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CA - Commissioner Rejects Experience Rating COVID-19 Claims

06/30/2022 | 0

California Insurance Commissioner Ricardo Lara rejected the recommendation from an agency attorney that he approve a request from the Workers’ Compensation Insurance Rating Bureau to start experience rating COVID-19 claims. Lara on Tuesday adopted all classification and payroll changes the WCIRB recommended in its annual regulatory filing but declined to adopt the proposal to use COVID-19 claims filed on or after Sept. 1 when calculating employers’ experience ratings. “After weighing and considering the evidence and arguments, I conclude it is unreasonable to make such ... Read More

MS - Worker Fails to Prove Permanent Disability, Entitlement to Additional Benefits, Treatment

06/30/2022 | 0

The Mississippi Court of Appeals ruled that a worker failed to prove he suffered a permanent disability from a fall and that he was not entitled to addition temporary disability benefits or treatment. Case: Duren v. Effex Management Solutions LLC, No. 2021-WC-00337-COA, 06/07/2022, published. Facts: J.W. Duren worked as a general laborer for Effex Management Solutions LLC, a temporary staffing agency. Effex placed Duren at Luvata, a manufacturing company. Duren fell while working for Luvata, injuring his back. A magnetic resonance image revealed a disc herniation at L3-L4 and L4-L5. Dr. Gr... Read More

TX - Trial Court Properly Confirms Arbitrator's Finding of Untimely Claim

06/30/2022 | 0

A Texas appellate court upheld a decision that a worker’s negligence claim against his nonsubscribing employer was time-barred. Case: Vargas v. Rigid Global Buildings LLC, No. 14-20-00309-CV, 06/28/2022, published. Facts: Antonio Vargas worked for Rigid Global Buildings LLC. Rigid was not a subscriber to the state Workers’ Compensation Act. As a condition of his employment with Rigid, Vargas signed an arbitration agreement in May 2017. The agreement provided that all claims related to his employment with Rigid, except for any benefit claims under the company's occupational i... Read More

PA - Court Says IRE Physician Erred in Evaluating Only Accepted Conditions of Claim

06/30/2022 | 0

The Commonwealth Court of Pennsylvania reinstated a worker’s total disability benefits, finding an impairment rating evaluator had not been limited to assigning a disability rating only for the accepted work-related injuries. Case: Sicilia v. API Roofers Advantage Program (WCAB), No. 747 C.D. 2021, 06/07/2022, published. Facts and procedural history: Vincent Sicilia suffered injuries in 1999 when he fell from a ladder while at work. His employer accepted liability for a lumbar strain and a left knee contusion. Sicilia later petitioned to expand the scope of the accepted work-related i... Read More

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Press - ALC Claims Collaborations names Dalene Bartholomew Chief Operating Officer

06/28/2022 | 0

ALC Claims Collaborations announced today that Dalene Bartholomew is joining the company as chief operating officer (COO). Dalene Bartholomew brings a 25-year record of success in the insurance industry including expertise in workers' compensation consultation, fraud abatement and investigation strategies, cost-mitigation solutions, vendor management programs, and creation of strategic business partnerships. She is a recognized speaker, author, expert witness, fraud regulatory compliance expert, and volunteers on several boards.  As ALC's COO, Dalene is responsible for oper... Read More

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Industry Insights

TN - Phillips: Self-Represented Litigants: Look at the Rules

By Judge Allen Phillips
06/30/2022 | 0

The right to self-representation has been part of American jurisprudence since the beginnings of our nation. Indeed, the Judiciary Act of 1789 provided that “in all the courts of the United States, the parties may plead and manage their own causes personally or by the assistance of counsel.” A few years later, the U.S. Supreme Court confirmed that “[n]atural persons may appear in court, either by themselves or by their attorney,” in Osborn v. Bank of the United States. The Supreme Court’s language from almost 200 years ago mirrors the rules of the ... Read More

NY - Court Overturns Summary Judgment Against Worker

06/30/2022 | 0

A New York appellate court overturned a grant of summary judgment to an employer in a Labor Law claim for a pallet jack accident and granted summary judgment for the worker. Case: Schoendorf v. 589 Fifth TIC I LLC, No. 158404/17, 06/02/2022, published. Facts: Richard Schoendorf was injured as he was attempting to move a 400-pound elevator platform from the front of a flatbed truck to the tailgate. The platform, which was about 7 feet long, rested on a pallet jack that was too small to allow the platform to rest properly on it, causing it to dip and touch the flatbed. As Schoendorf... Read More

NY - Worker Struck by Beam Gets Partial Summary Judgment in Labor Law Action

06/30/2022 | 0

A New York appellate court ruled that a worker was entitled only to partial summary judgment on his Labor Law claim for his injuries from being struck by a beam. Case: Zherka v. Hudson Meridian Construction Group LLC, No. 27365/18, 06/07/2022, published. Facts: Ilir Zherka suffered injuries while working on a construction project when a beam fell on him. Hudson Meridian Construction Group was the general contractor for the project. Procedural history: Zherka filed suit against Hudson, asserting claims for negligence and violations of the Labor Law. Bronx County Supreme Court Justice Lucin... Read More

CA - LAPD Officer Accused of Forgery

06/30/2022 | 0

The Los Angeles Police Department announced that it arrested a 12-year veteran officer suspected of forging a doctor’s notice to receive workers’ compensation medical benefits. Crystal Lara, was arrested Wednesday on a felony warrant for forgery, the department said. “The Los Angeles Police Department’s Internal Affairs Division investigated altered doctor’s notes Officer Lara submitted to the department for medical benefits,” the LAPD statement says. “Internal Affairs Division, in partnership with the Los Angeles County District Attorney’s Off... Read More

