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Judge orders Federal Way, WA Woman to Repay Nearly $25,000 in Workers’ Comp Scam

DLI News Release:

A Federal Way, WA woman who worked full time as a nanny while claiming she was too disabled to work pleaded guilty to felony theft.

Yurizan Cuevas, 33, was ordered to repay the Department of Labor & Industries (L&I) $24,847, the amount she received in wage-replacement payments over a period of almost two years. King County Superior Court Judge Bruce Heller also sentenced Cuevas to 20 days in jail, which was converted to 160 hours of community service.

Cuevas, who’s also known as Yurizan Cuevas Nava, pleaded guilty at the hearing this week to second-degree theft.

The Washington Attorney General’s Office prosecuted the case based on an L&I investigation.

Injured in workplace robbery

Cuevas was a baker and cashier at a cafe in the White Center neighborhood of Seattle when it was robbed in November 2010. While running from the robber, she hit a wall and injured her back.

Health care providers verified Cuevas couldn’t work because of injuries from the incident, allowing her to receive wage-replacement payments from L&I. 

An L&I investigation later revealed, however, that Cuevas worked full time as a nanny, earning an estimated $3,200 a month for nearly two years starting in September 2011. According to charging papers, she also worked six weeks in 2011 as a house cleaner for another employer — performing both jobs while stating on official forms that she could not work because of her injuries.

In an interview with an L&I investigator, Cuevas acknowledged that she worked as a housekeeper and said she babysat for just a few days. But when confronted with timesheets, charging papers said, Cuevas admitted she served as a nanny from the time her charge was three months old to two years old. She’s accused of stealing more than $24,800 in wage-replacement checks from the state.

 

Photo credit: Jason L. Parks via Foter.com / CC BY-NC-ND

 

 

Cutting Corners in Construction Costs Lives

Today’s post was shared by US Labor Department and comes from blog.dol.gov

an image of the collapsed parking garage
an image of the collapsed parking garage

In the construction industry, precision matters – corners need to be square, lines have to be level and plans must be followed. Following the rules keeps buildings and people safe. But when construction companies cut corners, workers often pay the price.

That is exactly what happened in Jacksonville, Florida, in December 2007. A construction company called Southern Pan thought eliminating basic safety procedures would save time and money. The result? A six-story parking garage came crashing down, killing one worker and injuring 20 others. The worker who was killed, Willie Edwards, was only there that day because he decided to pick up an extra shift to buy Christmas presents for his children.

This horrific tragedy could have been easily avoided.

The Occupational Safety and Health Administration enforces construction standards designed to keep workers safe from building collapses like this. To keep a building from collapsing during construction, a process called “shoring” is used, which involves wood or steel beams to help support the weight of concrete and other construction loads.

In violation of OSHA’s construction standards, Southern Pan chose to remove most of the shores from the first two floors of the parking garage, ignoring blueprints that required all shoring to remain from top to bottom until the building was completed. The company then knowingly permitted workers, including Edwards, to work in the…

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WCRI Studies Compare Outcomes of Injured Workers Across 15 States

Today’s post was shared by WC CompNewsNetwork and comes from www.workerscompensation.com

Cambridge, MA (WorkersCompensation.com) – New studies published today by the Workers Compensation Research Institute (WCRI) compare outcomes of injured workers across 15 states. The outcomes examined in these studies include recovery of physical health and functioning, return to work, earnings recovery, access to medical care, and satisfaction with medical care.

“The goal of the studies is to provide information about injured workers’ experiences with the workers’ compensation system. By examining outcomes of injured workers, policymakers and stakeholders can better understand how different state systems compare in order to identify and prioritize opportunities to improve system performance,” said Bogdan Savych, an economist at WCRI and one of the authors of the studies.

The research, Comparing Outcomes for Injured Workers, is a product of an ongoing, multiyear effort by WCRI to collect and examine data on the outcomes of medical care achieved by injured workers in a growing number of states. There are 15 individual studies for the following states: Arkansas, Connecticut, Florida, Georgia, Indiana, Iowa, Kentucky, Massachusetts, Michigan, Minnesota, North Carolina, Pennsylvania, Tennessee, Virginia, and Wisconsin.

Below is a sample of the findings from the 15 individual state studies.

