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KS - Doctors Support High Court Ruling on AMA Guides; Lawyer Sees Potential Upside in Decision

By William Rabb (Reporter)
01/19/2021 | 230 | 0 | 53 min read

The largest doctors' group in Kansas said it is much in favor of a state Supreme Court ruling that greenlights the continued use of the sixth edition of the American Medical Associations’ Guides to the Evaluation of Permanent Impairment. And a claimants' attorney involved with the case said he isn't so bothered by the ruling, either. Those were some of the opinions offered after the Jan. 8 decision in Howard Johnson III v. U.S. Food Service and American Zurich Insurance. The high court overturned an appeals court ruling that mandated the use of the fourth edition because be... Read More

CA - Employers Must Consider Wealth of Legal Issues Before Requiring COVID Vaccinations

By Mark Powell (Reporter)
01/19/2021 | 593 | 1 | 33 min read

As health care professionals begin to administer the COVID-19 vaccine, California employers may have to navigate myriad legal issues if they’re considering mandating or even suggesting that their employees get vaccinated, employment law and workers’ compensation experts said. And workers who report physical or psychological side effects related to being vaccinated may be able to file successful claims if their employer assisted or reimbursed employees’ efforts in getting vaccinated on their own, according to two attorneys from Thousand Oaks work comp defense firm Floyd, Sker... Read More

NY - Union Can't Pursue Lawsuit Over Allegedly Unsafe Work Environment

01/19/2021 | 131 | 0 | 26 min read

A New York appellate court threw out a union’s lawsuit contending the City of New York was failing to provide corrections officers with an adequately safe work environment. Case: Correction Officers' Benevolent Association Inc. v. City of New York, No. 24054/16E, 01/12/2021, published. Facts and procedural history: The Correction Officers' Benevolent Association Inc. filed a lawsuit seeking a judicial declaration that the City of New York has violated the New York State Public Employee Safety and Health Act and the Workplace Violence Prevention Law as a result of its failure to... Read More

OH - Court Upholds Verdict Finding Worker Entitled to Benefits for Shoulder Injury

01/19/2021 | 91 | 0 | 59 min read

An Ohio appellate court upheld a jury verdict that a worker was entitled to benefits for an injury to his shoulder, as there had not been any instructional error, and the record evidence supported the jury’s findings. Case: Towles v. MillerCoors LLC, No. CA2019-12-207, 01/11/2021, published. Facts and procedural history: Terry Towles worked for MillerCoors LLC. In November 2017, Towles filed a workers’ compensation claim seeking benefits for an alleged injury to his right shoulder from May 2016. The Bureau of Workers’ Compensation initially denied his claim, but it later a... Read More

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Press - Leading Workers' Comp Firm SRTK Promotes Paul G. Wolfe to Shareholder

01/13/2021 | 68 | 0

January 13, 2021, El Segundo, CA - California's leading workers' compensation defense law firm, Stander Reubens Thomas Kinsey (SRTK), has announced that, effective immediately, Paul G. Wolfe has become its newest Shareholder. Wolfe will remain in SRTK's Greater San Francisco office, where he has been the Senior Managing Attorney for 10 years alongside the office's Managing Shareholder, Stewart Reubens. Mr. Wolfe joined SRTK in 2010 after spending several years representing insurers and employers. Since 2001, his focus has primarily ... Read More

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Industry Insights

NATL. - Zachry: Best Practices for Claims Departments to Maximize the Effectiveness of an Audit

By Bill Zachry
01/19/2021 | 193 | 0

As a claims supervisor, I reacted very poorly to my first workers' compensation claims audit. I went through the familiar stages that one does when first audited: Anger (at how anyone could question my decisions or results). Denial (that someone in my claims unit had made mistakes). Negotiations (over the findings and how they had missed all of our successes and only focused on the mistakes). Depression (I was sure that since I was not perfect that I would not be retained as a claims supervisor). Acceptance (when the claims manager sat down and worked through the findings with ... Read More

MO - Carrier Can't Avoid Liability for Balance of Wrongful Death Award

01/19/2021 | 87 | 0 | 6 min read

A Missouri appellate court ruled that an insurance carrier could not avoid liability for paying the $7.5 million balance of a wrongful death judgment for a worker’s fatal injuries. Case: Geiler v. Liberty Insurance Corp., No. WD83363, 01/12/2021, published. Facts: In September 2015, Richard Geiler suffered fatal injuries when he was ejected from a vehicle. Sharpe Holdings Inc. owned the vehicle, and a Sharpe employee had been driving at the time of the accident. Geiler was a resident at the Heartland Men's Recovery Center, a rehabilitation program operated by CNS International Min... Read More