FL - No Change in 2023 Assessment Rates

06/30/2022 | 0

The Florida Department of Financial Services announced assessments that fund operations of the Division of Workers’ Compensation and the Special Disability Trust Fund will remain unchanged in 2023. The Workers’ Compensation Administration Trust Fund assessment, which covers DWC operating costs, is 0.79% for calendar year 2023, the DWC said in an informational bulletin. The assessment rate is applied to net premium collected by carriers and to the premium calculated by the Department of Insurance for self-insured employers. The agency also said the Special Disability Trust Fund a... Read More

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Press - ReAudio Podcast Season Two from ReEmployAbility Will Focus on Sharing the Good

06/23/2022 | 0

ReEmployAbility, Inc. Contact: Brandi Melton (866) 663-9880 | news@reemployability.com Brandon, FL (June 23, 2022) — ReEmployAbility's podcast, ReAudio, is celebrating its one-year anniversary and is excited to announce that season two will be bringing listeners stories of inspiration and success in the Workers' Compensation Indus... Read More

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NY - Property Manager Arrested for Alleged Comp Fraud

06/30/2022 | 0

The New York State Inspector General’s Office announced that the property and site manager for a state-regulated housing development was arrested on multiple felony charges, including workers’ compensation fraud. Victor Garvin, also known as James Garvin, worked for Marion Scott Real Estate managing the Harry Silver Houses in East Flatbush, the state Inspector General’s Office said in a joint statement with the Brooklyn District Attorney’s Office. He also owned an interior renovation company called Plighted Construction. The prosecutors said that in the first two mont... Read More

NATL. - Lawmakers Introduce Bill to Repeal 'Redundant' MSP Private Cause of Action

06/30/2022 | 0

Lawmakers from Illinois and Florida introduced a bill that they say will repeal a redundant private cause of action provision in the Medicare Secondary Payer system. U.S. Reps. Brad Schneider, D-Ill., and Gus Bilirakis, R-Florida, said they introduced HR 8063, the repair abuses of MSP payments, or RAMP act, to end unfair, unnecessary and costly financial claims. “The outdated provision from 1986 allows persons who incur damages to bring a double damage lawsuit against an insurer and keep payments rather than returning them to the Medicare Trust Fund,” Schneider’s office sai... Read More

OK - High Court Declines Request to Appoint Comp Judge

06/29/2022 | 0

The Oklahoma Supreme Court denied a request to make an emergency appointment so that the Workers’ Compensation Court of Existing Claims can continue hearing cases after its lone judge terms out Friday. The high court didn’t elaborate on its decision, saying only in Monday’s order that all justices concurred in the decision to deny the request for the court to assume original jurisdiction over the dispute. Claimants' attorney Bob Burke, who represented four injured workers who petitioned the Supreme Court to reappoint Judge Margaret Bomhoff to continue hearing cases afte... Read More

OH - Court Upholds Dismissal of Worker's Tort Claim Against Employer

06/29/2022 | 0

An Ohio appellate court upheld the dismissal of an injured worker’s tort claims against his employer and its sole member of the business. Case: Gundel v. Whalen Lawn & Landscaping LLC, No. 2021CA00128, 06/06/2022, published. Facts: Nicholas Whalen is the sole member of Whalen Lawn and Landscaping LLC. The number of people employed by WLL varies according to the demand for lawn and landscaping services. Whalen himself performed all the administrative and business-related duties for the company, but he mowed lawns when necessary and performed minor maintenance on the equipment. Chri... Read More

NY - Incident Report on Worker's Fall Properly Excluded From Evidence as Hearsay

06/29/2022 | 0

A New York appellate court ruled that an incident report describing a construction worker’s fall was properly excluded from evidence. Case: DeBenedetto v. Kingswood Partners LLC, No. 2019-07729, 06/01/2022, published. Facts: Gary DeBenedetto worked for the Accurate Plumbing and Heating Corp. While he was installing a water heater at a construction site, DeBenedetto allegedly slipped and fell, suffering injuries. The property was owned by Kingswood Partners LLC and leased to the TJX Cos. Inc. Schimenti Construction Co. LLC was the general contractor for the project. DeBenedetto testif... Read More

NY - Court Overturns WCB's Reduction of Worker's SLU Award

06/29/2022 | 0

A New York appellate court overturned a decision of the Workers’ Compensation Board reducing an injured worker’s schedule loss of use award. Case: Matter of Blue v. New York State Office of Children and Family Services, No. 534152, 06/02/2022, published. Facts: Maurice Blue injured his right leg while working for the New York State Office of Children and Family Services. He later established the compensability of a causally related medial meniscus tear and significant chondromalacia patella of the right knee. After Blue’s doctor placed him at maximum medical improvement, t... Read More

FL - Federal Appellate Court Overturns Denial of Carrier's Motion to Compel Arbitration

06/29/2022 | 0

A federal appellate court overturned a denial of a carrier’s motion to compel arbitration of a procedurally complex insurance dispute. Case: Benchmark Insurance Co. v. SUNZ Insurance Co., No. 21-1679, 06/06/2022, published. Facts: SUNZ Insurance Co. is a Florida insurance company licensed to write workers' compensation policies in 16 states. SUNZ Insurance Solutions LLC is one of its affiliates. Benchmark Insurance Co. is a Kansas insurance company with its principal place of business in Minnesota, licensed to write workers' compensation policies in 49 states plus the District... Read More