NM - Decision in Favor of Tribal Sovereignty Leaves Casino Worker Without Recourse for Injury
| 53 min read
A worker at a tribal casino can’t sue her employer in state court over a denied workers' compensation claim, the New Mexico Supreme Court ruled.
The high court ruled that Gloria Mendoza cannot sue the Isleta Resort and Casino because of the tribe’s sovereign immunity, leaving her with no recourse for her injury through the state’s comp program.
The Pueblo of Isleta didn't waive its sovereign immunity as part of the 2015 gaming compact it entered with the state allowing it to operate the casino, the Supreme Court said in its Jan. 16 decision. And the tribe never...
CO - Independent Contractor Test for Unemployment Applies to Comp Cases, Too
| 16 min read
The Colorado Court of Appeals ruled that the independent contractor analysis adopted by the state Supreme Court in an unemployment case also applies in the workers’ compensation context.
Case: Pella Windows & Doors Inc. v. ICAO, No. 18CA1908, 01/16/2020, published.
Facts: Christopher Pierce began working as a service technician for Pella Windows & Doors Inc. in June 2008. In March 2009, Pella laid off its entire team of 17 service technicians. Immediately thereafter, Pella offered nine of them “service subcontractor agreements.”
Pierce was one of the service t...
IL - Primary Jurisdiction Doctrine Can't Be Used to Stay IWCC Proceedings
| 113 min read
The Illinois Supreme Court unanimously ruled that the primary jurisdiction doctrine cannot be used by a trial judge to enter an order staying an administrative proceeding in the Illinois Workers’ Compensation Commission.
Case: West Bend Mutual Insurance Co. v. TRRS Corp., No. 124690, 01/24/2020, published.
Facts and procedural history: In October 2018, the West Bend Mutual Insurance Co. filed a complaint seeking a declaratory judgment against the TRRS Corp.
West Bend alleged that it issued a workers’ compensation and liability insurance policy to TRRS effective from June 20, 201...
LA - Lack of Credibility, Corroboration Sink Worker's Claim for Benefits
| 44 min read
A Louisiana appellate court upheld the denial of a worker’s post-termination claim for benefits for an unwitnessed accident due to her lack of credibility and the absence of evidence corroborating her version of events.
Case: Grant v. McConnell Painting Corp., No. 53,100-WCA, 01/15/2020, published.
Facts: Karen Grant worked for the McConnell Painting Corp. from October 2016 until July 2017.
In November 2017, Grant filed a workers’ compensation claim asserting she had suffered an injury to her right wrist during her employment with McConnell. Grant claimed she had been working at...
Press - MTI America Names Bea Scott Vice President of National Sales
POMPANO BEACH, Fla. (JANUARY 15, 2020) - MTI America announces that Bea Scott has been named Vice President of National Sales. Scott joined MTI in May of 2017 and is a distinguished sales executive with three decades of experience in the workers' compensation, managed care and medical/pharmaceutical industries. Prior to being named VP of National Sales, Scott served MTI as director of sales, western region.
In her new ...
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NATL. - Paduda: What Would You Do With Another $8,000?
The U.S. health care system is costing you $8,000 more than it should. That’s because you, the consumer, are at the mercy of hospitals, insurers, doctors, device companies, pharma.
You know this.
You know the health care “system” is designed to make money for health care providers, big pharma, device companies, health plans — not to help you and your family stay healthy and functional.
You know the health care system makes money — buckets of it.
You know we spend way more than any other country, yet we die younger.
NV - Court of Appeals Taking Comp Case Along for Road Trip
| 10 min read
The Nevada Court of Appeals will hear arguments about whether a police officer has a compensable workers’ compensation claim for hearing loss during a roadshow intended to give students and residents a chance to see the court in action.
The appellate court typically holds hearings in courtrooms in Carson City and Las Vegas. But it occasionally schedules proceedings in other venues, such as the
Thomas & Mack Moot Courtroom at the University of Nevada, Las Vegas, where it will hear the dispute involving former Henderson police Officer Jared Spangler on Tuesday.
The question before th...
NY - Board Posts Template to Help Doctors With Reports for CMS-1500 Submissions
| 45 min read
The New York State Workers' Compensation Board has posted a template to help doctors write better narratives when submitting medical bills.
Medical providers must use form CMS-1500 when requesting reimbursement for treating injured workers, and the form must be accompanied by a narrative, explaining a number of elements. The board, known to be a stickler for correct forms and cover sheets, said last week that the template is an effort to assist providers.
