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Injuries From a Fall While You Were Working in Washington

Have you been in an accident on the job? Have you suffered injuries from a fall while you were working in Washington?

Are you injuries from the fall while you were working in Washington going to cause you to miss time at work? Are you going to be disabled from these injuries for a long period of time? Where will you get the help that you need?

Washington workers’ compensation

Did you know that Washington was the first state in the United States to create a workers’ compensation program? The state of Washington is also unique in that employers in Washington cannot buy private workers’ compensation insurance.

In Washington, an employer has to buy workers’ compensation insurance from the Washington State Department of Labor & Industries. This state agency oversees and pays workers’ compensation benefits from an insurance pool that is known as the Washington State Fund.

An employer in Washington can choose to be self-insured if that employer meets certain state requirements. Your workers’ compensation rights and benefits are not different if your employer is self-insured. However, it is your employer who does your paperwork and pays for your workers’ compensation claim when your employer is self-insured.

Filing a claim

Do you know how to go about filing a Labor & Industries claim for your injuries from the fall? It is a simple matter.

You go to a doctor who handles Labor & Industries claims and tell the doctor that you suffered injuries from a fall while you were working. Then, both you and the doctor fill out a form that is called a Report of Industrial Injury or Occupational Disease (ROI).

Your doctor should file this report for you with the Department of Labor & Industries if it is a state fund case or with your employer in self-insured cases. If you are not sure whether your case is state fund or self insured, have the report sent to Labor & Industries and they will figure it out for you. The Department of Labor & Industries has to pay for your first visit to the doctor.

One thing that you need to be aware of is that your employer may try to suppress your Labor & Industries claim. This can be done in several different ways. These include:

Inducing you to treat your injury that happened while you were working as if it occurred off the job
Inducing you to not report your injuries
Threatening to fire you if you file a claim
Telling you that you do not need to file a claim, that they will take care of it
Trying to get you to put your accident on your health insurance
Telling you that if you file a claim you will cause all of your co-workers to lose their incentive bonus for keeping work place accidents down.

If your employer is trying to suppress your Department of Labor & Industries claim or your claim has been denied by this agency, you need the assistance of one of these attorneys. These attorneys know workers’ compensation laws in Washington and they will work hard to see that you are given all of the workers’ compensation benefits that are rightfully yours.

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Couple has to sue multiple defendants to get workers’ comp to reimburse Medicare

Florida work group begins effort to corral ‘shell-company’ scheme


Even though ultimately we strive here to provide equal access to all manners of workers’ comp issues, sometimes we just can’t help taking sides.

In other words, our basic premise is that injured workers need to be treated fairly.

That being said, we also realize that some workers try to game the system.

Shame on such workers, for they bring undue scrutiny and added costs to the system–which eventually mounts up societal costs not only in terms of the worker’s attempted scam but also allows critics to label the barrel rotten because of a few apples.

Another factor is the worker’s comp insurance carrier: They have their games, too.

As do medical providers–and sometimes even the workers’ comp officials, as has been so publicly revealed in Illinois.

Medicare paid $550,000 for worker stricken with cancer, but workers’ comp should have paid

An Ohio case shows just how far some people have to go to get justice. An Aug. 17 story at describes a couple’s lawsuit against three defendants over workplace-induced cancer, several surgeries and workers’ comp benefits to repay Medicare–which shelled out over half a million dollars for James Cliff’s treatment.

Apparently Cliff’s wife Delores speaks for him because he no longer has a larynx.

“He has no voice box,” she was quoted in the story. “They cut him from ear to ear.”

Employee at claims company altered ironworker’s documents

They filed the Monday suit in Hamilton County Common Pleas Court against her ironworker husband’s former employer, Fenton Rigging & Contracting of Pleasant Ridge; Roselawn’s Matrix Claims Management, the company they say handled workers’ comp claims for Fenton; and Crystal Nguyen, also known as Crystal Sikes, who was convicted of altering Cliff’s workers’ comp documents.

A call to Fenton was returned by an attorney who declined comment. A call to Matrix wasn’t returned. Nguyen, who worked for Matrix, couldn’t be reached.

Delores Cliff said her husband was an ironworker for 37 years and worked for Fenton at several local sites where he was exposed to chemicals and other contaminants that resulted in him contracting throat cancer requiring several surgeries.

Case was won in June 2010

At first, Medicare paid for treatments and surgeries. Later Medicare “required the Cliffs to file a workers’ comp claim because he contracted cancer due to his job. Cincinnati attorney Harry McIlwain Jr. helped the Cliffs win their workers’ comp case in June 2010.”

