AL - Court Denies Widower Benefits for Nursing Home Worker's Death
10/11/2024 |
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The Alabama Court of Civil Appeals upheld the denial of a widower’s claim for benefits for a nursing home worker’s death after her COVID-19 infection.
Rose Harrison worked for the Marion Regional Nursing Home.
Between March 1, 2020, and April 6, 2020, two Marion residents tested positive for COVID-19. A nurse who cared for the patients tested positive for COVID in March 2020.
Harrison also worked for Sunset Manor, which operated another nursing home, on two weekends in March 2020.
On March 21, 2020, Harrison reported she had possibly been exposed to COVID-19 at Sunset...
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OH - Public University Employee Can't Maintain Tort Suit for Campus Accident
10/11/2024 |
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An Ohio appellate court upheld the dismissal of a public university worker's civil suit against his employer for injuries from a fall on a campus walkway.
Case: Marzan v. University of Cincinnati, No. 24AP-203, 09/26/2024, published.
Facts and procedural history: Angel Marzan worked for the University of Cincinnati. He allegedly suffered injuries when he tripped and fell at work in September 2019.
Marzan filed a civil suit against the university, asserting that his fall was caused by its negligence in maintaining the walkway.
The university moved for summary judgment dismissing the act...
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WV - Worker Fails to Link Concussion Claim to Actions of Child Tapping Head
10/11/2024 |
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West Virginia’s Intermediate Court of Appeals upheld the denial of a school worker’s claim of injury from a child tapping her on the head.
Case: Hill v. Wyoming County Board of Education, No. 24-ICA-174, 10/01/2024, published.
Facts: Clisty Hill worked for the Wyoming County Board of Education. She filed a report of injury claiming a child had hit her on the back of the head on Jan. 3 and again on Jan. 4, 2023. Hill was diagnosed with a concussion.
Dr. Randall Short performed a physician’s review of Hill’s claim. He also reviewed video footage of a second-grader tapp...
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NY - Worker Gets Summary Judgment for Labor Law Claim Based on Painting Accident
10/11/2024 |
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A New York appellate court ruled that a worker was entitled to summary judgment for his injuries from a falling while painting a bathroom.
Case: Mosquera v. TF Cornerstone Inc., No. 23663/16, 09/26/2024, published.
Facts: Julio Mosquera allegedly suffered injuries while working on a construction project. He said he fell off the edge of a bathtub he stood on to paint the room's upper corners because the ladders provided to him did not fit inside the tub.
Procedural history: Mosquera filed a Labor Law Section 240(1) claim against TF Cornerstone Inc.
Section 240(1) imposes absol...
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Press - Miguel’s Jr. Embraces CRMBC's Collaborative Workers' Comp Approach
09/20/2024 |
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Javier Vasquez, CEO of Miguel's Restaurants
FRESNO, CA, UNITED STATES, September 19, 2024 -- California Restaurant Mutual Benefit Corporation (CRMBC) is pleased to announce that Miguel's Jr. Restaurants, a long-standing family-owned enterprise in Southern California, has joined its self-insured group (SIG). This strategic move reflects Miguel's Jr.'s commitment t...
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NATL. - Snyder: Five Ethical Guideposts for Negotiation Success
By Teddy Snyder
10/11/2024 |
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Despite a continuing plea for civility from pretty much every professional quarter, many parties come to mediation with a Rambo mentality. Keeping certain ethical guideposts in mind is a better way to efficiently settle.
Honesty
California lawyers are bound by the Rules of Professional Conduct. That includes Rule 4.1, which mandates truthfulness in statements to others: “In the course of representing a client, a lawyer shall not knowingly make a false statement of material fact or law to a third person.”
No person engaged in negotiation, whether or not they are a lawyer, sho...
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PA - House Passes Direct Deposit Bill, Senate Passes PTSD Bill
10/11/2024 |
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The Pennsylvania General Assembly passed a bill that would make direct deposit the default method for paying workers' compensation benefits, and the Senate signed off on a measure that would make it easier for first responders to receive benefits for post-traumatic stress disorder.
The state House of Representatives on Wednesday voted 202-0 to pass SB 1232, by Sen. Tracy Pennycuick, R-Berks, authorizing direct deposit of benefits.
The one-year bill would allow insurers and self-insured employers to offer direct deposit. After a year, they would be required to use direct deposit ...
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NATL. - WCRI: Medical Utilization Remains Down in Comp Post-Pandemic
10/11/2024 |
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Studies released Thursday by the Workers Compensation Research Institute found that utilization of medical services by injured workers has not rebounded to pre-pandemic levels in the majority of 17 states studied.
The 17 individual studies, addressing the percentage of claims receiving a particular medical service and the number of services provided, show that the industry “continues to see effects of the pandemic on 2022 claims with experience through March 2023,” said Sebastian Negrusa, vice president of research for WCRI, in a statement.
“Besides strained hospital capaci...
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NATL. - Enlyte Launches Physical Medicine Network
10/11/2024 |
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Enlyte on Thursday announced the launch of Apricus Physical Medicine, a network for rehabilitation services, including occupational therapy and physical therapy.
Enlyte said its specialty network brand will provide injured workers and payers with access to physical medicine services through a multidisciplinary specialty network. The program is integrated with bill review and data analytics programs. Case management and utilization review can also be integrated into Apricus.
Enlyte said the addition of physical medicine to the Apricus network enhances its ability to efficiently coordinate pat...