  • Florida: Workers in the state reported outcomes that were similar to the median study state on some of the key measures, but reported somewhat higher rates of…

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FDA approves first implant to treat opioid addiction

Today’s post was shared by Workers Compensation and comes from www.businessinsurance.com

(Reuters) — The first-ever implant to fight addiction to opioids, a class of drugs that includes prescription painkillers and heroin, was approved by the U.S. Food and Drug Administration on Thursday.

The matchstick-sized implant, developed by Titan Pharmaceuticals Inc. and privately owned Braeburn Pharmaceuticals, is by design less susceptible to abuse or the illicit resale that plagues existing oral therapies.

Currently, two drugs are predominantly used to treat opioid addiction — methadone, which is dispensed only in government-endorsed clinics, and the less-addictive buprenorphine, which exists as a pill or strip of film.

The implant administers buprenorphine for up to six months after users have been stabilized on the oral form of the drug.

“I intend to make this the most successful implant that’s ever been marketed … and I think it’s absolutely possible given the unmet need,” Braeburn CEO Behshad Sheldon said in an interview ahead of the FDA decision.

Fewer than half of the estimated 2.2 million Americans who need treatment for opioid abuse are receiving help, according to the U.S. Centers for Human and Health Services.

Authorities investigating the death of singer Prince found prescription opioid medication on him, sections of the media had reported. The music legend died one day before he was scheduled to meet a doctor who specializes in addiction treatment, the doctor’s lawyer revealed earlier this month.

Braeburn declined to forecast the…

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Trumponomics: Impact on Injured Workers and the Middle Class

Paul Krugman’s July 4 New York Times Op-Ed column, “Trump, Trade and Workers”, picked apart the economic plans posed by Donald Trump in a campaign speech the prior week.  Mr. Krugman examined “the general thrust of the speech: the candidate’s claim to be on the side of American workers.”  All of the points Mr. Kruman raised are valid.  I wish to add a bit of  perspective, though, from the world of representing injured and disabled workers: an effective safety net is also necessary for a strong middle class.  

Krugman: “What’s important is that voters not mistake tough talk on trade for a pro-worker agenda. No matter what we do on trade, America is going to be mainly a service economy for the foreseeable future. If we want to be a middle-class nation, we need policies that give service-sector workers the essentials of a middle-class life. This means guaranteed health insurance — Obamacare brought insurance to 20 million Americans, but Republicans want to repeal it and also take Medicare away from millions. It means the right of workers to organize and bargain for better wages — which all Republicans oppose. It means adequate support in retirement from Social Security — which Democrats want to expand, but Republicans want to cut and privatize.”

Access to Social Security disability benefits has become difficult to obtain, particularly for younger, middle-aged applicants.  Approval rates for applications for Social Security benefits are down across the country but are staggeringly low in some metropolitan areas, such as Seattle.  State’s have been under enormous pressure to reduce costs in their workers’ compensation systems, as well.

In Washington State, changes put into place including a major “deform” movement in 2011, have saved money, granted, but nearly all of the savings were taken out of the pockets of injured workers through reductions in benefits.  

Implementation of a required Medical Provider Network with increased cost and hassle for physicians has significantly limited access to the best care for Washington’s injured workers.  We went from one of the best states in the union for high-quality workers’ compensation insurance to a place where many workers avoid filing claims and seek care under private insurance to get the care they need, quickly.  

Without sufficient benefit levels and access to quality medical care, families suffer. An injured worker receiving temporary total disability benefits receives compensation while unable to work, typically between 60 – 70% of the pre-injury wage rate although higher wage earners may receive a far smaller percentage if they bump into the cap on benefit levels.  For example, a highly skilled tradesperson, particularly if in a union, may receive compensation at 40 – 50% of pre-injury levels.  It’s hard to maintain a middle-class lifestyle on half of your pay, and even harder if it takes months to get authorization for surgery – the road to recovery can be quite long and bumpy.

Washington’s Retro Group program, where employers can reduce premium costs by opting to pay claim costs dollar-for-dollar and can receive refunds of premiums paid if their costs are lower, have inserted a profit motive into what used to be a strong system where all workers and employers shared the cost of all injuries, spreading the burden out and providing predictable coverage expenses.  With the Retro Program, employers have a vested interest in denying coverage, reducing benefits, denying treatment – every penny saved goes right back into their pocket.  It’s a whole new contentious game.  Note that the workers, who in Washington pay ½ of the premiums charged to employers, never get a refund if claim costs are low.  It is unfair, lopsided and the fights that ensue between workers and employers over coverage are handled by State agencies, State  employees, adding to the State’s expense of running the overall workers’ compensation system and eating into the “savings” gained by the reform efforts.

