The payment of maintenance and cure benefits for injured seaman are supposed to be “virtually automatic.” These claims are protections afforded to mariners in recognition of the perils of seafaring life. Maintenance benefits provide for a seaman’s basic living expenses; cure for their reasonable and necessary medical treatment; and both are intended to provide basic care for a seaman until they reach maximum medical improvement. Because these benefits are supposed to be automatic, and unbeknownst to many injured seamen, denial of them can subject an employer or shipowner to punitive damages and attorney’s fees.
Under maritime law, the award of punitive damages for failing to provide maintenance and cure benefits occurs on a three-tiered sliding scale.
At the first level, if the Jones Act employer has a reasonable – but ultimately incorrect basis – for denying maintenance and cure benefits, a seaman is limited to recovering only the maintenance and cure owed. Refusal to provide benefits may be reasonable if the employer has a “reasonable factual or legal basis” for the denying the claim, as determined after a diligent investigation or if the seaman does not submit medical reports to document his claim. But any doubts must be resolved in favor of the seaman.
At the second level, if the fact finder determines that the employer unreasonably withheld benefits, the employer becomes liable for maintenance and cure payments, and also for any compensatory damages that have resulted from the failure to pay. These compensatory damages include elements of damage such as the aggravation of the medical condition, pain, suffering and mental anguish.
At the third level, a Jones Act employer’s willful and wanton, callous, or arbitrary and capricious failure to pay maintenance and cure benefits can result in punitive damages and attorney’s fees. A decision may be willful and wanton if the employer (i) failed to conduct any investigation into the seaman’s claim, (ii) withheld payments despite discovering through investigation that payments were due, (iii) rejected a documented claim because the seaman did not consult the employer before seeking treatment, (iv) rejected a claim because the seaman filed suit, (v) withheld payments on a pre-textual basis or (vi) rejected a claim because they seaman refused to settle.
The wrongful denial of these benefits can have tragic consequences for injured seaman. Retaining experienced attorneys from the outset who understand these damages tiers can properly assert your claim against your employer to obtain the benefits you are due and otherwise document the unreasonable or arbitrary refusal to pay, ensuring you the full compensation available to you.
If you or a loved has been seriously injured or killed while working offshore, find an attorney experienced and proven in handling maritime claims. Abraham, Watkins, Nichols, Agosto, Aziz & Stogner is the oldest personal injury firm in Texas. Our attorneys have handed many maritime injury claims. Contact us today by calling 713-396-3964 or 1-800-594-4884 for a free consultation.