Jackson v. Sedgwick Claims, 2010 WL 9311864 (E.D. Mich.)
This matter was sued in U.S. District Court in the Eastern District of Michigan claiming fraudulent denial of benefits under the federal RICO statute. The plaintiff alleged that the defendant TPA conspired with the employer and defense examiner to improperly deny a claim. Defendants filed a motion to dismiss based on the exclusive remedy provision of the WDCA and that the plaintiffs’ claims were not ripe, among other issues. The Court agreed with the defendants’ and granted the motion based on Rule 12(b)(6) failure to state a claim for which relief can be granted.

Key Point: RICO does not serve as an “end run” around the exclusive remedy provision of the WDCA. Even if RICO was applicable, the claims are not ripe because they are, in part, reliant on the determination that the plaintiffs are entitled to workers’ compensation benefits. (See also Lewis v. Drouillard, 2010 WL 3464308)