Category Archives: Workers’ Compensation

Article Published: Wisconsin and Minnesota Workers’ Compensation Claims Comparison

Tom Domer just published an article “A Comparison of Wisconsin and Minnesota Workers’ Compensation Claims” in the William Mitchell Law Review.

The article was prompted by calls from Minnesota colleagues asking whether Wisconsin or Minnesota jurisdiction would be appropriate for work injuries.  The article compared a hypothetical injury from Ole a 58 year old truck driver hired in Minnesota by a corporation registered in Minnesota and Wisconsin, who worked half time in Minnesota and half time in Wisconsin.  In route to Milwaukee for a delivery, he tripped in a pot hole at a sex shop in Wisconsin after stopping for lunch and drinking six beers.  He injured his neck, leaving a scar on his forehead, underwent neck fusion surgery with resulting permanent work restrictions.

The article compares Wisconsin and Minnesota on liability, the involvement of alcohol, whether the injury arose out of employment and was in the course of employment.  It further compared benefits in Wisconsin and Minnesota including Temporary Total Disability, permanency benefits, vocational rehabilitation, Loss of Earning Capacity, disfigurement, Permanent Total Disability, and whether there was a Social Security offset for workers’ compensation benefits.

While some benefits were better in Minnesota, overall the likelihood for recovery was better in Wisconsin.

“Independent” Medical Examinations in Workers’ Compensation (Anything but “Independent”)

“I thought their doctor Independent Medical Report was the last word on my case. I didn’t know any better.” 

This statement from a client I just met sums up the experience of many injured workers unfamiliar with the workers’ compensation process in Wisconsin (and many other states).

An insurance company or self-insured employer may request an injured worker submit to reasonable examinations by a physician, chiropractor, psychologist, dentist, podiatrist, physicians assistant, or Advanced Practice Nurse Practitioner of its choice. Wis. Stat. §102.17(1)(b). This examination is usually referred to as an Independent Medical Examination or “IME” although “adverse medical examination” more accurately reflects the process.  An Independent Medical Examination may be requested by the insurance company or self-insured employer in order to determine whether the claim is compensable and the extent of the disability or the necessity and type of treatment. 

Since only about one in ten injured workers in Wisconsin is represented by an attorney, nine out of ten unrepresented workers are not aware that the insurance company’s “IME” is actually an adverse exam by a doctor hired by and paid by the insurance company to issue his report. Although IME examiners would deny they routinely render an opinion in favor of the insurance carrier, my forty years of experience suggests just that. For many years lawyers representing injured workers have been proposing the terminology “Adverse Medical Examination” apply to give represented and unrepresented workers a more fair assessment of the process. Many IMEs make hundreds of thousands of dollars annually performing these examinations. At one of these examinations, my client overheard the IME physician (who had rented a motel room) speaking to a prospective young doctor trying to convince that doctor to perform IMEs. “This is a great practice.” He said.  “All you have to do is review the medical records, meet with the worker for a few minutes, and deny the claim. And for that you can charge $1,500.” Although my client’s testimony to this effect was barred, the underlying accuracy of his testimony is undisputable.

Beware the “Independent” Medical Examination.

Legislative Changes To Workers’ Compensation – Wisconsin and National

As we in Wisconsin wrestle with Governor Walker’s ill-advised proposal to split up an efficient and time-honored workers’ compensation system (for alleged purposes of “efficiency”), it is instructive to reflect on the legislative proposals during the first quarter of 2015 across the nation in workers’ compensation. 

A National Council on Compensation Insurance, Inc. (NCCI) annual issue symposium in Florida reported that over 600 workers’ compensation bills were filed in the first quarter of 2015. Over 10% of these (65) deal with presumptive coverage for First Responders, giving First Responders the presumption of workers’ compensation coverage for their injuries and occupational exposures. (This is a topic that has come up a lot since the September 11 attacks, bolstered by other tragic news such as the 2012 Sandy Hook Elementary School shooting).

The next most popular type of bills filed during the first quarter of 2015 included bills revising the definition of an employee (37 bills), occupational diseases (36 bills), reimbursement and fee schedules (33 bills) and indemnity benefits (32 bills).