The template includes the three elements that most narratives require: the patient's work status, the causal relationship of ...
CA - Amended Bill Would Require Biennial Updates to MLFS
| 31 min read
The California Division of Workers’ Compensation would be required to update the Medical-Legal Fee Schedule at least every two years, under amendments to a bill carried over from the 2019 legislative session.
Assembly Bill 1815 was introduced last year by the Assembly Insurance Committee as a vehicle for “technical, non-controversial changes to the Labor Code that may be requested by the Department of Industrial Relations.”
The measure was amended Thursday to propose changes to Labor Code Section 5307.6 that would require the DWC to revise the med-legal fee schedule biennia...
OH - BWC Proposes Minor Changes to Outpatient Fee Schedule
| 1 min read
The Ohio Bureau of Workers' Compensation is in the midst of a five-year rule review on its hospital outpatient services fee schedule and has posted proposed changes, including the removal of hip replacements from the list of approved procedures.
The proposed changes, which would take effect May 1, update wording of the rules and incorporate changes in Medicare's reimbursement rules and rates for outpatient services. Medicare's rules now include organ procurement organizations, for example. The rules also include modification of the Ohio inflation factor for the Medicare base ...
Press - IAIME Names Winners of 2019 Annual Awards
IAIME Names Winners of 2019 Annual Awards
East Dundee, IL; January 11, 2020 -- The International Academy of Independent Medical Evaluators is pleased to announce the winners of its 2019 awards. The awards were presented at the IAIME 33rd Annual Scientific Session in Austin, Texas, January 8 - 11, 2020.
The following individuals are recipients of the 2019 IAIME professional awards.
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AZ - Measure Would Make Cardiopulmonary Presumption Conclusive
| 30 min read
Arizona firefighters would enjoy a conclusive presumption that cardiopulmonary injuries and illnesses arose from work, under recently introduced legislation.
The Copper State currently allows employers the opportunity to rebut the presumption that heart, perivascular and pulmonary injuries occurring within 24 hours of a “known event” are compensable.
Firefighters must pass a pre-employment physical showing no signs of cardiopulmonary conditions to qualify for the presumption. The presumption doesn’t apply when there is evidence that a firefighter’s exposure to tobacco...
CO - Bill Proposes Comp Coverage for Audible Trauma
| 8 min read
Hearing violent acts or the aftermath of violence would qualify as a compensable traumatic event, under a bill introduced in the Colorado General Assembly.
Senate Bill 26, by Sen. Rhonda Fields, D-Aurora, would expand the definition of “psychologically traumatic event” to include hearing the death or serious bodily injury of one or more people.
The measure would build on a 2017 bill that eliminated a statute prohibiting post-traumatic stress disorder claims for events arising from a worker’s typical job responsibilities. Supporters said the 2017 bill, HB 1229, woul...
CT - New Guidelines Issued on Mediation: Parties Must Determine Files Needed
| 30 min read
The Connecticut Workers' Compensation Commission has issued new guidelines for mediation services, and 10 of the 16 commissioners have agreed to continue as mediators.
The bulletin, posted online last week, notes that parties should agree on the names of three commissioners they are requesting for the mediation. If the parties agree on only one name, the agency will try to accommodate and will make the arrangements.
The request for mediation should also advise if the request is for a half-day session (three hours) or a full-day session (six hours).
“It is the responsibility of the...
NY - Employers, Claimants Eye Comp Bills That Could Have Life This Year
| 91 min read
Other than measures that could decide the employment and benefits status of millions of gig-economy workers, New York companies aren't expecting much earth-shaking workers' compensation legislation this year.
But they are keeping an eye on some second-tier measures on the calendar, including three that passed the Senate last year but died in the Assembly. One would grant time off work to abuse victims; another would allow occupational and physical therapy assistants to be reimbursed; and another would expedite death benefits for volunteer firefighters.
Other bills that have...
FL - Supreme Court Changes Appealability of Orders on Sovereign Immunity
| 34 min read
The Florida Supreme Court changed the state’s rules of appellate procedure to allow appeals of nonfinal orders determining whether a defendant is entitled to sovereign immunity, but denials of workers’ compensation immunity remain unappealable.
Case: Florida Highway Patrol v. Jackson, No. SC18-468, 01/23/2020, published.
Facts: Vontavia Robinson died in a predawn car accident on Interstate 75 after smoke from a nearby brush fire caused visibility to deteriorate.
The Florida Highway Patrol had closed the interstate for several hours because of the smoke, and Robinson’s...