Recent news shows the importance of retaining experienced counsel in the often confusing world of workers compensation law.

Take the case of minor league hockey player, Canadian Andy Bezeau.

According to this AP brief from December 9, Bezeau, 39, is from St. John, N.B. but “was living in Michigan in 1998 when he signed a three-year contract with the now-defunct Detroit Vipers . . . .”

But the Vipers sent him to Providence, R.I., to play for the Bruins, “where he was injured Oct. 6, 2000.”

So what’s the problem? He was working, and he got hurt, right?

Well, not so fast.

“His request for compensation from the Vipers was under review when the Michigan Supreme Court ruled in 2007 a person must be a Michigan resident when hurt to collect.”

Oh, OK–so then he needs to collect from the Bruins’ carrier, right?

Well, what if he maintained his residence in Michigan and only had temporary digs in Rhode Island? Then what?

We’ll find out later–the Michigan board ruled against him, because of the state Supreme Court’s 2007 ruling, so now the Supreme Court has to rule on this specific case. Watch here for an update.

Here’s another example of a someone not from the U.S. getting hurt, this time a worker in Nebraska. The difference is that even though the worker was working here illegally, he’s still entitled to workers comp. Also from a December 9 AP account: “The Nebraska Court of Appeals has upheld a lower court ruling that an illegal immigrant injured at a slaughterhouse is eligible for workers’ compensation benefits.

“Cargill argued that because Odilon Visoso cannot legally work, he should not be eligible to receive weekly wages of about $340, payment for future medical expenses related to his spine injury and other benefits.”

And, get this: Cargill fired the guy after he got hurt–supposedly because he’s here illegally.

After a 100-pound slab of beef fell on him, he had surgery “in October 2007 and was fired shortly after by Cargill because, its officials say, he was an illegal immigrant.”

As a side note, one wonders why Cargill is not in trouble for hiring illegals in the first place…

At any rate, “. . . the court pointed out that state law says all employees, including illegal immigrants, are eligible for workers’ compensation.”

A copy of the ruling is here.

Another Michigan case also involves that state’s Supreme Court, which sent a RICO case back to lower courts. According to a December 10 account at ClaimsJournal.com, “The U.S. 6th Circuit Court of Appeals had found in Paul Brown et al. vs. Cassens Transport Co. et al., the plaintiffs could sue their employer and its workers’ compensation claims adjuster under federal racketeering laws.”

The details involve a so-called “cutoff doctor,” a term recognized by anyone who has ever worked for a health provider–it’s lingo for docs who seem to be in the pocket of insurance companies based on their patterns of claims denials and lowered injuries ratings.

“The six plaintiffs alleged that the defendants–Cassens Transport Co., Crawford & Company, and Dr. Saul Margules–had schemed to deny them workers’ compensation benefits under the Michigan Worker’s Disability Compensation Act (WDCA) in violation of the Racketeer Influenced and Corrupt Organizations Act (RICO).”

According to a December 8 brief at BusinessInsurance.com, the appeals court decision may set a bad precedent for employers and their carriers: “Attorneys and employer groups have criticized the appeals court decision, arguing among other things that it provides an avenue for federal courts to rule on workers comp claims decisions and that the ruling will raise costs.”

The Claims Journal account says that a lower court had ruled in favor of the defendants by dismissing “the plaintiffs’ RICO claims,” but in October 2008 the 6th Circuit court reversed that decision.

“The defendants had argued that WDCA preempts the plaintiff’s RICO claims and the lower court agreed. The appeals court found that was not the case, however, and determined that the plaintiffs had ‘sufficiently pleaded a pattern of racketeering activity,’ according to court documents.

“Specifically, the plaintiffs alleged that Cassens and Crawford deliberately selected and paid unqualified doctors, including Margules, to give fraudulent medical opinions that would support the denial of worker’s compensation benefits, and that defendants ignored other medical evidence in denying them benefits. The plaintiffs claimed that the defendants made fraudulent communications amongst themselves and to the plaintiffs by mail and wire in violation of” the racketeering act.”

That’s a case worth following, too.

Of course, employers can’t be too careful, either.

In California, a city official been charged with “workers’ compensation fraud after authorities allegedly caught her exercising and riding a motorcycle at a time she said she was too injured to do her job.”

If she did what authorities are alleging, it’s one of those head-scratching, you’d-think-she-knows-better kinda deals: the lady is not only a city council member but also a former mayor.

According to a December 3 piece in the portal to the San Francisco Chronicle, “The charges stem from a workers’ compensation claim that [Maggie] Gomez filed in 2005 with Seton Medical Center in Daly City, where she works as patient relations manager.

