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Wix Corp. v. Davis9/16/2005
the heart from the employer under workers' compensation as long as said treatment is reasonable and necessary and related to the alleged September 20, 1996 injury pursuant to the Workers' Compensation Act of Alabama."
(Emphasis added.)
In keeping with the parties' settlement agreement, for several years Davis sought and received care and treatment for his cardiac condition that was paid for by a health-insurance policy provided to Davis through American Health, Inc. Sometime in 2003, however, this insurance policy terminated, at which time Medicare became Davis's primary medical insurer.
The circuit court interpreted the first of the two above-emphasized passages of the settlement agreement as referring only to "private" health insurance, and not to Medicare insurance. We are not persuaded that, from its plain language, that passage can be so interpreted. Nonetheless, even if the reference to health insurance in the settlement agreement was not intended by the parties to be limited to "private" insurance, the circuit court correctly notes in its judgment that Medicare coverage is not to be available for the cost of treatments for injuries that would otherwise be covered under a state's Workers' Compensation Act. See 42 U.S.C. ยง 1395y(b)(2)(A)(ii).
Accordingly, it might be asked whether the parties intended by their settlement agreement to remove Davis's injuries from coverage under the Workers' Compensation Act, in an effort to cause Davis to retain coverage for those injuries under his Medicare insurance. Even if this was their intent, however, we are not inclined to accept the view that the parties lawfully could contract themselves out of workers' compensation coverage so as to force Medicare coverage for an injury that, in the absence of such a contract, would in fact be covered by workers' compensation. We therefore proceed to the question whether Davis's cardiac condition is in fact one that is covered under Alabama's Workers' Compensation Act.
The second of the two passages emphasized in the above-quoted portion of the parties' settlement agreement, as incorporated in the circuit court's February 14, 2000, order, states that Davis will be entitled to coverage under the Workers' Compensation Act for reasonable and necessary medical treatments for his heart condition as long as the same is "related to the alleged September 20, 1996 injury pursuant to the Workers' Compensation Act of Alabama." (Emphasis added.) In his brief to this court, however, Davis argues that the circuit court's October 19, 2004, judgment should be upheld because the evidence supports a finding that Davis's work-related activities of September 20, 1996, either caused or contributed to the cardiac condition for which he now seeks medical benefits. In its briefs to this court, Wix does not treat the issue presented to be as narrow as whether the injuries suffered by Davis as a result of his fall on September 20, 1996, in turn caused his heart condition. Instead, Wix, like Davis, treats the issue presented as whether there is substantial evidence that the physical activities in which Davis engaged on September 20, 1996, caused or contributed to his heart condition. We will therefore address both the factual issue of whether Davis's September 20, 1996, physical injuries caused or contributed to his heart condition and the factual issue of whether Davis's physical activities on September 20, 1996, caused or contributed to his heart condition.
Davis began his employment with Wix in 1961 as a sales representative. Thereafter, he worked for Wix on a continual basis until September 20, 1996. Davis testified that he first noticed symptoms relating to his cardiac condition in
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