2-14-12; An Illinois Workers’ Compensation claim, stemming from a 2000(!!!) work injury, made it all the way to the Illinois Supreme Court in 2012.

On January 25, 2012, the Illinois Supreme Court announced the cases where petitions for leave to appeal were allowed including Aber v. American Home Assurance, No. 113476. Aber was allegedly injured in 2000 while pulling a tarp over a trailer and working for Metal Transportation Systems. An ex-parte hearing was held and Aber was awarded benefits against the employer only.

The decision obviously went final and claimant Aber filed for and received a judgment in Circuit Court against Metal Transportation Systems. Claimant subsequently learned the company was preparing to file for bankruptcy and it was insured by AIG. After learning AIG insured Metal Transportation Systems, Aber filed a motion before the Arbitrator assigned to add AIG as a party respondent in her workers’ compensation case.

This motion was denied and the Commission, as well as the Circuit Court, and Appellate Court affirmed the denial. The Appellate Court noted due process would not permit a workers’ compensation claimant to enforce an award against the insurance carrier without first filing a separate action.

Due to the fact the matter was heard in an ex-parte setting, the Court noted AIG wasn’t afforded notice of the hearing and therefore did not have the opportunity to defend the action, investigate the case before the hearing, obtain an independent medical examination or cross-examine claimant Aber.

In February 2007, Aber filed a complaint in Circuit Court against AIG seeking payment of the workers’ compensation award. AIG moved to dismiss under 2-619.1 alleging Aber’s claims failed to state a cause of action and the Circuit Court lacked subject matter jurisdiction. The complaint was dismissed and Aber appealed to the Appellate Court.

The Appellate Court noted Circuit Court involvement in workers' compensation cases is authorized in only two circumstances. The first, under section 19(f), authorizes appeals directly from the Commission's findings of law and fact. 820 ILCS 305/19(f) (West 2002). The second, under section 19(g), authorizes orders enforcing the Commission's award. 820 ILCS 305/19(g) (West 2002).

As the Circuit Court’s involvement was not authorized by either of these sections the Appellate Court failed to see how the Circuit Court would have subject matter over the action against AIG and upheld the Circuit Court decision. We will see where the Supreme Court goes with this and report any noteworthy results.

This article was researched and written by Matthew Ignoffo, J.D. Please feel free to contact Matt about it at mignoffo@keefe-law.com.

2-14-12; Smoke and Mirrors--Does Illinois Truly Have a Better Business Climate? Does Anyone in the Reviewing Courts Care?

In response to another blast from Caterpillar CEO Doug Oberhelman about not moving a facility to our state, Governor Quinn again promised Illinois has enacted worker's compensation reform and passed a tax credit for research and development costs. In response, we feel the jury is still very much out on workers’ comp reform and don’t see costs dropping dramatically but hope our Arbitrators and Commissioners are hearing the Governor’s call.

Looking at the bigger picture, we feel Governor Quinn has become something of a public relations flack or apologist for Illinois’ sagging government situation and state employee unions. He has raised income taxes 66-2/3%, almost doubled our toll costs and can’t find money to pay what will soon be $10 billion in outstanding, overdue and unpaid state government bills. No one actually wants to do business with our Illinois State government because you aren’t going to get paid any time soon—we are told the Illinois State Police can’t afford bullets for target practice!! At some point, decisions like the one from Caterpillar and reported job cuts from ADM and Pepsi may send a message to our Governor and they may not—we don’t know if he is listening and he now appears to be claiming he somehow “volunteered” for the job, like that justifies the mess we are in.

As a few quick cost-cutting thoughts without any insider analysis or expertise:

1.    Why do we need human highway toll-takers? Indiana and lots of states don’t have them anymore—they were replaced with machines and saved jillions. We are told Illinois spends about $200 million annually on toll collection when all of it could be automated tomorrow. The reason they keep doing it is solely due to state employee unions who will fight automation and cost-savings that results in taxpayers saving a dime.

