Synopsis: Hello from the 23d Annual National Workers’ Compensation & Disability Conference & Expo in Chilly Las Vegas.
Editor’s comment: Your editor and several thousand WC folks from the across the U.S. and Canada are in freezie Vegas wondering what happened to the heat, sunburns and fun in the desert. As you read this, we have several interesting developments to report for folks at the largest WC conference in the U.S.
For the IL WC delegation, last week our new Fearless Leader IL Governor-Elect Bruce Rauner sent the WC industry on its heels when he reported it was his goal to trade an increase in the Illinois minimum wage against “business-friendly” changes to the IL WC Act. In our view, such changes
· Should have been discussed during the election campaign or
· Should be presented to the Governor-Elect’s “transition team” that is knowledgeable about workers’ comp issues;
· We hope the first meeting of the supposed WC transition team may meet before the soon-to-be-Governor is running for his second term.
Conference attendee and WC blog-master Mark Walls confirmed his view that “casual” or causal connection may be the major IL WC reform issue—Mark advised the State of Tennessee just moved to a requirement the work be a “major cause” of the work-related condition to be compensable and their WC insurance premium and cost savings have been dramatic. Mark and your editor have no idea if that is the basis for the new suggested changes in IL WC.
Chicago Mayor Rahm Emanuel was quoted as asking what Rauner’s “pro-business” changes might be. We assume both Speaker Madigan and Senate President Cullerton may be asking the same questions. We assure our readers no one has any idea what might be on the Republican WC legislative table. If you have any notion or inside information that is fit to print, please send it along. As we have said for as long as this KCB&A Update has published, we dislike and feel it is appropriate to criticize the WC process when it is run by secret-powers-that-be from either the Republican or Democratic side of the matrix. We are saddened and chagrined to hear the man who was selected to “shake up Springfield” is falling into the same secretive patterns of his predecessors.
As we indicate above, we have no idea what Governor-Elect Rauner is seeking or if the other side will accept his proposals but we are sure he has no way to effectively change the IL WC Act without approval by the other legislative side and the rabid Petitioner-Plaintiff lawyers from the Illinois Trial Lawyers Ass’n. Our worry for our political neophyte is our view that he needs veteran help in making any changes to the IL WC Act or they may agree to and make lots of “changes” that don’t change anything or actually make things better for the other side. It is his call on whether to ask for help and avoid the sort of errors made when the 2005 Amendments to the IL WC Act were passed which led to the 2006 corrections. Our vote is a confab to discuss important changes, as if we were what some observers call a “democracy.”
On a similar note, we were advised Chairman Latz may be on the way out and his successor is a solid and veteran defense lawyer from a Chicago-based WC defense firm. We think Chairman Latz is a great administrator and we would rather see him keep his current position but we understand the vagaries of political winds. If he is going to be replaced, we assure our readers we haven’t been consulted and have no idea how the successor may have been vetted and then selected. Again, we hate to see a new Chairman be selected as part of a secret and clandestine process. Lots of other states treat such jobs like real jobs and not political appointments—why not interview the top candidates and see who might be the best person?
Gene Keefe is a speaker at the Convention about Ethics in Claims Handling this Thursday—if you are in town and want to attend, send a reply. We appreciate your thoughts and comments on the issues above. Please post them on our award-winning blog.
Synopsis: Tom Nyhan, Rest in Peace.
Editor’s comment: We received news that Thomas D. Nyhan was at rest on Friday, November 7, 2014 while at his home with his family at his side. Tom was born December 26, 1929 in Chicago. Tom nobly served in the U.S. Navy during the Korean Conflict and was the founding partner of the law firm Nyhan, Bambrick, Kinzie & Lowry in Chicago. The roots of Nyhan, Bambrick, Kinzie & Lowry, P.C. go back to the late 1950's when Thomas D. Nyhan joined the now-defunct Chicago law firm of Pope, Ballard, Shepard & Fowle to assist a veteran attorney in handling workers' compensation claims for General Motors Corporation. Tom Nyhan's "helping out" turned into a 35 year journey as he became one of the premier workers' compensation attorneys in the State of Illinois.
Mr. Nyhan was one of the founders, as well as Executive Secretary, of the Illinois Self-Insurers’ Association which acts as a marketing unit for their firm. Tom also served as President and as a Board Member on the Executive Board of the National Council of Self-Insurers. Tom Nyhan served for many years as the workers’ compensation counsel to the Illinois Chamber of Commerce. He was active in numerous professional organizations and served on the Illinois Supreme Court Attorney Disciplinary Commission.
