CRB Case Annotations re: Section 31-299a

Payments under group medical policy not defense to claim for benefits. Health insurer’s duty to pay. Lien.

Bombria v. Anthony J. Bonafine, 5740 CRB-2-12-3 (March 6, 2013).

Claimant was awarded reimbursement of medical bills incurred as a result of compensable injury. Respondent’s insurer appealed order, stating evidence was that a group health insurer had paid much of the outstanding bills and there had been no liens asserted by providers or carriers. CRB remanded matter for further proceedings to establish proper grounds to pay medical expenses and correct amounts due. See also, Bombria, § 31-294d.

McCoy v. Cook Willow Convalescent Home, 5456 CRB-5-09-4 (May 18, 2010).

Trier ordered Connecticut Insurance Guaranty Fund (CIGA) to reimburse Anthem Blue Cross & Blue Shield for medical benefits paid on behalf of claimant pursuant to § 31-299a(b) C.G.S. in matter where workers’ compensation insurance carrier became insolvent and was liquidated. CRB reversed, holding that pursuant to plain language of § 38a-838(5) C.G.S., CIGA eliminates from its definition of covered claims any payment due any insurer. CRB distinguished instant matter from Franklin v. Superior Casting, 5269 CRB-7-07-9 (June 15, 2009), aff’d, 302 Conn. 219 (2011), noting that in Franklin, CIGA made initial decision to deny claimant’s medical treatment. CONCURRENCE (Delaney): Agreed with panel’s legal analysis and result reached but wrote separately to underscore concern that decision may impede future claimants’ access to medical care in contested claims. See also, McCoy, § 31-355(e).

Bilodeau v. Bristol Assn. for Retarded Citizens, 4245 CRB-6-00-5 (May 29, 2001).

See, Bilodeau, § 31-293, § 31-300.