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OH - Supreme Court Says Worker Who Resigned Didn't Lose Entitlement to TTD

11/28/2022 | 0

The Ohio Supreme Court ruled that a worker’s voluntary abandonment of her time-of-injury position to accept a new job does not bar her from receiving temporary total disability benefits for the time she was unable to work because of the injury. Lori Pratt worked for Ohio State University for nearly 10 years. On June 20, 2017, she gave the university a letter of resignation, stating that her last day of work would be July 5. However, on June 24, she sustained injuries while at work. The university, which was self-insured, accepted liability. Pratt underwent surgery on June 27, 2017, an... Read More

LA - Court Tosses $1.4M Verdict, Finding Judge Erred in Classifying Worker as Seaman

11/28/2022 | 0

A Louisiana appellate court overturned a $1.4 million award to an injured shipyard worker, finding he was not a seaman covered by the Jones Act. Case: Jackson v. Chem Carriers LLC, No. 2022 CA 0043, 11/04/2022, published. Facts: The Plaquemine Point Shipyard LLC is a floating ship repair and cleaning facility attached to the east bank of the Mississippi River. The PPS cleaning plant prepares cargo barges for load preparation, and the repair facility repairs barges as customers need. Clarence Jackson worked for PPS as a welding foreman. He suffered injuries in a trip-and-fall at work. Proce... Read More

NY - Defendant Gets Summary Judgment Dismissing Worker's Claims

11/28/2022 | 0

A New York appellate court ruled that a defendant in a Labor Law action should have been granted summary judgment dismissing the injured worker’s complaint. Case: Smith v. MDA Consulting Engineers PLLC, No. 823 CA 22-00548, 11/10/2022, published. Facts: Nicholas Smith suffered injuries after falling off of a foundation wall while erecting a salt storage shed for the Town of Mansfield. MDA Consulting Engineers PLLC had contracted with the town to assist in preparing a bid package, solicit bids, assist the town in obtaining grant money from the state and review the bids for the pro... Read More

NY - Carrier's Delay in Challenging Coverage for Accident Results in Forfeiture of Argument

11/28/2022 | 0

A New York appellate court ruled that an insurance carrier that waited until after a worker’s claim was established to dispute coverage was barred from maintaining its position that its policy did not cover the site of the injury. Case: Matter of Trombino v. FMB Inc., No. 532194, 11/10/2022, published. Facts and procedural history: Marc Trombino filed a workers’ compensation claim asserting he had work-related lung conditions, including silicosis and chronic obstructive pulmonary disease from his employment as an ironworker for FMB Inc. The Workers' Compensation Board i... Read More

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Press - 2022 Comp Laude® Award Winners Revealed in Huntington Beach

10/05/2022 | 0

Huntington Beach, CA - October 5, 2022: The 2022 Comp Laude® Award recipients were revealed CompLaude Award WinnersTuesday evening, October 4, in an in-person ceremony at the Paséa Hotel and Spa in Huntington Beach, CA.  Yvonne Guibert and Rafael Gonzalez, Esq. co-hosted the awards ceremony that took place on Paséa's Ocean Lawn with the sun setting over the Huntington Beach Pier. Yvonne Guibert, vice pre... Read More

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Industry Insights

NATL. - Paduda: Dramatic Changes

By Joe Paduda
11/28/2022 | 0

Work comp pharmacy has changed dramatically in the last 18 years. Costs are much lower, brand drug usage has fallen off a cliff, pharmacy benefits managers are by far the dominant delivery channel, and there aren’t any real problems these days. At least that’s what I’ve gleaned from doing 15 surveys of work comp execs on their perspectives and quantitative measures related to pharmacy. Way back when: Generic fill rates were around 70%. generic efficiency was around 90%. Cost inflation was in the mid-to-high single digits. Expect that we’ll h... Read More

WA - Contractor Accused of Taking $127K in Benefits While Running Company

11/28/2022 | 0

The Washington State Department of Labor and Industries announced that a contractor in Clark County was charged with stealing $127,000 in workers’ compensation benefits for allegedly working at his own construction business while claiming he was too injured to work. Daniel J. Lesieur, 54, pleaded not guilty to one count of first-degree theft in Clark County Superior Court on Tuesday. Lesieur injured his left shoulder shoveling asphalt while working on a road crew for several months in 2018. Providers determined he was unable to resume similar work, based partly on his statements. Their... Read More

CA - Assembly Speaker Reappoints CHSWC Commissioner Shelley Kessler

11/28/2022 | 0

The Commission on Health and Safety and Workers’ Compensation announced that California Assembly Speaker Anthony Rendon reappointed Shelley Kessler to represent labor on the state’s advisory panel for a term that expires Dec. 31, 2025. Kessler is a former executive secretary-treasurer of the San Mateo County Central Labor Council, where she worked for 31 years. During that time, she was also a vice president of the California State Labor Federation and a member of the International Association of Machinists and Aerospace Workers. Her experience in working on the floor at Gene... Read More

NATL. - DOL Official Identifies Three 'Concerning' Comp Trends

11/28/2022 | 0

Workers misclassified as independent contractors, reductions in benefits, and states looking to make workers' compensation protections optional for employers are three “troubling” trends for the insurance industry, a U.S. Department of Labor official wrote in a recent blog post on the agency’s website. Christopher Godfrey, director of the DOL’s Office of Workers’ Compensation Programs and a member of the Study Panel on Workers’ Compensation Data at the National Academy of Social Insurance, wrote that the number of U.S. workers covered by workers' co... Read More

NATL. - N.J. Most Expensive State for Comp; Wyoming Jumps to Top 10 in Latest DCBS Study

