Workers Compensation Blog



August 30, 2010

Ohio workers’ comp council settles for $70k in religion in workplace case

In the case of three workers fired from Ohio’s Workers’ Compensation Council, council Director Virginia McInerney has been nothing but consistent: consistently tight lipped.

When last we discussed the case (third item here), McInerney had simply denied all allegations of the workers who complained of wrongful discharge, religious discrimination and harassment, retaliation and age discrimination–and said she couldn’t discuss an ongoing case.

Employer-companies to pick up tab

On August 27, the “three former employees of the council–executive assistant Stephanie Irwin and staff attorneys Kim Finley and Shadya Yazback — signed a settlement that will net them a combined $55,102, according to documents filed with the Ohio Court of Claims,” says a report in The Plain Dealer.

The attorney for the trio gets another 15 grand, bringing the total settlement to about $70,000, which according to the Plain Dealer will eventually be borne by Ohio employers. “The money will be paid out of the council’s budget, which is funded by assessments on Ohio employers who pay workers’ compensation premiums, according to the Ohio Attorney General’s office. The council’s overall budget is $650,000 a year.”

Claims: ‘God to permeate the workplace’

McInerney fired the women in February; in March, they wrote letters to council members and, apparently, to legislators “charging that McInerney told her staff that she was sent by God to her job, that she wanted God to permeate the workplace and that Satan was to blame for obstacles the staff encountered in their jobs. She inquired about their religious beliefs, called them to pray aloud, cited Scripture in her reprimands and asked Irwin to listen to CDs of sermons and take notes on them, they said.”

As we posted in March, an AP story from March 3 quoted “a former staff attorney as writing in a letter that ‘It became increasingly clear that the Director was judging employees not on professional performance but on the quality of their faith, according to her beliefs.’ ”

No change in director’s ’status’

McInerney retains her job and title as agency director–along with its $102,000 salary.  However, the agency’s chairman, state Sen. Steve Buehrer, released a less-than-ringing endorsement in his post-settlement assessments. From the Plain Dealer: ” ‘The move to settle in this case averts risk and avoids costly litigation.’ While Buehrer’s statement didn’t address McInerney’s future with the board, the lawmaker relayed through an aide that there is ‘no change in the status of her employment.’ ”

However, another legislator has taken aim at the entire council, which itself was created in reaction to a scandal that cost the state’s worker insurance fund $300 million in losses from questionable investments.

State rep wants to gut council

According to an Aug. 30 post at InsuranceNews.net, “State Rep. Dan Dodd, a member of the council, has questioned whether the council is even necessary. In an April blog entry on his website, Dodd [wrote], ‘In this economy, every dollar matters to employers. That is why the Workers’ Compensation Council needs to have its funding stripped before more money is wasted.’ ”

The Plain Dealer reports that “Dodd also sponsored a bill eliminating funding for the council that has cleared the Ohio House and is sitting in the Senate. Lawmakers are not expected back into regular session until after the November election.”

According the insurance trade site, “McInerney, who worked for the Ohio Legislative Service Commission before being hired as staff director, has taught seminars at Vineyard Church of Columbus and also wrote a book in 2003, “Singles Not Separate: How to Make the Church a Family.” Reportedly, she also has appeared on the 700 Club.

She hired a temp worker after firing executive assistant Stephanie Irwin and staff attorneys Kim Finley and Shadya Yazback and has said she is awaiting hiring instructions following the settlement. Laconic as ever about details of the firings, McInerney declined to comment on that aspect but said of the settlement’s resolution, “I have a 21-year track record of dedicated service and hard work for the general assembly. I stand on a solid record, not only of achievements but also with respect to my conduct.”

The awards are follows: $20,688.81 to staff attorney Finley; $22,051.50 to Yazback and $12,363 to staff assistant Irwin. Their attorney, John S. Marshall, will get $15,000.

Court approval needed; no wrongdoing acceded

After announcement of the settlement–which according to BusinessInsurance.com still requires court approval–Finley said that “obviously, we wouldn’t have brought anything forward that was untrue, but the matter has been resolved and we’re moving on with our careers,” according to the Plain Dealer.

In the agreement, the council characterized the settlement as a compromise, acknowledging no wrongdoing on behalf of the council or the director.

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Have you, a friend or a loved one been injured on the job? Whether you’re merely seeking answers about your rights or believe a lawsuit may be necessary, be sure to seek counsel with attorneys trained and experienced in workers’ compensation. Here’s some resources:

Workers compensation basics

Injury on the job

Filing a claim





August 27, 2010

Among several concerns in review, North Dakota’s aggravated-injury provision draws particular attention

Whew–the workers comp picture in North Dakota resembles a bowl of spaghetti.

The issues sort of splay all over the place, with some overlapping others, then disappearing into the pile and re-emerging on the other side.

Unusual provision

An Aug. 16 post at Insurance Journal says, “An unusual North Dakota workers’ compensation law provides reduced benefits when a job injury worsens a medical problem the employee already has, and a consultant told state lawmakers on Friday they should repeal it.”

The Aug. 12 Bismark Tribune reports, “The latest performance evaluation of the Workforce Safety and Insurance department shows denials of claims have nearly doubled since 2005.

Claims denials

“The report, prepared by Sedgwick Claims Management Services for today’s Interim Worker’s Compensation Committee, finds that while North Dakota’s initial claims denials are lower than the national average, they are high compared with other states.

“The report recommends looking further into whether the denials are ‘appropriate based upon state law, administrative code and WSI internal claims practices.’ ”

On Aug. 16, claimsjournal.com had this to say: “A review of North Dakota’s workers compensation agency says its number of denied benefit claims has risen steadily since 2005.

Data skewed by over-reporting?

“Workforce Safety and Insurance director Bryan Klipfel says the numbers are inflated because they include incidents when a worker didn’t lose job time or need medical treatment. Klipfel says some denials were reversed later when new information became known.”

An AP post, also Aug. 16, at Bloomberg BusinessWeek has yet another angle: “North Dakota’s workers compensation director says outside reviews of his agency are too frequent and expensive.

WSI director cites too-frequent reviews

“North Dakota law says the performance reviews of Workforce Safety and Insurance must be done every two years. Auditors concentrate on specific issues and write reports for state legislators to review.

“WSI director Bryan Klipfel says it would be better to have reviews every three or four years. He says sometimes the agency barely has time to digest one set of recommendations when it has to start preparing for another.”

Gosh, no kidding, Mr. Klipfel–where do you start?

The ‘aggravation’ provision

Well, let’s start with the “unusual North Dakota law.” It’s called the aggravation provision, as in aggravating a previous injury.

Here’s how KXMC TV describes it, our emphasis added: “Under the current ‘aggravation’ law, a worker may get a reduced benefit if his job injury worsens a medical problem the worker already has. The consultants’ report says it should be repealed, and workers should get full benefits in those cases. WSI estimates the agency would have to raise insurance rates by about 2.7 percent to cover the extra $4.8 million cost.”

In other words, let’s say Mary gets in a car wreck and hurts her shoulder. Time passes and she’s back on the job; an accident occurs, and the injury aggravates the previous shoulder injury.

Most people would think well, she got hurt on the job, so what? Just take care of her. Right?

Not in North Dakota.

