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 ...
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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...
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...
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...
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 ...
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...
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...
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...
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...
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...
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...
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...
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...
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...
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...
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...
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...
