Synopsis: The Least IL WC Claims Adjusters/Attorneys/Arbitrators Need to Know About Common Medical Conditions in the WC Arena.
Editor’s comment: Here are our thoughts and information from your editor and his fellow lawyer and sister, Ellen Keefe-Garner who is a brilliant trial lawyer and also a registered nurse in IL and MI. We tell our law students to always refer towww.wikipedia.org or www.youtube.com for simple follow-up information/research to what we are providing below.
Head: The main IL workers’ comp concerns in relation to head injuries are skull or facial bone fractures. For a diagnosed fracture of a non-facial skull bone, there is a minimum of six weeks of PPD due. For a fracture of most facial bones, there is a 2-week minimum. It would be a rare Illinois WC claim where the minimum statutory weekly value would be all that an injured worker would be awarded for a skull fracture.
In dealing with instances of severe closed head/brain trauma, we recommend adjusters/attorneys/arbitrators consider getting the injured worker to either the Rehabilitation Institute of Chicago www.ric.org or QLI Omaha www.qliomaha.com for short or long-term care. Both institutions are amazing and at the top of the field in this part of our planet.
Neck/Back/Spine: The neck is the top of our spinal column which is the primarily bony structure that protects our spinal cord. The spinal cord is our bodies’ information/electric superhighway. The four spinal “sections” are called cervical, thoracic, lumbar and sacral. The human spinal column is made up of 33 bones - 7 vertebrae in the cervical region or C1-7, 12 in the thoracic region or T1-12, 5 (usually) in the lumbar region or L-1-5, 5 in the sacral region or S1-5 and 4 in the coccygeal region that are fused into one bone for adults.
The bones are separated by “intervertebral discs” or tough, fibrous material that our bodies use to keep the bones from touching/grinding on each other. The problem we face is overstressing or traumatizing an intervertebral disc may cause it to bulge or rupture and put pressure on the nerves that swing in and out of this superstructure. When they bulge, the docs usually give patients anti-inflammatories and painkillers to keep us from whining too much. When the discs rupture, spine docs will sometimes treat them with drugs but more often may go into our bodies and clean out the disc material, as it will compress your nerves. They may “fuse” the spine where the disc ruptured by taking bone from other parts of your body, usually your hip and grafting it into place where the disc used to be. This fusion procedure may include hardware, such as plates and screws to stabilize the newly placed bone grafts.
For adjusters/attorneys/arbitrators, the important or “most-seen” sections are the cervical and the lumbar spine. Those are the action areas of our bodies—if you suffer “whiplash” or otherwise injury your cervical spine the joint most commonly affected and operated on is C6-7. For lumbar injuries, the joint most commonly problematic is the L5-S1 which is the arched fulcrum upon which the spinal column rests.
Past IL WC PPD awards for bulging discs range from 0-15% LOU of the BAW or body as a whole. Spinal surgeries that aren’t fusions, like a laminectomy/discectomy traditionally resulted in PPD awards in a range from 12.5%-25% LOU of the BAW. Fusions are considered complex surgeries with an expectation of permanent restrictions. The IL WC awards for fusion surgeries run from 20-35% BAW. All of the traditional values may be impacted by implementation of impairment ratings for IL WC claims occurring on and after September 1, 2011.
Shoulder: The shoulder is your arm’s “universal joint” with lots of range of motion in lots of directions. The shoulder is a ball and socket joint held into place with a tough membrane called our “rotator cuff.” The rotator cuff is a group of four tendons that stabilize and basically comprise the shoulder joint. Each of these tendons attaches to a muscle that moves the shoulder and the biggest arm bone, your humerus in a specific direction. Rotator cuffs can tear—when that happens, doctors will go back in an clean out the debris and sew the tear up. This can leave an injured worker with less range of motion and sometimes limited strength, particularly above the waist. There are several different versions of surgical shoulder repairs—most of the time, they will result in traditional values at about 5-15% BAW. Remember, in the Forest Preserve District of Will County ruling, after about 100 years of the shoulder being awarded PPD benefits based upon LOU of the arm, our resolute Appellate Court, Workers’ Compensation Division found a dictionary and then magically changed valuation for an Illinois injured worker’s shoulder problems to compensation for loss of use of body as a whole.