11/23/2022 | 0

New Jersey maintained its spot as the most expensive state for purchasing workers’ compensation coverage in the latest biennial rate ranking by the Oregon Department of Consumer and Business Services. And while the top half of the list remains populated by usual suspects including California, New York and Hawaii, Wyoming came barreling into the top 10 following a more than 29% increase in average costs in 2022. Average premiums of $2.44 per $100 of payroll in New Jersey were 192% of the study median — $1.27 per $100 of payroll set in Pennsylvania. New Jersey topped the last study... Read More

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Press - Athens Administrators Names New Sales Director

10/12/2022 | 0

CONCORD, CA Athens Administrators, a recognized leader in third-party claims administration services, welcomes Workers Compensation veteran Andrea Contreras as their new Director of Sales for Northern California. Andrea joins Athens with over 13 years of Worker Compensation experience. She brings a strong understanding of the nuances within workers compensation and a multifaceted approach to the complex landscapes of the industry. Andrea joins Athens from a brokerage agency where she excelled as an advocate for her clients; facilitating relationships with carriers, TPAs and vendo... Read More

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DC - High Court Upholds Denial of Nurse's Claim of Back Injury

11/23/2022 | 0

The District of Columbia Court of Appeals upheld the denial of a nurse’s claim for benefits, finding her ongoing complaints were unrelated to an on-the-job back injury. Case: Coder v. DOES, No. 21-AA-0190, 11/03/2022, published. Facts: Jeanne Coder injured her lower back during her employment as a clinical nurse in April 2018. She sought treatment from Dr. Malady Santhosh Kodgi, a pain management specialist. Kodgi diagnosed Coder with low back pain with radiculopathy, which was attributed to degenerative disc disease, and possible nerve root irritation caused by a Tarlov'... Read More

SD - Report: Woman Appeals Denial of COVID-19 Death Claim

11/23/2022 | 0

A South Dakota woman is appealing an administrative decision denying her claim for workers’ compensation death benefits after her husband died from COVID-19 he contracted while working for Smithfield Foods Inc., according to a report by the Sioux Falls Argus Leader. Attorneys for Karen Franken on Monday argued that Craig Franken’s death in April 2020 was compensable because he died from COVID-19 that he contracted at work. "This was a hotbed of Smithfield's making and created this increased risk of hazardous exposure and infection," Franken’s attorney, Br... Read More

MS - Worker's Claim Over Alleged Mishandling of Surgery Request Time-Barred

11/23/2022 | 0

The Mississippi Court of Appeals upheld the dismissal of a quadriplegic worker’s suit against an entity that had been involved in the allegedly delayed review of his doctor’s request for surgery. Case: Keys v. Rehabilitation Inc., No. 2021-CA-01338-COA, 11/01/2022, published. Facts: Darryl Keys was injured while working as an aircraft mechanic for the Mississippi Military Department in February 2017. After his accident, he was referred to Dr. Richard Clatterbuck, a neurosurgeon who previously had treated him for spinal issues. In July 2017, Clatterbuck told Keys that he urgentl... Read More

NY - Court Revives Welder's Claim Against Property Owner for Slip-and-Fall Accident

11/23/2022 | 0

A New York appellate court revived a welder’s Labor Law claim against a property owner for her injuries from falling while moving a scaffold. Case: Musse v. Triborough Bridge and Tunnel Authority, No. 158546/15, 11/03/2022, published. Facts: The Port Authority of New York and New Jersey owns the Brooklyn Marine Terminal and leased a portion of the space to Red Hook Container Terminal LLC. Tutor Perini Corp. hired RHCT to offload and store material for a construction project Tutor Perini was undertaking at the Verrazzano Narrows Bridge. The bridge is owned by the Triborough Bridge and ... Read More

NY - Worker Struck by Gang Box Lid Gets Partial Summary Judgment on Labor Law Claim

11/23/2022 | 0

A New York appellate court granted partial summary judgment to a worker on his Labor Law claim for his injuries from being struck by a gang box lid. Case: Cotroneo v. Van Wagner Sign Erectors LLC, No. 162038/15 595393/16 595504/19 596052/20, 11/03/2022, published. Facts: Cosmo Cotroneo suffered injuries while working at a constriction site when a gang box lid fell on him. Procedural history: Cotroneo filed suit against various defendants, asserting claims for violation of the Labor Law. He then loved for summary judgment as to liability on his Section 240(1) and Section 241(6) claims. Sect... Read More

CA - DWC Posts Additional Adjustments to Hospital, ASC Fee Schedule

11/23/2022 | 0

The California Division of Workers’ Compensation announced additional changes to the Hospital Outpatient Departments and Ambulatory Surgical Centers section of the Official Medical Fee Schedule, based on revisions made by Medicare. The division in October announced it was adopting Medicare’s quarterly changes to the hospital and ASC section of the fee schedule. The division then adopted more changes that the Centers for Medicare and Medicaid Services adopted in the middle of October. CMS, for a third time, revised fee schedule documents on Nov. 14. The DWC’s latest order a... Read More

NATL. - WCRI Webinar to Cover Behavioral Health Care in Comp

11/23/2022 | 0

The Workers Compensation Research Institute will host a free 30-minute webinar on Dec. 15 to discuss its recent study, “A Primer on Behavioral Health Care in Workers’ Compensation.” The report combines stakeholder perspectives with information from treatment guidelines and medical literature to try to form a common understanding about behavioral health in workers’ compensation. “Workers’ compensation stakeholders recognize that unaddressed behavioral health issues might delay a worker’s recovery and return to work and increase medical costs,&rdqu... Read More