Back to the Insurance Journal:

“I don’t think there’s another jurisdiction in the country” that has a similar law, Malcolm Dodge, a Sedgwick assistant vice president, said in an interview.

“The provision, often called the “aggravation” law, says a worker’s benefits could be reduced by half after 60 days if he or she suffers a work injury that makes an employee’s existing medical problem worse.

“Dodge said the law would come into play if an employee injured his or her back in a car accident away from work, and then suffered a similar back injury on the job. The law says the work injury must substantially accelerate or worsen the existing injury for the employee to be eligible for full benefits.”

To his credit, Klipfel has said WSI will draft legislation that will change the provision–but it does incite wonder that such a provision would be on the books in the first place.

Denials explained

Concerning the number of denied claims, the ClaimsJournal report that ” . . . Klipfel says the numbers are inflated because they include incidents when a worker didn’t lose job time or need medical treatment. Klipfel says some denials were reversed later when new information became known.”

The Insurance Journal piece indicates that despite several concerns noted in Sedgwick’s report, Assistant VP Dodge gives the agency a passing grade on its denial rate, and Klipfel seems confident about continued progress at an agency that has seen its share of trouble in recent years:

“Dodge said the national average was about 94 percent. The consultants’ review, he said, showed WSI was applying state law correctly to claims decisions.

“Klipfel said he thought the report’s conclusions favored WSI. The agency has been in turmoil in recent years; its former director was forced out of his job and later prosecuted for misspending public funds.

” ‘Things are going good at this agency,” Klipfel said. ‘There’s a lot of positive things that we have going on … We confirmed that our claims practices are sound.’ “

***********************************************************************************************************************
Have you, a friend or a loved one been injured on the job? Whether you’re merely seeking answers about your rights or believe a lawsuit may be necessary, be sure to seek counsel with attorneys trained and experienced in workers’ compensation. Here’s some resources:

Workers compensation basics

Injury on the job

Filing a claim





August 21, 2010

Workers comp cases reveal fraud, effects of unintended consequences

We think it’s always instructive to follow workers’ comp fraud, regardless of whether it’s providers, carriers or claimants trying to pull a fast one.

In our first case for this edition, the person who got busted did not pull a fast one.

She pulled a slow one.

79-year-old pleads guilty

From a recent winner of a  Pulitzer prize, an Aug. 17 post of the Glens Falls Post-Star: “A 79-year-old Lake Luzerne woman who illegally collected $242,000 in worker’s compensation has pleaded guilty to a felony charge and been ordered to pay the money back.

“Anna R. Healey was sentenced to a three-year conditional discharge after her guilty plea to a misdemeanor charge of offering a false instrument for filing.”

Here’s the hook-line-sinker part, though–the authorities may be a tad late on ordering her to pay it back. Not only is she crowding 80 years-old but also the payments she apparently swindled date back to the late 1970s.

“The benefits were to be discontinued if she remarried, and investigators from the state Insurance Department sought a criminal investigation by the State Police after determining she had gotten married again.

“Healey illegally collected worker’s compensation payments for 30 years beginning in 1978.”

In other words, what are the chances that any given 79-year-old woman can come up with the dough to pay it back before she dies? True, from this one account we don’t know but what’s she’s now wealthy beyond measure.

But more likely the quick and dirty math takes over, which says she collected less than $700 a month during all that time. And most of us know where $700 a month goes in most householdds: utilities, food, and staples such as fuel and toilet paper.

Maybe it will turn out that she funded a trading account and became super-wealthy. If that’s the case, she should not only pay it back, but pay it back with penalties and interest–including charges against her estate.

Public oversight

But here’s the deal– the truly important thing involves public money. If one old lady got away with something, that’s one thing. Maybe she really needed it, but that’s a question for another topic.

The real question is this: Why did this  go undiscovered for so long? And, given the parameters, how many more similar cases are ongoing?

Shouldn’t we demand more and better of our public officials?

Ok, here’s another one.

This guy got popped for taking comp money as if he couldn’t work, but according to the sources he could indeed work. The totals involved don’t even approach Healey proportions but do involve jail time and maybe some different questions about the system.

Double dipping

According to an Aug. 18 post at claimsjournal.com, former truck driver Martin DaLaRosa was “was sentenced to brief jail time and ordered to repay $1,647 in benefits to Texas Mutual.”

One thing we notice here is the source is Texas Mutual.

Now that doesn’t mean it’s wrong. As alluded to earlier, there really are people who scam insurance companies. We know this.

In DeLaRosa’s case, the Denton, Texas, man “reported a job-related injury while working as a truck driver for Texas Environmental Management of [nearby] Justin, Texas. He claimed he was unable to work as a result of the injury, and Texas Mutual began paying income benefits to him.”

Subsequently, however, the insurance company “uncovered evidence that DeLaRosa was working as a car salesman for a Denton car dealership while receiving income benefits.”

See, the problem is not that DeLaRosa could no longer drive trucks. State law requires claimants to report when they resume employment, period. Otherwise claimants are said to be “double-dipping because the claimant collects benefits for being too injured to work when he or she is, in fact, gainfully employed.”

Insurance carriers like to point out that double-dipping costs all employers who carry workmen’s comp via across-the-board premium hikes. (Texas is the only state that doesn’t require employers to carry workmen’s comp insurance.)

The case underscores the need for competent legal counsel–not only to help claimants receive the benefits they deserve but also to make sure claimants do not run afoul of the law once benefits have been awarded.

Volunteer firefighters back in the news

The final case we’ll look at today is interesting for a different reason. Justin Fauer was a volunteer firefighter who died while trying to save his boss in a farming accident. As we’ve noted in a previous installment, volunteer firefighters can find themselves–and the communities they serve–mired in complex situations concerning workers comp coverage.

But Fauer’s case is also interesting because the parties at odds do not include either Fauer’s employer or his survivors but rather two insurance companies.

Fauer and his boss were working at a manure pit, according to an AP account in the Aug. 15 Chicago Tribune, at Johnson Valley Beef in 2005.

“Fauer’s boss, Dwight Johnson, climbed into a manure pit at Johnson Valley Beef to retrieve a chain that had fallen into the pit and was overcome by methane fumes, court records show.

“Fauer, a volunteer firefighter with Andover Volunteer Fire Department, ran to the house to tell Johnson’s wife to call 911 and then returned to the pit where he climbed in and was also overcome.

“A deputy workers compensation commissioner ruled that Fauer responded to the emergency as both a farm hand and a volunteer firefighter because some of the injuries that led to his death occurred after he would have been notified in his capacity as a firefighter.”

Grinnell versus Travelers

The carrier for the farm, Grinnell Mutual Reinsurance Company, paid on the Fauer claim but subsequently sought to have Travelers pay half, hence the importance of the commissioner’s ruling, which left Travelers–the workers comp carrier for the volunteer fire department–responsible for paying one-half the amount to Grinnell.

Then came the turnabout:

“Traveler’s appealed but the commissioner ruled the timing of the notice to Fauer’s pager ‘was not critical to the determination of coverage … because Justin has been summoned to duty as a volunteer firefighter by the circumstances themselves.’

