Category Archives: Workers’ Compensation

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“Independent” Medical Examinations in Workers’ Compensation (Anything but “Independent”)

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

“I thought their doctor Independent Medical Report was the last word on my case. I didn’t know any better.” 

This statement from a client I just met sums up the experience of many injured workers unfamiliar with the workers’ compensation process in Wisconsin (and many other states).

An insurance company or self-insured employer may request an injured worker submit to reasonable examinations by a physician, chiropractor, psychologist, dentist, podiatrist, physicians assistant, or Advanced Practice Nurse Practitioner of its choice. Wis. Stat. §102.17(1)(b). This examination is usually referred to as an Independent Medical Examination or “IME” although “adverse medical examination” more accurately reflects the process.  An Independent Medical Examination may be requested by the insurance company or self-insured employer in order to determine whether the claim is compensable and the extent of the disability or the necessity and type of treatment. 

Since only about one in ten injured workers in Wisconsin is represented by an attorney, nine out of ten unrepresented workers are not aware that the insurance company’s “IME” is actually an adverse exam by a doctor hired by and paid by the insurance company to issue his report. Although IME examiners would deny they routinely render an opinion in favor of the insurance carrier, my forty years of experience suggests just that. For many years lawyers representing injured workers have been proposing the terminology “Adverse Medical Examination” apply to give represented and unrepresented workers a more fair assessment of the process. Many IMEs make hundreds of thousands of dollars annually performing these examinations. At one of these examinations, my client overheard the IME physician (who had rented a motel room) speaking to a prospective young doctor trying to convince that doctor to perform IMEs. “This is a great practice.” He said.  “All you have to do is review the medical records, meet with the worker for a few minutes, and deny the claim. And for that you can charge $1,500.” Although my client’s testimony to this effect was barred, the underlying accuracy of his testimony is undisputable.

Beware the “Independent” Medical Examination.

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Washington State Workers’ Compensation Payments Up as of July 1st

For most workers injured before July 1, 2014, time-loss and pension benefit payments will increase by 4.168 percent based on the change in the state’s average wage, as announced by the Department of Employment Security on June 24.

State law requires that benefits be recalculated each year to reflect the change in the state’s average wage from the previous calendar year.

The increase also applies to pension benefits paid to family members of those who died because of a work-related accident or disease.

As a result of the increase, the new maximum monthly benefit will be $5,482.90, or 120 percent of the state’s average monthly wage. Less than 4 percent of L&I claimants receiving wage-replacement benefits collect the maximum.

The increase becomes effective July 1, 2015.

 

Photo credit: brizzle born and bred / Foter / CC BY-SA

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BMX Bike Racer Defrauded State, Must Pay Back $14,000

A Port Orchard, WA man who was caught on video racing BMX bikes while claiming he was too injured to work pleaded guilty to stealing more than $14,000 in disability benefits.

 

Tony T. Perry Sr., 52, pleaded guilty to two counts of third-degree theft, a gross misdemeanor, in Thurston County Superior Court. Judge Anne Hirsch sentenced Perry to 364 days in jail, but suspended all but 15 days if he obeys the law for two years. She is allowing him to serve the 15 days in electronic home monitoring, according to the Washington Attorney General’s office, which prosecuted the case.

 

Judge Hirsch also ordered Perry to repay the Washington State Department of Labor & Industries (L&I) $14,422. That was how much Perry received in workers’ compensation wage-replacement checks from January 2012 to August 2013 while misrepresenting his physical abilities.

 

Perry paid the full amount. The money will be returned to the state workers’ compensation fund, which helps employees recover from workplace injuries.

 

“It’s outrageous when people try to scam the workers’ comp system so boldly. When they steal from us they’re stealing from you,” said Elizabeth Smith, assistant director of L&I Fraud Prevention & Labor Standards. “A tip from the public helped us get to the bottom of this. We appreciate it, and encourage people to tell us when they’re aware of workers’ comp fraud.”

 

BMX racing is an off-road, physically demanding bicycle competition typically held on dirt race courses with hills requiring riders to jump in the air.

 

Racing throughout the Pacific Northwest

 

The criminal case resulted from an L&I investigation. Investigators found that Perry began racing BMX bicycles as an amateur in January 2012, eventually competing throughout the Pacific Northwest and Nevada.

 

The case investigator videotaped Perry competing in two races, and found numerous Facebook posts about Perry’s racing activities, charging papers said. In a post about a May 2012 race, Perry described how he crashed and injured his ribs ­− but told L&I he hurt himself at home that day due to a fall caused by his injured knee.

