10-31-11; AN Employers’ Scariest Nightmare!!!—Late Accident Reporting. In this Federal Ruling, the Court Ruled Late Reporting Justified Termination. Should you consider ramping...

One tough concept for all U.S. employers to consider is heightened accident reporting rules. What may be mildly misleading is Illinois and many states have wildly lax reporting rules when it comes to the time an employee can report an accidental injury and still be entitled to workers’ compensation benefits. In Illinois, that period is 45 days which means one of your workers could be injured today and keep it a secret from you until the middle of December and then let you know. The monster problem that causes is your ability to investigate and learn from what happened to him/her is just about negated. It is also a Nightmare to set reserves accurately. Accident investigation has to be conducted within 24-48 hours to have a ghost of a chance at effectiveness.

The Ghoulish question risk managers and HR folks have to ask is whether an employer require employees to report their workers compensation injuries more quickly than required under state workers’ comp laws? Please note late or delayed reporting may be a new and Scary Illinois WC phenomenon as injured workers seek to sidestep the impact of the new Amendments to the IL WC Act which makes refusal to take a blood test into a Frightful presumption the employee was intoxicated. No one knows if intentionally late accident reporting will be treated as a refusal to test.

We are certain the most aggressive accident reporting model is “end-of-shift” reporting—we have one client who will terminate a worker if they aren’t told about the “accidental injury” or claim of repetitive trauma during the shift where it happens or appears. What is Shocking is their union supports this aggressive approach. We are happy to consult with any of our readers on how to put more aggressive accident reporting models into place.

A ruling from the U.S. Court of Appeals for the Sixth Circuit may be illustrative on the law. Please note this is the federal level just under the U.S. Supreme Court and is therefore a pretty strong statement by our judiciary in relation to U.S. law on the issue. The time period for the U.S. Supreme Court to consider the claim is still pending.

In Geronimo v. Caterpillar, (No. 09-6401, Opinion issued September 7, 2011 and we didn’t make the name up!!!) claimant was a female employee who worked for a large corporation as an at-will employee for approximately seven years. In June 2007, the company transferred the employee from her position as a machinist to an assembler position. The employee alleged she began to experience pain in her hands while completing the tasks required in her new position. The employee explained she experienced pain akin to “a muscle strain” in her palms, upper arms, and fingers each time she pressed down on the clutch plates on the assembly machine. She noted after she let go of the machine pain would stop. The employee claimed she experienced tightness in her muscles at end of her first day and stiffness in her muscles when she awoke the next morning. These pains continued over the next two weeks. After approximately four weeks on the job, the employee began experiencing numbness and tingling while performing everyday non-work tasks with her hands and arms which she attributed to her tasks at work.

By Aug. 1, 2007, the employee began to suspect she had carpal tunnel syndrome she related to work. After doing some internet research, the employee spoke with a company nurse for the first time about her pain on Aug. 14, 2007. By this time, the employee stated pain had become almost unbearable and was causing the employee to lose sleep. When the nurse asked why the employee had not reported her pain earlier, the employee explained she wanted to “try to work through it” because she was afraid she had no “other options than to do the job.” She also stated she didn’t tell her supervisor because “she didn’t want him to think she couldn’t do the job.”

The nurse informed the employee she would try to set up an appointment for the employee to see a doctor. The next day, the company fired the employee for “not meeting expectations” because of her “failure to communicate an injury in a timely manner.” Specifically, the employee was cited for failing to abide by the company’s stated policy requiring employees to report the occurrence of injuries immediately or, if the injury was gradually occurring, to report it as soon as an employee realized they are injured and suspects it is work-related.

The employee filed a complaint alleging the company unlawfully terminated her in direct retaliation for making a claim for benefits and/or asserting her right to benefits under the applicable state workers’ compensation act. The Federal District Court dismissed the employee’s claim finding the company’s policy did not violate state workers’ compensation law, and the employee appealed.

In affirming the dismissal of the employee’s claim, the Sixth Circuit noted although the employee was correct state WC law allowed employees a lengthy period in which to report a gradually occurring injury for the purpose of filing a claim of workers’ compensation, the statute does not expressly prohibit or establish a public policy prohibiting an employer from imposing a separate notice requirement for workplace injuries. In our opinion, the IL WC Act also provides 45 days for reporting an event but it does not prohibit an employer creating a shorter requirement for accident reporting and investigation.

It is also vitally important to note this Federal Appellate Court noted the employer had not disputed the employee’s workers’ compensation claim filed after her termination. We feel this decision effectively stripped out any monetary damages in the termination dispute--the employer and/or its TPA already paid for the employee’s surgery to correct a carpal tunnel problem. Thus, the court felt it was clear the company was not retaliating against the employee for having a medical problem or reporting her injury, but rather the employer was enforcing its own well-promulgated safety and accident reporting policy. Accordingly, the Sixth Circuit dismissed the employee’s claim.

We appreciate your Conjuring-up thoughts and comments. Please feel free to post them on our Eeeerie award-winning blog. If you want the web cite to the ruling above, send a reply.

10-25-11; Painful as it is to say, tornados aren’t work-related risks, folks. However, at the last minute, the Accident Fund Insurance Company of America steps to the plate!!!