In our view, Tom Nyhan for the defense and Irv Greenfield for the claimant side worked out the Illinois workers’ compensation system that we have today. Tom Nyhan was a strong proponent and implemented the concept of proposed decisions on Arbitration—prior to the creation of that concept, IL WC Arbitrators could simply issue summary decisions without any basis for their reasoning/rulings. Whether an Arbitrator rules for or against either side, we feel it is a solid idea to that the reasoning laid out clearly and with some detail. Tom’s daughter Suzanne Nyhan is the tireless editor and publisher of the Q-Dex that is a listing of decisions of Arbitrators and the Commission and is a guide for everyone in the IL WC process.
Tom Nyhan was your editor’s first WC mentor and teacher. Like many of the men and women on both sides of the Illinois WC bar, Tom was a great lawyer, a good father and a kind man. Tom understood the need for lawyers to aggressively advocate for clients while also respecting your opponent. He will be forever missed. We send our condolences and best wishes to his family and friends.
Synopsis: Woman “Un-burned” Due to Faking Hot Coffee Burn Injuries! A woman in Victorville, California is charged with allegedly faking second-degree coffee burns from her McDonald’s cup of joe. Analysis by Bradley J. Smith, J.D.
Editor's Comment: A woman in California has been indicted by the San Bernardino County district attorney with twenty-one (21) felony counts of insurance fraud and workers’ compensation fraud. The woman allegedly bought coffee from McDonalds at the drive-through window, and claims that coffee spilled on her right hand when she was handed a cup of coffee with an unsecured lid. The woman allegedly was attempting to obtain $10,000.00 from McDonalds for her injuries. However, the insurance company became suspicious of the woman’s claims and referred the case to state investigators, who launched an investigation.
As evidence of the alleged burns, the woman provided pictures of second-degree burns on what purported to be her hand. However, upon further investigation, those photos and medical bills were allegedly false. Investigators state the photos were actually taken from the Internet of real burns, albeit from another unknown individual’s hands. In fact, investigators determined the photos were from a hospital website. Even more damning, the woman’s medical providers advised authorities that she had not received any medical treatment.
This prosecution comes after the over twenty (20) year old verdict of $2.9 million to a 79-year-old woman who was badly burned after hot coffee from a McDonald’s restaurant spilled into her lap causing severe and delicate burns. That case is history, but clearly not forgotten.
Insurance fraud is an obvious and ever-present problem that effects not only insurance and related companies, but also befalls normal individuals paying insurance premiums every day. In the event of observing insurance fraud, it should immediately be reported to the insurer and their attorneys. As premiums are always on the rise, anything that can be done to prevent false and fraudulent claims aids in a goal that is common both among insurers and insureds, lower premiums.
The lawyers at Keefe, Campbell, Biery & Associates, LLC always investigate and report suspected insurance fraud to the appropriate authorities in order to protect their clients and the general public from any foul play. We are happy to share our expertise and training to insure you pay the claims you owe and fight the phony claims you should fight.
The research and writing of this article was performed by Bradley J. Smith, J.D. Bradley can be reached with any questions regarding insurance fraud and general liability defense at firstname.lastname@example.org.
Synopsis: Sharpline Allocations, Our Favorite U.S. MSA Provider.
Editor’s comment: One of the great vendors in Vegas this week is the team from Sharpline Allocations. Sharpline Allocations is a customer service and relationship driven provider of Medicare Compliance and Settlement Planning services. At Sharpline, they understand each client’s unique needs, and deliver customized services that allow the claims professional to have complete certainty that each claim is in full compliance with Medicare Secondary Payer regulations.
The main differentiator between Sharpline and their competitors is great service and their hands on approach. They not only make recommendations, but provide assistance and follow up on with adjusters, risk managers, nurse case managers, Plaintiff/Defense counsel and other vendors to follow through on suggestions to reduce exposure and the potentially high cost of an MSA. They stay with the MSA until settlement, as opposed to moving on from the MSA once completed.
They are also piloting a new MSA Intervention program with one of their National accounts that has significant exposure at this time. The idea is that as soon as a Medicare eligible claimant reaches MMI, the file is referred to Sharpline for early intervention/bird’s eye view of any issues and to make recommendations to prep the claim for future settlement with closure of medical rights, and dramatically reduce MSA exposure by that time. This will potentially reduce the future MSA exposure and reserves. It will also drive claim costs down as the client will be able to settle and get the claim closed faster, rather than waiting to address issues at the time of MSA.
They can discuss this concept further if you are interested or to address any questions/ concerns. If you want more information, go to their great website at http://www.sharplineallocations.com/