Posts Tagged ‘workers compensation’

Workers’ Compensation Boards Debate Disability Guidelines

Thursday, September 2nd, 2010

The default rate among self-insured group trusts has produced an alarming level of assessments on small businesses throughout the country. Workers’ compensation boards in states like New York are increasingly deliberating “safety programs” that would lower workers’ compensation costs.

Certain critics—notably the insurance industry itself—have long argued that the injury benefits awarded by state workers’ compensation boards are overinflated, and do not accurately reflect the true costs of a given injury.

While cases of fraud and “presumptions” are significant factors, many claim that the inability of workers’ compensation boards to objectively assess and quantify disability is a much greater problem. For years, many WCBs have not had a working definition of levels of disability or percentage-based schedules of loss. These boards have used arbitrary and every-changing criteria to calculate hundreds of millions of dollars’ worth of permanent damages benefits. On top of this there have been the massive cost of trials and testimonies to calculate what WCBs claimed had no definition in the first place.

At the present moment, workers’ compensation boards across the nation are once again involved in debates over the creation and use of more standardized, objective guidelines to evaluate disability. Yet for generations, the workers compensation system has carried on profitably by not having such standards. In short, disputes have been resolved by an arrangement in which worker’s compensation attorneys and insurers must engage in expensive and inefficient disputes until both sides are worn down and settle for a number around 50%, giving the misleading impression of a fair and reasonable outcome.

According to Seattle Workers’ Compensation Attorney Theodore Ronca, this state of affairs has come about through the unique history of workers comp boards.  In New York State, for example, the board has employed a medical advisor since its very first days. The initial advisors established guidelines that were widely accepted and implemented, until they eventually came to be considered obsolete in the 1950s.  After that point, the New York State workers’ compensation board had no working guidelines, and attempts to create new criteria came to a state of deadlock through stubborn opposition on all sides.

The New York Workers’ Compensation Board continued to operate (unofficially) with the older guidelines, and then later with no criteria at all for the next forty years. Responding to pressure in the 1990s, it produced new written guideline for workers’ compensation benefits, but failed to make these binding.  In practice, they were generally ignored when negotiating workers’ compensation claims.

This, of course, raises the question as to whether guidelines would automatically solve anything. As Ronca points out, “unless the guideline can be tested to determine if it can measure what it purports to measure it remains a blank yardstick masquerading as a set of calipers.”  Calculations of workers’ compensation disability, ultimately, result in the final settlements of injury claims, some that currently stand above $200,000 (and rising).  Whether these numbers are too high or too low is a question for which many workers’ compensation boards still have no satisfactory answer.

Healthcare Worker Recovers Medical Benefits After Foreign Blood Splashed on Face and Eyes

Sunday, August 29th, 2010

In accordance with a group of cases that have allowed workers to recover medical benefits after being exposed to blood or other bodily fluids—even when no actual proof of harm has been established—a Kentucky court recently agreed to award $700 in medical benefits to a health care worker who was splashed in the face and eyes with a patient’s blood while flushing an I.V. line (Kentucky Employers Safety Association versus Lexington Diagnostic Center, No. 2008-SC-000671-WC. [May 21, 2009])

The case arose out of a medical fee dispute between the employee and his workers’ compensation insurance carrier.  Immediately following the incident, the worker notified his employer of the accident and received medical attention; at this point, the post-exposure protocol required by OSHA was performed.  The process called for five office visits, including laboratory tests for blood-borne pathogens.  The total cost of medical services amounted to $700.  The employee’s workers’ compensation insurance carrier agreed to pay for the first two visits and a portion of the third, but then refused further compensation.  According to the insurance company, while an exposure to bodily fluids “may have potentially harmful effects,” it does not officially constitute an injury unless and until objective medical findings prove that the exposure has caused a harmful change in the human organism.  The insurer wrote that the insurance policy had paid for one initial test and a follow-up primarily “as a matter of custom and practice and a courtesy to its members.”

According to the official opinion of the Supreme Court of Kentucky, “At issue is whether a healthcare worker who was splattered in the face and eye with blood sustained a compensable injury and, as a consequence, whether the employer or the insurance carrier bears liability for the expense of OSHA-required prophylactic testing.  Affirming a decision by the Workers’ Compensation Board, the Court of Appeals determined that the worker sustained a compensable injury and, thus, that the carrier was liable.”  In other words, the court determined that being spattered in the face and/or eyes with foreign blood, or with any other potentially infectious bodily fluids, does indeed constitute a traumatic event for the purposes of KRS 342.0011(1); meanwhile, the presence of another person’s blood in the worker’s eyes counts as exposure as defined in 29 CFR 1910.1030(b), which defines a “harmful change” in an individual as—among other things—the introduction of foreign blood or potentially infectious substances into the worker’s body.

