Westfield Insurance v. Gilliam

Westfield Insurance Company v. Michael Gilliam Misc. No. 4, September 2021 Term Motor Vehicle Insurance – Uninsured Motorist Benefits – Statutory Offset for Benefits Recovered Under Workers’ Compensation Claim. When a person injured in an automobile accident during the course of employment is eligible for benefits under both the workers’ compensation law and the uninsured motorist coverage of a motor vehicle insurance policy, Maryland law seeks to avoid a duplication of benefits by means of an offset provision in the statute governing motor vehicle insurance. Under Maryland Code, Insurance Article, §19-513(e), a motor vehicle insurer that pays uninsured motorist benefits to an injured person may deduct from those benefits any benefits recovered by the injured person as a result of a workers’ compensation claim for which the workers’ compensation insurer has not been reimbursed.

Motor Vehicle Insurance – Uninsured Motorist Benefits – Statutory Offset for Benefits Recovered Under Workers’ Compensation Claim – Medical Benefits. As part of benefits provided under the workers’ compensation law, a workers’ compensation insurer is to pay medical benefits on behalf of a claimant “in the amount that prevails in the same community for similar treatment of an injured individual with a standard of living that is comparable to that of the covered employee.” Providers must accept those amounts, set by the Fee Guide of the Workers’ Compensation Commission, in satisfaction of the full cost of treatment. An injured person who has received such medical benefits under the workers’ compensation law may also seek benefits under the uninsured motorist coverage of an appropriate motor vehicle insurance policy. Assuming that the fair and reasonable value of the medical treatment exceeds the payments made by the workers’ compensation insurer according to the Fee Guide, that difference is not part of the offset against uninsured motorist benefits under IN §19-513(e), because that amount was not recovered by the claimant and is not capable of reimbursement to the workers’ compensation insurer.

United States District Court for the District of Maryland Case No. 1:19-cv-03550-SAG Argued: October 8, 2021 IN THE COURT OF APPEALS OF MARYLAND Misc. No. 4 September 2021 Term WESTFIELD INSURANCE COMPANY v. MICHAEL GILLIAM Getty, C.J., McDonald Watts Hotten Booth Biran Gould, JJ. Opinion by McDonald, J. Filed: February 8, 2022 Pursuant to Maryland Uniform Electronic Legal Materials Act (§§ 10-1601 et seq. of the State Government Article) this document is authentic. 2022-02-08 08:54-05:00 Suzanne C. Johnson, Clerk The United States District Court for the District of Maryland has certified to this Court, pursuant to statute and rule,1 a question of law regarding the calculation of the damages payable to an injured person under the underinsured motorist provision of a motor vehicle insurance policy (“auto policy”) when a workers’ compensation insurer has paid the injured person’s medical expenses at rates set by the State Workers’ Compensation Commission. Maryland law permits the auto policy insurer to reduce its payment of benefits under the underinsured motorist coverage to the extent that the injured person has “recovered benefits under the workers’ compensation laws … for which the provider of the workers’ compensation benefits has not been reimbursed.”2 The case before the federal district court arose after Michael Gilliam was injured in an automobile accident while driving in the course of his employment.

He received payments from his employer’s workers’ compensation insurer and the other driver’s liability insurer, and now seeks to recover, from the insurance policy covering the vehicle he was driving (issued by Westfield Insurance Co.), the amounts by which the other driver was underinsured. The health care providers who treated his injuries had generated bills in face amounts greater than the amounts set by the Workers’ Compensation Commission, but (as required by Maryland law) accepted payments at those lower amounts in full satisfaction for their services. The question asked of this Court is whether the difference between the amount of those bills – or perhaps more precisely, the fair and reasonable value 1 Maryland Uniform Certification of Questions of Law Act, Maryland Code, Courts & Judicial Proceedings Article (“CJ”), §12-601 et seq; Maryland Rule 8-305. 2 Maryland Code, Insurance Article (“IN”), §19-513(e). of those providers’ services – and the payments made by the workers’ compensation insurer constitutes a “benefit” that the injured person has “recovered” under the Workers’ Compensation Act that is to be offset against any recovery the person would obtain from the underinsured motorist coverage of the auto policy. For the reasons set forth in this opinion, we hold that only the amount that the workers’ compensation insurer actually paid for medical expenses is part of the statutory offset against underinsured motorist benefits.