 

After receiving a summary of L&I’s investigative findings in March 2014, Perry’s physician told L&I he would have ended Perry’s wage-replacement payments as of January 2012 had he known about his physical abilities.

 

Perry had been receiving workers’ comp benefits based on knee and other injuries he sustained when lifting a heavy box while working in grounds maintenance.

 

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Death on the Job Annual Report from AFL-CIO Informative, Useful

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

The AFL-CIO’s annual report about “the state of safety and health protections for America’s workers” has been written about in a previous year on this blog. The recently released 2015 version focuses in an in-depth manner on data from 2013 and includes around 200 pages of text, tables, details and information, along with a bit of jargon.

The report is extremely informative, and Nebraska and Iowa’s numbers will be examined in more detail in future blog posts, as these are states where the firm’s attorneys are licensed.

The report can also feel overwhelming once a person processes through the fact the each numeral on each chart represents the death of one person due to the workplace. There is also a ripple effect, as each person represented here had loved ones who both cared about and relied on that person. And for many involved, their lives changed drastically when their loved one died.

I appreciate the work, funding, thoughtfulness and effort put into compiling and analyzing the data, which includes a methodology section at the end of the report.

Here’s some sobering information from the summary.

“In 2013, 4,585 workers were killed on the job in the United States, and an estimated 50,000 died from occupational diseases, resulting in a loss of 150 workers each day from hazardous working conditions.

“Nearly 3.8 million work-related injuries and illnesses were reported, but many injuries are not reported. The true toll is likely two to three times greater, or 7.6 million to 11.4 million injuries each year.”

States with the highest fatality rate in the nation include a couple of relative neighbors: North Dakota and Wyoming. West Virginia, Alaska and New Mexico round out the top five. Lowest state fatality rates in 2013 were Hawaii, Washington, Connecticut and Massachusetts (tied) and New York and Rhode Island (tied).

Please contact an experienced workers’ compensation lawyer if you or a loved one is hurt on the job or has questions about job safety.

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Focus on Preventing Falls During “Safety Stand-Down”

In the first three months of 2015, three construction workers in Washington state died from falls. Falls account for the highest number of deaths among construction workers nationally and more than half of all worker hospitalizations across all industries in Washington.

Because of the high number of construction-related falls, the Washington State Department of Labor & Industries (L&I) has teamed up with the federal Occupational Safety and Health Administration for the second year to sponsor a “Safety Stand-Down.” The work site safety focus started last week and runs through Friday, May 15.

“It’s time to be proactive as opposed to reactive to help prevent all accidents on our job sites—especially life threatening accidents from falls.”

A safety stand-down is a voluntary event where employers take time at a construction site to discuss potential hazards and how to prevent injuries. It could be a short toolbox talk, refresher training, reviewing safety bulletins or watching a safety video.

“Fatal falls are preventable but it takes a dedicated effort by employers and workers to make it an important part of every workplace safety plan,” said Anne Soiza, assistant director for L&I’s Division of Occupational Safety and Health. “We’re asking all construction employers to pause in their workday and talk with their workers about preventing these tragedies.”

As part of the effort, L&I sent educational materials to all construction employers, is running bus ads in several communities, and is promoting the event through social media.

Construction is really picking up in our state, so it’s more important than ever to reinforce the importance of fall prevention, according to John Erwin, owner of John Erwin Remodeling Inc., and former president of Olympia Master Builders.  “Three construction workers have died this year in our state, which is tragic. None of us would want that to happen on our job sites. It’s time to be proactive as opposed to reactive to help prevent all accidents on our job sites—especially life threatening accidents from falls,” said Erwin.

As part of his safety stand-down, Erwin directed his staff to inspect all their ladders and ended up taking two of the more well-used but questionable ladders out of service and replaced them with new approved ladders.

Participating employers can print out a certificate of participation and add their name to a list of safety stand-down supporters. For ideas and resources or to get a certificate of participation, visit www.Lni.wa.gov/StopFalls.

 

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Workers’ Comp Programs Further Injure Injured Workers

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

Those of us who represent injured workers have known for a long time that workers’ compensation does not restore an injured worker to his pre-injury wage or status.  Two reports released in March show how workplace injuries have failed injured workers and leave them deeper in debt.  OSHA released a report indicating the changes in workers’ compensation programs have made it much more difficult for injured workers to receive benefits or medical expenses.  Although employers pay insurance premiums to workers’ compensation insurance companies who are supposed to pay benefits for medical expenses, employers provide just 20% of the overall financial cost of workplace injuries through workers’ compensation according to the OSHA report. 