NY - Demolition Worker Can Proceed With Labor Law Claim

01/19/2021 | 111 | 0 | 2 min read

A New York appellate court ruled that a worker could proceed with his Labor Law claim for injuries from being struck by a portion of the ceiling in a bathroom where he was working. Case: Santana v. MMF 1212 Associations LLC, No. 21150, 01/12/2021, published. Facts: Juan C. Santana allegedly suffered injuries while performing demolition work in an apartment bathroom when a portion of the ceiling fell and struck him. Procedural history: Santana filed suit against MMF 1212 Associations LLC and Richard Mishkin Contracting Inc., the owner of the property and the general contractor for the projec... Read More

CA - Southern California Firefighter Gets 90 Days in Jail for Comp Fraud

01/19/2021 | 461 | 0 | 31 min read

A Ventura County firefighter was sentenced to 90 days in jail and two years of probation after pleading guilty to workers’ compensation fraud, prosecutors said. Perry Adam Lieber, 34, was ordered to pay $100,000 in restitution to York Risk Services and the County of Ventura. He also was ordered to pay $30,000 in fines, the Ventura County District Attorney’s Office said in a news release. Lieber made false statements while obtaining disability and workers’ comp benefits after filing a claim with the Ventura County Fire Department, according to the news release. York Risk Se... Read More

NV - Workplace Safety Fines to Increase With Inflation

01/19/2021 | 97 | 0 | 176 min read

Administrative penalties for Nevada employers that fail to comply with workplace safety requirements increased 1.18% on Friday to keep pace with inflation. The Nevada Occupational Safety and Health Administration said Senate Bill 40, enacted in 2019, requires the state to adopt penalties that are consistent with those imposed by federal OSHA. And a 2015 law requires OSHA to annually evaluate penalties for inflation by Jan. 15 of each year. Nevada OSHA said administrative penalties increased 1.18% for any penalty assessed on or after Friday, regardless of when an inspection was opened. As a ... Read More

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Press - Drive to thrive: Sedgwick highlights industry trends for 2021

01/12/2021 | 181 | 0

MEMPHIS, TN., January 12, 2021 - Sedgwick, a leading global provider of technology-enabled risk, benefits and integrated business solutions, today published "Drive to thrive in 2021," which highlights major industry trends and issues that employers, carriers, brokers, risk management and human resources professionals should watch throughout the coming year to remain ready as we move from "what now" to "what's next." Read More

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TX - DWC Extends Deadline on COVID Data Call

01/19/2021 | 94 | 0 | 42 min read

Participating Texas insurers have six more months to compile data on COVID-19 comp claims, the Division of Workers' Compensation announced Thursday. The division had set a January deadline for the data call for 66 carriers, self-insurers, hospital districts, cities and counties but has changed the submission deadline to July 30. Data should be collected through the end of June. “To ensure that DWC has sufficient information to determine the impact of COVID-19 injuries on the Texas workers’ compensation system, DWC has extended the data call through June 2021,”... Read More

MT - Draft Bill Would Require Periodic Increase in Burial Expenses

01/19/2021 | 75 | 0 | 12 min read

Montana regulators would be required to adjust the maximum burial expense paid for occupational deaths every five years under a draft bill. The measure currently identified as Legislative Concept 2927, requested by Rep. Derek Harvey, D-Butte, would order the Department of Workforce Services to adjust burial expenses based on cost-of-living changes published by the U.S. Bureau of Labor Statistics. The draft bill would also require the department to start by increasing the burial expense to $10,000 from $4,000. The Montana legislative session started Jan. 4 and is scheduled to run throug... Read More

NATL. - Reports Show Deep Impact of COVID on Claims, Premium

By William Rabb (Reporter)
01/15/2021 | 1244 | 0 | 131 min read

Two new national reports shed light on 2020 and the impact that the COVID-19 pandemic has had on the workers' compensation industry. First, net written premium for 2020 has taken a significant hit, but profit levels remain strong, the National Council on Compensation Insurance said in a report released Thursday. Net premium for calendar year 2020 is estimated to be at just under $39 billion — an 8.1% drop from 2019, based on data from across the country. But the combined ratio, a measure of profitability, will rise only slightly to 86% compared to 2019's near-record low level o... Read More

PA - Specific Loss Benefits Subject to Subrogation Lien

01/15/2021 | 151 | 0 | 53 min read

The Commonwealth Court of Pennsylvania ruled that the specific loss benefits payable to a worker’s daughter are subject to the employer’s subrogation lien. Case: Kinzler v. WCAB (Association for Vascular Access), No. 165 C.D. 2020, 01/06/2021, published. Facts and procedural history: Janet Kinzler worked for the Association for Vascular Access as its director of marketing, outreach and membership. Kinzler fell from a high stool while at a work-related event at a Cheesecake Factory restaurant in June 2013. She landed on her back and suffered injuries. AVA accepted liability... Read More