“The commissioner determined that failure to allow volunteer firefighters to call themselves to duty would have the ‘absurd result of deterring them from immediately rendering assistance upon encountering an emergency.’ ”

Traveler’s sought a review by the court and a district court rejected the commissioner’s ruling. “It concluded a volunteer firefighter cannot be summoned to duty by circumstances, but can only be summoned by the fire department or some other official channel.”

An Aug. 19 piece in a Southwest Iowa news outlet picks up it from there:

A chilling effect on volunteer response?

“So, where does that leave the countless volunteer firefighters spread across southwest Iowa?

“ ‘It’s an interesting ruling,’ said Council Bluffs Fire Chief Alan Byers, himself a former volunteer firefighter.

“ ‘The expectation for firefighters, if you’re paid or a volunteer, is that if you come upon an accident or fire, you’ll help,’ Byers said. ‘What if you’re driving down the street and see smoke from a house? You call 911 and try to make a difference and get hurt or worse, die, there’s no workers compensation there. It’ll make firefighters think differently in those instances.

“ ‘If (volunteers) get hurt or worse and can’t get back to their day job, workers comp is all they have.’

“Byers said he’s seen the ruling generate discussion across the state on message boards, through e-mail and in discussions.

“ ‘I think a lot of people were saddened by the decision,’ he said.

“Both Byers and Jeff Theulen, the Pottawattamie County Emergency Management Coordinator, Treynor assistant fire chief and a 30-year volunteer firefighter, speculated that the state Legislature would examine the issue.”

It’s very sobering to realize how the actions of one or two individuals can effect change that potentially affects thousands of other people.

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Have you, a friend or a loved one been injured on the job? Whether you’re merely seeking answers about your rights or believe a lawsuit may be necessary, be sure to seek counsel with attorneys trained and experienced in workers’ compensation. Here’s some resources:

Workers compensation basics

Injury on the job

Filing a claim





July 31, 2010

Hearing, audit raise serious questions about Texas’ regard for workers

Anyone considering moving to Texas to find work may want to reconsider.

A recent hearing conducted jointly by two committees of the Texas House raises serious questions about worker safety in the Lone Star State. Related questions may make one question the official regard of workers in general, given news about advice given to employers regarding unemployment benefits.

Texas employers not required to carry workers comp insurance

According to a July 29 article in The Texas Tribune, the nation’s second-largest state is dead last in requiring employers to carry workers’ compensation insurance. That is to say, it’s the only state that allows all employers except “public entities” to choose whether to provide workers comp coverage:

“Texas is the only state that does not require employers to purchase workers’ compensation insurance. As such, 33 percent of Texas employers [in 2008] elect[ed] not to purchase such insurance; the committee sought information about whether that number had changed in the wake of the Entergy decision. Cathy DeWitt, vice-president for government affairs at the Texas Association of Business, testified that her group would not support making workers’ comp mandatory.”

To be fair, a slide show linked to from the article, from the state department of insurance indicates that 70 per cent of employers who elect not to subscribe to workers comp do cover employers through private insurance. Further, the presentation shows that the one-third of employers without workers comp is a declining number; in 1993, the number was 44 per cent.

Still, that’s a bunch of uncovered workers. Of course, without buying workers comp coverage, the employer leaves itself open to lawsuits–and some indicate employers indicate that’s the main reason they do buy coverage.

On the other hand, as the hearing shows, there’s plenty of room in the entire system for improvement.

House hearing focuses on serious workplace injuries

The pair of committees–Business and Industry, and Judiciary & Civil Jurisprudence–convened to examine “concerns over whether benefits in Texas were adequate in the case of serious workplace injuries,” concerns apparently fueled by reports coming from the BP tragedy in the Gulf.

“José Herrera, a worker badly burned by hot oil in an accident in a Citgo refinery in 2008, testified that his benefits (which will not last a lifetime) amounted to less than one-quarter of his former take-home pay and that his insurance has often delayed needed surgeries. ‘I’m in pain the day this happened to me, til now, for the rest of my life,’  Herrera told the committees.

“Some lawmakers voiced support for reviewing benefits allotted to badly injured workers. ‘I would hope somewhere along the line some subcommittee would look at the adequacy of benefits,” said state Rep. Jim Jackson, R-Carrollton.

Entergy ruling limits abilities to sue

“Herrera’s ability to sue for damages is severely constrained by a 2007 Texas Supreme Court decision. In Entergy Gulf States v. John Summers, the court ruled that plant owners can shield themselves from lawsuits by injured contract workers by purchasing workers’ compensation insurance, which pays workers a portion of their wages as well as medical bills in the event of injury. Contractors — the companies that actually employ the workers — are already able to shield themselves in this way; what was new was the extension of this right to companies that own the workplace.”

Another Tribune piece, also dated June 29, says, “The Entergy ruling startled many Texas officials and stirred anger among some lawmakers, who argued the legislative intent was ignored. But so far, efforts to change the law to get around the ruling have fallen short — the Texas Supreme Court reaffirmed its ruling last year — though another try is expected in the coming session.”

Audit finds more workers comp issues

Yet another July 29 piece, this in Texas Watchdog, reports more troubling details. After acknowledging long-standing features that traditionally have drawn workers to Texas (no state income tax, relatively available work, and a decent cost of living), the Watchdog notes that, “But if you hit some hard times, the place isn’t so hospitable, a recently released audit shows. In fact, one could say the state is in no hurry to police employers who might abuse the rights of employees injured or otherwise compromised.”

Citing a report from the state auditor’s office, the Watchdog says “pending workers’ comp enforcement cases have been open for an average of 467 days. That’s about a year and three months.

“Fifty-eight of those cases have been open since 2007, and one lingers from 2006, when oversight for worker’s comp moved from the dismantled Texas Worker’s Compensation Commission to the insurance department. The division of workers’ comp issues disciplinary orders when providers and carriers have not complied with the law.”

Among other findings:

  • “The case log that Division management used to monitor workers’ compensation enforcement cases was not complete. Auditors identified 81 . . . cases that were not on . . . the log and 61 pending  . . . cases that the Division had assigned to [Division employees] whose employment had been terminated the prior calendar year.”
  • “The Division did not consistently conduct supervisory reviews of staff’s work . . . . According to the Division, from March 2009 to March 2010, the Division conducted only two supervisory reviews of cases that were progressing to disposition.”
  • The audit also found a reporting problem caused by physical layout: “This reporting structure makes it difficult for the Associate Commissioner . . . to monitor . . . enforcement cases.”
  • Perhaps most disturbing, this finding regarding reduced penalties: “In addition, for two cases with the largest penalties assessed, the team leader . . . approved settlement amounts significantly less the amount recommended by the staff  attorneys assigned to the cases. However, there was no documentation justifying the reduced penalty amounts. According to Division procedures, settlement amounts and their correspondence should be documented.”

Skirting unemployment benefits

Now, what about those unemployment benefits? The Watchdog also cites the case of a high-ranking Texas Workforce Commission employee who has been giving some dubious advice during employer workshops. It comes from a July 7 story in the Houston Chronicle:

“Say you’re the boss and you’re going to fire one of your employees. Instead of booting the employee out the door, the Texas Workforce Commission recommends giving your employee the option to resign.

“Employees given that choice are more likely to conclude they aren’t eligible for benefits, said Jonathan Babiak, who spoke before 800 Houston area employers recently at a seminar sponsored by the Texas Workforce Commission.