2.    Why does Illinois need a State Treasurer and a Comptroller? They have been going back and forth on this one for years: http://ballotpedia.org/wiki/index.php/Illinois_Treasurer_and_Comptroller_Amendment_(2012) The current plan appears to be wasting even more time and money to maybe put it on a ballot someday. Our thought would be to try to remember you are flat broke and cut through the red tape, Governor and start saving at least $12 million a year.

3.    Can we cut out “odd-lot” total and permanent disability claims for Illinois state workers by bringing them back to work and offering them new state jobs right now? We are told the cost of this is well into the millions, maybe as much as $10 million a year. These awards almost always insure the injured workers get more money in retirement than they received while employed. These “double-pensions” are paid on top of regular pensions with no set-off. Most of such workers get the T&P benefits solely because the Lisa Madigan’s troops and CMS won’t defend our State in hearings and CMS won’t take action to put such workers on a priority status to insure they are hired with accommodation when appropriate positions open up. Captains of private industry like Doug Oberhelman don’t smile to see his tax dollars thrown away like in such a stupid fashion. If you don’t understand how this works, please send a reply.

On top of all of it, last week we saw what we feel is one of the more anti-business rulings out of our Appellate Court in some time. In Patel v. Home Depot USA, 2012 IL App (1st) 103217, issued February 2, 2012, our Circuit and Appellate Courts were asked to enter a judgment for an injured worker on a workers’ compensation award. It appears the injured worker was awarded $22,798.54 by the IL WC Commission. However, the IWCC decision and Appellate Court ruling indicate the employer was unquestionably entitled to a credit of $32,357.47. From our review, Home Depot didn’t pay the $22,798.54 because they were incontrovertibly owed the difference or $9,558.93.

In most states across the country, those two findings would have meant most courts would have rapidly thrown out any claim for a judgment against this major national retailer. One has to wonder how the courts unquestionably use the word “credit” but paradoxically ruled it isn’t a “credit.” As we have told our law students in the past, that “plain English language” version of our IL WC Act and Rules sometimes appears to be magically and randomly suspended in this state. You have to remember you are dealing with the Illinois WC system. We sometimes feel the only thing one can be sure of in this system is employers and their attorneys always get treated unfairly, particularly in the reviewing courts.

What these Illinois courts did was to take what we consider a very, very narrow view of Section 19(g) of Workers Compensation Act which allows for judgments to be entered on an administrative WC award. The Circuit and Appellate Courts found Section 19G does not provide a remedy for an employer's inadvertent overpayment of benefits for a certain time period. Both the lower and appellate courts ruled the employer cannot apply a “credit” for its overpayment against benefits to which employee was previously entitled. With respect to our Circuit Court judge and Appellate Court justices, we don’t agree at all and feel there were many other simple paths they could have taken to either equitably or legally reached a fairer conclusion to the controversy.

On top of all of that, the Circuit Court then provided what we consider staggering largesse to the worker and his attorney and against this employer--the court entered an additional judgment in favor of Patel for

·         Attorney fees of $47,000.00;

·         Costs of $5,315.31 and

·         Interest of $13,679.08.

Please note this does not include fees to present this matter to the Appellate Court! If you are doing the math, the judgment without any credit to the employer was for about $22K and the courts provided counsel and claimant almost $67,000.00 in additional monies!!!??? If you are doing more math, Home Depot was owed $9,559.93 and they will now have to pay claimant and his counsel about ten times that much money or more due to the way our courts have interpreted the law. With respect to our jurists, that blunt outcome borders on irrationality—please note the legal issue presented in this claim wasn’t simple or patent and there are very few rulings from which to reach this end result. To see our courts take literally the most punitive possible approach has to make every business person in and around our state cringe.

In our view as academicians, the award of fees, costs and interest is simply anti-business and wholly punitive. We feel it is shocking and astounding to simple common sense. Giving claimant’s counsel every benefit of the doubt, attorney’s fees in Section 19G filings are relatively simple—you can get fees at the Commission consistent with the statute or 20%. That amount could be no more than about $4,400. The rest of the attorney’s fees are to draft a two-page complaint and seek recovery at the Circuit Court. Such fees can’t be more than a thousand dollars at the worst—it is a simple and summary pleading. We have no idea how counsel could conceivably be able to charge $47K. Similarly, we have literally no idea what over $5K in costs might be for.

