New Jones Act case from the Fifth Circuit Court of Appeals. It is Manderson v. Chet Morrison Contractors, Inc., 2012 U.S. App. LEXIS 18 and can be found here.
The facts don't seem to be controversial: an engineer on a vessel was hospitalized and received treatment for ulcerative colitis, diabetes and a liver condition. He did not return to work. He brought a Jones Act suit, claiming relief under general maritime law, the Jones Act, maintenance and cure and for attorney's fees.
At trial, the claimant was denied relief for his Jones Act and general maritime law claims, but was awarded relief for maintenance and cure and attorney's fees related to that claim. In awarding attorney's fees, the trial court found that the employer was arbitrary and capricious in failing to pay maintenance and cure payments.
On appeal, the claimant challenged the denial of Jones Act and his maritime law claims, but the appeals court agreed with the trial court's handling of those claims.
As to maintenance and cure, the employer challenged the cure award under the "collateral source rule." For those non-tort types out there, the collateral source rule bars a tortfeasor from reducing the damages awardable to the plaintiff by referencing sources of compensation (like health insurance) that are independent of the tortfeasor. Therein is the rub: maintenance and cure is a very, VERY strict requirement for employers of seamen.
So, the court did not allow a reduction for medical payments paid by the claimant's health insurer. As anyone who has read their health insurer's explanation of benefits (THIS IS NOT A BILL) form, what doctors charge is not what insurance companies pay. The court in this instance only awarded maintenance and cure damages for what was actually paid to the doctors. SIDE NOTE: for those that think it unfair to pay the claimant for injuries paid for by a third party, under Hawaii law, the health insurer has a statutory, contractual and equitable lien against any recoveries that relate to injuries they provided benefits to treat.
The court rejected the trial court's award of attorney's fees. In responding to the demand for maintenance and cure, the employer referred the demand to its carrier which investigated the claim. In two months, the claim was brought. Based on these facts, the appeals court declined to find the employer's position arbitrary and capricious.