A reader sent us an article about an individual severely injured in the horrific storm in Joplin, MO, earlier this year. It appears there is no question Mark Lindquist is a hero. He was a low-paid social worker who nearly gave his life trying to save three developmentally disabled adults from the storm. Both houses of the Missouri legislature honored Lindquist, the Senate resolution calling him "a true hero and inspiration to others." From our review, the Missouri Senate’s assessment is clearly accurate and we salute Mr. Lindquist for his sacrifice and heroism.

The problem is heroism doesn't pay the bills. The tornado's winds tossed Lindquist nearly a city block, broke all of his ribs, shattered his shoulder, knocked out most of his teeth and put him in a coma for about two months. Medical expenses now exceed $2.5 million and the bills remain ongoing. The main social problem we all face is Mr. Lindquist had no private medical insurance as he couldn’t afford it. He assumed workers' compensation would cover his bills, but his claim was initially denied "based on the fact that there was no greater risk than the general public at the time you were involved in the Joplin tornado" according to his company's workers' comp provider. Full disclosure--we work for that provider and have to agree with that difficult initial assessment.

That reasoning has angered observers in some quarters including family, co-workers and some lawmakers. Lindquist watched the skies darken on the evening of May 22, 2011 on his way to the Group Home occupied by three middle-aged men with Down’s syndrome. When he got there, a tornado siren began to blare. The employer, Community Support Services recently put workers through a tornado drill, so Lindquist and a co-worker knew what to do. Because there was no basement or shelter and the developmentally disabled residents moved too slowly to relocate, Lindquist and the other worker placed mattresses over the men for protection, then climbed atop the mattresses for added ballast.

The EF-5 tornado was among the nation's worst of all time. It destroyed more than 7,000 homes, including the Group Home, and killed 162 people, many of whom were at work. Lindquist's survival defies common sense. After the storm, rescuers found Lindquist buried in rubble, impaled by a piece of metal. Bones from his shoulder crumbled as he was placed on a door used as a makeshift stretcher. He was later delivered to the Hospital. His injuries were so severe his body had become swollen and unrecognizable. He fell into a coma. Debris in open sores caused a fungal infection, one that killed five other Joplin tornado victims. Lindquist overcame the fungus but remained at the first hospital for about a month. Still in a coma, he was flown to another hospital for a little over a month before being sent to a rehab center where he awakened.

His recovery amazed doctors. His right arm remains in a sling, but he has use of the hand. The eye that was temporarily blinded has full sight. He moves slowly and has short-term memory loss, but speaks well.

Critics claim the insurance company's decision is unfathomable because if Lindquist hadn't been at work, they assert he wouldn't have been hurt. Some observers feel he could have jumped in his van and fled as the tornado approached.

In our view, this is an example of deflecting fault when anything bad happens. First, in blaming doctors/hospitals and care-givers, they can sometimes be demonized regardless of the losses they take in such situations. Some folks feel there was an area-wide emergency so the doctors and hospitals should all work for free and provide all durable medical equipment, prescriptions, diagnostics and other costs at no charge. Americans want unlimited, on-demand medical care for all of our problems the moment their arise. No one sees hospitals and doctors have their own bills to pay and they can go broke.

Second, there are some folks who feel problems from such unforeseen and cataclysmic events are "the employer's fault." In this model, they double-deflect the blame from the employer to the supposedly “wealthy” WC insurance carrier and assert the carrier is to somehow “blame” for simply following the state’s rules and their underwriting guidelines. The fact workers’ comp insurance requires an event to both arise out of and occur in the course of employment is forgotten. In our view, tornados aren’t risks that arise out of employment—they are risks common to the public whether we are working or not. If insurance carriers and self-insured employers have to pay for risks common to the public, the cost is wildly higher, as can be seen in this instance.

Some folks like to blame the "government" and say taxes should always be set aside and be immediately available to pay for storm injuries and damages. Sometimes government can help and sometimes government has to pay their own bills and there isn’t much left around to cover the unexpected events that clearly arise.

There are probably thousands of survivors of the Joplin tornado who weren't working during this terrible storm and have similar stories. All of them are heart-wrenching and compelling. The question is who has to pay for the societal costs of storms. In our view, Acts of God are risks of everyday life that we all have to face and prepare for. Taxes should be set aside for such things also but we have to remember taxes aren't free either.

As this is going to press, we learned

Accident Fund Insurance Company of America announced it was changing course. "Upon further review of the case, and receiving additional information on the facts involved in this situation, Accident Fund believes the appropriate decision is to honor Mr. Mark Lindquist's claim for worker's compensation benefits," Mike Britt, president of the Lansing, Mich.-based insurance company, said. "We are committed to working with Mr. Lindquist to ensure he receives all the benefits to which he is entitled and helping him to recover from his injuries."

All we can say is God bless them for doing so and helping this hero in his time of need. Kudos from KC&A to Mr. Britt and all of his staff who are also unquestionably heroes. We appreciate your thoughts and comments. Please feel free to post them on our award-winning blog.