Thus, a difference between a higher face amount billed by a health care provider and the amount actually paid by the workers’ compensation insurer is not part of that offset. I Legal Landscape The question of law certified by the federal district court arises from litigation over insurance coverage for a motor vehicle tort. It concerns damages related to the plaintiff’s resulting medical treatment and involves the interplay between the State workers’ compensation law and motor vehicle insurance law as they provide compensation for the victim of an automobile accident. It thus arises against the backdrop of tort and contract law.

To set the stage for that question – and our answer – we first review its legal context. A. Damages for Health Care Treatment Occasioned by a Tort An individual who is the victim of a tort may recover compensatory damages from the person responsible for that tort – commonly referred to as the tortfeasor. Anne Arundel County v. Reeves, 474 Md. 46, 66 (2021); Restatement (Second) of Torts §903. Such damages include, among other things, compensation for medical treatment that the victim 2 obtained – or will obtain – as a result of the tort.

Restatement (Second) of Torts §924(c) & comment f. As a general rule, it does not matter if those health care services were initially financed by someone other than the victim – for example, the victim’s health care insurance, other insurance, or a relative. Plank v. Summers, 203 Md. 552, 562 (1954). The tortfeasor remains responsible for paying the victim the “fair and reasonable” value of the health care services that the victim needed as a result of the tort.

Shpigel v. White, 357 Md. 117, 128-29 (1999). 1. The Fair and Reasonable Value of Health Care Services Determining the fair and reasonable value of health care services is not easy. There are often two readily available benchmarks: (1) the amount billed by health care providers and (2) the amount actually paid – whether by the patient or by some other payor.3 But those two benchmarks seldom align. And neither figure alone may represent the actual value of the services.

Higgs v. Costa Crociere S.P.A. Co., 969 F.3d 1295, 1311-14 (11th Cir. 2020). The fair and reasonable value of health care services can be quite distinct from the amounts billed by health care providers or the amounts actually paid to the providers by the tort victim or other payor. Shpigel, 357 Md. at 128-29 . In many instances the nominal list price generated by a health care provider billing service may be a less meaningful indicator of market value than the MSRP4 sticker on a 3 To reduce the expense of litigating cases in which smaller amounts are in controversy, a statute provides an evidentiary shortcut for admitting provider bills to establish the fair and reasonable value of medical treatment in those cases.

CJ §10-104(e); see James v. Butler, 378 Md. 683 (2003). That statute does not apply to this case. 4 “Manufacturer’s suggested retail price.” 3 new car in an auto showroom.5 See George A. Nation III, The Valuation of Medical Expense Damages in Tort: Debunking the Myth That Chargemaster-Based “Billed Charges” Are Relevant to Determining the Reasonable Value of Medical Care, 95 Tul. L. Rev. 937 (2021). That is because, among other things, health care billing involves nominal prices seldom actually paid, alternative charges negotiated between providers and insurers, and rates set by government entities. “The complexities of health care pricing structures make it difficult to determine whether the amount paid, the amount billed, or an amount in between represents the reasonable value of medical services.” Stanley v. Walker, 906 N.E.2d 852, 857 (Ind. 2009).

And, “[b]ecause this market structure may obscure the real value of medical services, courts have struggled to square tort law with the realities of modern healthcare finance.” Higgs, 969 F.3d at 1309 . Under Maryland law, the amount of a bill or an actual payment is inadmissible without evidence to prove that the bills or payments actually reflect the “fair and reasonable” value of the services. See Shpigel, 357 Md. at 128 ; see also Brethren Mut. Ins.