The rigging company had hired Matrix Claims Management to administer its workers’ comp claims. Incredibly, the Matrix employee named as co-defendant attempted to forge documents after missing a deadline to appeal the workers’ comp ruling.

Nguyen, 29, initially was charged with forgery, tampering with records and telecommunications fraud. She cut and pasted part of a different person’s workers’ comp claim to Cliff’s claim to make it appear as if she’s appealed the decision on time, a spokesman for the Ohio Attorney General’s Office said Wednesday.

In March, Nguyen accepted a plea deal. She pleaded no contest to and was convicted of telecommunications fraud for faxing the altered documents. In exchange, the other two charges were dismissed. She was placed on probation for two years by Common Pleas Court Judge Beth Myers.

The Cliffs have fought since they won the workers’ comp case to get bill collectors seeking reimbursement for his medical bills to leave them alone.

Maybe punitive damages will allow couple to stay in home

Beyond the husband’s condition and the medical bills, says the story, the couple also care for a daughter with special needs as well as two grandchildren.  Plus, they fear losing their home.

The suit aims to force the co-defendants to reimburse Medicare and pay punitive damages.

State CFO leads effort to stop abuse of Florida system

Workers’ comp fraud is so bad in Florida that CFO Jeff Atwater is leading a task force to end the practice of using “shell companies” in a workers’ comp scheme that seems to be flourishing in the construction industry. The group includes law enforcement, state officials and trade groups.

According to an Aug. 30 piece at Insurance Journal, “officials held the first meeting of a working group to investigate the role of check cashing companies with an eye on developing legislative recommendations to be considered year.

“Atwater said the various check cashing schemes are becoming endemic around the state and hurting both employers and injured workers.”

An Aug. 26 account from The News Service of Florida explains:

Shell companies enable bypassing of legit policies

The schemes center on people who create shell companies that are used to buy minimal workers-compensation insurance policies. With the policies in hand, operators of the shell companies then hook up with construction sub-contractors who need workers-compensation insurance to get jobs — but don’t want to buy it.

The shell-company policies are used to get what are known as “certificates of insurance,” which are sent to general contractors as proof of coverage. The sub-contractors are purported to be employees of the shell companies, which allows the sub-contractors to get the jobs.

When construction jobs are finished, general contractors write checks to the shell companies. Those checks are taken to money-services businesses, with the sub-contractors getting paid in cash and the operators of the shell companies taking a cut for providing the insurance certificates.

Authorities said Thursday that operators of money-services businesses also are often part of the scheme, as the shell companies typically provide the certificates to numerous sub-contractors. The businesses get a cut for cashing large numbers of checks and going along with the fraud.

Authorities want to prevent premium hikes on legitimate operators as well as head off confusion over payments or treatment for injured workers.

We can help you find an attorney

Frequently enough, a worker’s compensation case may be so complex as to demand legal representation. However, sometimes what seems like a cut-and-dried situation to an injured worker may result in a smaller award than envisioned–or even a denial. 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

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

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 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, “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 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

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.

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.


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, 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.


Are you covered by Workman’s Compensation?

Read here for an introduction.

Execs, managers charged in variety of schemes to reduce or deny benefits; DA says incentive program, bonuses partly to blame in CA case from ’06

As we’ve mentioned before, the stereotype of the scheming worker is not a myth. Insurance investigators frequently bust idjits and ne’er-do-wells who fake injuries and file false claims–only to be caught in videos performing activities too vigorous for their supposed injuries–curiously, some get caught when they themselves post the damning material online.

Nevertheless, judging from news stories, anyway, it seems the reverse is more often true. That is, it seems some employers just can’t stop themselves from trying to game the system by misreporting employee head-counts, denying or discouraging treatment or delaying the process any number of ways. We’ve covered some such actions here and here.

Well, here’s some more.

After all the horrible news about catastrophes in various mines through the years, wouldn’t you think a mine operator would be one of the last to get charged with safety or workers comp violations?

Obviously, the most recent case to grab headlines is the explosion in West Virginia, reported on April 6 in The New York Times and commented on the same day in an NYT editorial. No telling what sorts of legal actions and lawsuits may arise from such a well publicized tragedy.

Hiding mine employees in ‘trucking company’

But what about the smaller, “less volatile” cases?  For instance, According to an April 5 post at, Pamela Allen, “listed as the sole officer of Sly Branch Energy, an underground coal-mining operation” in Kentucky “has been indicted on charges stemming from an alleged scheme to avoid paying workers compensation insurance.