“It’s not the employer’s obligation to correct that misunderstanding, said Babiak, [then-]deputy director of appellate services for the Texas Workforce Commission in Austin. If employees resign, he said, ‘chances are they won’t file a claim.’ “

The Chronicle also quotes an attorneys, speaking from appropriate disgust:

” ‘This is outrageous,’ Houston employment lawyer Margaret Harris said. ‘If you resign in lieu of termination, of course you’re entitled” to benefits.

” ‘This is an agent of the state of Texas telling employers how to defraud citizens of the state of Texas of a benefit to which they are lawfully entitled and that they very much need,’  said Harris, of Butler & Harris.”

The Watchdog was unable to get a statement from Babiak, but did manage to reach an attorney across the hall from him.

“Across the hall from Babiak at the Texas Workforce Commission sits the office of Ronald Congleton, the commissioner representing labor in Texas.

” ‘We certainly were not happy with those comments,’ said Bob Stewart, an attorney in Congleton’s office. ‘Counseling employers how to avoid paying unemployment? We aren’t in favor of that.’ “

The Watchdog also learned that Babiak is no longer a deputy director of appellate services.

Nope, he’s been transferred, apparently…

…to the human resources department.

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Have you, a friend or a loved one been injured on the job? Whether you’re merely seeking answers about your rights or believe a lawsuit may be necessary, be sure to seek counsel with attorneys trained and experienced in workers’ compensation. Here’s some resources:

Workers compensation basics

Injury on the job

Filing a claim





July 26, 2010

In West Virginia, workers comp coverage for volunteer fire fighters raise questions of life, death–and big problems for homeowners

A snarl in workers comp coverages for volunteer fire fighters in West Virginia could result not only in  loss of coverage but also in at least one court case as well as hefty raises for insurance premiums on homes that would no longer be served by volunteer departments.

According to a mid-June Charleston Gazette article re-posted at a fire-and-rescue trade site, West Virginia legislators were mulling options “as hundreds of volunteer fire departments around the state [were facing] sharp increases in Workers’ Compensation premiums, effective July 1.

Homeowners insurance premiums could triple

“If volunteer fire departments ultimately shut down because of the high workers’ comp costs, residents in those areas would see their homeowners’ premiums nearly triple, Insurance Commission Rates and Forms director Tonya Gillespie told the Joint Committee on Government and Finance.”

The problem is doubly vexing for West Virginia because most of the state relies on volunteer forces; accordingly, many departments are affected–and, potentially, so are a lot of homeowners.

A June 16 piece in The State Journal says that State Fire Marshal Sterling Lewis Jr. explained that “447 fire departments operate in West Virginia. Only 12 are full-time fire departments. Another 16 are a combination full-time and volunteer, and the rest are volunteer.”

Some VFD departments’ rates could more than double

Various sources have reported that volunteer departments in the state have historically paid  “suppressed rates”  (artificially low) and that the current provider, Brickstreet  Mutual, has been losing money since 2006 under laws requiring it to provide coverage. The first of July was to have been  the end of that arrangement, and Brickstreet was set to raise the rates, in some cases more than double.

The Journal reported that “[o]ne department in Wayne County would see its premiums increase from $23,000 to $48,000 a year, State Fire Marshal Sterling Lewis Jr. said. Any departments that can’t afford workers’ compensation must shut down and leave residents in those areas without ready access to emergency services.

” ‘We’re hoping that between the executive branch and the legislative branch there could be some quick resolution to the problem because on July 1, that could be doomsday,’ he said.”

Governor pulls off a temporary fix

The doomsday deadline was averted, however, by an agreement reported on June 18 in the Mineral Daily News-Tribune:

“Volunteer fire departments throughout the state will get a reprieve — at least for a year — in the expected skyrocketing costs of Worker’s Compensation premiums.

“Gov.  Joe Manchin on Thursday joined Department of Revenue Cabinet Secretary Virgil Helton, Brickstreet Insurance CEO Greg Burton, West Virginia Insurance Commissioner Jane Cline, members of the West Virginia State Firemen’s Association and others to announce Brickstreet Insurance’s decision to delay increasing state’s volunteer fire departments’ (VFDs) workers’ compensation premium rates for one year to allow time for the state to develop a long-term solution.”

Lost wages and severe injuries

One remarkable aspect of the situation involves the method calculating payments to injured volunteers. Premiums are based on awards to fire fighters working for minimum wage, but payouts addressing lost wages are calculated on actual lost wages–not from the unpaid volunteer position but for the person’s regular job income. Thus, an accountant or other highly paid worker can take on the voluntary duty without worrying about the financial repercussions to family in event of an injury.

Another interesting angle is that costs are significant not because of the number of claims but because when injuries do occur, they typically are severe.

According to the Journal, “BrickStreet currently is providing coverage to volunteer firefighters at a 600 to 700 percent loss, meaning it pays out roughly $7 in claims for every $1 it receives in premiums, [CEO Greg] Burton wrote [in an e-mail]. The company still will lose money at a rate of $3.5 million to $4 million a year even after the increase in premiums goes into effect.

“Not all volunteer fire departments will see a large jump in premiums. The increase may range from 3 to 10 percent in some cases, Lewis said. But in others, the increase could be more than 100 percent.”

Dramatic questions over ‘broad form’ liability

More intrigue enters the story due to requirements for supervisors to be covered in case of litigation filed by an inured fire fighter against one of the departments. ” . . . BrickStreet has announced it will stop providing such coverage after Sept. 1,” according to a July 24 article in The Intelligencer. “Other companies also are unwilling to provide the policies, according to the State Fireman’s Association.

” ‘Broad form’ liability policies cover officers and board members of volunteer fire companies. They protect officials against lawsuits by firefighters who are injured in the line of duty. Clearly, a volunteer fire company chief without such protection would have to be a fool to command members of his unit to enter a burning building.”

The intrigue ramps up, according to another Gazette article, from July 26, which reports that “a memo from the state Insurance Commission advises that the VFDs don’t need the coverage.”

Says the Gazette:

“Last week, representatives of VFDs protested at the Capitol, warning that some fire departments may “shut the doors” rather than risk personal liability for injury claims.

“A day later, Commissioner Jane Cline told lawmakers that directors and officers of VFDs don’t need the coverage, since state law gives them immunity under the Government Tort Claims Act.

“Under that law, she said, officials in state government as well as all government subdivisions have immunity from lawsuits stemming from employees’ work-related injuries — unless there is proof the employer had a deliberate intent to put the employee into unsafe working conditions.

But, says one VFD lobbyist, that raises an even larger question.

“There’s some glaring questions that jump out, including why was BrickStreet selling us broadform coverage if we didn’t need it?” said [Sam Love, lobbyist for the West Virginia Fireman's Association]. “There’s a lot of questions out there, that I don’t think this memo leaves firemen with a warm and fuzzy feeling.

“I’m afraid where it’s going to be headed is to a court case,” he said of issues regarding potential liability of VFD directors and officers.

