LA - Court Finds Worker's Need for Shoulder Surgery Unrelated to Prior Work Accident
11/20/2024 | 0
A Louisiana appellate court ruled that a worker failed to link her need for shoulder surgery to a prior work accident.
Sanjanette Rixner worked for Jefferson Parish Hospital Service District #2. She allegedly suffered injuries to her neck and arm while bathing an obese patient in December 2012.
The workers’ compensation court found that Rixner’s injuries were compensable.
In January 2022, Rixner sought reimbursement for medical expenses incurred for the left shoulder surgery she underwent in 2021, as well as penalties and attorney fees.
The workers’ compensation court ren...
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A New York appellate court upheld a determination that a transit worker did not suffer a neck injury from an on-the-job accident.
Case: Matter of Daniels v. New York City Transit Authority, No. CV-23-0766, 11/07/2024, published.
Facts: Mary Daniels was a train conductor for the New York City Transit Authority. She filed a workers’ compensation claim for alleged injuries to her right shoulder, right elbow and right hand from a March 2022 accident.
Procedural history: A workers’ compensation law judge established a claim for injuries to Daniels' right shoulder and right elbow ...
A New York appellate court upheld a determination that a factory worker failed to link his COVID-19 infection to his job.
Case: Matter of Herrera v. American Badge Inc., No. CV-23-0928, 11/07/2024, published.
Facts: Patricio Herrera worked for American Badge Inc. in a factory.
According to Herrera and his treating physician, Herrera began experiencing symptoms of COVID-19 on April 10, 2020. He last worked on April 17, 2020, and he tested positive for COVID on April 22, 2020.
Procedural history: A workers’ compensation law judge established a claim for Herrera’s infection b...
The West Virginia Supreme Court upheld the denial of a widow’s claim for death benefits, finding occupational pneumoconiosis was not a material contributing cause of her husband’s death.
Case: Harris v. Pine Ridge Coal Co., No. 23-615, 10/30/2024, published.
Facts: Carl Harris worked for Pine Ridge Coal Co. He filed several workers’ compensation claims between 1985 and 2002 after he was diagnosed with occupational pneumoconiosis. Harris received multiple permanent partial disability awards totaling 30%.
Harris was also diagnosed with several other health conditions, includ...
The consumption of illicit substances, such as alcohol, marijuana and prescription narcotics, before or during work hours is on the rise among American workers, thus giving rise to more workers’ compensation claims involving the intoxication defense.
California has long recognized that illicit drug and alcohol use on the job poses an increased risk of industrial injuries. Intoxication is an affirmative defense to compensability. Per LC 3600(a)(4), an injury "is not compensable when the injury is caused by the intoxication, by alcohol or the unlawful use of a cont...
New York lawmakers finally sent the governor a bill that would increase the threshold used to identify medical procedures needing prior approval.
Senate Bill 6929 was delivered to the governor's desk Friday. The bill, by Sen. Nathalia Fernandez, D-Bronx, would raise the limit for treatment that can be provided without prior approval to $1,500 from $1,000.
The bill would also clarify that medical treatment guidelines are only a list of treatments that do not require carrier approval and that procedures can't be summarily denied because they're not on the list.
"Based on...
With the lack of federal rules to protect workers from heat, New Jersey lawmakers are proposing that the state's Occupational Safety and Health Administration adopt and enforce its own heat injury and illness prevention rules.
Assembly Bill 5022 and identical companion measure Senate Bill 3884 would order the commissioner of the Labor and Workforce Department to adopt rules establishing a heat stress standard.
Until the commissioner adopts heat safety rules, the bills would define excessive heat to be a heat index above 85 degrees for most jobs and a lower threshold of 80 degrees when pe...
Although the formula for calculating temporary total disability benefits in New York is consistent with other large states and its neighbors, the actual maximum benefit in New York is lower than all peer states except New Jersey, according to a new report.
Injured workers in New York are eligible for benefits of up to two-thirds of their average weekly wage for the 52 weeks before the injury.
States including California, Florida, Illinois, Pennsylvania and Vermont all set the benefit rate at two-thirds of the injured worker's average weekly wage. Max benefits in Connecticut are capped at...