I-1082 Opens Workers’ Compensation to Private Insurers

Saturday, July 17th, 2010

In mid-July, an initiative qualified for the November ballot that could have far-reaching effects for Washington workers, employers and taxpayers.  I-1082, which would effectively privatize the current state-run workers’ compensation program, is backed by the insurance industry and a conservative trade group called the Building Industry Association of Washington (BIAW).  If the initiative passes, these two groups will reap enormous benefits.

I-1082 would allow private insurers to offer workers’ compensation coverage in competition with the current public system, giving yet another lucrative handout to the taxpayer-bailed-out insurance industry.  After receiving billions of taxpayer dollars over the past few years, firms like AIG (the world’s largest workers’ compensation insurer) are now attempting to undermine Washington’s non-profit public system — a system that “is statutorily required to keep costs down,” says Nicholas Corning, former President of the Washington State Association for Justice. If the private insurance industry is successful, I-1082 will leave Washington businesses “to deal with out-of-state corporations [who are] only concerned about siphoning profits into their Wall Street war chests.”  And state employers can expect a costly outcome from this transfer; as Corning points out, the existing state-run workers’ compensation program, L&I, operates with only 18% administrative costs; the private industry average, on the other hand, is 68%.

Opposition to I-1082

Small business owners and community leaders feel that privatization would prove highly unfavorable to businesses, employees and taxpayers, and have organized opposition groups to I-1082.  The campaign No on I-1082 maintains that the highest priority of our existing public system is to ensure that injured workers receive the medical care and job retraining they need.  For-profit insurers are not likely to share this priority.  According to the opposition group’s communications director, Adrianne Williams, “Handing our public, non-profit system over to the private insurance industry is mostly [designed] to generate profits for the industry and less about getting injured workers back to work.”  Other prominent groups opposing I-1082 include the Washington State Labor Council AFL-CIO, the Washington State Association for Justice, and Democratic Underground,

Many Washington businesses are also concerned about the higher insurance premiums they can expect if 1082 passes.  Alex Fryer, the spokesman of “No on I-1082,” argues that private insurance companies will end up “cherry-picking businesses that have low claims, forcing the remaining higher-risk businesses to pay higher premiums under the state plan.”  To underscore the consequences of moving away from a non-profit workers’ compensation plan, he cites figures on states that have adopted a private insurance option, some of which experienced a 200 percent premium increase.

In addition, I-1082 proposes to abolish the existing state mandate requiring employees to pay a portion of the state’s premium costs, shifting the entire financial burden to employers.  Analysts predict that this would cause small business owners’ annual costs to go up by 25 percent.

I-1082 would have an unfavorable outcome for workers as well, eliminating any transparency from the claims management process.  Under the present Washington State workers’ compensation system, L&I is required to come to a final decision regarding treatment of a worker’s injury or illness, and must notify all parties of that decision.  If L&I does not comply with these obligations, it can be compelled to do so by a writ of mandamus.  But I-1082 includes a provision stating that insurers do not have to notify anyone if a claim is rejected; in fact, the workers’ compensation insurer would never have to come to a decision on an injury claim at all.  This puts the insurance companies at a tremendous advantage, allowing them to protect their profit margins by denying or delaying claims indefinitely, without ever facing the threat of enforcement.  Not only would this potentially prevent workers from returning to their jobs; it would also make it extremely difficult for employers to verify whether an employee is able to work.

Critics of the initiative are also alarmed that I-1082 would leave the insurance industry unregulated and free of L&I oversight.  Private insurers would be allowed to set their own rates with no approval from the Washington State Insurance Commissioner. Equally troubling is the fact that I-1082 would abolish the Insurance Guaranty Act, leaving Washington businesses and employees vulnerable to insurer insolvency.  Currently, all lines of private insurance in the state are protected against fraud or bankruptcy by the Insurance Guaranty Act.  But with that regulation removed, an insurance company could collect workers’ compensation premiums and then fail to pay benefits due to insolvency.  Because of these reasons, Washington Insurance Commissioner Mike Kreidler and State Auditor Brian Sonntag both oppose I-1082.