The definition of employee versus Independent Contractor or subcontractor has been a popular issue regarding lawsuits such as Uber Technologies and Lyft, Inc. and the self-storage and moving marketplace eMove, Inc. Interestingly, on the issue of benefits (and attorney fees that apply to those benefits) “If you increase attorney fees you are likely to increase attorney involvement,” aid Lori Lovgren NCCI Division Executive of State Relations . However, she also noted: but “injured workers are going to need assistance. If the compensation to attorneys is not enough for attorneys to assist, then there is going to be an access problem.” Her reference was to the Florida Supreme Court case Ciastellanos v. Next Door Company, which explores whether attorney fee caps were constitutional.

 

Illinois Facing Proposed Rollback Of Workers’ Compensation Law

Wisconsin is not alone. While Wisconsin is facing a proposed dismantling of the basic structure of its incredibly efficient worker’s compensation program, based on the Governor’s Budget proposal, the workers in Illinois are also facing major legislative problems. As part of a series of articles in ProPublica and NPR, which discuss the overall dwindling of worker’s compensation benefits, a recent story discusses the worker’s compensation deforms currently proposed in Illinois.

One of the foremost experts on worker’s compensation, Professor John Burton, testified at an Illinois legislative hearing on the issue. Of note is that Burton’s national research generally shows that whenever and wherever the worker’s compensation eligibility standards are tightened the Social Security Disability and Medicare/Medicaid rolls go up in virtual direct proportion. Legislatures should be wary off unintended consequences on the taxpayers of alleged worker’s compensation “reforms.”

Poverty And Social Insurance

My business-owning friends harp constantly about “entitlements,” which, they say, cost them money in taxes and premiums. I routinely reply that these programs are a social safety net, the small price we pay to live together relatively peacefully  in a “civilized” nation.

My friend and Iowa workers’ comp colleague Paul Mc Andrew sent me an email that sums up this concept succinctly:

Did you know that in 2013, there were more than 25 million reasons to give thanks for social insurance? According to Census Bureau data released this fall, more than 45 million people in the U.S., or 14.5% of the nation, lived in poverty in 2013. The good news? Three vitally important social insurance programs – Social Security, unemployment insurance (UI), and workers’ compensation – and a related program, Supplemental Security Income (SSI), kept the poverty rate from being much higher. Together, these four programs kept more than 25 million people out of poverty.

Workers’ Compensation alone lifted 87,000 people out of poverty in 2013, including:

  • 16,000 children; and
  • 60,000 non-elderly adults; and
  • 11,000 elderly adults aged 65+

−−Elisa Walker, National Academy of Social Insurance

We workers’ comp lawyers can only help one injured workers at a time, but collectively…..

Alternatives to Workers’ Comp: Paranoia or Possibility

I joined a national organization of lawyers representing injured workers (the Work Injury Law and Advocacy Group) twenty years ago when it was first formed. Then, I heard horror stories about legislators messing with an otherwise stable workers’ compensation system after every election cycle. My colleagues in other states were constantly fighting battles over workers’ compensation “deform.” 

I thought we were insulated in Wisconsin because we had a workers’ compensation advisory council composed of labor and management who every two years fought out a compromise bill and submitted it to the legislature, which automatically rubber-stamped the proposed bill without changes. That changed in Wisconsin in 2014. For the first time in nearly 50 years, the Republican legislature rejected the “agreed upon” bill proposed by the workers’ compensation advisory council, despite the approval of the bill by management members.

Governor Scott Walker’s most recent budget contains a provision to dismantle the workers’ compensation system as we know it. Those of us representing injured workers (and those rational members on the management side) are busy lobbying to remove the workers’ compensation dismantling provisions from the budget.