Workers’ compensation is intended to provide protections to those injured on the job for the purpose of ensuring a speedy recovery and return to employment, hopefully with limited financial impact to the worker and their family.  When done right, the protections can save an injured worker from financial ruin.  Implemented poorly, the system can add to the physical, emotional and financial pain after an injury.

Photo credit: George Eastman House via RemodelHunt / No known copyright restrictions

8 Steps to Keep Workers Safe in the Heat

Today’s post was shared by US Labor Department and comes from blog.dol.gov

Keep workers safe in hot weather with water, rest and shade.
Keep workers safe in hot weather with water, rest and shade.

Forecasters are calling for above-average temperatures across much of the country this summer. Are you prepared to beat the heat?

Every year, thousands of workers become ill from working in the heat, and some even die. Construction workers make up about one-third of heat-related worker deaths, but outdoor workers in every industry – particularly agriculture, landscaping, transportation, and oil and gas operations − are at risk when temperatures go up.

Heat-related illnesses and deaths can be prevented. Employers and supervisors can save the lives of workers in hot environments by following these eight simple steps:

  1. Institute a heat acclimatization plan and medical monitoring program. Closely supervise new employees for the first 14 days or until they are fully acclimatized. Most heat-related worker deaths occur in the first 3 days on the job and more than a third occur on the very first day. New and temporary workers are disproportionately affected. If someone has not worked in hot weather for at least a week, their body needs time to adjust.
  2. Encourage workers to drink about 1 cup of water every 15-20 minutes. During prolonged sweating lasting several hours, they should drink sports beverages containing balanced electrolytes.
  3. Provide shaded or air-conditioned rest areas for cooling down, and empower workers to use them.
  4. Provide workers with protective equipment and clothing (such as water-cooled…

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Work Comp Cost-Containment: IME Company May Fetch Billions

Today’s post comes from guest author Rod Rehm, from Rehm, Bennett & Moore.

In January, I wrote about how workers’ compensation has a cost-containment industrial complex that not only harms workers but also is a potential profit generator for groups like private-equity firms.

According to this link from The Wall Street Journal, a private-equity firm named Leonard Green & Partners LP recently submitted an offer to buy an IME company called Exam Works for $2.2 billion. Yes, that’s billion with a B.

“The insurance-defense-industrial-complex has become a multi-billion dollar enterprise,” as was noted on Aleksy Belcher Law Firm’s Facebook page earlier last week (Aleksy Belcher is a workers’ compensation plaintiff’s firm based in Chicago).

The Wall Street Journal article linked above talks about the hundreds of millions of dollars of revenue that Exam Works posted last year and also its purpose.

“It said it serves more than 6,000 clients globally, including property and casualty insurance carriers, law firms, third-party claim administrators and government agencies, helping them manage costs and enhance their risk-management and compliance processes,” according to The Wall Street Journal.

What this means for injured workers and their loved ones is that the big business and added bureaucracy of “cost-containment” may translate to even more profit at the expense of injured workers, going into the private-equity company’s pockets if the sale goes through.

The way IME companies are seen as potential profit centers for private-equity firms is one of the many reasons that if an IME – Independent Medical Exam – or DME – Defense Medical Exam – is ordered for an injured worker, that injured worker should seek the advice of an experienced workers’ compensation lawyer. Workers’ compensation lawyers advocate for injured workers and help them understand the workers’ compensation process, including IMEs, so the playing field of the workers’ compensation process might be a little more even. That way, cost containment, though not as profitable for private-equity firms, can give way to injured workers getting the medical treatment and compensation that they need to move on with their lives.

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Need Joint Replacement and on Medicare? Better Not Be Sick.

Having a lung ailment may make it more difficult to obtain coverage for joint replacement.

Today’s post comes from guest author Charlie Domer, from The Domer Law Firm.

A new Medicare rule that took effect April 1, 2016 retools Medicare payments for hip and knee replacements.  Patients with serious medical conditions such as heart disease, obesity, diabetes, and lung ailments may not be able to find an orthopaedic surgeon willing to perform the joint replacement because hospitals face financial incentives to avoid patients with a high risk of complications. 

