Category Archives: Workers’ Compensation

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How Attorney Fees Work in Washington Workers’ Compensation Cases

Frequently, Causey Law Firm gets calls from individuals whose cases have been appealed from the Department of Labor & Industries to the Board of Industrial Insurance Appeals. Most often those individuals have already spoken with one or more attorneys who has declined to take their case. Undoubtedly this is a scenario faced by most—if not all—workers’ compensation practitioners at one time or another. In many such instances, the unfortunate reality is that the costs of litigating the individual’s case far outweigh the potential monetary benefit. Welcome to the world of contingent fees.

A contingent fee is a “fee charged for a lawyer’s services only if the lawsuit is successful or is favorably settled out of court . . . . Contingent fees are usually calculated as a percentage of the client’s net recovery.” Black’s Law Dictionary 338 (2004). Put somewhat less artfully: your attorney doesn’t get paid until and unless you do. The underlying purpose of contingent fee billing is ostensibly beneficial to poor or disadvantaged individuals: it provides an incentive for an attorney to take on a case where a person cannot afford that attorney’s hourly fee. But there is a downside as well.

Where monetary benefits are not at issue, there is little—if any—incentive for an attorney to take on a case. This frequently arises in the context of Washington State workers’ compensation cases where coverage of medical treatment is at issue. For instance, the Department of Labor & Industries may deny coverage of a surgical procedure under the person’s workers’ compensation claim. It might also deny coverage of a certain medication or device, or of a condition in its entirety. In those cases, it could cost $5,000 or more to present a case at the Board of Industrial Insurance Appeals. If there are no concurrent or resultant monetary benefits to the injured worker at stake, the attorney does not get paid. While we attorneys certainly do take on these cases from time to time, it would be unsustainable to take on every such case.

There are other models. For instance, under the Longshore and Harbor Workers Compensation Act (LHWCA), the attorney is paid an hourly fee for any services provided to an injured worker when the employer or its insurance carrier disputes the injured worker’s entitlement to benefits—whether monetary, medical/surgical, or otherwise. The fee is payable to the injured worker’s attorney by the employer’s insurance carrier. This has two significant effects. First, it ensures that there is an incentive for attorneys to take on cases where there are non-monetary issues at stake, such as entitlement to additional treatment or coverage of a disputed medical condition. Second, it allows the worker, in cases involving monetary compensation, to keep the full value of his or her disability compensation.

Washington State should seriously consider the idea of providing for an hourly attorney fee in so-called medical only cases. This is not a new idea. Draft bills have floated around for years. But the issue ought to be seriously reconsidered in light of the increased litigation that has resulted directly from the legislature’s adoption of laws allowing increased employer participation in the system through so-called “retro groups.” These groups aggressively fight workers’ compensation claims and allowance of treatment under those claims. They are incentivized to do so through refunds of their workers’ compensation premiums. Why shouldn’t injured workers’ and their attorneys have an incentive to pursue entitlement to medical treatment which would help them get back to work?

 Photo credit: quaziefoto / Foter / Creative Commons Attribution 2.0 Generic (CC BY 2.0)

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Mercer Island Construction Firm Recognized by L&I for Safety Excellence

Bayley Construction in Mercer Island has been recognized with a safety and health award from the Department of Labor & Industries (L&I) for its exemplary safety and health prevention program at two worksites.

Bayley Construction is the first construction company — and only the sixth company in the state — to achieve recognition through the Safety through Achieving Recognition Together (START) program.

START recognizes workplaces with exemplary safety records that have shown a commitment to health and safety at work. It is modeled on a federal program.

Bayley Construction was awarded with START certification at its corporate office in Mercer Island and at its equipment yard in Bellevue.

“The goal of START is to showcase businesses with excellent safety and health programs as a way of encouraging other companies to improve their safety efforts,” said Lynda Stoneberg, Consultation Program Manager for L&I’s Division of Occupational Safety and Health (DOSH). “We hope the companies who earn START certification will share their experiences with other employers who might have safety challenges.”

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

“We are really proud of this recognition as we always want to be the best that we can be, and safety goes right along with that,” said Ron Bayley, Chairman and CEO.

L&I presented the certificate to the company at a special ceremony last month.

Bayley Construction has 75 employees at its Mercer Island headquarters, where it oversees company operations in three western states. At its equipment yard in Bellevue, employees are responsible for the mobilization and de-mobilization of project sites, inventory, tracking and maintenance of all hand and small tools as well as providing will-call services and pickup and delivery services for Washington project sites.