***********************************************************************************************************************
Have you, a friend or a loved one been injured on the job? Whether you’re merely seeking answers about your rights or believe a lawsuit may be necessary, be sure to seek counsel with attorneys trained and experienced in workers’ compensation. Here’s some resources:

Workers compensation basics

Injury on the job

Filing a claim





July 10, 2010

Appointed Workers’ Comp judge’s
bid for election raises questions

Following months of wrangling, Oklahoma recently passed a workers comp reform package, which we discussed here. Now the Sooner State has a legal dust-up involving the presiding judge of the state’s Workers’ Compensation Court.

Judge Kent Eldridge has apparently decided he’d rather be an elected Oklahoma County District judge than a state-level appointed judge–even though the positions pay the same, according to a June 5 article in The Oklahoman.

Of course, there’s nothing wrong with a job change or furthering one’s career.

The problem is, the law might restrict Eldridge from running for the elected post while sitting as the workers comp judge.

Should he resign before running?

“Some attorneys say Judge Kent Eldridge appears to be violating the law by not resigning before running for office.

Eldridge and his legal adviser say he’s not required to resign.”

But whether he must resign the workers comp position is only part of the story–campaign contributions are also raising questions.

Fundraising and an ‘unseemly atmosphere’

According to a July 5 piece at Newson6.com, “Eldridge says no one has complained to him and he is not aware of it if anyone has complained to the workers’ comp court’s administration. He says he has never suggested that he might be influenced by a contribution to his campaign.”

The Oklahoman reports says, “Critics also say Eldridge’s campaign has created an unseemly atmosphere at the workers’ compensation court. They claim attorneys who represent both employers and injured workers are being pressured by other lawyers to give to his campaign to prevent opposing attorneys from gaining the upper hand in cases.”

In that account, the judge is described having assigned responsibility for all campaign activities to campaign chairman Bill Liebel and, further, has directed campaign officials to not reveal to him the names of any contributors “because he can’t be influenced by contributors when he doesn’t know their identities.”

Invitation present at court

Apparently, at least one fundraiser invitation was present at  workers comp court, and it ” listed nearly two dozen workers’ compensation and district court attorneys as sponsors for the June 8 fundraiser. Sixteen of those individuals were listed on an invitation as sponsors of another reception for Eldridge scheduled for 3 p.m. to 5 p.m. May 13 at the Faculty House.”

The article also says, “Eldridge acknowledged he attended a fundraiser for him in the home of workers’ compensation attorney [Sid Musser] and made a point of trying to visit with everyone there. A number of workers’ compensation attorneys and other lawyers reportedly were in attendance.”

Three attorney reached by the paper say they believe the judge ran afoul of Oklahoma statute Title 20, Chapter 19, Section 1404, which reads “20‑1404.  Additional grounds for removal of judicial officer:

“5.  A judicial officer becoming a candidate for any nonjudicial office or for another judicial office whose term is to commence before the expiration of his present term of office; provided that no judge holding a nonelective judgeship shall become a candidate in a race in which the incumbent seeks to retain an elective judicial office unless he first resign his appointive judgeship.”

Eldridge’s position is that he sought qualified legal opinion before declaring for election. Maybe the part about “the incumbent” gets him off the hook, as the incumbent has declined to seek re-election.

Attorney contributions commonplace

One thing seems apparent: The campaign contributions issue is not likely to result in charges. For one thing, Eldridge’s opponents who are assistant DA’s are probably getting attorney contributions, too.

“Terry West, general counsel for the Council on Judicial Complaints, said contributions from attorneys to judges have been an issue for a long time since district judges are allowed to accept campaign contributions from attorneys who practice before them.

” ‘It’s very uncomfortable for judges and very uncomfortable for lawyers,’ West said. ‘No one else is particularly interested in a judge’s race so they pretty much have to solicit from lawyers.’ ”

Gad–what a system.

***********************************************************************************************************************
Have you, a friend or a loved one been injured on the job? Whether you’re merely seeking answers about your rights or believe a lawsuit may be necessary, be sure to seek counsel with attorneys trained and experienced in workers’ compensation. Here’s some resources:

Workers compensation basics

Injury on the job

Choosing an attorney





June 23, 2010

‘Local workers’ favored in BP cleanup, but advocates say maze may await those who get sick or injured

According to a June 20 article in The New York Times, “Hundreds of workers hired by BP subcontractors to help with the cleanup of the oil spill in the Gulf of Mexico are complaining that they traveled long distances to assist in the effort — only to be told that their jobs had been given to local residents.”

Governors favor local workers

Apparently contractors and subcontractors started out hiring anyone they could get with related experience and skills, but as time wore on the governors of the affected states (Louisiana, Mississippi, Alabama and Florida) began pressing  to favor local job seekers over imported workers–even if the workers had already signed contracts.

“In Florida, 86 percent of cleanup workers are now Floridians; in Alabama, 82 percent are from that state; and in Mississippi, 83 percent of the cleanup work force are residents. Those figures have nearly doubled in the last month, BP records show.

“ ‘You hate to take away anyone’s livelihood,’ said Dan Turner, a spokesman for Gov. Haley Barbour of Mississippi. ‘But the locals here have already had their livelihood taken away, through no fault of their own.’

“Subcontractors say they must follow the desires of BP and the governors if they hope to keep their contracts.”

The cleanup crews now total about “25,000 workers [who] have been hired by more than 100 subcontractors” to work both on shore and in the Gulf. Ultimately, though, the out-of-state workers who have been–or will be–turned away may turn out to be the lucky ones.

(Note: estimates of current workforce levels range from 24,000 to 27,000 among various reports.)

Damaged cleanup workers may face bureaucratic maze

Sure, everybody needs the work and the paychecks, but the regulatory infrastructure is such a mish-mash that workers who get sick or injured may find themselves in bureaucratic purgatory.

This is from the Washington NBC affiliate, dated June 16: “An army of 24,000 temporary workers have swarmed the Gulf Coast to help clean up the mess from the massive BP oil spill. But it is far from clear who is responsible for ensuring the safety and long-term health of those doing the critical and often dangerous grunt work.

“Already workers have been injured, some hospitalized.

“Workers are covered by a patchwork of federal, state and local agencies and regulations. The government only last week announced how worker safety efforts in the Gulf would be coordinated, more than 50 days after the rig explosion.”

And here’s what a June 22 Reuters article says: “Workers struggling in the heat to clean up oil from the the ruptured BP (BP.L) well in the Gulf of Mexico risk short-term lung, liver, and kidney damage from fumes, experts said on Tuesday.”

The experts appeared at an Institute of Medicine hearing in New Orleans, reporting that “[s]tudies of the health effects after seven supertanker spills showed that clean-up crews had suffered short-term health problems from volatile organic compounds.”

” ‘You really are talking about a triangle of heat, chemical exposure, and then the behavior changes that you see as a result,’ said Linda McCauley, dean of Emory University’s School of Nursing in Atlanta.”

Images of 9/11 and Exxon Valdez remediation

The NBCWashington report says long-term lawsuits are to be expected, and makes comparisons to the 9/11 rescue workers (whose recent settlement we covered here) and the 1989 Exxon Valdez spill.

“Based on past disasters, workers could become tangled in years of litigation if they suffer any injuries or other ill health effects while cleaning up the Gulf region.

“ ‘We’ve been through this before,” said Rep. Jerrold Nadler, D-N.Y., referring to workers who helped clean up the World Trade Center site after the 9/11 attacks.

