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CA - Committees Pass COVID Presumption, Fraud Investigation Bills

07/01/2022 | 1

Policy committees in the California Senate passed bills that would extend COVID-19 presumptions and review the process for carriers, prosecutors and regulators to work together to fight workers’ compensation fraud. The Senate Committee on Labor, Public Employment and Retirement on Wednesday voted 4-1 to pass AB 1751, by Assemblyman Tom Daly, D-Anaheim. The Senate Judiciary Committee on the same day voted 10-0 to pass AB 1681, also by Daly. AB 1751 would extend presumptions of compensability for COVID-19 through Jan. 1, 2025. Lawmakers in 2020 enacted SB 1159, which created a presu... Read More

OK - Court of Existing Claims Judge Extends Her Own Term

07/01/2022 | 0

The lone judge on the Oklahoma Workers’ Compensation Court of Existing Claims on Thursday signed orders extending her term that was slated to expire at midnight. Judge Margaret A. Bomhoff cited sections in the state’s workers’ compensation statutes as authorizing her self-appointment. Specifically, the orders mention 85 O.S. 400(M) and 85 O.S. 400(Q) as the authority for her action. The first subsection vests the Court of Existing Claims, which was established as part of the reforms that created the state’s administrative comp system, to hear older claims with a date ... Read More

PA - Administratrix of Worker's Estate Can't Pursue Tort Claim Against Employer

07/01/2022 | 0

The Pennsylvania Superior Court ruled that the administratrix of a worker’s estate could not maintain a negligence and wrongful death suit against his employers, since the exclusive remedy provision of the Workers’ Compensation Act barred her claim. Case: Riemenschneider v. D. Sabatelli Inc., No. 1842 EDA 2021, 06/07/2022, published. Facts: David Scott Macleary sustained fatal injuries when the brakes failed on a dump truck he was operating. Macleary was acting within the course and scope of his employment with D. Sabatelli Inc. He received workers' compensation benefits thro... Read More

OR - Court Overturns ALJ's Rejection of Citation Against Employer for Gas Leak

07/01/2022 | 0

The Oregon Court of Appeals overturned an administrative law judge’s finding that the state Occupational Safety and Health Administration failed to establish an employer’s violation of a safety regulation that resulted in a natural gas leak. Case: Occupational Safety & Health Division v. Loy Clark Pipeline Co., Nos. 1700028SH and A171747, 06/08/2022, published. Facts: In July 2016, Loy Clark Pipeline Co. was doing excavation and utility work at a construction site in northwest Portland near the intersection of NW 23rd Avenue and NW Glisan Street. Loy Clar... 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

NJ - Burk: Section 20 Settlements Versus Orders Approving Settlement

By Maura Burk
07/01/2022 | 0

Our clients often ask great questions regarding settlements in New Jersey workers’ compensation, particularly regarding the two types of settlements — orders approving settlement and Section 20/full and final — and the differences between them. This post provides examples of scenarios where an argument can be made for a Section 20 settlement. There are two ways to settle a workers’ compensation claim in New Jersey. Most cases in New Jersey settle under NJSA 34:15-22 (known as an order approving settlement) with a specific percentage of disability. In... Read More

NY - Worker Struck by Granite Panel Gets Summary Judgment on Labor Law Claim

07/01/2022 | 0

A New York appellate court ruled that a worker should have been granted summary judgment on his Labor Law claim for his injuries from being struck by a granite panel. Case: Roman v. Zapco 1500 Investment LP, No. 156146/2017, 06/07/2022, published. Facts: Geigel Roman suffered injuries when a 400-pound granite panel fell on him at a construction site in Manhattan. Procedural history: Roman filed suit against Zapco 1500 Investment LP, asserting a claim for a violation of Labor Law Section 240(1). Section 240(1) imposes absolute liability on property owners, general contractors or t... Read More

NY - Owner of Apartment Building Fails to Prove Status as Employer's Alter Ego

07/01/2022 | 0

A New York appellate court ruled that the owner of an apartment building was not entitled to summary judgment dismissing an injured worker’s tort claim, since it failed to prove it was an alter ego of the employer. Case: Savino v. 700 Victory Boulevard LLC, No. 2020-01007, 06/08/2022, published. Facts: Josephine Savino worked as a rental agent for Samson Management at an apartment building owned by 700 Victory Boulevard LLC. She injured her hand while at work in December 2016. Procedural history: Savino filed suit against Victory seeking damages. Victory moved for summ... Read More

LA - Supreme Court Orders Disbarment of Attorney for Abandoning Workers' Comp Clients

07/01/2022 | 0

The Louisiana Supreme Court disbarred an attorney with a long history of disciplinary actions for mishandling six workers’ compensation matters. William K. Hawkins was admitted to the practice of law in Louisiana in 1988. In 2008, he was suspended from the practice of law for one year, fully deferred, subject to one year of unsupervised probation for having mishandled client and third-party funds. On May 31, 2019, Hawkins was declared ineligible to practice law for failure to comply with mandatory continuing legal education requirements. He was also ineligible for failure to pay ... Read More

CA - Commissioner Issues Bulletin on Carrier Bias, Discrimination

07/01/2022 | 0

California Insurance Commissioner Ricardo Lara issued a bulletin Thursday reminding carriers that they are prohibited from using consumer data in biased or discriminatory ways. “I have serious concerns that insurance companies’ increasing use of consumers’ data will exacerbate inequities or cause consumers to be charged more, either deliberately or inadvertently,” Lara said in a statement. “Algorithms and artificial intelligence are susceptible to the same biases and discrimination we have historically seen in insurance.” The bulletin says carriers must av... Read More

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Press - ReEmployAbility CEO Debra Livingston to speak at Florida RIMS July 27th

06/28/2022 | 0

Brandon, FL (June 23, 2022) - CEO Debra Livingston will join Dr. Claire Muselman at Florida RIMS July 27th at 1:30 p.m. for a discussion on "How Volunteering Impacts Employees Mental Health Emerging from COVID Social Distancing." Livingston and Dr. Muselman will lead a discussion on volunteering's impact on employees, especially after they were isolated from COVID social distancing measures and offices utilize remote work opportunities. Using experiences with the human connection and empathy needed in workers' compensation, they will discuss how volunteering benefi... Read More

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CA - DWC Posts Adjustments to Pathology and Clinical Laboratory Fee Schedule

07/01/2022 | 0

The California Division of Workers’ Compensation posted an order adjusting the pathology and clinical laboratory section of the Official Medical Fee Schedule to conform to changes in the Medicare payment system. The order adopts Medicare’s July 2022 quarterly update to the pathology and clinical laboratory fee schedule. In addition, DWC orders continued use of prices for specified COVID-19 testing codes based upon 120% of the rate established by the California Medicare Administrative Contractor. The order adopting the OMFS adjustment is effective for services rendered on or afte... Read More

TX - DWC Seeks Comments on MQRP Rules

07/01/2022 | 0

The Texas Division of Workers’ Compensation is seeking comments on proposed rules addressing the Medical Quality Review Panel that evaluates the quality of care provided to injured workers. “The proposed amendments change the 10-year lifetime maximum service limit with multiple two-year terms for membership on the MQRP, to a 10-year maximum term to more closely align with the language and intent of the statute,” the division said. “They provide for periodic review of members during their terms and require members whose terms are expiring to submit new applications... Read More

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

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