Ultimately, I-1082 would establish an unregulated and largely independent playing field for private insurers to reap profits by squeezing Washington businesses and undermining worker safety.  Before voters cast their ballots in November, they should be aware that I-1082’s success would be a huge win for special interests, and a loss for the wellbeing of small businesses and injured workers.

Read more about I-1082:

Emery Reddy Files Class Action Lawsuit Against Safeway

Monday, May 24th, 2010

The attorneys at Emery Reddy recently filed a class action lawsuit against Safeway for failing to pay overtime wages and illegally preventing employees from taking meal and rest breaks.

Emery Reddy is committed to ensuring that workers receive the full compensation and benefits to which they are entitled under state and federal law.  To follow the developments of this and other overtime and wage violation cases, please check back regularly for updates.

Wage, hour, and benefit violations of this kind are unacceptably common in today’s workplace. Employers violate the law and their workers’ rights when they refuse to pay overtime wages, do not meet a state’s legally established minimum wages, fail to comply with the Equal Pay Act, coerce an employee to work off the clock, refuse to allow workers their mandatory breaks, or withhold commission payments, final wages or any other portion of a worker’s earned wages without that employee’s written consent.  For more information on wage disputes and workers’ rights, visit Emery Reddy’s Employment Law information center or the websites for the Washington State Department of Labor and Industries (L&I) and the US Department of Labor.

Federal Court Ruling Opens Way for FMLA Claims Against Individuals

Sunday, April 18th, 2010

This article by Timothy W. Emery, Esq., a partner with Emery Reddy, PLLC, Attorneys at Law.

A federal district court recently ruled in favor of an employee suing several human resources executives after he was allegedly fired for requesting time off under the Family and Medical Leave Act (FMLA).  The ruling may set a precedent in which individuals can be held personally liable for damages allowed through FMLA, including financial loss from a denial of benefits, compensation for back pay, lost wages and attorney fees.

The suit was brought against Cardone Industries and five of its senior HR executives by Dmitry Narodetsky, a tool designer who worked for the company for nearly twelve years before his termination.  His case includes a three-count complaint for violation of the Family Medical Leave Act, the Consolidated Omnibus Budget Reconciliation Act (COBRA), and the Employee Retirement Income Security Act (ERISA).

Several weeks prior to his termination, Narodetsky was diagnosed with a leg injury requiring surgery.  His wife promptly notified Narodetsky’s managers that her husband would need time off for the upcoming operation, and requested that they provide short-term disability for his medical leave.  Following the conversation, three of the company’s HR executives and another manager conducted a forensic examination of Narodetsky’s work computer, uncovering evidence of a pornographic email he allegedly forwarded to a coworker over a year earlier.  Before scheduling the surgery, Narodetsky was called into a meeting attended by the defendants, shown the email he had allegedly forwarded, and fired.

Narodetsky alleges that his employers conducted the computer search solely to find a pretext for terminating his employment so they could avoid granting him leave. He filed a suit alleging that not only the company, but also the five individual defendants interfered with his rights under FMLA and the Employee Retirement Income Security Act.

Attorneys for the defense argued that none of the individual claims were warranted because Narodetsky’s suit did “little more than simply list each such defendant’s title,” and because it failed to include “any facts showing how each defendant was involved in plaintiff’s alleged request for medical leave or the decision to terminate.”

Yet U.S. District Judge Thomas N. O’Neill of the Eastern District of Pennsylvania refused to dismiss Narodetsky’s claim, noting that it went well beyond the narrow characterization of the defense by alleging that each of the individual defendants “participated in the forensic search of [the plaintiff’s] computer with the goal of finding a reason to justify his termination because he had requested FMLA leave.”  O’Neill also maintained that the executives and manager were properly named as defendants since each possessed the authority to fire and played a role in the decision to terminate Narodetsky. “The allegations support an inference that each of the defendants exercised control over the plaintiff in the decision to terminate him,” O’Neill wrote.  The judge also stated that “Given the timing of his termination–falling right on the heels of his request for medical leave–I find that it is reasonable to infer that the defendants terminated his employment for the purpose of interfering with his plan benefits.”

Both the individual defendants and Cardone Industries, Inc. have declined to comment publicly on the ruling.  The case is now proceeding to adjudication in a new trial. See O’Neill’s full opinion in Narodetsky v. Cardone Industries Inc. (pdf)

Citation: Narodetsky v. Cardone Industries et al., Case #09-4734; February 24, 2010, U.S. District Court, Eastern District of Pennsylvania.