Today’s post comes from guest author Brenda Fulmer from Pasternack Tilker Ziegler Walsh Stanton & Romano.
Post-menopausal women welcomed the class of drugs called “bisphosphonates,” which purportedly increase bone density by slowing the body’s natural turnover of bone cells and were touted as a safe and effective treatment for osteoporosis and osteopenia. Bisphosphonates are also widely used to treat both male and female patients whose cancer has spread to their bones and by patients who have a progressive bone disease called Paget’s disease.
Many patients who are being prescribed “bisphosphonates” for the treatment and prevention of osteoporosis are unaware of any risks associated with the use of such drugs.
Popular bisphosphonate drugs and their manufacturers include:
Today’s post comes from guest author Tom Domer from The Domer Law Firm.
Washington State has a similar program for filing claims of discrimination when a worker is punished for reporting unsafe work conditions. Contact one of us to discuss your case if you have suffered such discrimination.
The connection between unsafe workplaces and the increased frequency of work injuries seems like a no brainer. A study released by NCCI Holdings indicated worker’s compensation claims rose by 3% during 2010 (the first rise in frequency in over a dozen years). The study attributed the increased frequency to several factors
Because of these repeat violations,OSHA cited United Contracting and placed the firm on its “Severe Violator Enforcement Program”
including increases in employment since the onset of the recession in 2008, workers possibly being less fearful of losing their jobs for filing claims, and a lack of light duty jobs to which injured workers could return because of the poor economy.
One factor not referenced is the connection between increasingly unsafe work environments and work injuries. Two recent news stories in Wisconsin underscored this connection. OSHA fined a Wisconsin contractor $150,000
for violations while working on two bridges along highways in Wisconsin. The violation is more alarming because the contractors were working under a State contract to repaint the bridges. OSHA charged that the company did not have proper scaffolding at the bridges exposing workers to falls, and in fact one worker was injured in June after falling from a scaffold at one of the bridges. Because of these repeat violations, Continue reading Unsafe Workplaces Equal More Injuries.→
A Press Release by the National Academy of Social Insurance
WASHINGTON, DC – Workers’ compensation benefits declined to $57.5 billion in 2010 according to a report released today by the National Academy of Social Insurance (NASI). The drop in workers’ compensation benefits was largely due to a 2.1 percent drop in medical benefits for injured workers. Employers’ costs for workers’ compensation also fell by 2.7 percent in 2010. As a share of covered wages, employers’ costs in 2010 were the lowest in the last three decades.
“As a share of covered wages, employers’ costs in 2010 were the lowest in the last three decades.”
“Employers’ costs as a percent of payroll declined in 43 jurisdictions,” said John F. Burton, Jr., chair of the study panel that oversees the report. “This decline is probably due to the slow pace of the recovery, with many jurisdictions still experiencing relatively high unemployment rates.”
Workers’ Compensation Benefits, Coverage, and Costs, 2010
Change Since 2009 (%)
Covered workers (in thousands)
Covered wages (in billions)
Benefits paid (in billions)
Employer costs (in billions)
Per $100 of Covered Wages
Change Since 2009 ($)
Source: National Academy of Social Insurance, 2012.
“This report represents the first time the Academy has released employers’ costs by state.”
This report represents the first time the Academy has released employers’ costs by state. For a table showing employers’ costs for all fifty states and the District of Columbia, refer to Table 12 (page 34).
Most states reported a decrease in the number of workers covered but an increase in covered wages between 2009 and 2010. During the same period, the total amount of benefits paid to injured workers declined in 26 jurisdictions and increased in 25. As a share of payroll, benefits paid to injured workers fell by three cents to $0.99 per $100 of payroll in the nation.
The share of medical benefits for workers’ compensation has increased substantially over the last 40 years. During the 1970s medical benefits nationally accounted for 30 percent of total benefits, whereas in 2010 the share of benefits paid for medical care was almost 50 percent. Experts attribute this trend to the rising cost of health care.
Today’s post comes from guest author Charlie Domer from The Domer Law Firm. It is particularly relevant now, at a time when we are seeing a spike in the number of cases where surveillance video is being used to bring claims to a halt here in Washington State.
A dozen attorneys in Montana representing injured workers made headlines petitioning their Supreme Court to stop State fraud investigators sharing surveillance videos with doctors of worker’s compensation claimants. About 14,000 Montana residents are covered by the State Fund and the Fund’s Investigative Unit conducts video surveillance on about 500 claimants each year and shows the videos to claimants’ treating physicians. This practice raises questions about physician-patient privilege and patient privacy.
In Wisconsin and most other States, the physician-patient privilege is waived by an employee who reports a work-related injury. The waiver only extends, however, to any condition or complaint reasonably related to the work injury. Considerable debate sometimes arises over which treatment records are reasonably related to a claim. A broken toe, for example, is not likely relevant to an asthma condition but a prior Hepatitis-C claim may be. Employers and insurers may attempt to obtain records from a medical provider without a release, and practitioners must provide reports to the employer, insurer, employee, or Worker’s Comp Division within a reasonable time after written request.