Hospitals will be given a “target price” for total joint replacements for the patient’s entire care from the hospital stay to outpatient rehabilitation through 90 days after discharge, according to a new rule from the Center for Medicare Services.  If the reimbursement is less than the target price, the hospital may receive an additional payment from Medicare as an incentive for good outcomes.  On the other hand, the hospital may be required to pay back part of their reimbursement that goes above the target.  The rule is intended to control costs on the $7 Billion Medicare spends for hospital care and for almost one-half million beneficiaries who receive a hip or knee replacement each year.  However, since Medicare will pay only one “bundled payment” for the patient’s entire care after total joint replacement surgery, the hospital will be accountable for the quality of care through the incentives and penalties.  The surgeon shares responsibility when a patient is re-admitted to the hospital and receives a “black mark” even when the re-admission has nothing to do with the joint replacement.  An unintended consequence of this payment model may be “cherry picking” of low risk patients.  Patients claiming a work-related connection to joint replacement surgery who have been denied by Medicare may face additional hurdles in obtaining their surgery. 

Stay tuned…

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Countertop Workers Face Silicosis Risk from Engineered Stone Countertops

Today’s post comes from guest author Leonard Jernigan, from The Jernigan Law Firm.

Engineered stone countertops, a popular fixture in today’s homes, pose a health risk to workers who cut and finish them. The danger stems from the material the countertops are made from, processed quartz, which contains silica levels up to 90 percent. Silica is linked to a debilitating and potentially deadly lung disease known as silicosis, as well as lung cancer and kidney disease.

While the countertops do not pose a risk to consumers in their homes, they do pose a risk to the workers who cut and finish them before they are installed. When the countertops are cut, silica particles are released into the air, which when breathed in by the workers can start processes leading to silicosis. Manufacturers of the engineered stone countertops assert that worker hazards can be reduced through the use of protective respirators and equipment designed to trap silica dust. Despite this assertion, many safety precautions taken by employers are often inadequate.

The first documented case of silicosis among countertop workers in the United States was reported two years ago. In countries such as Israel and Spain, where engineered stone products gained their popularity, many more countertop workers have been diagnosed with silicosis and have had to undergo lung transplants. The danger of silicosis in the construction industry led OSHA to recently issue new rules requiring construction workers’ silica exposure to be reduced by 80 percent beginning on June 23, 2017.

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Work Force Development Center Earns Second Safety Excellence Award

Work Force Development Center (WFDC) in Mukilteo has received a second safety and health award from the Department of Labor & Industries (L&I). This one is for the center’s second worksite for aerospace assembly training.

The worksite is the ninth in the state to be recognized through the START program, which stands for Safety through Achieving Recognition Together. In 2015, the center’s first worksite was the first Washington nonprofit to ever receive the award.

The START award recognizes occupational safety and health excellence which leads to a safer workplace, lower costs and improved morale. It’s modeled after a federal program.

The WFDC is a nonprofit vocational training organization that provides apprenticeships for disabled, socioeconomically disadvantaged or otherwise at-risk high school juniors and seniors in aerospace assembly. Students earn minimum wage and high-school credit while getting valuable experience with the tools and processes in the aerospace industry to prepare them for entering the work force.

The award winning worksite specializes in using Computer Numerical Controlled machine tools that cut, drill and carve out aerospace parts from blocks of titanium, aluminum, nylon and phenolic resin.

“Learning to work safely in an industrial environment is an essential part of our students’ educational experience,” said Carmela Morelli, WFDC Director of Human Resources & Student Services. “We are so proud of our employees and students for their commitment to following the guidance of the L&I safety and health consultants.”

To participate in the program, employers must have an injury rate below their industry’s average for at least a year. They must also allow safety and health experts to visit the worksite and review workplace hazards, examine safety and health programs and interview workers and managers.

“Work Force Development Center is clearly a safety leader in the community that others can learn from,” said Lou Flores, Consultation Program Manager for L&I’s Division of Occupational Safety and Health. “This award is a tribute to the center’s hard work and commitment to making sure that trainees and employees are safe on the job and learn safe work habits that will last a lifetime.”

WFDC has 54 employees and 99 high school-age student trainees from schools in three counties at its aerospace assembly training center worksites in Mulkiteo.

Photo credit: San Diego Air & Space Museum Archives viaHackers / No known copyright restrictions

Published by Causey Law Firm