10-25-11; Safeworks Illinois’ 19th annual Work Injury Conference tackles Challenges*Debates*Solutions of REFORM 2011.

Last week in Champaign, IL, several hundred industry movers and shakers jammed the I-Hotel on the campus of the University of Illinois for the 19th annual work injury conference produced by Dr. David Fletcher of SafeWorks Illinois. This year’s theme REFORM 2011:Challenges*Debates*Solutions centered on the changes to the Illinois workers’ compensation system following the May 2011 reform.

Jay Tebbe, President & Publisher of the Belleville News-Democrat riveted the audience with his review of the BN-D’s investigation of the Menard prison scandal, which gained the attention of the State House and paved the way for WC reform. Tebbe stated the BN-D has a pending law suit against CMS to turn over nerve conduction velocity test results of a sample of 50 prison guard cases awarded carpal tunnel syndrome claims that resulted from infrequent turning of locks of old manual prison doors, even though Attorney General Lisa Madigan’s office has recommended turning over the results to the BN-D while CMS is being defended by private outside counsel.

The morning sessions focused on challenges and debates following the passage of HB1698. Petitioners’ attorney Kim Presbrey gave an insider look at how the new law came about following the State of Oregon WC study that alleged Illinois was number 3 in the country for WC costs. Presbrey said “Illinois is a market-driven insurance market and the failure for new reform to set up a mandated state-run insurance option to compete against the private sector to offer employers a lower cost alternative was wrong, especially in light of NCCI asking for a 3.5% increase in workers compensation rates for Illinois next year.” Presbrey noted the recent 3.1% increase came after the NCCI sought an 8.8% decrease in advisory rates in Illinois after state lawmakers adopted workers comp reform legislation last May based largely on a 30% reduction of Illinois' medical fee schedule under the new law.

A panel of industry leaders from all stakeholder point of views including medical providers, petitioners’ attorneys, respondents’ attorneys, employer/business representatives, insurance managers and labor delegates gave perspectives on what HB1698 will bring. The consensus of the panel is doctors, hospitals and other medical care-givers got the worst of the reforms. While it is well known that the IL WC medical fee schedule got reduced 30% the actual effect of the fee schedule reduction was even more drastic with the collapse of 29 geo-zips into 4 regions for the new fee schedule—up to 45% reduction in some areas, such as Champaign.

Illinois State Medical Society (ISMS) policy analyst Patrick Gallagher provided an analysis of the fee schedule cut:

Code

Desc

2011 WC Champaign

After 30% cut WC Champaign

Medicare

% Below Medicare

 

 

 

99203

off visit new pt

$157.26

$110.08

 $110.68

-0.54%



 

99204

off visit new pt

$225.41

$157.79

 $170.93

-7.69%

 

 

 

99212

off visit

$72.33

$50.63

 $44.16

14.65%

 

 

 

99213

off visit

$97.50

$68.25

 $73.90

-7.65%



 

99214

off visit

$146.79

$102.75

 $109.66

-6.30%



 

Studies show once physician reimbursement is less than 160% of Medicare that access to medical care is a real issue.

The mismanagement of workers’ compensation for employees of the State of Illinois was a major recurring topic. “Just change the locks…” was the mantra of several audience members when the discussion of the Menard prison scandal was brought up repeatedly as symbolic of the public sectors’ failure to be pro-active.

Unfortunately, about 10 days before the conference, Governor Quinn’s office pulled a speaker from IDOT who was supposed to discuss highlighting model programs IDOT had implemented to promote worker safety and save money for the Illinois taxpayers. In response to this censorship by Governor Quinn’s office, Illinois Chamber President Doug Whitley said: ”It is of course disappointing, but not surprising that the Governor’s office did that. The State is missing the boat and failing the taxpayers by not devoting the resources and efforts that a private employer would pursue. The pursuit of seeing the State’s WC program privatized will be a part of the Illinois Chamber’s next campaign to build support for another round of WC changes in 2013.”

The afternoon’s session featured solutions being touted to further help with WC cost control. Dr. Charles Bush-Joseph managing partner for Midwest Orthopaedics at Rush (MOR) spoke about the formation of Preferred Provider Program (PPP) networks Illinois employers can offer injured workers as their first option of care before choosing to opt out of the PPP system and then utilize their final choice of treating provider. Dr. Bush-Joseph touted a smaller elite PPP network that would be based employee assurance of quality. He believed it was important to have independent or community-branded providers in the network and providers needed the skill-set in dealing with injured workers by understanding the nature of the work environment. He also felt effective providers must engage in efficient communication with all stakeholders.

We did receive a draft copy of the PPP “opt-out” form and we would be happy to email it to anyone who wants it. We were told it may make the IWCC website today or later this week. If you want a copy, send a reply.

Dr. Fletcher gave an overview of the AMA Guides and the physicians new Permanent Partial Impairment (PPI) ratings that arbitrators now have to consider when arriving at PPD awards, along with other enumerated factors.

Dr. Fletcher wrote this article and it was briefly edited for space and content. A DVD of the conference is being produced and our readers may contact Dr. Fletcher for more details at their website: www.safeworksillinois.com or via email to dfletcher@safeworksillinois.com.