The Fund’s Investigative Unit conducts video surveillance on about 500 claimants each year and shows the videos to claimants’ treating physicians… In Wisconsin and most other States, the physician-patient privilege is waived by an employee who reports a work-related injury. The waiver only extends, however, to any condition or complaint reasonably related to the work injury.
In Washington State, the majority of workers’ compensation claims are “State Fund” claims managed by the Department of Labor and Industries (Department), with perhaps a third are comprised of “self-insured” claims managed by third-party administration companies under the oversight of the Department. In “State Fund” claims, managed by State employees, benefits are paid from monies received from both workers and employers – – Washington is the only state where workers and employers each pay half of the medical insurance premiums. When a dispute arises in a claim, the aggrieved party can file an appeal to the Board of Industrial Insurance Appeals (Board), another State agency. When an appeal is filed with the Board, the Department is represented by the Office of the Attorney General, yet another State agency.
Since the economic crisis hit Washington, as it has in every other state in the union, the Department of Labor and Industries has become very cautious concerning any expenditures.
Since the economic crisis hit Washington, as it has in every other state in the union, the Department of Labor and Industries has become very cautious concerning any expenditures. After all, audits have found mis-spent money — nothing worthy of headlines, but the media loves a good fraud story as much as they love a government waste story. Fraud investigations and video surveillance have increased dramatically in recent years at great expense to the Department with minimal economic benefit. The Department was recently found to have spent a significant sum on no-show fees to independent medical examination companies without recouping those charges from the claimants who failed to attend the examinations or, in some of the cases, without properly notifying those companies to avoid the charges when a cancellation was known to have occurred. The end result of the Department’s caution is that benefits clearly payable to a claimant are being delayed or denied simply based on the amount of money at stake.
Payments of minor amounts can be made by Department claims managers at their discretion, based on the records on file. Amounts over a few thousand dollars, however, trigger the need for supervisor review and approval before payment can be made. Consequently, we are working much harder to obtain payment administratively because the Department increasingly requires proof of entitlement to benefits “beyond a reasonable doubt” rather than simply based upon the opinion of a treating physician. One doctor’s opinion of a worker’s inability to work seems no longer enough to establish entitlement to benefits. We increasingly face roadblocks to payment in cases where the Department concocts an issue over whether the inability to work is related to the covered injury or condition or is instead due to some pre- or post-existing condition, even if the disabling condition is clearly shown to be related to the original injury or the treatment procedures for that injury. If payment or authorization for treatment for a condition is denied, we are forced to demand an order be issued. We then file an appeal, and off to litigation we go.
In the current economic climate simply the amount of money involved increasingly drives the decision-making process at every administrative level.
The paralegals and attorneys at our firm work diligently to document the benefits we are seeking and the medical support for the claims we are making. In some cases, the monetary benefit at issue is a fairly significant amount. In the current economic climate simply the amount of money involved increasingly drives the decision-making process at every administrative level. Denials are much more common when a significant sum is at stake, regardless of the validity of the claim. We encounter a “make them prove it” attitude, forcing cases to go through time-consuming and expensive litigation rather than being resolved through mediation discussions or agreement between the parties.
Yesterday, I received phone call apology after a denial order had been issued, expressing condolences but the hope that we will be able to prevail on appeal. Today, I was told by an Assistant Attorney General that she would likely not be able to get authority from her client – the Department — to accept our settlement offer due to the amount of money at issue – “the case will just have to be litigated.”
I can accept these denials when there is a genuine dispute over the facts, over whether a claimant is entitled to the benefits or not. I cannot accept it when the answer is simply “it’s too much money.” I would prefer the other side tell me why my argument lacks merit, tell me that I am wrong in my belief that the claimant is entitled to the benefits at issue, tell me where the hole in my case is – anything – but, please, don’t just say that it’s too much money. That is not a reason for a State Agency which, unlike an insurance company, has no inherent profit motive, to deny benefits.
Consider the relatively low values in workers’ compensation claims: 60 – 72% of pre-injury wages as wage-replacement compensation; surprisingly small awards for permanent impairment, with no consideration given to the impact on lifestyle or earnings ability. If there is a significant sum at stake, it is because of YEARS of delay, or years of benefits at issue, not because the claimant is lucky or greedy. The claimant didn’t win the lottery; he or she was simply injured on the job and denied benefits when they were most needed. That required hiring an attorney, and in many cases expended large sums of money in efforts to support their case. The significant sums often at issue in these cases do not make claimants RICH, nor do they make them WHOLE. They only provide the limited measure of compensation that our workers’ compensation system allows.
My message to our State: Don’t add insult to injury.
My message to our State: Don’t add insult to injury. Show claimants the respect they deserve and promptly make decisions in their claims based on the merits of their arguments and the evidence presented, without being influenced simply by the amount of the check that may be issued.