Elbow: The elbow is the simple joint in the middle of your arm. The most common WC elbow surgery is cubital tunnel repair or “cleaning” we consider to be more common in our state than any other place on the globe.
Wrist: The wrist is the joint between your forearm and hand. For reasons lost in time and IL workers’ comp tradition, injuries to the wrist are usually compensated as LOU of the hand and not the arm; despite the fact most wrist injuries involve arm bones or tissue. You may occasionally see a condition called a ganglion cyst—these are almost never traumatic or work-related in origin.
Hip: Like the shoulder, this is your leg’s universal joint. It is also a ball and socket joint with a tough, fibrous membrane that holds the biggest bone in your body, your femur in place. We don’t see as many hip tears as we see rotator cuff tears in the shoulder. We are starting to see more and more hip arthroplasties or hip replacement surgeries. In such a procedure, the surgeons enter, cut out the bones above and below the joint and put in a plastic/metal thing that takes over the place of your creaky old bones. We have seen awards in the range of 40-60% LOU leg for such work.
Knee: The knee is an oft-abused but simpler joint between your femur and your tibia bone that is in the bottom of your leg. Basically there is a very limited range of motion—this joint is a limited hinge. The most common surgical issues are menisectomies and ACL repairs. The meniscus is tissue that goes across the knee and is designed to keep your femur and tibial plateau from coming into bone-on-bone contact. Orthopedic surgeons for decades have been trimming out damaged and cut tissue which leaves a small area of such bone-on-bone grinding. If they take enough out, you may eventually need knee arthroplasty or joint replacement surgery. Traditional menisectomy PPD awards were 12.5% to 25% LOU of the leg. Like hip arthroplasties, knee joint replacement is also 40-60% LOU leg.
Your ACL is a ligamentous membrane that is in a “cross” or x-configuration and keeps your knee in line. If that is ruptured, docs need to harvest similar tissue from somewhere else in your body and reattach it. The values for such complex surgeries are from 20-35% LOU leg.
Ankle: The ankle is the joint between your lower leg and foot. The most common injuries are ATF or ankle ruptures. Like wrist injuries, these are treated as LOU foot and not leg.
· Amputation = bone loss.
· Always pay on statutory losses immediately or the minute you are aware of the extent of bone loss.
· Failure to pay exposes employer to 50% penalties and 20% fees—why wait?
· Attorneys’ fees capped at $100 for accepted statutory loss that you pay—amputation, skull/vertebral fracture
· Illinois has very high minimum and maximum amputation rates—check Shawn Biery’s current rate chart
IL WC PPD RULES OF THUMB:
· Simple fracture/simple surgery traditionally utilized an informal 15-25% rule;
· Simple strains w/o fracture or surgery shouldn’t rise to 15%;
· For injuries involving more than simple fractures/surgery, go to www.qdex.com or call/email KCB&A;
· PLEASE NOTE physician’s AMA disability ratings “shall be” considered by the IWCC for injuries after September 1, 2011. If you don’t bring a rating, they can’t consider it!
We appreciate your thoughts and comments. If you want our KCB&A Rules of Thumb, send a reply. If you want our list of recommended vendors/experts, send a reply.
Synopsis: Illinois WC Rates Jump Again and Your PPD Reserves Need Retroactive Updating. Send a Reply to Get a Free Copy of Shawn R. Biery’s Updated IL WC Rate-Sheet!
Editor’s comment: We remain chagrined to continue to watch the endless spiral of IL WC rates. Starting in the 1980’s, the IL WC Act provides a formula that effectively insures no matter how poor the IL economy is doing, our WC rates keep climbing.
We caution our readers to pay attention to the fact the IL WC statutory maximum PPD rate is now $712.55. When it was published, this rate changed retroactively from July 1, 2012 to present. If you reserved a claim based on the prior rate for the period from July 1 to right now, your reserves are wrong. If you have a claim with a date of loss after July 2012 and a max PPD rate, you need to take a look and see if the new maximum PPD rate applies. If this isn’t clear, send a reply.
