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Millican v. General Motors Corp.11/1/2000
by its employees, GM has established a "General Motors National Benefit Center"; this center administers all claims for benefits: workers' compensation claims, as well as those for sickness/accident and medical expenses. Upon filing a claim, a worker is assigned an adjuster based upon an alphabetic system, i.e., according to the first letter of his surname. At that time, the employee must submit all pertinent information concerning the accident and disability to his adjuster, who then begins issuing payments. As noted above, since the weekly amount payable under the sickness and accident program always exceeds the amount payable under Louisiana workers' compensation law, an injured Louisiana employee receives $500 per week under the sickness and accident program.
The same adjuster also determines whether a claim is compensable under Louisiana workers' compensation law. Prior to this determination, the adjuster requires that an injured worker sign a written agreement which contractually obligates the employee to repay General Motors any money that GM may ultimately decide that the employee is entitled to receive under workers' compensation. Also of importance is that the amount of the weekly benefit received by the injured worker is set at $500, regardless of whether the accident or injury is found by the adjuster to be compensable under Louisiana workers' compensation law. If the adjuster determines that the worker is entitled to workers' compensation benefits, what occurs is basically an accounting adjustment; GM's workers' compensation program "repays" the amount of the weekly benefit found owing to its sickness and accident program.
Millican was injured on September 28, 1998. He did not begin missing work, however, until November 16, 1998. After undergoing lumbar disc surgery on January 11, 1999, Millican returned to work at General Motors on April 3, 1999.
Millican contacted the National Benefit Center in November 1998. The adjuster he was assigned for his claims for sickness/accident benefits, workers' compensation benefits and medical expenses was Brenda McIntosh. Millican testified that Ms. McIntosh related to him that the most he would receive under either the sickness/accident plan or workers' compensation program was $500 per week. She also informed him that prior to receiving any benefits, he would have to sign a reimbursement agreement.
Millican submitted all of the requested information and documentation to Ms. McIntosh. After the adjuster confirmed that Millican was unable to return to work due to his back injury , he began receiving $500 per week from the National Benefit Center.
On June 2, 1999, two months after his return to work, Millican's workers' compensation claim was denied by Ms. McIntosh. The letter of denial did not explain the basis for the rejection of his claim for workers' compensation benefits; instead, Millican was urged to call Ms. McIntosh should he have any questions.
Millican testified that he telephoned the adjuster on numerous occasions. During one such conversation, Ms. McIntosh informed him that he had to "appeal" her decision to the OWC. Furthermore, since he had submitted documentation and information to Ms. McIntosh and had received disability benefits as well as medical expenses, Millican believed that he had already filed a formal claim. The adjuster fostered and encouraged this belief when she informed Millican that he had to "appeal" her decision. Millican thereafter requested information from the OWC and, based upon the "Statement of Rights" form he received from that office, believed that he had plenty of time to file his "appeal."
While we are cognizant of the supreme court's ho
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