Looking at the bigger picture in this claim, we feel the mistake by Home Depot’s defense counsel is patent—immediately sue or countersue claimant to recover the credit provided by the IL WC Commission. The monies were clearly overpaid. It is such a simple thing to do to protect yourself and your client, we cannot imagine why they didn’t do it. They should clearly do so right now, if they haven’t.

And looking at the bigger picture, we hate to analyze and report such shenanigans because we don’t want our readers to shy away from this state. But the facts are the facts and we have a duty to report them. We appreciate your thoughts and comments. Please do not hesitate to post them on our award-winning blog.

2-8-12; Lots of things promised in the 2011 Amendments aren’t going to be happening any time soon.

A brilliant reader pointed out there are lots of things the Illinois legislature did that aren’t going to happen for some time, if ever. In our view, it is part of the “crazy-making” that happens in every legislative session designed to misdirect our attention from more important things.

First, Governor Quinn and most legislators passed a law indicating they might actually do something about the scandal that is the continuing mismanagement of State of IL workers’ comp defense program. This amazingly screwed-up program is marked by claims adjusters that have an impossible number of claims to adjust, defense attorneys who roll over on every claim because they aren’t given evidence to present in defense of the claim and penalties/fees issued by state employees (Arbitrators) against state employees (claims adjusters) to the enormous benefit of the injured state worker and to the immense detriment of Illinois taxpayers. Over $100 million in WC benefits are paid to Illinois state workers every single year. Some day, they may actually do something about it in a state awash in a sea of red ink.

Second, we are all awaiting the PPP concept to allow great managers like Darren Stahulak of CorVel and David Kolb of HFN to do their magic and give Illinois employers control over medical care in this state. We are all awaiting JCAR or the Joint Committee on Administrative Rules to get their things together and issue final rules and allow implementation. The expected savings is $500 million or more.

Third, we are advised there is a reporting concept that isn’t going to match the statute. New Section 29.2 of the IL WC Act says (in pertinent part):

(b) The Director of Insurance shall promulgate rules requiring each insurer licensed to write workers' compensation coverage in the State to record and report the following information on an aggregate basis to the Department of Insurance before March 1 of each year, relating to claims in the State opened within the prior calendar year:

        (1) The number of claims opened.

        (2) The number of reported medical only claims.

        (3) The number of contested claims.

        (4) The number of claims for which the employee has attorney representation.

         (5) The number of claims with lost time and the number of claims for which temporary total disability was paid.

         (6) The number of claim adjusters employed to adjust workers' compensation claims.

         (7) The number of claims for which temporary total disability was not paid within 14 days from the first full day off, regardless of reason.

         (8) The number of medical bills paid 60 days or later from date of service and the average days paid on those paid after 60 days for the previous calendar year.

         (9) The number of claims in which in-house defense counsel participated, and the total amount spent on in-house legal services.

         (10) The number of claims in which outside defense counsel participated, and the total amount paid to outside defense counsel.

         (11) The total amount billed to employers for bill review.

         (12) The total amount billed to employers for fee schedule savings.

         (13) The total amount charged to employers for any and all managed care fees.

         (14) The number of claims involving in-house medical nurse case management, and the total amount spent on in-house medical nurse case management.

         (15) The number of claims involving outside medical nurse case management, and the total amount paid for outside medical nurse case management.

         (16) The total amount paid for Independent Medical exams.

         (17) The total amount spent on in-house Utilization Review for the previous calendar year.

         (18) The total amount paid for outside Utilization Review for the previous calendar year.

We assume this information may be of interest when it is published. The Department shall make the submitted information publicly available on the Department's Internet website or such other media as appropriate in a form useful for consumers. At present, the Illinois Department of Insurance hasn’t promulgated the required rules. We will all watch to see if the Department will promulgate the rules any time soon. Such rules may have to go through the JCAR process which is the Joint Committee on Administrative Rules and the rules haven’t even been written yet.

We thank the reader who sent this note to us. We appreciate your thoughts and comments. Please feel free to post them on our award-winning blog.