“Gomez said she had been injured while working, authorities said. From 2005 to 2007, she lied to doctors, insurance companies, claims administrators and the state Employment Development Department ‘regarding the injury and the extent of her disability,’ said Karen Guidotti, an assistant district attorney.

“Investigators with the district attorney and state Department of Insurance allegedly saw Gomez exercising at the gym, walking long distances while shopping, riding a motorcycle and climbing out of her boyfriend’s truck, all activities she said she was unable to do.”

Another high-profile case hinging on questions of employee status (which we profiled here ) involves a woman who was severely injured by a chimpanzee. She was on Oprah recently, providing details of the attack and insights into life since the mauling. Here’s the update, but be forewarned: Some of the pictures include shots of her without the veil she normally wears–and the images are highly disturbing.
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Whether you’re an injured employee or an aggrieved employer, if you’re facing legal problems regarding workplace injuries, be sure to seek counsel with attorneys trained and experienced in workers’ compensation. Here’s some resources:

Workers compensation basics

Denial of benefits

Choosing an attorney

If Carl Kelly is lying about his mental health problems, he better not join Facebook and post “happy pictures.” Natalie Blanchard, a Quebec woman on long-term leave from a Canadian IBM office, was receiving payments after being diagnosed with depression. But the company’s insurer, Manulife, cut her off this fall, at least in part because “several pictures Blanchard posted on the popular social networking site, including ones showing her having a good time at a Chippendales bar show, at her birthday party and on a sun holiday,” according to a Nov. 21 report at CBC.com.

The idea is that the pix constitute “evidence that she is no longer depressed, Manulife said.” One insurance-industry blogger writes: “Manulife says it was just doing its job, sort of like a workers compensation firm would do when investigating an ‘injured’ worker who finds himself atop a surf board while collecting benefits for his injury.”

Mr. Kelly’s case is, in fact, a worker’s comp case–one that may be precedent setting, as described in a Nov. 22 report by the Anchorage Daily News with the hed, “Compensation case sets mental injury rule.” Here’s their lede: “A former prison guard at the Anchorage Jail who was threatened by a convicted murderer intoxicated on hair spray and armed with a sharpened pencil deserves workers’ compensation for mental injury, the Alaska Supreme Court has ruled. “Carl Kelly, 60, suffered psychological health problems, maybe even post-traumatic stress disorder, from the 1994 confrontation, the court said.”

Apparently, Kelly’s employer, the Alaskan corrections department, believes guards should expect to face hairspray-huffing inmates armed with handheld, No.2 punji sticks. But the state supreme court disagreed: “The state Department of Corrections had argued unsuccessfully that every prison guard expects a certain level of misbehavior from inmates and that Kelly’s experience in jail was no different from that of other guards. But Kelly argued successfully that what happened went beyond what he expected from the job and beyond what a reasonable person would expect from the job, according to the court’s decision last month.”

Kelly, “according to paperwork from the Alaska Workers’ Compensation Appeals Commission,” had served in the U.S. Navy, tried several jobs before signing on as a corrections officer in 1987, including truck driver  and air traffic controller–not exactly a history one associates with lack of either responsibility or mental stress.

Nevertheless, the conditions in the facility eventually wore him down, including having urine dumped on him, threats of physical violence and “knowing where you live,” according to testimony. In 1994 he had a run-in with an inmate who had threatened him before, one “Jacob Kochutin, [who was] serving 99 years for sexually assaulting, then murdering a 7-year-old boy on St. Paul Island in mid-1980s . . . .”

Assigned on solo-duty to a unit that held “inmates with mental disorders,” the unarmed Kelly encountered Kochutin, who was “was intoxicated on hair spray and confronted Kelly with the sharpened pencil, according to Kelly’s testimony. The prisoner said he was going to poke Kelly’s eyes, blinding him, then stab him to death. Kelly was too scared to call for help, which finally arrived after he didn’t answer calls on his radio, he testified.”

What happened afterward may be in the medical or court record, but the news account does not address it. But “[t]hree weeks later, Kelly checked into a hospital with high blood pressure and chest pain. A physician said he was suffering from significant anxiety about his safety at work and his safety outside of work. He prescribed Kelly anti-depressant and anti-anxiety medication. “A month later, Kelly filed for temporary workers’ compensation because of what he alleged was his mental injury caused by mental stress, a rare filing because most filings for workers’ compensation in Alaska stem from physical injuries.”

In the years in between, he’s worked only one year, and the case has taken this long to grind through the system, and there’s more legal proceedings in the works.

But if Kelly prevails, he “could recoup lost wages back to the early part of this decade, when his workers’ comp benefits ended and he last worked. He could look forward to salary compensation potentially as long as he lives.”

One note of caution, Mr. Kelly: Don’t post on social media any photos that can be mistaken for anything other than the appearance of shell-shocked terror.