Co. v. Suchoza, 212 Md. App. 43, 57 (2013) (holding that trial court properly excluded evidence of actual payments when record contained no expert or other evidence that they reflected the fair and reasonable value of providers’ services). 5 Perhaps in recognition of this, a statute governing medical malpractice cases limits a judgment against a health care provider for the plaintiff’s medical expenses incurred as a result of malpractice to what was paid, or is obligated to be paid, by or on behalf of the plaintiff rather than what the plaintiff was billed. CJ §3-2A-09(d). 4 2. Collateral Source Rule As a general rule, whatever value can be determined for health care treatment required as a result of a tort, “a plaintiff is entitled to but one compensation” for the loss, regardless of whether there are multiple causes of action or multiple tortfeasors. That principle is sometimes called the “one recovery rule.” Beall v. Holloway-Johnson, 446 Md. 48, 70 (2016); Reeves, 474 Md. at 67 .6 And, generally, under a sometimes countervailing principle known as the “collateral source rule,” the tortfeasor should be responsible for that recovery, regardless of whether the victim has another source of compensation.

Haischer v. CSX Transp., Inc., 381 Md. 119, 132 (2004).7 The label “collateral source rule” actually denotes two related common law “rules”: one is a substantive principle of damages; the other is an evidentiary rule. The substantive principle of damages provides that an injured person is ordinarily entitled to full compensation from the tortfeasor, regardless of any compensation the person has received from sources unrelated to the tortfeasor with respect to the same injury. Haischer, 381 Md. at 132 . Such collateral benefits may include insurance payments, negotiated lower rates, statutory benefits, or simply an affluent family member’s goodwill.

See Restatement (Second) of Torts §920A, comment c (providing examples of collateral benefits not subtracted from the plaintiff’s recovery from the tortfeasor). 6 The one recovery rule originated in English common law. Gunther v. Lee, 45 Md. 60, 66-67 (1876). 7 See also St. Louis v. Beckles, 81 Md. App. 41, 52 (1989) (describing the collateral source rule as an exception to the one recovery rule). 5 The primary purpose of the collateral source rule, as substantive law, is to ensure that a tortfeasor does not escape liability by enjoying a benefit accruing to the injured party. Haischer, 381 Md. at 132 ; see also Restatement (Second) of Torts §920A, comment b. Thus, a plaintiff may recover damages for a harm for which the plaintiff has already been compensated and, as a result, in some instances be made “more than whole.” Higgs, 969 F.3d at 1310 .

Given a choice between a windfall for the tortfeasor and a windfall for the tort victim, the law favors the victim. In addition, to the extent that the collateral source is an insurance policy, the rule favors the maintenance of insurance. Haischer, 381 Md. at 132 . In that sense, the rule ensures that a plaintiff is not penalized for prudence.

In support of that substantive principle of damages, the evidentiary aspect of the collateral source rule ordinarily renders inadmissible evidence that a plaintiff received compensation from a third party. See Eastern Shore Title Co. v. Ochse, 453 Md. 303 , 341- 43 (2017) (discussing application of collateral source rule and exceptions to the rule). The matter becomes more complicated when the tort is an automobile accident to which motor vehicle insurance applies – particularly when the tortfeasor’s liability coverage is inadequate and the tort victim must look to the underinsured motorist coverage under the policy applicable to the victim’s vehicle. The matter becomes yet more complicated if the accident occurs in the course of the victim’s employment and a workers’ compensation insurance policy comes into play.

In such a case, the victim will typically first seek benefits under the workers’ compensation policy. We turn to that law next. 6 B. Medical Benefits Paid by Workers’ Compensation Insurance 1. Generally The Maryland Workers’ Compensation Act is intended to ensure that employees receive sufficient and timely compensation for work-related injuries and occupational diseases regardless of fault. As amended and recodified since its initial enactment more than a century ago,8 the law is now codified in Maryland Code, Labor & Employment Article (“LE”), §9-101 et seq.