“Nadler said the government told workers at the site that they, too, were safe, but today ‘thousands of people are sick or dying.’

“ ‘I’ve been fighting for years to get proper health care and monitoring for the thousands of people who are sick today who worked in the World Trade Center,’ said Nadler, who sponsored a bill to provide health care and compensation to 9/11 first responders and survivors of the tragedy. ‘Now I see the whole thing reproducing itself in the Gulf.’ “

As mentioned in the article, the Valdez  and BP tragedies are similar not only in regards to oil and coastal waters but also because a corporate entity is ultimately responsible.

Governor wary of  ‘committee approach’

However, what’s not clear is who is in charge of running the cleanup show, and hence which agency is overseeing workers’ safety issues and health-related claims: ” . . . even within the government there is confusion about who is in charge of protecting the 24,000 individuals engaged in the Gulf cleanup, including nearly 19,000 contract workers dispersed offshore and along the coast lines of Louisiana, Mississippi, Alabama and Florida.”

For example, Alabama Gov. Bob Riley reportedly complained to CNN about a “committee approach” among government agencies that complicates the process, using an example involving a state wildlife agency’s “push to clean beaches [that] met with resistance from federal Occupational Safety and Health Administration over limits on how many hours cleanup crews could work.”

“Adding to the complication is the fact that OSHA typically oversees safety on land, while the Coast Guard deals with worker safety issues on inspected vessels. That means smaller boats that are not inspected by the Coast Guard would come under OSHA,” says the NBCWashington report.

Although OSHA and the Coast Guard have signed an agreement of understanding, OSHA “is stretched extremely thin,  with only has 25 staffers in the four-state spill region, according to Jordan Barab, deputy assistant secretary of Labor for OSHA.”

Safety and health incidents already have occurred, and “Barab said there have been safety lapses on the part of BP but added: ‘Every time we’ve asked them to clean up their act, they’ve done that.’ ”

Regardless of that vote of confidence, keeping track of the numbers is difficult, even at this relatively early stage of the cleanup.

Some workers have already been treated

For example, this June 15 account in The Kansas City Star says, “Although Louisiana state records indicate that at least 74 oil spill workers have complained of becoming sick after exposure to pollutants, BP’s own official recordkeeping notes just two such incidents.”

After a couple of short grafs, the account continues: “The gap between the state data and BP’s reflects the difficulty in tracking the health effects of [toxic compounds] from the oil spill. It also raises questions about whether the federal government can rely on BP to determine whether conditions remain safe for the more than 27,000 workers now engaged in cleaning up the worst oil spill in the nation’s history.”

The NBCWashington piece quotes a Houston attorney thusly: “Workers are protected by ‘a hodgepodge of regulations,’ said Matthew Shaffer, an attorney with Houston-based Schechter, McElwee, Shaffer & Harris, a firm that handles maritime-related personal injury cases, who said he has already heard from injured oil spill workers.

“He expects to see many workers come down with illnesses stemming from on-the-job conditions. ‘No one’s really in charge, and a lot is left to employers or the industry to police themselves,’ he said.”

BP spokesman Ray Viator indicated the company is working with OSHA and another agency, the National Institute for Occupational Safety and Health, in monitoring air quality and the need for protective gear such as respirators (”not needed, yet” seems to be the consensus so far).

The NBCWashington piece also poses this question: “So what will happen to BP workers if they do get injured or suffer long-term illnesses?”

Spokesman: workers comp first, then BP to pay

The answer, says Viator, is that “workers’ compensation is provided through the contract workers’ employers.

“As for claims beyond that, he said, ‘BP has agreed to reimburse its contractors for legitimate costs relating to certain worker injuries sustained during their course and scope of employment with the contractor companies.’

“That’s not enough, said [Congressman] Nadler. ‘Unlike at the World Trade Center, you have a private party who’s responsible and who should be covering the costs for all of this,’ he said.

“But he said he was more concerned ‘not with claims, but preventing thousands of people from getting sick.’ “

Apparently, the bottom line is this: We’ve only begun the long, intense cleanup of the Gulf region–and once it’s over, we’ll have a lengthy process of mopping up the human damage.

***********************************************************************************************************************
Have you, a friend or a loved one been injured on the job? Whether you’re merely seeking answers about your rights or believe a lawsuit may be necessary, be sure to seek counsel with attorneys trained and experienced in workers’ compensation. Here’s some resources:

Workers compensation basics

Injury on the job

Choosing an attorney





June 17, 2010

Schwarzenegger smacked down again; 9/11 workers get improved settlement; Oklahoma reform passes

Schwarzenegger furloughs headed to Supreme Court

As a follow-up to our March 22 post, “California furloughs of workers comp attorneys ruled ‘illegal’, “ we see a June 13 piece in the San Francisco Chronicle reporting that yet another court has found that “[a]bout 7,900 state workers’ compensation employees were furloughed illegally by Gov. Arnold Schwarzenegger last year and are entitled to $25 million in back pay . . . .”

The March ruling was from a different appellate panel, which “found Schwarzenegger acted illegally when he furloughed about 500 lawyers and hearing officers employed by the same insurance fund.”

The June 11 ruling applies to all employees of the fund, which “sells workers’ compensation insurance to employers and uses their payments to run its operations.”

According to the Silicon Valley MercuryNews,The furloughs were part of an cost-cutting move by the governor last year, when he ordered nearly 200,000 state employees to take two days off each month without pay.”

However, the issue does not appear to be over. Both outlets report that the state Supreme Court has agreed to review the furlough issue.

Fired manager plans WC fund for construction insustry

Another brawl over workers comp funds is shaping up in Minnesota, where, says a June 14 StarTribune.com report, “The founder and former head of Minnesota’s largest workers compensation self-insurance fund is launching a new, competing insurance program for the construction industry.

“David Bjorklund said The Builders Group (TBG), the Eagan-based fund he founded in 1997, has lost its way, citing its recent $30,000 state fine for falsifying safety-related scores and a drop in its financial reserves.”

According to the article, Bjorklund was fired as manager by the fund’s board, 11 years after he created the fund. He says he was a whistle-blower and that speaking out is what got him fired. Subsequently, he and other ex-employees helped the state during an investigation of the fund.

“Last week, he said, he met with several concerned fund members to outline the new venture. His goal is to line up charter members for a new ‘captive’ insurance company owned and controlled by the membership.” Such firms “are a bit like self-insurance funds, but members don’t bear ‘joint and several’ liability for losses, Bjorklund said. The venture, yet to be submitted to insurance regulators or given a name, would operate under the umbrella of a large insurer, though Bjorklund said he would administer it.”

Settlement for 9/11 workers extends benefits, caps legal fees

Yet another captive insurance fund made news recently, as part of the revised, $712 million settlement between New York City and thousands of 9/11 rescue workers.  According to a June 10 piece in Bloomberg BusinessWeek, “Lawyers for 10,000 workers claiming illnesses from rescue, recovery and debris removal after the Sept. 11 World Trade Center attack have agreed with New York City on a $712.5 million compensation fund to settle the cases.”The city and its WTC Captive Insurance Co., set up with $1 billion from [FEMA], joined with plaintiffs’ attorneys to present the agreement today to U.S. District Judge Alvin Hellerstein in Manhattan.”

