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How insurance companies may try to deprive you of benefits

Working on a sea vessel in New York is different than working at a job on dry land. In the former case, if you become injured on the job, you do not receive workers’ compensation. Instead, if the Jones Act applies, you receive maintenance and cure benefits. At Tabak Mellushi & Shisha, we know these terms can be confusing. “Cure” refers compensation for your medical expenses, while “maintenance” refers to a daily stipend intended to cover your day-to-day expenses. 

However, maintenance and cure benefits are similar to workers’ compensation in that, rather than paying you out of pocket, your employer holds an insurance policy to cover maintenance and cure benefits owed to seamen. Unfortunately, your employer’s insurer may go to great lengths to minimize the amount you receive in maintenance and cure benefits. 

In order to receive maintenance and cure benefits, your injury must be the result of your maritime work. An insurance company may allege that your condition was pre-existing, giving them grounds to deny your claim outright. Additionally, the insurance company may accuse you of willful misconduct as grounds to deny your claim. 

Even if the insurance company does not deny your claim outright, it may place an unreasonable limit on the benefits you receive. Sometimes it is necessary to get a second opinion from another doctor who can confirm the extent of your injuries and the need for cure benefits with an objective medical examination. Your union’s collective bargaining agreement may limit the maintenance benefits you receive, and sometimes the rate of daily stipends an insurance company is willing to pay is absurdly low at baseline. 

Insurance companies have a vested interest in minimizing the benefits they pay out. However, the Jones Act is there for a reason, and no one has the right to circumvent the law regarding maintenance and cure benefits. More information is available on our website. 

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