In Brown v. Muskego Norway School District Group Health Plan (2018AP1799), the Court of Appeals District II held that the plaintiff was in the course of his employment when he was injured in a motorcycle accident; therefore, his health plan excluded coverage because he was eligible for worker’s compensation.
Plaintiff William Brown was injured in a motorcycle accident that occurred while he was travelling on the main route between a plant in Juneau and his primary office in West Bend. Brown’s employer provided worker’s compensation benefits, but Brown declined the benefits, hoping instead to use coverage under his health insurance plan.
The health insurance plan included a provision excluding coverage for injuries arising out of employment if worker’s compensation benefits are available. The language of the plan specifically stated that the exclusion applies whether or not the policyholder obtains the available worker’s compensation benefits.
The issue before the court was whether Brown was eligible for benefits under the worker’s compensation statute Wis. Stat. § 102.03(1)(f), which provides for benefits for employees injured while travelling. The statute provides a presumption of coverage unless the employee is “engaged in a deviation for a private or personal purpose.” Brown claimed his motorcycle ride was a personal deviation, so the exemption applied. However, the court found § 102.03(1)(f) was applicable to Brown’s accident because testimony suggested he had left on a lunch break and was ultimately to return to his primary office that day. Since Brown was eligible for worker’s compensation, the coverage exclusion under his health insurance policy applied.