For more information on START, visit www.Lni.wa.gov/Safety/Topics/AtoZ/Start/ .

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Are Firefighter Cancer Deaths an Occupational Disease?

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

Workers’ compensation has provided benefits or coverage for occupational diseases for generations. Occupational disease is defined by Nebraska law as: “a disease which is due to causes and conditions which are characteristic of and peculiar to a particular trade, occupation, process, or employment and excludes all ordinary diseases of life to which the general public is exposed.” This is a typical definition of an occupational disease. Some examples of recognized occupational diseases are black lung disease for miners, mesothelioma for asbestos workers, lung disease for rubber workers, and leukemia for workers exposed to benzene.  

More studies are done to determine the cause of diseases as medical science advances. A recent study concludes that smoke and chemical exposure by firefighters may cause higher rates of cancer among firefighters. Firefighters, while usually healthier than the general population, have a higher incidence of cancer. More studies need to be done to determine if the peculiar exposure to smoke causes or aggravates cancer.

As medicine and science evolve, there may be more recognized “occupational diseases” and more workers and their families compensated for harm caused by the workplace.

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Mileage Reimbursement Set at 56 Cents per Mile for 2014

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

Getting reimbursed for mileage and travel expenses is often part of the medical process in a workers’ compensation claim. However, it’s essential to keep detailed receipts and have a plan for submitting those expenses in a timely manner.

The federal government has set the 2014 mileage reimbursement rate to 56 cents per mile. This rate was effective Jan. 1, 2014. This is a decrease from 56.5 cents per mile last year, but the price of gasoline is also slightly cheaper.

Generally speaking, the federal rate changes annually. However, when gas prices went soaring in 2008, a mid-year increase went into effect.

As a reminder from a blog post that firm partner Todd Bennett wrote in 2011, injured workers can be reimbursed for activities such as “travel to seek medical treatment, pick up medications, or while participating in a vocational rehabilitation plan.”

The best way to do this is to work with your attorney and legal assistant to keep track of all mileage. This can include appointments for Independent Medical Exams (IME), too. Then your attorney can help you get reimbursed. 

It is often essential to save receipts and keep a record for yourself of your doctor’s visits and other reimbursable trips, including physical therapy and trips to pick up medication. Providing that log to your attorney and saving receipts incurred from specific doctor visits and other reimbursable trips creates a “narrative” that makes it easier to justify those expenses.

Because money is always tight for injured workers, contact an experienced workers’ compensation attorney if you have questions about a specific situation.

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Facebook Pictures’ Use Evolving in Workers’ Compensation Cases

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

We routinely advise our clients to be aware of the possible discovery of Facebook and other social media sites. First step – check your privacy settings. If you do not control your privacy settings, your employer or the insurance carrier may easily access your posts. Also, do not post comments about your case, your employer, or your injury online.

In the past, I have warned about the possible pitfalls of social media on a workers’ compensation claim.

However, the Nebraska Workers’ Compensation Court has never really ruled on Facebook in the context of discovery matters in a work comp claim, meaning how much access can your employer have to your Facebook account if you file a workers’ compensation claim? 

Recently, however, the Nebraska Workers’ Compensation Court (at least one judge) has taken the position that in order for your employer to gain access to photographs from your Facebook profile, it must “make a showing of the necessary factual predicate underlying [the] broad request for access.” In other words, your employer must have a decent reason to suspect that a certain photograph or something from your Facebook account has the potential to be relevant to the work comp case before the court will simply grant full access to your Facebook account to your employer.

Therefore, depending on your situation, your Facebook may be safe from your employer to some degree. However, this is a cautionary tale to remind you that even though your employer cannot simply have blanket access to all of your Facebook photos – at least according to one Nebraska judge – it does not mean that your Facebook photos or posts are necessarily safe from your employer gaining access to them at some point during your work comp case. I think the judge in this case takes a step in right direction, but you still must be aware that anything you put on Facebook may be subject to discovery (i.e., your employer may still possibly get access to it) at some point in the future.

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Is It Really WorkMAN’s Compensation or Workers’ Compensation?

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

I often hear my clients refer to their work-injury claim by the antiquated term, “workman’s compensation.” This was formerly the common vernacular when referring to a work-injury claim. Now however, most – if not all – jurisdictions have adopted the more gender-neutral term “workers’ compensation.”