According to Reuters, the revision includes a larger payout to the workers but less to the attorneys: “In March a federal judge rejected an initial settlement of up to $657.5 million, saying it needed to be more transparent and that too much of the money — about one third — would be spent on lawyers’ fees.”

The settlement caps attorney fees at 25 per cent, which lowers “their previous cut by more than $50 million. The WTC Captive Insurance Company has agreed to pay up to an additional $55 million to the workers as part of the revised settlement.”

BusinessWeek says the judge termed the agreement “a very good deal,” and  “signed an order dismissing the lawsuit, and set a June 23 public hearing for claimants and their attorneys to raise any objections. At least 95 percent of the plaintiffs must consent to the agreement for it to become legally binding.”

Oklahoma finally passes WC reform package

Elsewhere, reform is the name of the game in Oklahoma, where Gov. Brad Henry has signed legislation aimed at upgrading the workers comp system. According to a May 28 report from TulsaWorld.com, “The key features include a reorganization of the workers compensation courts and a tightening of definitions and benefit eligibility.

“Supporters say the reforms will save businesses more than $60 million a year.”

A June 12 piece at NewsOK.com explains that the legislative reform comprises four separate bills and that its passage removes one ballot proposal from November elections.

“The two bills signed by the governor Friday were part of four measures legislators approved after months of negotiations with business, medical and legal representatives. Henry earlier this week signed Senate Bill 1973, which allows the state Supreme Court to review workers’ compensation claims like any other civil case and requires that the claimant be in attendance unless all parties agree, and HB 1611, which requires workers’ compensation claims adjusters to have six hours of education on the state workers’ compensation act.”

A twenty-two point, bulleted list of changes in the reform measures are spelled out at InsuranceJournal.com.

***********************************************************************************************************************
Have you, a friend or a loved one been injured on the job? Whether you’re merely seeking answers about your rights or believe a lawsuit may be necessary, be sure to seek counsel with attorneys trained and experienced in workers’ compensation. Here’s some resources:

Workers compensation basics

Injury on the job

Choosing an attorney





May 30, 2010

States around the nation facing workers comp budget woes; Texas whistleblowers ‘blasted’ by chief

Update from preceding post: Sandra Herold died Monday night, according to the Boston Herald. Herald, 72, was the owner of the 200-pound chimp who mutilated Charla Nash. We first covered the story here because of the legal questions raised about workers’ compensation versus a civil settlement. Herold’s cause of death was reportedly a ruptured aortic aneurysm. Any effect on the $50 million civil suit filed by Nash’s attorney was unknown at post time, but we will continue to follow the case.

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We’ve discussed successes and shortcomings of various states’ workers comp programs, from furloughs that were ruled illegal in California, to subsequent California rulings contrasted against efforts to privatize in Oklahoma and Colorado– and even looked over the best and worst “report cards” for various states.

But according to at least one report, states may have more pending budget crunches in common than not.

Workers comp and state budgets

In a May 24 post, BusinessInsurance.com says, “State budget shortfalls are hindering the resolution of workers compensation cases and may increase employer claims costs as states cut back on judges and other critical staff, risk managers say.

“Furloughs of state workers including administrative law judges, auditors and other public employees that handle claims are increasing litigation expenses and even hamper return-to-work efforts, risk managers say.”

The article says an opposing point of view is that reduced personnel is OK because injuries/claims are going down, so less staff, at least temporarily, is not an impediment to processing and treating injured workers.

Still others counter that these same staff reductions are linked to rises in claims’ resolution problems.

“In an April report, the National Conference of State Legislatures said ’state budget gaps loom as far as the eye can see.’ It said 31 states and Puerto Rico foresee fiscal 2012 budget gaps of at least $73.5 billion, and 21 states project fiscal 2013 budget gaps of at least $64.7 billion. ‘Including previous amounts, states will have addressed budget gaps in excess of $531 billion since the recession began in December 2007,’ according to the report.

“The issue is not apparent in all jurisdictions and depends on the state, risk managers say.”

Colorado lege thinks Pennacol is lowballing

For example, in Colorado, Pinnacol Assurance remains a hot topic for industry news, occasionally even wandering into the streetlights of mainstream news. Apparently, Pinnacol’s latest bid to take itself private–out from under its “status as a political subdivision of the state” to being a private vehicle owned by policy holders, in the form of a mutual insurance company.

“Gov. Bill Ritter Jr. had examined selling off Pinnacol as a solution in addressing Colorado’s estimated $1.3 billion shortfall for the fiscal year that begins in July,” says BI.

Pinnacol submitted a bid on itself, offering $200 million.

Nobody bit that hook, so Pinnacol recently upped the ante to $330 million–but still can’t get the lege to bite:

“Talks broke down after it became apparent that there was a lack of support for the proposal among state lawmakers, many of whom said the insurer’s worth was far greater than what Pinnacol was offering. No legislation aimed at privatizing the insurer was ever introduced.”

No legislation? At all? Not even one bill? In either house? Wow–usually some lobbyist can get at least one bill introduced.

I-1082 in Washington State

OK, let’s swing over to Washington state, where something called I-1082 is a lightning rod of sorts. (Google it. Can’t say how far down the links are relevant, but “I-1082″ returns more than 18 million results, in .33 seconds.)

A May 24 opinion piece at the Kitsap Peninsula (Washington state) Business Journal says that Washington employers of every stripe are sick of rising costs for workers comp premiums and are afraid there’s no end in sight.

“Our per worker costs are the second highest in the nation, according to the National Academy of Social Insurance. And while improvements in workplace safety have reduced injuries 55 percent since 1990, claims are taking longer, and costs skyrocket as workers are off the job until their claims are resolved.

“According to the Washington Department of Labor & Industries, injured workers who miss work are off an average 274 days, over twice the national average. Washington also leads the nation in the number of expensive, lifelong pensions awarded each year, a rate that has ballooned more than 300 percent since 1996.”

During times of plenty, writes Don Brunell , president of the Association of Washington Business, premiums were invested, thereby masking weaknesses in the system; but that’s been stripped away during the financial crisis.

Among other measures being considered, Brunell describes “Initiative 1082″ as “only the beginning” but also the only real hope for ending “the state’s monopoly on workers’ compensation insurance. Washington is one of only four states with a monopoly. With the exception of 375 large self-insured businesses, all employers are required to purchase their insurance from the government. The initiative would allow private insurers to compete with the state under the very same rules and restrictions governing L&I and self-insured companies like Boeing.”

We’ll end this post with a Texas twister on attempts to reform and streamline workers comp systems.

Workers comp whistleblowers canned in Texas

Earlier this month, the Texas Tribune ran a story called “The Workers’ Comp Whistleblowers,” Following is the nut graf, referring to former state fraud enforcement attorney Cathy Lockhart, who first was put on “emergency leave” then fired a few weeks later for ” ’secret and clandestine’ activity — namely, that she researched how much money had been spent on medical fraud investigations”:

“Lockhart, along with three other former division employees who have come forward, say the division’s staff identified and recommended sanctions for nearly 70 Texas physicians who overbilled and overtreated patients, engaging in such practices as ordering needless surgeries or prescribing unnecessary narcotics. In the process, the former employees say, a relatively small number of rogue doctors cost insurers millions of dollars and, more importantly, placed patients in harm’s way. Yet since 2005, division records show, the state has sanctioned just five doctors with removal from the workers’ comp system — and only in cases involving paperwork violations rather than harm to patients. The other cases are said to be pending.”

