5-12-2011; News from around the IWCC. Reinsurance Insurance Company of America liquidating and transcript payments clarified by new Notice form

While our sources at RIMS tell us most of their insurance was in the life insurance and personal sectors, Reinsurance Insurance Company of America wrote some WC coverage. If you have claims for which funds may be sought from Reinsurance Company of America, you will have to hold your water.

 

The IWCC has formally confirmed an Order of Liquidation was entered against Reinsurance Company of America on April 27, 2011. This order triggers the obligations of the Illinois Insurance Guaranty Fund for workers' compensation claims.

 

It also triggers a 120-day stay from the date of the order against insureds of Reinsurance, pursuant to 215 ILCS 5/551. This means that no findings, orders, judgments, or penalties should be made or awarded during the stay period. 

 

A copy of the order can be found on the web at http://www.iwcc.il.gov/RCAorder.pdf

 

In other and unrelated news, the IWCC Notice of Motion and Order form has also been revised in an effort to clarify responsibility for the payment of transcripts. A line was added to the top of the Notice of Motion and Order (IC4) form which indicates:

 

"Upon filing of a motion before a Commissioner on review, the moving party is responsible for payment for preparation of the transcript."

 

The forms section of the IWCC website reflects this change at http://www.iwcc.il.gov/IC04FORM.pdf

 

 

 

5-12-2011; Employer who paid full salary to teacher while she was injured entitled to credit for such payments to the extent of its duty to pay total temporary disability liability

The Appellate Court reversed the Circuit Court and the Commission on the issue of whether an employer was entitled to a credit for a section 8(j)2 credit for salary paid to Petitioner in lieu of TTD benefits in Elgin Board of Ed. V. IWCC and Linder Weiler, No. 1-09-3446WC (April 25, 2011). The Commission and Circuit Court rulings on causation and Petitioner’s average weekly wage calculation were upheld.

 

Petitioner was a teacher and underwent an arthroscopic procedure on her right knee which was unrelated to her work duties on November 7, 2002. After returning to work on November 13, 2002 she struck her knee on a desk and the surgical incision opened up and the knee began to swell. Her doctor diagnosed hemarthrosis which is “blood in a joint creating some inflammation.” Petitioner was not released until March 31, 2003.

 

During the year preceding the injury Petitioner was required to work 40 weeks and the parties stipulated she received an annual salary of $61,459.00. She received her annual salary year round even though she had the option of only being paid during the academic year. Petitioner testified she received her regular salary through the use of accumulated sick pay for the period of time she was off work. She claimed her sick pay had not been reinstated.

 

The Arbitrator ruled Petitioner sustained a compensable accident on November 13, 2002 and the hemarthrosis was causally connected to the accident. In calculating Petitioner’s average weekly wage the Arbitrator inexplicably determined Petitioner worked 42 weeks during the school year and therefore divided her annual salary by 42, yielding an AWW of $1,463.31. The Arbitrator also determined Respondent was entitled to a credit for the salary paid to the extent of its TTD liability pursuant to section 8(j)2 of the Act.

 

The Commission modified the arbitration ruling with respect to the AWW calculation and the 8(j)2 credit. The Commission noted Petitioner only was required to work 40 weeks during the school year and the relevant inquiry was the number of days an employee worked, not the fact he or she may have an annual contract. Therefore, Petitioner’s annual salary was divided by 40 yielding an AWW of $1,536.48.

 

Regarding the credit, the Commission examined the decision in Tee-Pak, Inc. v. Industrial Comm’n, 141 Ill.App. 3d 520 (1986) and stated an employer receives no credit for benefits which would have been paid irrespective of the occurrence of a workers’ compensation accident. Petitioner testified she had to utilize earned sick pay to receive her full salary and her sick pay carried value as it impacted her retirement benefits. The Commission held Respondent was not entitled to a section 8(j)2 credit for salary paid to Petitioner in lieu of TTD benefits. The Circuit Court confirmed the Commission’s ruling. This appeal followed.

 

In regard to the AWW issue the Appellate Court examined the language of Section 10 of the Act which notes in relevant part:

 

[3] Where the employment prior to the injury extended over a period of less than 52 weeks, the method of dividing the earnings during that period by the number of weeks and parts thereof during which the employee actually earned wages shall be followed.

 

The Court noted Petitioner’s employment prior to the injury extended over a period of less than 52 weeks and Petitioner was required to devote or apply her time and energy teaching for less than 52 weeks. See Washington District 50 Schools v. Workers’ Compensation Comm’n, 394 Ill.App.3d 1087 (2009). As such, the Commission did not err in dividing Petitioner’s annual salary by 40 to calculate her AWW. The Court noted its ability to address Respondent’s position Petitioner was employed pursuant to an annual contract was “hampered” because the contract was not made a part of the record.

 

Regarding the 8(j) credit issue, Respondent argued it was entitled to a credit because Petitioner received full salary payments in lieu of TTD benefits. The Court looked to Section 8 of the Act and noted,

 

“The first clause of section 8(j)2 states that an employer is entitled to a credit only for compensation payments made pursuant to the Act. 820 ILCS 305/8(j)2 (West 2002); see also World Color Press, 125 Ill. App. 3d at 471 (“The statute clearly credits the employer with any payments made by the employer as compensation payments”). The second clause of section 8(j)2 states when an employer pays money other than compensation payments under the Act, the employer “shall receive credit for each such payment only to the extent of the compensation that would have been payable during the period covered by such payment.” (Emphasis added.)