The current TTD weekly maximum is $1,320.03. A worker has to make over $1,980.04 per week or $102,962.34 per year to hit the new IL WC maximum TTD rate. Do such folks truly need full TTD value? Does any state in the United States have a TTD maximum that high?
The new IL WC minimum death benefit is 25 years of compensation or $495.01 per week x 52 weeks in a year x 25 years or$643,513.00! The new maximum IL WC death benefit is $1,320.03 times 52 weeks times 25 years or a lofty $1,716,039.00 plus burial benefits of $8K.
The best way to make sense of all of this is to get Shawn Biery’s awesome and easy-to-understand IL WC Rate Sheet. If you want it, simply reply and we will send it along.
Synopsis: New IL WC Reform Legislation proposed by Dwight Kay, R-112th Dist.
Editor’s comment: While we don’t think they will pass, here are new bills/reform legislation our plucky, pro-business rep has floated out there in Springfield. The comments are the opinions of your editor and don’t reflect Mr. Kay’s thoughts.
HB0114—At present, a ruling on a IL WC claim by state workers ends at the IWCC. This creates the weird situation in which a WC claim by a state worker goes before other state workers--the IL Arbitrator and Commission panel. Many folks feel it has a less-than-objective perspective. The same situation was present when IWCC Arbitrators were having their personal WC claims handled by other IWCC Arbitrators. The 2011 Amendments created “independent” arbitrators to hear such claims.
The IL State agency that currently manages WC claims, Central Management Services has crabbed about being limited to hearings/appeals only at the IWCC for years and they wanted what they felt were poor rulings from the IWCC to be appealable to the local circuit courts, so the matter would be brought to someone outside the IWCC. This legislation would then stop the appeal at the Circuit Court level so claims would not then move to further appeals before the liberal and pro-labor IL Appellate Court, Workers’ Comp Division.
HB0115—Medical bills and TTD for state workers would be charged to the budgets of their respective state agency. We thought this was already enacted in recent Senate bill. We feel any T&P benefits paid to a state worker due to the respective state agencies’ almost criminal refusal to accommodate them, creating the fantasy of an “odd-lot” total and permanent claim for hundreds of state workers, should also be charged to the respective agencies.
Someday, we hope the media or the Governor or someone in the federal government should investigate and stop the “odd-lot” thing for all state workers. Every single one of them are, by definition, ghost-payrollers. If you don’t understand why this is a secret WC scandal in our state, send a reply.
HB0107—This is the “major contributing cause” requirement. The same bill was floated out in the legislature last April and didn’t get much traction.
HB0109—This language would require a signed, written, verified report of injury within 45 days of onset. That language would be a very sweeping change to WC law and practice in IL. The language would potentially reverse the Durand ruling where a woman knew of a condition and didn’t report it for four years. In Durand, the IL Supreme Court said they couldn’t “punish” her for failing to report a known condition while “working in pain” for the four-year period. We have always wondered what “punish” has to do with following the very clear rules and why our highest court didn’t feel they were “punishing” the employer by making them pay benefits not due.
HB0112—This language would limit CTS claims to impairment ratings only if the worker went back to regular work. In large part, we feel such legislation would completely eviscerate any CTS claim because the impairment ratings for CTS are almost always zero. Try to imagine a state where the “tunnels of Illinois” were closed in the WC arena and the number of CTS claims would again mirror the rest of the country. Another concern is the same concept should apply to cubital tunnel syndrome.
HB0113—This legislation mildly changes the intoxication defense so the employee has to show intoxication was not the proximate cause of the injury where the Act currently says either sole proximate cause or just proximate cause. We are not sure how this would truly modify what we are dealing with in the battle over the intoxication defense.
HB0111—This proposed law would effectively create a “limit” on body as a whole awards of 500 weeks. Business reps have wanted “credit” for prior BAW awards so if someone got 30% BAW, they would have to show 50% loss to be entitled to a 20% recovery. From our view, this legislation doesn’t take that approach—it simply caps all lifetime BAW awards at 500 weeks. We feel common sense should make this law unnecessary; Duh??--how can the IWCC find someone to be 145% disabled while they are on the same planet? The problem Rep. Kay is addressing is the sometimes missing “common sense” thing in this WC system.
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