Why the change? While one would have a strong argument that the change reflects the new age of political correctness, an equally compelling case can be made that the change was merely to reflect the increasing numbers of work injuries suffered by women. When compared to the times when workers’ compensation laws were initially enacted, more and more women have moved into industrial jobs. Of course, it naturally follows that as women move into more dangerous and laborious jobs, more women are going to be injured on the job.

For example, in Nebraska 42.7% of all reported work injuries were to women, according to the Nebraska Workers’ Compensation Court Statistical Report For Injury Years 2003 – 2012.  So, while I certainly understand when my clients say “workman’s compensation,” once in a while I jokingly remind them that all injured workers are covered, regardless of their gender. 

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$46 Million Stolen: 2013′s Top Ten Workers’ Compensation Fraud Cases

Professor Leonard T. Jernigan Jr. has compiled a list of 2013′s Top 10 Workers’ Compensation Fraud Cases

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

Employer Fraud Cases (9):$44,962,492.00
Employee Fraud Cases (1): $1,500,000.00
Total: $46,462,492.00

Every year we hear about fraud in Workers’ Compensation cases and the public believes the fraud is employee driven. However, in 2009 I began tracking the Top Ten Fraud Cases and 100% of the Top Ten between 2009-2012 involved employers or shady characters posing as legitimate businesses. The amount of employer fraud is staggering. In 2013 one employee fraud case did crack the Top Ten, so the record is now 49-1 (employer fraud v. employee fraud) over the past five years.

  1. Florida: Owners of Diaz Supermarkets in Miami-Dade are Accused of $35 Million Fraud (4/16/13)

    John Diaz

    John Diaz and his wife Mercedes Avila-Diaz owned and operated four supermarkets in the Miami-Dade area. They have been arrested and accused of workers’ compensation fraud and other fraudulent transactions totaling $35 million. One business they operated had no coverage for employees for ten years. They allegedly engaged in a scam to help subcontractors obtain false certificates of insurance that allowed the subs to work for general contractors who required the certificates.

  2. California: Hanford Farm Labor Contractor Convicted of Fraud in the Amount of $4,195,900 (12/6/2013)

    Richard Escamilla, Jr.

    Richard Escamilla, Jr. (47), owner of ROC Harvesting, misrepresented information to workers’ compensation insurance carriers by using new business names to obtain insurance and avoid providing a claim history. Escamilla pleaded guilty on October 29th and was sentenced to pay restitution of $4.1 million and serve six years in prison.

  3. Michigan: Insurance Executive Embezzled $2.6 Million from Workers’ Comp TPA (06/06/2013)

    Jerry Stage

    Jerry Stage (67), the former CEO of a non-profit workers’ compensation insurance company, and George Bauer (55), the bookkeeper, both pleaded guilty to embezzling from the Compensation Advisory Organization of Michigan (CAOM) for more than a decade. Mr. Stage embezzled $2.6 million from the company and conspired with Mr. Bauer to cover up the embezzlement.

  4. California: Employee Wasn’t Wheelchair Bound After All – Fraudulently Took $1.5 Million in Benefits (8/9/13)

    Yolandi Kohrumel

    Yolandi Kohrumel, 35, claimed for nine years that she was wheelchair bound after complications from toe surgery, but after she had collected $1.5 million in benefits it was revealed her claim was false. Her father, a South African native, was also engaged in the scam. Both pleaded guilty to insurance fraud, grand theft and perjury. Ms Kohrumel was sentenced to one year in jail, plus restitution.

  5. California: Father and Son Landscapers Accused of $1.45 Million in Insurance Fraud (5/7/13)

    Sunshine Landscaping

    Jesse Garcia Contreras (57) and Carlos Contreras (33), who operate a Thousand Palms landscaping business, are accused of committing $1.45 million in insurance fraud. They are accused of defrauding the California State Compensation Insurance Fund by misclassifying employees from January 2008 to March 2012. Mr. Jesse Contreras is the president and CEO of Sunshine Landscaping and his son is Director of Accounting. If convicted, they each face up to 19 years and 8 months in prison.

  6. Florida: Workers’ Compensation Check Cashing Operation Charged with $1 Million in Fraud (2/27/13)

    As a result of its investigation of I&T Financial Services, LLC, a company that was allegedly set up to execute a large scale check cashing scheme for the purpose of evading the cost of workers’ compensation coverage. Domenick Pucillo, the ringleader of the fraud scheme, was arrested and charged with filing a false and fraudulent document, forgery, uttering a forged instrument, and operating an unlicensed money service business. If convicted on all charges, he faces up to 45 years in prison. $1 million was seized during this investigation.

