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CA - After Contentious Legislative Session, Lower-Profile Comp Bills Head to Newsom's Desk

By Mark Powell (Reporter)
09/21/2021 | 0

Following a California legislative session that featured several high-profile pieces of potentially impactful workers’ compensation legislation, a relatively modest set of bills is headed to Gov. Gavin Newsom’s desk. And while employer and insurer advocates are likely relieved, injured workers and labor representatives are now hoping Newsom signs into law the legislation that did make it through. “We are grateful that, in the face of unprecedented challenges, the Legislature showed restraint in not requiring additional presumptions and disruptive system changes which ar... Read More

ME - Court Reinstates Injured Worker's Claims for Disability Discrimination, Retaliation

09/21/2021 | 0

A federal appellate court revived a Wal-Mart employee’s claims of disability discrimination and retaliation after she was fired for missing too much work while getting treatment for a compensable injury. Case: Benson v. Wal-Mart Stores East L.P., No. 20-1495, 09/15/2021, published. Facts and procedural history: Wal-Mart employee Margaret Benson worked at a store in Windham, Maine. She suffered a piriformis injury while at work in October 2014. The injury prevented her from working, and she took a leave of absence. Wal-Mart initially denied that the injury was work-related&n... Read More

OR - Fee Available if Attorney Secures TD Award on Reconsideration

09/21/2021 | 0

The Oregon Court of Appeals ruled that claimants’ attorneys are entitled to an award of assessed fees if they obtain temporary disability benefits for workers in proceedings on reconsideration. Case: In the Matter of Dancingbear, Nos. 1604039 and A167743, 09/15/2021, published. Facts and procedural history: Mekayla N. Dancingbear worked for Alternative Services Oregon. She suffered injuries at work in October 2015 and filed a workers’ compensation claim. Alternative had workers’ compensation insurance coverage with the SAIF Corp., which accepted liability for Dancingb... Read More

NY - Worker's Unsuccessful Pursuit of Comp Claim Bars Later Attempt at Civil Suit

09/21/2021 | 0

A New York appellate court ruled that a worker’s unsuccessful pursuit of benefits for his alleged injuries at a construction site barred him from later pursuing a civil remedy for the same claimed incident. Case: Lennon v. 56th & Park (NY) Owner LLC, No. 2018-07336, 09/15/2021, published. Facts: Sean Lennon allegedly suffered injuries to his knee in July 2014 while working at a construction site in Manhattan. Lennon claimed he had been riding in a hoist elevator when it made multiple sudden unanticipated rises and drops. Procedural history: Lennon filed a workers’ compensati... Read More

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Press - New Whitepaper: Workers' comp networks are constantly evolving

08/18/2021 | 0

Coventry, a leading provider of care-management and cost-containment solutions for workers' compensation, has released a new whitepaper titled "Workers' comp networks are constantly evolving."   Amid all the changes in health care - and all the challenges that remain - experienced workers' comp networks are evolving to meet the needs of providers, injured workers, and employers. Today, we see constructive partnerships between providers and payers that include a wide variety of provider types and a range of specialty services to serve injured workers. ... Read More

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Industry Insights

CA - Young: The Cost of Doing Business

By Julius Young
09/21/2021 | 0

California workers’ comp is an expensive system to operate. That has been a frequent focus of this blog over the years. High “frictional costs” have plagued the system despite various reform efforts, many of which resulted in takeaways from workers. Frictional costs are a continued focus of the California Workers’ Compensation Insurance Rating Bureau. I wasn’t able to attend last week's online WCIRB Actuarial Committee meeting, but it was well covered in Wednesday's piece by WorkCompCentral reporter Mark Powell. Powell noted something I ha... Read More

NY - Homeowner Gets Summary Judgment on Labor Law Claims

09/21/2021 | 0

A New York appellate court upheld the dismissal of a Labor Law and negligence action against a homeowner for a worker’s allegedly fatal injuries from a fall while cleaning the rain gutters on the home. Case: Khan v. Khan, No. 2018-10173, 9/15/2021, published. Facts: In December 2012, Luqman Ahmad allegedly slipped on moss and fell from the roof of a house while cleaning the gutters. He died on Jan. 18, 2013. Procedural history: The administratrix of his estate filed suit against the homeowner, Zafar Khan. The estate asserted claims for negligence and violations of Labor Law Secti... Read More

CA - DWC Adjusts Pathology and Clinical Laboratory Section of Fee Schedule

09/21/2021 | 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 made by Medicare. The order adopts Medicare’s quarterly update for services provided on or after Oct. 1. In addition, the order maintains prices for specific COVID-19 testing codes based at 120% of the rate established by the California Medicare Administrative Contractor. A copy of the order is here. ... Read More

CA - Owners of Painting, Construction Companies Accused of $5 Million Fraud Scheme

09/21/2021 | 0

The California Department of Insurance announced that owners of painting and construction companies were charged with orchestrating a scheme to underreport payroll and fraudulently reduce workers’ compensation premiums by $5 million. Brian Christopher Mitchell, former co-owner of Signature Painting and Construction Inc., in Walnut Creek, allegedly used A-1 World Class Painting and Valhalla Consulting as shell companies to pay employees. Eric Andrew Oller, a co-owner of Signature Painting and Construction, owned Valhalla Consulting. Yama Sekander owned A-1 World Class Painting. T... Read More