 

The Court discussed its decision in Tee Pak, Inc. and noted it determined because the employer in Tee Pak “failed to show that the salary payments the employee received were limited to occupationally-related disabilities, the employer was not entitled to a credit under section 8(j) or the Act.” The Court stated in Tee Pak there was evidence the employer intended its employees to collect both TTD and salary for the same period of time. There was no such evidence in the present case. As such, Respondent was entitled to credit for the salary paid, but only to the extent of its TTD liability.

 

Justice Holdridge dissented regarding the credit issue. He noted, according to Tee Pak, an employer can receive credit for benefits paid to an employee only where the benefits “are limited to occupationally related disabilities.” He stated because Petitioner, in the present case, could access her sick leave benefits without regard to the occupational nature of her disability Tee Pak should apply and prohibit the employer from taking the credit.

 

We are pleased with the majority decision as we feel the school should be given credit due to the fact it paid Petitioner for the time she was off. We note the majority did not address the reimbursement of Petitioner’s sick time which is likely an issue which will require litigation outside of the workers’ compensation arena.

 

Matthew Ignoffo, J.D. researched and wrote this analysis. Please do not hesitate to contact Matt at mignoffo@keefe-law.com.

4-26-2011; Illinois WC Reform Update

At present, the Illinois legislature is on an Easter/Passover break until next week. Enjoy the break!! We assume things may start cooking again next week. Again, we point out the best place to reform the Illinois WC system isn’t in the legislature.

 

Crain’s Chicago Business provided its thoughts in what we consider a somewhat heavy-handed editorial approach. They claim:

 

·         Illinois workers compensation system is the most expensive in the nation.

o    We have no idea what metrics support that comment; to our knowledge and based upon national research, Illinois is number three.

·         The complaints by Illinois business made no impact on the combination of Democratic politicians, unions, doctors and lawyers who profit from the system.

o    We point out there are Republican politicians, doctors and lawyers who profit too.

o    And “profit” is okay and completely legal in the good old USA; we are just trying to get the profits down to a more reasonable level.

·         Governor Quinn’s cuts in medical reimbursements would cut as much as $500M and then leave Illinois with the second highest medical costs in the country

o    Again, we are unsure of the metrics or measurements upon which this claim is made. The Governor hasn’t released his research on this fascinating claim and we urge his staff to do so.

o    We caution everyone, if medical reimbursements are cut to levels below what companies like Blue Cross/Blue Shield© pay, you may have problems getting Illinois docs and hospitals to take WC patients.

 

Don’t take our word for it. Take a look for yourself at:

 

http://www.chicagobusiness.com/article/20110416/ISSUE07/304169991/editorial-quinn-backed-workers-comp-bill-must-go-further

 

The Chicago Tribune outlined its report of the events in Springfield last week. They clearly attacked the failure of the Democrat Senators to vote on SB1349 by simply announcing they were “present.” The Tribune’s editorial staff noted the "present" vote has a long and storied history in our legislature, enabling Illinois lawmakers to block bills while avoiding the political fallout from actually voting against them.

 

We were happy to see a national news source finally confirm our determination the 2005-6 Amendments to the Illinois WC Act did not help Illinois business and increased IL WC costs. The Tribune said actions in 2005 for the legislature to “just-do-something…led to nothing but window-dressing in 2005: A law described as a landmark reform of workers' compensation turned out to be just a head-fake. Illinois' costs only got worse in its aftermath, especially compared with states like Missouri that enacted real reform.”

 

As we have said many times, one easily definable way to enact immediate and definable WC reforms would be to roll back the PPD, death benefit and wage differential increases from the 2005 Amendments to our Illinois Workers’ Compensation Act. You could also end the five WC funds that only help a very, very limited group of folks and cost Illinois business millions. We also point out the IWCC’s budget tripled while the speed of claim resolution remained virtually unchanged.

 

You can read their editorial and “draw your own contusions” at:

 

http://www.chicagotribune.com/news/opinion/editorials/ct-edit-workcomp-20110419,0,4379580.story

 

Risk and Insurance Magazine weighed in with its thoughts; focusing on Governor Quinn’s as-yet undrafted legislative proposals.

 

They cite the same report from the Governor with the claim that even with a 30% cut in WC medical reimbursements, Illinois would still have the second highest WC medical costs in the country. As one can imagine the President of the Illinois State Medical Society doesn’t feel it would be “reform” to bring WC medical costs down. We have no idea what he might mean.

 

Again, don’t take our word for it, here is the link:

 

http://www.riskandinsurance.com/story.jsp/storyid=533336209

 

For all the lawyers who feel compelled to repeatedly tell us to limit reporting of current status and news of Illinois WC reform, please send your letters and comments to the editors of these national news organizations. If you want us to publish your side of the reform issue, forward your thoughts and we will consider them for publication.

 

We are committed to continue to report what is happening for our readers who continually ask for progress on issues they clearly feel critical to their companies and careers. Every single link above was forwarded to us by a reader and we thank them for their input.

 

We appreciate your thoughts and comments. Please do not hesitate to post them on our award-winning blog at www.keefe-law.com/blog.