This “cost shifting” is borne by the taxpayer.  As a result of this cost shifting, taxpayers are subsidizing the vast majority of the income and medical care costs of injured workers.  After a work injury, injured workers’ incomes average more than $30,000 lower over a decade than if they had not been injured.  Additionally, very low wage workers are injured at a disproportionate rate. 

Another report by ProPublica and National Public Radio found that 33 states have workers’ compensation laws that reduced benefits or made it more difficult for those with certain injuries and diseases to qualify for benefits.  Those hurdles, combined with employers and insurers increasing control of medical decisions (such as whether an injured worker needs surgery) reduced the worker’s likelihood of obtaining the medical care needed.

Overall, injured workers who should be paid under workers’ compensation are receiving less benefits and their medical care is being dodged by insurers and paid for by taxpayers through Medicaid and Medicare, or by increased insurance premiums for all of us through group health insurance rate increases.

Our general sense that injured workers are faring poorly is borne out by the research.

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Examining Workers’ Compensation Costs to Employers

Source: Bureau of Labor Statistics National Compensation Survey 1991 – 2014 (Credit: Sisi Wei/ProPublica)

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

Business and insurance interests are bombarding state legislatures every day of the week to take workers’ rights away by complaining how most states’ workers’ compensation systems are too expensive.

Recently, ProPublica and NPR produced a very detailed explanation of the state of workers’ compensation, focusing, rightly so, on injured workers. This article, which was the first in the series, included an interactive graphic that showed that even though business are complaining about rising premius, workers’ compensation insurance coverage is generally at its lowest rate in 25 years, “even as the costs of health care have increased dramatically,” according to the article.

As examples, using the average premium cost to the employer per $100 of workers’ wages, Nebraska employers paid $1.93 in 1988, while they actually paid $.15 less for the premium in 2014, for a total of $1.78 per $100 of workers’ wages, according to the chart. Iowa was more dramatic, with the price of workers’ compensation insurance $2.79 per $100 of workers’ wages in 1988. It went down $.91 to $1.88 per $100 of workers’ wages in 2014.

By scrolling down in the article, a person finds another graphic that shows how employer costs have risen for other categories, but have fallen for workers’ compensation. Most notably, the cost of workers’ compensation insurance coverage (per $100 of workers’ wages) went from $2.71 in 1991 to $2.00 in 2014. During the same timeframe, the cost of health insurance went from $8.55 to $12.52 and the cost of retirement benefits went from $5.50 to $7.29, all per $100 of workers’ wages, according to the chart in the article.

The offices of Rehm, Bennett & Moore and Trucker Lawyers are located in Lincoln and Omaha, Nebraska. Six attorneys represent plaintiffs in workers’ compensation, personal injury, employment and Social Security disability claims. The firm’s lawyers have combined experience of more than 90 years of practice representing injured workers and truck drivers in Nebraska and Iowa in state-specific workers’ compensation systems. The lawyers regularly represent hurt truck drivers and often sue Crete Carrier Corporation, K&B Trucking, Werner Enterprises, UPS, and FedEx. Lawyers in the firm hold licenses in Nebraska and Iowa and are active in groups such as the College of Workers’ Compensation Lawyers, Workers’ Injury Law & Advocacy Group (WILG), American Association for Justice (AAJ), and the Nebraska Association of Trial Attorneys (NATA).  We have the knowledge, experience and toughness to win rightful compensation for people who have been injured or mistreated.

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Workers’ Compensation – A System Destroyed

            A recent national study confirms what most attorneys who have practiced in the workers’ comp arena have observed over the past ten to twenty years:  the business lobby and the insurance industry, enabled by the ever-increasing takeover of state legislatures by the Republican party, have largely dismembered our nation’s 100-year-old workers’ comp system.  ProPublica, an independent, non-profit newsroom producing public interest investigative journalism, has shined a light on what has happened to the most important safety net for workers.  The full article is here. The whole series is an exhaustive look at the changes afoot; well worth a read.

            Under the banner of reforming a system described as suffering “out of control costs,” the allied forces have drastically reduced coverage for injured workers over the past ten years, and have shifted the cost of workplace accident and illness from the responsible businesses and industries and onto the American taxpayer through Social Security Disability Insurance, Medicare and Medicaid, systems now under extreme pressure themselves.