NATL. - One Call Names Jay Krueger President

09/21/2021 | 0

One Call, a provider of workers’ compensation ancillary services, announced that Jay Krueger will join the company in the newly created role of president, overseeing the company’s operations, specialty network solutions, complex network solutions and provider network teams. He brings more than a decade of senior-level leadership experience in the workers’ compensation industry, One Call said in a statement. Krueger has been an independent director on One Call’s board of directors since 2019. Before that, he was the head of strategy and product development for Optu... Read More

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Press - Centre for Neuro Skills Signs Agreement With Political Subdivision Workers' Compensation Alliance Covering More Than 500,000 Texas Public Entities' Employees

08/24/2021 | 0

Austin, TX. (August 24, 2021) - The Texas Brain Injury Alliance reports that 144,000 Texans sustain a traumatic brain injury each year - one every 4 minutes. Centre for Neuro Skills (CNS), a premier provider of treatment for traumatic and acquired brain injury, announced today it is now a participating provider in the Political Subdivision Workers Compensation Alliances (PSWCA) direct contracting program. Five risk pools that offer workers' compensation coverage and claims services to public entities in Texas, representing more than 3,000 public employers and 500,000 employees, form... Read More

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TX - DWC Hosting Health Care Provider, Insurer Quarterly Meetings

09/21/2021 | 0

The Texas Division of Workers’ Compensation is hosting its quarterly meetings with health care providers and carriers over Zoom on Oct. 14. The DWC holds quarterly meetings to provide updates on routine information and data topics, and to highlight current issues specific to each industry. Quarterly meetings are informal and are intended to facilitate communication between the division and system users. The health care provider quarterly meeting is 9:30-11:30 a.m. The insurance carrier meeting is 1:30-3 p.m. Agendas for both meetings and instructions for attending are available here... Read More

CA - Affirmative Defense Options Could Make or Break Employer's Case, Defense Attorneys Say

By Mark Powell (Reporter)
09/20/2021 | 1

Workers’ comp attorneys with expertise in affirmative defense options are more likely to successfully defend an employer’s case against a claim, lawyers from a California firm said during a recent webinar. And while California's comp system seems to include ever-changing statutes, attorneys who have knowledge of concrete case law and stay up to date on changes may have the upper hand as a case winds its way through the legal system, they said. “The burden of proof always lies with the one who is trying to prove whatever,” said Don Barthel, founding partner of... Read More

ND - Alleged Employer Doesn't Get Attorney Fees for Successful Challenge

09/20/2021 | 0

The North Dakota Supreme Court upheld a finding that a roustabout provider did not have an employment relationship with a group of workers but ruled that the company was not entitled to attorney fees after successfully challenging a contrary decision.  Case: State ex rel. Workforce Safety and Insurance v. Badger Roustabouts LLC, No. 20210022, 09/16/2021, published. Facts and procedural history: Judd Sturm owns Badger Roustabouts, a limited liability corporation that provides roustabouts to oil drilling companies. For a time, Badger provided roustabouts exclusively to... Read More

PA - No Unemployment Benefits for Worker Who Resigned as Part of Comp Settlement

09/20/2021 | 0

The Commonwealth Court of Pennsylvania upheld a denial of unemployment benefits to a school custodian who resigned as part of the settlement deal for his workers’ compensation claim. Case: Smith v. Unemployment Compensation Board of Review, No. 242 C.D. 2020, 09/09/2021, published. Facts: Lloyd Smith worked for the Bethlehem Area School District as a custodian. On Aug. 21, 2019, the district issued a notice that it was suspending his employment without pay because of allegations that he had been involved in an altercation with another employee. The notice advised Smith that the d... Read More

FL - Officer Can't Claim Presumption for Hypertension

09/20/2021 | 0

A Florida appellate court ruled that evidence precluded a law enforcement officer's claim of industrial causation for high blood pressure. Case: Holcombe v. City of Naples, No. 1D20-565, 09/15/2021, published. Facts: Joshua Holcombe underwent a liver transplant at 16 and had to take anti-rejection medications until 2003. He experienced secondary hypertension as a side effect of the medications, but it resolved after he stopped taking the drugs. In 2007, the City of Naples hired Holcombe as a law enforcement officer. He underwent a pre-employment physical examination, during which he&nbs... Read More

TX - Benefits to Increase 5.1% on Oct. 1

09/20/2021 | 0

The Texas Division of Workers’ Compensation will increase maximum temporary income benefits by 5.1% to $1,058 from $1,007, effective Oct. 1. The maximum temporary total disability benefit is set at 100% of the state’s average weekly wage. Last year, the average weekly wage increased to $1,058.38 from $1,006.71. Lifetime income benefits and death benefits are also set at 100% of the state’s average weekly wage and will increase to $1,058. Other benefits will also increase by the same 5.1%, including the minimum temporary income benefit, maximum and minimum impairment income... Read More

NATL. - Comp Pays More Than Group Health for Similar Medical Services

09/20/2021 | 0

Workers' compensation insurers pay more for medical services than group health pays to treat comparable injuries, according to a research report released Friday by the National Council on Compensation Insurance. In examining the workers' comp experiences from NCCI’s medical data call, which captures transaction-level details — service, charges, payments, procedure codes and diagnosis codes — on medical bills processed on or after July 1, 2010, for 35 states, researchers found that costs for chronic injuries in comp are 235% higher and 160% higher for acute injuries. ... Read More