The Texas Division of Workers' Compensation updated its rules governing pharmaceutical benefits.
The division said the final rules it adopted removed obsolete provisions and updated references and language to be consistent with other regulations.
"When the rules were originally adopted, they included transition provisions to move workers’ compensation to a closed formulary system," the division said. "Those transition provisions are no longer necessary, so the amendments remove them. The changes also include nonsubstantive editorial and formatting updates for plain l...
A New York appellate court upheld the denial of a widow’s claim for benefits for a 41-year-old bartender’s fatal heart attack.
Joseph Rizzo worked for The Springut Group Inc. as a bartender.
Between May 10 and May 18, 2018, Rizzo worked an office job from 7 a.m. until 2 p.m. After that, he tended bar at the Lilac Festival for Springut until about 11 p.m.
On May 17, 2018, Rizzo complained about pain in his left shoulder and left side of his chest. He attributed the symptoms to his work at the festival and a possible pinched nerve.
After Rizzo finished his shift at the festival o...
An Ohio appellate court upheld the summary dismissal of a worker’s claims against her employer after she was terminated for fighting with a colleague.
Case: Smith v. Lincoln Electric Co., No. 113340, 10/31/2024, published.
Facts: Chanel Smith worked for Lincoln Electric Co. On Aug. 11, 2022, Smith posted a picture of herself and an ex-boyfriend to Instagram. The following day, LEC employee Jhasmine Peeler confronted Smith in the women’s locker room regarding the picture because Smith’s ex-boyfriend was Peeler’s current boyfriend.
After a verbal exchange, the two enga...
A Louisiana appellate court overturned a judgment in favor of an injured worker that made substantive changes to a prior award and vacated the decision because it contained calculation errors.
Case: Batiste v. Minerals Technology Inc., No. 24-207, 10/30/2024, published.
Facts and procedural history: Timothy Batiste worked for Minerals Technology Inc. He injured his back at work in April 2017.
In January 2020, a workers’ compensation judge ruled that Batiste was entitled to supplemental earning benefits from April 2017 onward and medical benefits. The judge als...
The West Virginia Supreme Court upheld the denial of a worker’s request for an independent medical evaluation because he failed to show he was at maximum medical improvement.
Case: Johnson v. Kanawha Stone Co. Inc., No. 23-460, 10/31/2024, published.
Facts and procedural history: Lloyd Johnson worked for Kanawha Stone Co. Inc. He slipped and fell at work in April 2005, injuring his back and right ankle.
Johnson injured his back again in 2011 when he fell off a stool.
Dr. Victoria Langa evaluated Johnson in August 2015 and assigned a 4% impairment rating for the 2005 injury and 4...
Florida Insurance Commissioner Mike Yaworsky issued a final order approving an average 1% rate decrease for policies incepting on or after Jan. 1.
“I’m pleased to announce that Florida businesses will see a further reduction in workers’ compensation rates for the eighth consecutive year," Yaworsky said in a statement. "Following historic legislative reforms in this space, it is abundantly clear that the workers’ compensation market in Florida is stable and competitive. A further reduction in workers' compensation rates will assist new and existing busines...
The California Workers' Compensation Institute reported that the Official Medical Fee Schedule conversion factor as a percentage of Medicare for professional services increased a little more than 17% from 2017 to 2024.
Each section of the fee schedule uses distinct rules to calculate payment and different inflation factors to update reimbursement rates. For example, OMFS sections for inpatient services, outpatient and ambulatory surgery centers, ambulance services and durable medical equipment use Medicare's inflationary factors, CWCI said. The cumulative percentage increase in the OM...
Claims investigation and medical management firm Ethos is hosting a free webinar to explore the role of artificial intelligence in the claims process.
The program will review the latest AI tools using pattern recognition and automation to enhance efficiency and accuracy. The webinar will also discuss how to leverage AI to detect suspicious claims and how AI can be used to handle complex cases.
"We’ll explore how AI tools are reshaping claims handling, fraud detection and risk assessment to stay one step ahead of scammers, from spotting suspicious patterns to automating the to...