The statute is to be construed liberally to achieve its remedial purpose. Reger v. Washington Co. Board of Education, 455 Md. 68, 96 (2017); see also LE §9-102. The Workers’ Compensation Commission (“Commission”) administers the law. Benefits under the Act are generally paid by an insurer with whom an employer contracts or by a self-insured employer.9 For simplicity, in this opinion, we shall refer to a payor of workers’ compensation benefits as the “WC insurer.” 2.

Medical Benefits As part of the compensation provided by the law, the WC insurer may be required to provide and pay for health care services for the injured employee occasioned by the work-related injury or occupational disease. LE §9-660. The Act authorizes the 8 The predecessor of the current statute was enacted in 1914. Chapter 800, Laws of Maryland 1914. 9 In certain circumstances, the Subsequent Injury Fund or the Uninsured Employers’ Fund may pay benefits under the Act.

See LE §9-801 et seq.; §9-1001 et seq.; §10-201 et seq.; §10-301 et seq. Based on the facts presented to us in the certified question, those circumstances do not pertain to this case. 7 Commission to oversee and adopt regulations concerning the provision of health care services and the payment for those services. LE §§9-662, 9-663. The fees and other charges for medical services approved by the Commission are to be limited to “the amount that prevails in the same community for similar treatment of an injured individual with a standard of living that is comparable to that of the covered employee.” LE §9-663(b)(2).

The Commission has adopted regulations concerning compensation for health care services since the inception of the workers’ compensation statute. See COMAR 14.09.08.10 The allowable fees and charges are regularly updated and published in the Commission’s Guide of Medical and Surgical Fees, commonly referred to as the “Fee Guide.” Falik v. Prince George’s Hosp. & Med. Ctr., 322 Md. 409, 414-17 (1991). Those fees and charges may not always equal the rates prevailing in a particular locality, but are not to exceed them.

Id. at 415 . A health care provider that treats an injured individual as part of the individual’s benefits under the Act may not charge more than the amounts set by the Commission in the Fee Guide without the Commission’s approval. LE §9-731(a)(1)(ii). This provision is intended to “protect[] the economic integrity of injured employees by preventing unreasonable or excessive charges for health care services.” Queen v. Agger, 287 Md. 342, 346 (1980). 10 Those regulations derive the specified fees from a number of sources, including the federal Center for Medicare and Medicaid Services and the State Health Services Cost Review Commission. 8 3.

Coordination of Workers’ Compensation Benefits with Other Benefits When an employee covered by the law incurs a work-related injury, the WC insurer is to pay benefits under that law to the covered employee. However, the workers’ compensation law “neither excuses third-parties from their own negligence nor limits their liability.” Great Atl. & Pac. Tea Co. v. Imbraguglio, 346 Md. 573, 583 (1997). If an injured employee brings an action against a tortfeasor related to the incident underlying the employee’s workers’ compensation claim, the collateral source rule excludes evidence that the plaintiff previously received workers’ compensation benefits.11 Restatement (Second) of Torts §920A, comment c; Ochse, 453 Md. at 341-42 .

However, the WC insurer is subrogated to the employee’s claim against the tortfeasor and has a statutory lien on any recovery with respect to that claim in an amount equivalent to the workers’ compensation benefits paid. LE §9-902(e)-(f).12 The employee must reimburse the WC insurer out of the monetary damages awarded from the tortfeasor (minus court and attorney’s fees). Id. The employee may keep the balance of the damages awarded.