            The usual cited basis for these cutbacks and shrinking coverage – rising costs – has now been shown to be totally fraudulent.  Employers are paying the lowest workers’ comp rates since the 1970s, and insurers are enjoying their highest profits in a decade – 18% in 2013.

            Some other findings in the ProPublica report:

  1. Since 2003, 33 states have passed laws reducing benefits or making qualifying for them more difficult.

  2. Employers and insurers now largely medical decisions—in 37 states workers can’t choose their doctor, or must choose from a restricted list.

  3. Increasingly, benefits are terminated before workers have regained the ability to re-enter employment.

And what has the federal government done, mandated in 1972 to ensure that states maintained minimum federal standards?  Nothing since 2004, after budget cuts eliminated funding for the feds to track and monitor what was happening in the states.  With the disappearance of any federal oversight, workers’ comp in the states has become a “race to the bottom.”

      For context, ProPublica briefly refreshes the mostly-forgotten history of the origins of workers’ comp – the grand bargain arising out of the age of early industrialization that caused grisly, incapacitating injuries whereby workers surrendered their, often illusory, right to sue their employers in return for the limited but certain remedies of workers’ compensation.  Fifty years after most states had enacted workers’ comp laws, a federal commission convened by President Richard Nixon reviewed the state of the laws, found them “inadequate and inequitable,” and made an extensive list of recommendations. The commission advised Congress to mandate 19 of the recommendations as minimum standards, and for a period of time the national state of workers’ comp laws improved.  But about twenty years ago, the rising conservative tide in the states initiated a new era of cutbacks, to the point that, according to ProPublica, only seven states now follow at least fifteen of the commission’s recommendations.

      The ProPublica report details several shocking examples of how workers’ comp, shrunken as a remedy by the chambers of commerce whose representatives often write the “reform” legislation in the various states, is failing the American worker.  It cites a study by a University of California health economist who estimates that workers’ comp covered less than a third of injured workers’ medical costs and lost earnings in 2007.

In the summer of 2014 a Florida judge ruled that the state’s workers’ comp benefits had been decimated to such an extent, and that the comp law failed so miserably as to safety, health, welfare and morals, that it had become “unconstitutional.”  That would mean the end of the “grand bargain” in that state and the restoration of the right of workers to sue their employers.  One hundred years after the enactment of the first workers’ comp laws, we may be standing on the precipice of a new era of worker rights for the consequences of workplace injury and disease.

Graphic credit: Matt Rota for ProPublica

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Facebook Postings Hurt Workers’ Compensation Claims

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

While Facebook is extremely popular and used by over a billion people every day, no Facebook posting has ever helped an injured worker in a workers’ compensation claim. On the contrary, use of a Facebook page poses real dangers for injured workers pursuing workers’ compensation benefits.

Since Facebook is a public site, anything posted can be used by respondent insurance companies in claims denial. Even the most benign postings (birthday parties, family gatherings, etc.) can pose problems. For example, a grandparent lifting a 30 pound grandchild when doctors have imposed a 10 pound lifting limit could damage a claim. Additionally, nothing prevents an Administrative Law Judge from looking at a Facebook page.  Even innocent posts may be subject to misinterpretation. A picture of the worker riding a motorcycle or fishing taken prior to the injury but posted afterward could place the seed of doubt in an ALJ’s mind that the worker is not as limited as he claims. The best advice is to be extremely careful about what is posted because “friends” are not the only one who can access your Facebook page.

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Medical Procedures: What do they cost?

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

Blue Cross Blue Shield has created an online pricing tool to help patients compare prices of about 1,200 non-emergency medical procedures. Patients can now search for the best financial deal for services offered within North Carolina.

 By exposing this previously undisclosed information, patients are now able to go and see services according to the databases average procedure costs. The pricing tool also reveals the most expensive and most affordable option for each procedure.

In order to look up costs and doctors available to preform your procedure, you first access the pricing tool at: http://www.bcbsnc.com/content/providersearch/treatments/index.htm#/ . Then, you enter the treatment or service you would like in the first blank, your current location, and how many miles you are willing to travel for the service. Once you have entered all of this information, you just click search and your results will be immediately displayed. You can organize your results by cost, provider name, or distance.

 

To see the original article by John Murawski in The News and Observer explaining the pricing tool, click below:

http://www.newsobserver.com/2015/01/31/4516241_blue-cross-pricing-tool-could.html#storylink=misearch