicus curiae brief printing services to help them with the necessary legal documents.
The State gave several reasons why it should compensate employees only for what they actually paid to take care of themselves during the denial of benefits. First, it argued that measuring the damages based on any other value would overestimate the cost of the harm that the State inflicted. Second, it argued that measuring the damages through any other method would allow the employees to skip the necessary step of proving that each member of the group suing the State actually suffered some harm from the denial of benefits. Third, it suggested that any other method would result in a windfall for any employees who did not incur any medical expenses during the time they were wrongfully denied health benefits.
The employees argued that the damages should be measured by more than the actual costs that they paid to receive medical care during the time of the denial. First, they claimed that the method proposed by the State would result in a windfall for the State because the State would retain a significant portion of the money it should have paid to provide health benefits to the employees. Second it suggested that the State’s proposed method would fail to account for the deferred health costs of employees who did not obtain medical care because they could not afford it. If your injuries require medical treatments or intensive therapy, try to find a facility that has partnered with ABA Billing Companies to ensure that your insurance claim and other billing documents are processed efficiently.
The Court rejected the arguments of the State and agreed with the employees. It explained:
People without health benefits are less likely to seek and obtain medical treatment, especially preventive care. This is true as a matter of common sense and as shown by the evidence in the record. The State would use this fact as a reason to use a lower estimate of the damage it caused to the employees to whom it improperly denied health benefits. But those lower short-term medical costs have significant long-term consequences, both medical and financial, to uninsured individuals. We see no error in the… decision to consider those long-term consequences in [the] damages calculation.
While rejecting the State’s approach, the Court suggested that a more accurate method to measure the damages would be to treat the amount that the State would have paid for health benefits as a form of lost wages. However, the Court also clarified that this suggested approach was not the only appropriate way to calculate the damages. After describing this “lost wage” type of approach, the Court further explained:
[W]e are not providing a one-size-fits-all measure for valuing health benefits in all circumstances; however, the “lost wages” method used in Cockle and generally supported by the trial court in this case is one lawful method of measuring the damage caused by the improper failure to provide health benefits.
After rejecting the State’s argument that damages should be limited to the actual costs paid by employees during the period where benefits were denied, the Court sent the case back to a trial court to calculate the exact damages based on the approach that it recommended.
This decision is a “win” in several respects, but most importantly by expanding the scope of damages to not just out-of-pocket damages, but also other damages arising from the denial of health care benefits. While the State, unsurprisingly, tried to argue for the recovery of only narrow, hard damages, the Court was clearly persuaded by the fact that many employees suffered not easily quantifiable, but certainly real, potentially long term, medical repercussions by not obtaining medical treatment because of their financial constraints. This case gave them the hope of recovering for those losses.