Ok, you get the drift. Now let’s fast-forward a few days, to May 18, when the Tribune answers its own headline question “Workers’ Comp: What’s Next?” with this lede: “On the heels of allegations last week by former employees of the Texas Department of Insurance’s Division of Workers’ Compensation that their higher-ups have failed to sanction or remove dozens of doctors accused of overtreatment and overbilling, Texas lawmakers are pledging to investigate the consequences for patient care and the state’s finances. In addition, sources say the division’s lead enforcement attorney has resigned, bringing to six the number of employees who’ve exited the division’s medical oversight and enforcement staff since February.”

Deeper in the story, this nugget: “Three former employees of the division — Dr. Bill Nemeth, its first medical advisor, who served from 2001 to 2007; Dr. Ken Ford, the assistant medical advisor from 2004 to March of this year; and Dr. Clark Watts, a consultant on the division’s Medical Quality Review Panel (MQRP) — each say they resigned out of frustration that cases were not being enforced, and in some instances, the division leadership “traded political favors” (Nemeth’s words) in keeping cases from moving into enforcement.”

OK, so high-ranking officials quit in frustration and whistleblowers were fired. Still, “Texas lawmakers” are aware of the situation and “are pledging to investigate.” That should put a stop to any shenanigans, right?

Well, apparently not. On May 21, we get this lede from a Tribune blog, entitled “Workers’ Comp Chief Blasts Whistleblowers”: “As the Division of Workers’ Compensation heads into a public hearing at the Sunset Advisory Commission next week, Commissioner Rod Bordelon is blasting his former employees for their allegations in the Texas Tribune earlier this month, putting the blame on them for abuse and mismanagement in the system.”

The entire matter was headed for a showdown May 25 in a hearing of the Sunset Advisory Commission. More on that when it becomes available.

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Are you covered by Workman’s Compensation?

Read here for an introduction.





May 25, 2010

Chimp-attack victim evaluated for transplants; officer who killed chimp at center of ‘mammal attack’ proposal

We first covered the Charla Nash story back in October 2009.

She’s the Connecticut lady who got ripped apart by the 200-pound chimpanzee owned by Sandra Herold, who has been described as both friend and boss. While in recovery after the attack, Nash learned that she may not be able allowed to sue for damages because the boss maintains Nash was working and therefore is covered by workers comp provisions. If that is the case, Nash will lose recourse to possibilities for a larger settlement from a civil suit.

Officer cites emotional stress

In the meantime, the case has taken another twist that may affect state worker’s comp law: the police officer who had to shoot the chimp applied for coverage for treatment of emotional stress, according to a May 6 piece at stamfordadvocate.com. Initially declined, the claim has led to legislative proposals to close what has been called a “loophole” in dealing with dangerous animals. Shelved by missing a deadline, the proposal will likely resurface in the 2011 legislative session.

Lawsuit not stopped yet

Nash appeared on Oprah’s TV show in November, and Oprah removed the hat and veil covering what’s left of Nash’s ravaged face (here’s a clip from ABC, but be warned: as the commentator mentions, many will find it disturbing).

According to an ABC.com May 7 post, Nash was discharged from the Cleveland Clinic earlier this month and transferred to Brigham and Women’s Hospital in Boston, where experts were evaluating her for face and hands transplants. William Monaco, Nash’s attorney, told ABC that the $50 million civil suit he filed is proceeding but that “he did not know when the case would go to court,” and it is “possible Nash would testify.

” ‘It remains to be seen if she’ll testify,’ Monaco said. ‘She does not remember much about the attack, but her testimony about her life since then will be key.’ ”

Frank Chiafari is the Stamford police officer who, apparently, was next on the list for the attacking chimp. According the Advocate, “After almost killing Nash, the chimp charged at Chiafari, who shot and fatally wounded the frenzied animal.”

‘Monster with fangs’

According to various reports, subsequent tests revealed the presence of the prescription drug Xanax in the chimp’s system, but it’s unknown whether that contributed to the animal’s violent behavior. Regardless, the chimp was so agitated that Chiafari had to plug him four times at what must have been very close range. During the legislative process, the officer described the encounter as running up against a “monster with fangs and blood all over it . . . .”

Subsequent to his saving Nash and killing the animal, says the Advocate, “Chiafari applied for workers’ compensation . . .  asking the city of Stamford to cover his treatment for post-traumatic stress disorder. The city denied his claim at first, but later agreed to cover out-of-pocket . . .” expenses “. . . related to his treatment.”

The loophole: Humans? Check. Animals? No.

Revealed in the process was the loophole the new legislation aimed to sew shut: As the law stands, police officers can “receive workers’ compensation for emotional stress following a dangerous situation involving another human being” but not for similarly threatening encounters with animals.

What’s barely been mentioned is whether the stress derives from encountering “wild-animal” behavior or, instead, from putting down a pet that has gone loco.

Regardless, lawmakers were not able to push the bill through both houses during this session, and the wording has already undergone an oddball change in language.

Originally “introduced to the General Assembly nearly a year after” the event, the bill passed the state Senate 29-4 in April. “But it died in the state House of Representatives when the legislative session deadline passed Wednesday night [May 5] before it could vote on it. State Sen. Andrew McDonald, D-Stamford, introduced the bill and said he will do so again during the next legislative session.”

All animals? No–let’s restrict that to ‘mammals’

McDonald was quoted as saying the bill had enough support in  the House, but the reps’ missing the deadline cut it short. However, there’s apparently some dissension in the lege about how far to stretch the new parameters. For example, the original wording applied to “imminent danger” from animals. But a later version changed the wording from all animals to “mammals.”

Which, of course, rules out dangerous encounters with reptiles and raptors… For example, although rarely encountered, Connecticut does have Timber Rattlers and Northern Copperheads as well as hawks and owls. That’s not to suggest that such animals are inherently dangerous. Still, if cornered, they could certainly damage a human.

Oh, and what the other end of the scale, away from big, scary creatures toward little scary critters, as in bacteria and viruses? That’s something any public safety or health worker might encounter.

Think that’s silly? Maybe. But look where the lawmakers took the discussion.

Skunks and squirrels squeak into the question

The bill’s sponsor, McDonald, alluded to “pockets of opposition” that would have created enough drag on the process to threaten other needed legislation. “McDonald said lawmakers who opposed the law by claiming it would allow for officers to gain workers’ compensation benefits for encounters with mammals such as skunks did not thoroughly read the law.”

” ‘People who talk about the skunk and the squirrel are choosing to disregard language that the officers be in imminent risk of dying,’ McDonald said. ‘It’s not the emotional trauma of having to shoot a dog or anything like that.’ ”

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Have you, a friend or a loved one been injured on the job? Whether you’re merely seeking answers about your rights or believe a lawsuit may be necessary, be sure to seek counsel with attorneys trained and experienced in workers’ compensation. Here’s some resources:

Workers compensation basics

Injury on the job

Choosing an attorney





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