LE 11 Typically, a person injured during the course of employment pursues a workers’ compensation claim before resolving a tort claim against a third party or, as in this case, before seeking recovery under the underinsured motorist coverage of a motor vehicle insurance policy. See Clifford Sobin, 2 Maryland Workers’ Compensation (Sept. 2021 update) §25:21. Some types of damages that may be recoverable in a tort action are not included in the benefits that may be recovered through a workers’ compensation claim – for example, pain and suffering and loss of consortium. See, e.g., LE §§9-101(e)(1), 9-601 et seq. 12 Under LE §9-902, a WC insurer that pays benefits to an employee may bring an action against the tortfeasor.

If the WC insurer does not do so within two months of an award under the workers’ compensation law, the employee or the employee’s dependents may pursue an action against the tortfeasor. LE §9-902(c); see Erie Ins. Co. v. Curtis, 330 Md. 160, 164 (1993). 9 §9-902(e). This subrogation right serves the legislative goal of “protect[ing] both the employee and the employer by ensuring that a third party tort-feasor will not escape liability by having another pay its debt.” Podgurski v. OneBeacon Ins.

Co., 374 Md. 133, 148 (2003) (emphasis in original). The statutory lien also avoids a situation where an injured employee receives “a windfall recovery from both sources for the same damages.” Parry v. Allstate Ins. Co., 408 Md. 130, 136 (2009). It is sometimes in the WC insurer’s interest to accept less than the full amount of a lien in satisfaction of the lien as part of the employee’s settlement of a claim against a culpable tortfeasor.

See Richard Gilbert, et al., Maryland Workers’ Compensation Handbook, §15.07[7]; Clifford Sobin, 2 Maryland Workers’ Compensation (Sept. 2021 update) §25:21 (“Many employer/insurers will agree to reduce their lien to less than the statutory lien if there is a significant issue which may impair the ability to successfully prosecute the third party claim.”); cf. 5 U.S.C. §8132 (providing, in federal workers’ compensation scheme, for federal government lien on any third-party recovery by claimant beneficiary, but allowing beneficiary to retain at least one-fifth of that recovery after deduction of legal fees). The WC insurer’s statutory lien does not apply, however, to a particular source of recovery of the tortfeasor’s liability pertinent to this case – uninsured or underinsured motorist coverage under a motor vehicle insurance policy. Erie Ins. Co. v. Curtis, 330 Md. 160, 169 (1993).

Instead, the benefits provided pursuant to the workers’ compensation law and those provided pursuant to compulsory motor insurance law are coordinated differently, as we explain in the next section of this opinion. 10 C. Underinsured Motorist Coverage 1. Generally In Maryland, an owner of a registered motor vehicle must carry prescribed minimum levels of liability and other types of auto insurance. Maryland Code, Transportation Article (“TR”), §§17-103, 17-104; IN §19-501 et seq. Among the types of insurance included in a motor vehicle policy is uninsured motorist (“UM”) coverage.

TR §17-103(b)(4); IN §19-509. It is well-settled that UM coverage includes coverage for accidents caused by underinsured motorists – what we shall refer to as “UIM” coverage – and the phrases “uninsured motorist” and “underinsured motorist” are often used interchangeably. Connors v. Gov’t Emps. Ins.

Co., 442 Md. 466 , 474 n.4 (2015); Swartzbaugh v. Encompass Ins. Co., 425 Md. 614, 617 (2012).13 This Court has frequently observed that this coverage is to be “liberally construed to ensure that innocent victims of motor vehicle collisions are compensated for their injuries.” E.g., Connors, 442 Md. at 475 (quoting Brethren Mut. Ins. Co. v. Buckley, 437 Md. 332, 347 (2014)) (internal quotation marks omitted).