“A federal grand jury in Lexington has charged Pamela Allen with five counts of mail fraud.”

The allegations center around a fake trucking company, apparently created on paper in order to show mine employees as trucking company employees instead.

“The indictment charges that by hiding employees this way she was able to pay less than she should have for workers compensation insurance.”

Former Smurfit-Stone managers plead guilty

In California, two brainiac, ex-managers for Smurfit-Stone have pleaded guilty to charges involving a slapdash plot to dodge the workers’ comp system by allegedly, for instance, steering  injured workers to a physician’s assistant instead of using the proper medical channels; attempting to fudge leave time; and denying time off to recuperate.

If  it’s the same large company that uses the Smurfit-Stone name throughout North America and a couple of overseas locations, the problem may trace to the company’s pursuit for an exemplary safety record.

News accounts say the employees were managers at Smurfit-Stone’s Salinas, CA, factory, and the Smurfit-Stone Web site indicates that it does have a facility there.

The Insurance & Financial Advisor Web news site posted April 5 that subsequent to an investigation begun in 2006, “[t]wo former managers of a California-based container company pleaded guilty to conspiring to deny injured employees workers’ compensation benefits.

“David Lawrence Polk, 53,  . . .[and] Douglas Minoru Tateoka, 61, both former managers of the Smurfit-Stone Container Corp. plant in Salinas, Calif., recently entered the pleas, according to the California Department of Insurance.”

Between the IFA’s account and a late-March report in the The Herald of  Monterey County,  the picture that emerges is a twisted take on Dumb and Dumber, but instead of unintentionally intercepting a load of ransom money, the principals were intentionally misrouting injured workers away from bona fide medical treatment–and from the injury-reporting system.

Workers steered to physicians assistant

The local DA’s office was contacted in October 2006 by a pair of Smurfit-Stone employees, says The Herald, complaining that workers were discouraged from filing workers’ compensation claims at the Salinas plant.

“The original complaints . . . [reported] that workers were taken to the company doctor, who actually was a physician’s assistant.”

The IFA report says that Polk and Tateoka even managed to insert themselves into the examination area where they tried “to influence the diagnosis and treatment of injuries.

“Polk and Tateoka allegedly concealed workers’ injuries, tried to prevent leave time from being medically prescribed and denied injured workers time off to recover, officials said.”

Effort to reduce reporting injuries

Furthermore, in an apparent effort to keep from reporting time lost due to injuries, the affected employees were reassigned to answering phones, shown training videos, and in some cases relegated to “even remaining in their vehicles in the parking lot . . . .”

In 2007, officials from the DA’s office and state insurance regulators arrived with a search warrant and found that workers were being handled outside the system–so much so, according to The Herald, that “[o]ne employee was given a prescription written in the manager’s name, with the understanding the medication could be given to other employees at the manager’s discretion without medical consultation.”

Perhaps the  larger issue is whether Polk and Tateoka are competent managers who were pressured by a too-stringent company policy, or were they simply a pair of goofballs who overzealously interpreted a strong-but-good-faith effort by the company?

The prosecutor is on the record for the company’s sharing blame, according to The Herald: “Part of the motivation, said the DA, was an incentive program that paid bonuses to managers and other employees if the number of reported injuries was minimized.”

Certainly, we’ve such issues before, which we mentioned in our “Report Cards” post in September 2009, describing the concerns of Colorado legislators over reports of bonuses for state agency workers who denied workers comp claims.

And there’s little doubt that Smurfit-Stone with this homepage takes pride in its claims to safety. On the Web site’s “About our company” page, this is third paragraph: “When it comes to our people, safety is at the core of our operating culture. We are proud to have been recognized as the industry’s safety leader every year since 2001.”

Then, there’s a separate “Corporate Safety” page, with six paragraphs about goals, meeting objectives and so forth, including this: “We are proud to have led the industry in safety since 2001, and our performance continues to improve year after year. Our 2008 corporate safety goal was met by achieving a recordable case rate (RCR) of 0.94, making 2008 Smurfit-Stone’s safest year yet.”

Below a link to Pandemic Preparedness (with a specific bullet point admonishing workers to “stay at home” rather than coming to work sick) are three paragraphs that emphasize the RCR highlights of different divisions.

Unanswered e-mails

But what role the case that resulted in these guilty pleas played in the company’s emphasis on safety–if any–is unclear. Two separate e-mails requesting clarification from media relations personnel remained unanswered at post time.

According to The Herald and IFA, Polk and Tateoka are set to be sentenced May 20.