  7. California & North Carolina: Cleaning Company Owner Convicted of Underreporting Payroll and Ordered to Pay $898,000 (8/3/2013)

    L. D. Hardas, President of Awesome Products Inc., said support from the community and the state was key to bringing his company to Mount Airy.

    The president of Awesome Products, a cleaning company in California, was convicted and sentenced for underreporting his payroll by over $8 million, resulting in a premium loss of $898,000. Loksarang Dinkar Hardas (53) was sentenced to five years in state prison, stayed pending successful completion of 10 years of formal probation, a $250,000 fine, and restitution payment of $898,000. Notwithstanding his conviction, the town of Mount Airy, N.C was standing by Mr. Hardas and willing to give his company taxpayer money in hopes that Awesome Products would build a manufacturing facility and create jobs in Surry County, N.C.

  8. West Virginia: Coal Company Contractor in Mingo County Caught in $405,000 Scam to Avoid Workers’ Comp Premiums (11/6/13)

    Bank of Mingo

    Jerame Russell (50), an executive with Aracoma Contracting, LLC, a company that provided labor to coal companies on a contract basis, entered a guilty plea to a scam that involved funneling over $2 million through a local bank to pay employees in cash, thus avoiding payroll taxes and $405,000 in workers’ compensation premiums. Aracoma also bribed an insurance auditor to cover up its true payroll.

  9. Ohio: Roofing Business Owners Guilty of $283,592 in Workers’ Comp Fraud (7/30/2013)

    Frederick Diebert

    The owners of Triple Star Roofing were found guilty of fraud on July 15 for failing to report payroll to the Ohio Bureau or Workers’ Compensation(BWC). The company failed to report to the BWC from 2004 to 2008, resulting in under-reported premiums of $283,592.

  10. Florida: Owner of Staffing Company arrested for $130,000 in Workers’ Comp Fraud

    Preferred Staffing of America, Inc.

    The owner of Preferred Staffing of America, Inc., a temporary staffing agency in Tampa, has been arrested for allegedly running an organized workers’ compensation fraud scheme. Preferred Staffing’s owner misled clients into believing that his company was a licensed professional employer organization (PEO) and could provide workers’ compensation insurance coverage. Employers were reportedly charged more than $130,000 for workers’ compensation insurance and other services that were never provided.

For more information, contact: Leonard T. Jernigan, Jr. Adjunct Professor of Workers’ Compensation N.C. Central School of Law The Jernigan Law Firm 2626 Glenwood Avenue, Suite 330 Raleigh, North Carolina 27608 (919) 833-0299 ltj@jernlaw.com www.jernlaw.com @jernlaw

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A History of Workers’ Compensation – With a Washington State Slant

English Fire Insurance Laws Enacted in 1667

c2000, BC

Hammurabi, ruler of Babylon, was responsible for the Code of Hammurabi, part of which bears resemblance to today’s workers’ compensation laws.

c460-c377, BC

Hippocrates, the father of contemporary medicine, established .a link between the respiratory problems of Greek stonecutters and the rock dust surrounding them.

1667

The Great Fire of London (September 2-7, 1666) caused the first English fire insurance laws to be enacted.

1880

William Gladstone pushes Employers’ Liability Act in Britain

1864

The Pennsylvania Mine Safety Act (PMSA) was passed into law.

1871

Otto Eduard Leopold, Prince of Bismarck, Duke of Lauenburg, (known as Otto von Bismarck, a Prussian statesman) enacts the Employers’ Liability Act.

1877

The state of Massachusetts passed a law requiring guarding for dangerous machinery, and took authority for enforcement of factory inspection programs.

1878

The first recorded call by a labor organization for a federal occupational safety and health law is heard.

1884

Otto von Bismarck enacts Workers’ Accident Insurance

1902

The state of Maryland passed the first workers’ compensation law.

1911

Industrial Insurance laws enacted in Washington State.

1911 – 1915

During this period, 30 states passed workers’ compensation laws.

1968

President Lyndon Johnson called for a federal occupational safety and health law.

1970

President Richard Nixon signed into law the Occupational Safety and Health Act (OSHA), thus creating the OSH Administration and the National Institute for Occupational Safety and Health (NIOSH).