NY - Bus Driver Fails to Prove Continuing Disability From Deep Vein Thrombosis

01/15/2021 | 141 | 0 | 127 min read

A New York appellate court ruled that a bus driver with deep vein thrombosis failed to prove a continuing causally related disability entitling her to additional benefits. Case: Matter of Marable-Greene v. All Transit, No. 531433, 01/07/2021, published. Facts and procedural history: Celeste Marable-Greene worked for All Transit as a bus driver. She established her entitlement to workers’ compensation benefits for right lower extremity deep vein thrombosis, and she received benefits from October 2017 through August 2018. The parties then submitted additional medical evidence on whether... Read More

MO - Treatment Provider Waits Too Long to Challenge Reduction of Bill for Services

01/15/2021 | 158 | 0 | 28 min read

A Missouri appellate court ruled that a treatment provider’s claim for additional payment was subject to summary dismissal as untimely. Case: Chesterfield Spine Center LLC v. Best Buy Co., No. WD83757, 01/12/2021, published. Facts and procedural history: In April 2013, a Best Buy Co. employee suffered injuries when a refrigerator fell on him. The employee filed a workers’ compensation claim shortly after the accident. Best Buy had workers’ compensation insurance coverage with XL Insurance America, which authorized Chesterfield Spine Center LLC to provide treatment. C... Read More

NY - Hospital Employee Gets Benefits for Assault Injuries

01/15/2021 | 107 | 0 | 51 min read

A New York appellate court ruled that a hospital employee who was assaulted as she left work is entitled to benefits. Case: Matter of Jean-Pierre v. Brookdale Hospital Medical Center, No. 530449, 01/07/2021, published. Facts: Marie Anite Jean-Pierre worked in a medical complex in Brooklyn. On Aug. 6, 2018, she left the hospital after finishing her shift at around 11:30 p.m. As she was walking through the complex, she was attacked by an unknown assailant. Jean-Pierre sustained multiple injuries and suffered from emotional distress. Procedural history: Jean-Pierre filed a workers’... Read More

KY - Third Coal Mine Manager Pleads Guilty to Cheating in Dust Sampling

01/15/2021 | 187 | 0 | 48 min read

Another Kentucky coal company manager has pleaded guilty to rigging dust sampling procedures in mines in order to hide the extent of dangerous conditions that could trigger federal penalties. Steve DeMoss, who was a foreman and safety director for Armstrong Coal, agreed that he had helped to submit misleadingly low coal dust readings to mine regulators, according to a news report and his plea agreement in federal court. The sampling deception, which miners in the case have said is widespread, involved pulling air pumps off of miners before the end of a scheduled dust-sampling period and sign... Read More

OR - OSHA Fines Fitness Center More Than $126,000 for COVID-19 Violations

01/15/2021 | 131 | 0 | 184 min read

Oregon’s Occupational Safety and Health Administration has announced more than $126,000 in fines levied on a Salem fitness center for “willfully continuing to potentially expose employees” to COVID-19, the agency said in a news release. Marion County is considered an “extreme risk” area for the virus, and OSHA said the center continued to ignore public health orders to limit its capacity. OSHA fined Capitol Racquet Sports Inc. after investigators inspected the facility in response to multiple complaints, the agency said. The $126,749 penalty is the largest... Read More

NY - NYPD Sgt. Fraudulently Obtained 9/11 Benefits, Justice Department Says

01/15/2021 | 112 | 0 | 4 min read

A New York City police sergeant has been charged after allegedly filing false claims in order to receive workers’ compensation benefits following the Sept. 11, 2001, terrorist attacks, according to the Department of Justice. Prosecutors last week charged Sally Spinosa, 55, of Freehold, New Jersey, with one count of submitting false claims, one count of wire fraud and one count of aggravated identity theft after she allegedly lied about how long it took her to recover from the attacks. If convicted, she could face more than 20 years in prison, the DOJ said in a news release. After the ... Read More

FL - DWC Sets Another Hearing on Medical Reimbursement Dispute Rule Changes

01/15/2021 | 172 | 0 | 115 min read

The Florida Division of Workers' Compensation on Feb. 9 will hold another hearing on proposed medical reimbursement dispute rules. The hearing, the third since October, will begin at 9:30 a.m. Eastern and will be held virtually on the GoToMeeting platform. The link is here. Stakeholders may also join via telephone by calling 571-317-3116. The access code is 236-089-133. The DWC for the past few years has deliberated proposed changes to the 69L-31 family of rules, which govern reimbursement dispute petitions, carrier response requirements and overutilization issues. A related set of rules... Read More

MN - Department to Offer New EDI Functionality on Claims System

01/15/2021 | 124 | 0 | 300 min read

Two weeks from now, the Minnesota Department of Labor will roll out a new feature for its online workers' compensation claims management system. The update to the Work Comp Campus system will provide an electronic data interchange (EDI) release and enhanced functionality, including new flexibility on employer identification numbers for sole proprietors; more flexibility when duplicate transactions are encountered; easier editing on employee dates of birth; and more, the department said in a bulletin. The Jan. 28 update will also improve error messages. Stakeholder feedback has shown... Read More