UM/UIM coverage aims to “provide an injured insured with resources equal to those which would have been available had the tortfeasor carried liability coverage equal to the amount of uninsured motorist coverage which the injured insured purchased from his own insurance company.” Connors, 442 Md. at 475 (quoting Waters v. U.S. Fidelity & Guar. 13 In 2017, after the incident giving rise to this case, the General Assembly provided an option for a vehicle owner to purchase “enhanced underinsured motorist coverage.” Chapters 20, 815, Laws of Maryland 2017, codified at IN §19-509.1. That provision does not pertain to this case. 11 Co., 328 Md. 700, 714 (1992).14 It is often referred to as a form of “first-party coverage,” based on the insurance contract under which the UM/UIM insurer directly covers the injured insured person when “third-party coverage” is inadequate – i.e., “the at-fault tortfeasor has no liability insurance or insufficient insurance funds.” TravCo Ins. Co. v. Williams, 430 Md. 396, 403 (2013). However, this coverage also has aspects of third-party coverage, as it is based not only on the insurance contract, but also on a showing of fault of the alleged tortfeasor.

See Andrew Janquitto, Maryland Motor Vehicle Insurance §8.5 at 323-24 (3d ed. 2011). 2. Coordinating Workers’ Compensation Benefits and UM/UIM Benefits An employee who receives workers’ compensation benefits as a result of an automobile accident during the course of employment may also have a claim against the alleged tortfeasor and, if the tortfeasor’s liability coverage is inadequate, a claim for UM/UIM coverage under the relevant motor vehicle insurance policy. In that case, the benefits provided by the WC insurer may overlap those provided by the tortfeasor’s liability policy and the UM/UIM coverage. As noted above, the WC insurer has a statutory lien against any recovery from the tortfeasor or the tortfeasor’s liability insurer.

However, as also noted earlier, the statutory lien under the workers’ compensation law does not extend to a recovery based on UM/UIM coverage. Instead, the State insurance law provides that UM/UIM benefits are reduced as 14 To the extent that the injured person is able to obtain compensation from the tortfeasor, or the tortfeasor’s insurer, UM/UIM benefits are reduced. IN §19-509(g). 12 a result of the claimant’s receipt of worker’s compensation benefits. The statute provides for an offset against UM/UIM benefits as follows: Benefits payable under the coverages described in … [IN §] 19-509 [uninsured motorist coverage] of this subtitle 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.

IN §19-513(e).15 As is evident, this statute offsets UIM coverage benefits by the amount of workers’ compensation benefits recovered by the employee for which the WC insurer has not been reimbursed.16 Like the WC insurer’s statutory lien on compensation received from a tortfeasor or the tortfeasor’s liability policy, IN §19-513(e) serves to avoid “the duplication of benefits” provided to the employee. State Farm Mut. Auto. Ins.

Co. v. Ins. Comm’r, 283 Md. 663, 675 (1978). D. Some Principles to Apply The discussion above yields the following principles, some in tension with each other, pertinent to our decision in this case: 15 IN §19-513(e) also provides for an offset against other coverage under a motor vehicle insurance policy, known as personal injury protection (“PIP”) coverage, under IN §19-505. The offset against PIP benefits is not part of the question before us. 16 This provision applies with respect to the entire UM/UIM coverage benefits and can thus offset elements of a UM/UIM recovery that are not compensable under the workers’ compensation law, such as damages for pain and suffering.

Parry v. Allstate Ins. Co., 408 Md. 130, 142-43 (2009) (quoting Hines v. Potomac Electric Power Co., 305 Md. 369, 376-77 (1986)). 13 1 – Although the victim of a tort is entitled to only one recovery for the injuries incurred, a wrongdoer – i.e., a tortfeasor – should be responsible for the damages caused by the tortfeasor’s conduct and should not benefit from the victim’s prudence. 2 – The workers’ compensation and UM/UIM laws are to be liberally construed to compensate an injured person, but any construction of those laws must be consistent with the statutory language and legislative purpose. 3 – Under UM/UIM coverage in a motor vehicle insurance contract, the insurer steps into the shoes of the tortfeasor and, subject to policy limits, is to provide the remedy that would otherwise be provided by a similarly-insured tortfeasor. 4 – Consistent with the one recovery rule, duplication of benefits is avoided through subrogation, liens, and offsets. The certified question in this case concerns the application of the offset provided by IN §19-513(e) with respect to medical benefits recovered under the Maryland Workers’ Compensation Act. The next section of this opinion outlines the circumstances in which that question arises. 14 II Background A. The Accident and Insurance Claims On January 6, 2017, while driving a vehicle provided by his employer, Mr. Gilliam was rear-ended by another vehicle.