1972

Self-Insurance for Workers’ Compensation allowed for individual businesses in Washington State.

2012

Compromise and Release Structured Settlement Agreements allowed for certain Washington State workers’ compensation claims that meet basic criteria.

 

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How Safe Is Healthcare for Workers?

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

The issue raised by Mr. Rehm was investigated thoroughly in a book given to us by a client, an injured nurse who contributed her story to the effort under a pseudonym: Back Injury Among Healthcare Workers, published by Lewis Publishers. It is a great resource, providing case-studies, statistics and suggestions for improvements for workers in the healthcare field.

The article that today’s blog post is based upon is an in-depth look at how one state’s OSHA office interacts with a sector of the healthcare community: hospitals. Like Iowa, but unlike Nebraska, Oregon is one of 27 states or U.S. territories that has an OSHA office at the state level

The “Lund Report: Unlocking Oregon’s Healthcare System” article talks extensively about nuances within ways that OSHA offices, whether state or federal, can measure the safety of healthcare providers like hospitals and nursing homes. 

As evidenced in previous blog posts about senior-care workers and lifting injuries, I have continuing concerns for the safety of healthcare workers. 

According to the in-depth article, “A Lund Report review suggests that in Oregon, regulators are de-emphasizing attention to hospital employee safety, despite national data showing that healthcare workers are injured in the U.S. each year at rates similar to farmers and hunters. Most Oregon hospitals have not been inspected by the state Occupational Safety and Health Division in years. And when on-the-job hazards are detected, Oregon’s OSHA office levies the lowest average penalties in the country.”

Should workers get lost as the patients are the focus of these healthcare institutions? Should regulation and inspections or fines by such groups as OSHA be the driving force toward workplace safety for healthcare employees?

It seems to me that healthcare administrators’ emphasis on profit is more important than proper concern for their employees – the nation’s caregivers. And if you or your family member is the healthcare worker who gets hurt on the job, this lack of focus on the worker is more than just a philosophical argument.

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Worker Privacy Concerns : Employers’ Access to Employees’ Prior Worker’s Compensation Claims

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

Washington similarly allows employers to access all prior claim records, even from other employers, when one of their employees files an injury claim. Workers’ compensation claims already had a lower privacy standard than other types of records – workers’ compensation is excluded from HIPPA protections – but this now allows easy access to all records, relevant or not, once a worker files an injury claim.

Republican legislators are feeling their oats these days. Throughout the Midwest, legislators are depriving workers of collective bargaining rights and trying to restrict workers’ rights in workers’ compensation claims.

In Missouri, workers’ compensation legislation was recently proposed that would have permitted an employer to provide a potential hire’s name and Social Security number so an employer could identify the potential employee’s prior workers’ compensation claims and the status of those claims. The Missouri Division of Workers’ Compensation estimated an online data base that would include over a half million claim records with over 10,000 records added each year.

To his credit, Democratic governor Jay Nixon vetoed this proposed online data base which would allow businesses to check a prospective employee’s workers’ compensation claims. He said it was “an affront to the privacy of our citizens and does not receive my approval.” As expected, supporters of the workers’ compensation data base (employers primarily) said the legislation would speed the hiring process and help bosses and workers. Regularly, information about workers’ compensation claims is available by written request and takes about two weeks to arrive.  Supporters of the legislation indicated the law was “preventing workers’ compensation abuses.”

Wisconsin’s workers’ compensation records are subject to Wisconsin public records law, except for records identifying an employee’s name, injury, medical condition, disability, or benefits – which are confidential.  Authorized requestors are limited to parties of the claim (the employee, the employer, and the insurance carrier), an authorized attorney or agent, a spouse or adult child of a deceased employee. Workers’ Compensation Division staff may provide limited confidential information regarding the status of claims to a legislator or government official on behalf of a party. In addition, workers’ compensation staff are not permitted by law to conduct a random search to determine if other injuries have been reported.

If the requestor is the same employer or insurance carrier involved in a prior injury, then access will be allowed. If the requestor is a different employer or insurance carrier but they make a reasonable argument that the prior injury and the current injury are related, access may be allowed. For example, the Department considers injuries “reasonably related” if the two injuries involve the same body areas.

Simply put, in Wisconsin, at least for the present, claimant information is confidential and not open to the public, other than to the parties to a current claim.