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LA - Res Judicata Does Not Bar Worker's Intentional Tort Claim Against Colleague
10/10/2024 |
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A Louisiana appellate court ruled that res judicata did not bar a school district employee’s intentional tort claim against a colleague even though she received a workers’ compensation settlement for her alleged injuries.
Elizabeth Hill worked for the East Baton Rouge Parish School Board at Broadmoor Middle School. Darcy Franklin was the school’s assistant principal of instruction.
On Feb. 3, 2012, Franklin and Hill disagreed with each other about a school policy and went to discuss it with the principal. While in the principal’s office, Franklin allegedly g...
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Press - Networks By Design announces access to our National PPO Network
09/20/2024 |
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September 20, 2024
Tracy, CA Networks By Design, a California based customized PPO and MPN network, has announced access to our National PPO network delivering a best-in-class provider network service program. According to Kevin Conley, Principal of Workers' Compensation and Group Health Services, Networks By Design is excited to offer our extensive experience in providing customized provider networks and services to national clients. Since 2010 we have been a recognized expert in providing client custom networks, which provides the best savings to each client based on geographic an...
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PA - Court Upholds Dismissal of Claim Against Sedgwick CEO
10/10/2024 |
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The Pennsylvania Superior Court upheld the dismissal of a medical provider’s claim for damages against an insurance company executive for the carrier’s alleged failure to pay for the treatment of workers’ compensation patients.
Case: Stempel v. North, No. 1503 EDA 2023, 09/24/2024, unpublished.
Facts and procedural history: Dave North is the president and chief executive officer of Sedgwick Insurance Co. Dr. Meredith Stempel is a licensed physician who treats workers’ compensation patients insured by Sedgwick. Mikhail Levitin is her office manager.
Stempel and Leviti...
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WV - Worker Gets No Referral for Evaluation of Noncompensable Condition
10/10/2024 |
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West Virginia’s Intermediate Court of Appeals upheld the denial of a referral to a neurosurgeon for evaluation of a condition that had not been accepted as compensable in a worker’s claim.
Case: Frush v. Macy’s Corporate Services Inc., No. 24-ICA-119, 10/01/2024, published.
Facts: Theresa Frush worked for Macy’s Corporate Services Inc. She allegedly suffered injuries in a fall at work in November 2022.
A claims administrator for the company's insurance carrier accepted liability for an unspecified sprain of the left wrist, strain of muscle and tendon of...
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NY - Defendant Gets Summary Judgment Dismissing Claims, Granting Cross-Claim
10/10/2024 |
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A New York appellate court ruled that a Labor Law defendant should have been granted summary judgment dismissing an injured worker’s claims against it and for its breach of contract cross-claim against homeowners.
Case: Chavarria v. Bruce Nagel & Partners Architects PC, No. 2022-08987, 09/25/2024, published.
Facts: David and Ellen Wasserman hired KDMAX to serve as the general contractor for their home renovation project. The Wassermans also hired Bruce Nagel & Partners Architects PC to provide certain architectural services.
The contract with BN&PA also stated th...
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LA - High Court: No Compensation for Jouster Injured at Renaissance Festival
10/10/2024 |
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The Louisiana Supreme Court declined to hear the appeal of a decision finding that a man injured while jousting was excluded from the state's workers' compensation system.
On Tuesday, a 6-1 majority on the high court denied a petition for writ of certiorari and agreed to let stand the decision of the Court of Appeal for the 1st Circuit of Louisiana in McKeane v. LA Renfest LLC.
John McKeane worked for War Horse Productions as a jouster and farmhand. War Horse contracted with LA Renfest LLC to present a jousting demonstration during the 2021 Louisiana Renaissance Festival in Hammond. ...
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ME - MEMIC Announces $18.7M Dividend
10/10/2024 |
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The board of directors for Maine-based workers’ compensation carrier MEMIC Group approved an $18.7 million dividend.
The dividend announced Wednesday represents about 11% of the premiums policyholders paid in 2021, the carrier said. About 17,000 policyholders are eligible to receive a dividend, which will be mailed in November.
MEMIC said the 2024 dividend brings its total policyholder distributions to $370 million since 1998.
MEMIC Group President and CEO Michael Bourque said the dividend reflects collective efforts to protect workers and return to gainful employment those ...
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CA - DWC Adopts Medicare Changes to Hospital, ASC Fee Schedule
10/10/2024 |
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The California Division of Workers' Compensation posted an order updating the hospital outpatient department and ambulatory surgical centers section of the Official Medical Fee Schedule.
The division in October posted an order adopting Medicare’s changes to its hospital and ASC fee schedule for the final quarter of the year. On Oct. 2, Medicare adopted additional changes to its fee schedule.
The division said the order adopts the October 2024 update of Addendum A and Addendum B of the CMS Medicare Hospital Outpatient Prospective Payment System.
The updated fee ...
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TX - DWC Adopts Research Agenda
10/10/2024 |
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The Texas Division of Workers' Compensation on Wednesday announced that it adopted the 2025 agenda for its Workers' Compensation Research and Evaluation Group.
The research group will study the feasibility and impact of adopting a more current version of the American Medical Association’s Guides to the Evaluation of Permanent Impairment.
Texas currently uses the fourth edition of the AMA guides. Twenty-seven states use more recent editions, with 13 using the fifth edition and 14 using the sixth.
The research group will also study medical costs and use of services in the state&...
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