The driver of the other vehicle had a motor vehicle insurance policy with a liability coverage limit of $30,000.17 As the driver of a company vehicle, Mr. Gilliam was covered by his employer’s motor vehicle insurance policy with Westfield. The Westfield policy included UM/UIM coverage with a policy limit of $1,000,000. Mr. Gilliam’s employer also carried workers’ compensation insurance.18 Mr. Gilliam filed a workers’ compensation claim with his employer’s WC insurer. Mr. Gilliam’s health care providers billed Mr. Gilliam a total of $243,399.33 for services related to his care following the January 6 incident.

In accordance with the Fee Guide of the Workers’ Compensation Commission, the WC insurer paid $118,369.15 to the health care providers for the health care services provided to Mr. Gilliam.19 As indicated earlier, 17 The driver of the other car, Nicholas Tinsley, had a motor vehicle insurance policy with USAA Auto Insurance Company. To minimize the number of proper names in the text, we refer to Mr. Tinsley and USAA as the tortfeasor and the tortfeasor’s motor vehicle insurer, respectively. 18 Mr. Gilliam’s employer was Ecomize USA, LLC, which had obtained workers’ compensation insurance from Chesapeake Employers’ Insurance Company. Again, for simplicity, we refer to them in the text as Mr. Gilliam’s employer and the WC insurer. 19 A cursory review of a spreadsheet of bills and payments that was filed in federal district court and that is appended to Westfield’s brief in this Court reveals that, in most 15 the health care providers were required to accept those amounts as full compensation for their services unless they sought an exception to the Fee Guide; apparently, none of the providers did so. Thus, neither Mr. Gilliam, nor his employer, nor the WC insurer was responsible for paying any additional sums to the health care providers.

In addition to the medical benefits, the WC insurer paid Mr. Gilliam $510,316.47 in other benefits related to the accident.20 In sum, the WC insurer paid a total of $628,685.62 ($118,369.15 medical payments + $510,316.47 other benefits). The WC insurer asserted a statutory lien under the workers’ compensation law in that amount against any compensation related to the accident that Mr. Gilliam might recover from a third-party tortfeasor. In fact, Mr. Gilliam did recover some compensation from the tortfeasor. The tortfeasor’s motor vehicle insurer paid Mr. Gilliam a settlement award of $30,000.00 – the policy limits.21 The WC insurer accepted one-third of that amount – $10,000.00 – in satisfaction of its statutory lien.22 instances, there is a substantial difference between the amount billed and the amount paid to a particular provider. 20 Among other benefits, Mr. Gilliam received temporary total disability benefits in the amount of $117,621.47 and permanent disability benefits in the amount of $375,000. 21 Westfield consented to that settlement with the tortfeasor’s insurer.

See IN §§19- 511(f)-(g), 19-511.1(f)-(g) (requiring consent of UIM insurer for injured person’s settlement with tortfeasor’s liability insurer in order to preserve UIM claim). 22 As noted earlier, a WC insurer in some instances may consider it to be in its interest to compromise its lien as part of the employee’s settlement with a tortfeasor. See Part I.B.3 of this opinion. 16 Mr. Gilliam also made a claim against Westfield under the UIM portion of his employer’s motor vehicle insurance policy with Westfield. As indicated earlier, any recovery Mr. Gilliam might obtain from Westfield would not be subject to a statutory lien by the WC insurer. However, under IN §19-513(e), any recovery from Westfield would be offset by any benefits that Mr. Gilliam received from the WC insurer for which the WC insurer had not