It is no secret that many major corporations dislike workers’ compensation, despite statistics indicating premiums are at their lowest for employers, and profits at their highest for insurers. However, nearly two dozen major corporations including Wal-Mart, Nordstrom’s and Safeway are behind a multi-state lobbying effort to make it harder for workers hurt on the job to collect workers’ compensation benefits. The companies have financed a lobbying group the Association for Responsible Alternatives to Workers’ Compensation (ARAWC) that has already helped write legislation designed to have employers “opt out” of a State workers’ compensation system. ARAWC has already helped write legislation in Tennessee. That group’s executive director Richard Evans told an insurance journal in November that the corporations ultimately want to change workers’ compensation laws in all fifty states. Lowe’s, Macy’s, Kohl’s, SYSCO Food Services, and several insurance companies are also part of the effort. The mission of ARAWC is to pass laws allowing private employers to opt out of the traditional workers’ compensation plans that almost every state requires businesses to carry. Employers who opt out would still be compelled to purchase workers’ compensation plans, but would be allowed to write their own rules governing when, for how long, and for which reasons an injured employee can receive medical benefits and wages. Two states, Texas and Oklahoma, already allow employers to opt out of State-mandated workers’ comp. In that state, for example, Wal-Mart has written a plan that allows the company to select the physician and the arbitration company that hears disputes. A 2012 survey of Texas companies with private plans found that less half the companies offered benefits to seriously injured employees or the families of workers who died in workplace accidents. 

Oklahoma passed an opt out measure in January 2014 and the oil and gas industry along with major retailers such as Hobby Lobby pushed hard for the change. ARAWC wants to take that Texas and Oklahoma model nationwide. Seeing the workers’ compensation provision in Wisconsin’s budget bill as part of this overall “scheme” may seem paranoid, but the history of recent “deform” legislation suggest the connection is at least a possibility. 

See the complete article at http://www.motherjones.com/politics/2015/03/arawc-walmart-campaign-against-workers-compensation.

Workers’ Comp Programs Further Injure Injured Workers

Those of us who represent injured workers have known for a long time that workers’ compensation does not restore an injured worker to his pre-injury wage or status.  Two reports released in March show how workplace injuries have failed injured workers and leave them deeper in debt.  OSHA released a report indicating the changes in workers’ compensation programs have made it much more difficult for injured workers to receive benefits or medical expenses.  Although employers pay insurance premiums to workers’ compensation insurance companies who are supposed to pay benefits for medical expenses, employers provide just 20% of the overall financial cost of workplace injuries through workers’ compensation according to the OSHA report. 

This “cost shifting” is borne by the taxpayer.  As a result of this cost shifting, taxpayers are subsidizing the vast majority of the income and medical care costs of injured workers.  After a work injury, injured workers’ incomes average more than $30,000 lower over a decade than if they had not been injured.  Additionally, very low wage workers are injured at a disproportionate rate. 

Another report by ProPublica and National Public Radio found that 33 states have workers’ compensation laws that reduced benefits or made it more difficult for those with certain injuries and diseases to qualify for benefits.  Those hurdles, combined with employers and insurers increasing control of medical decisions (such as whether an injured worker needs surgery) reduced the worker’s likelihood of obtaining the medical care needed.

Overall, injured workers who should be paid under workers’ compensation are receiving less benefits and their medical care is being dodged by insurers and paid for by taxpayers through Medicaid and Medicare, or by increased insurance premiums for all of us through group health insurance rate increases.

Our general sense that injured workers are faring poorly is borne out by the research.

Medical Procedures: What do they cost?

Today’s post comes from guest author Leonard Jernigan, from The Jernigan Law Firm.

Blue Cross Blue Shield has created an online pricing tool to help patients compare prices of about 1,200 non-emergency medical procedures. Patients can now search for the best financial deal for services offered within North Carolina.

 By exposing this previously undisclosed information, patients are now able to go and see services according to the databases average procedure costs. The pricing tool also reveals the most expensive and most affordable option for each procedure.

In order to look up costs and doctors available to preform your procedure, you first access the pricing tool at: http://www.bcbsnc.com/content/providersearch/treatments/index.htm#/ . Then, you enter the treatment or service you would like in the first blank, your current location, and how many miles you are willing to travel for the service. Once you have entered all of this information, you just click search and your results will be immediately displayed. You can organize your results by cost, provider name, or distance.

 

To see the original article by John Murawski in The News and Observer explaining the pricing tool, click below:

http://www.newsobserver.com/2015/01/31/4516241_blue-cross-pricing-tool-could.html#storylink=misearch