11-5-12; Justice John McCullough RIP; Joe D'Amato, JD reviews "intrusion upon seclusion ruling; Matt Ignoffo, JD reviews new WI ruling expanding WC coverage and more

Synopsis: Last week marked the passing of Illinois Appellate Court Justice John J. McCullough.

 

Editor’s comment: Writing a news article about the passing of this distinguished Justice for a WC business observer and court-watcher is, to say the least, challenging. Justice McCullough proudly served his country in the U.S. Army (1955-57). Following four years in private practice, he was elected county judge in 1962 and Chief Judge of the 11th Judicial Circuit in 1974 and served in that position until his election to the Fourth District Appellate Court in 1984, where he served for the past 28 years.

 

In addition to his regular judicial duties, Justice McCullough served 22 years on the Workers' Compensation Division of the Illinois Appellate Court and acted as the Presiding Justice of the five-member panel for each of those years. Justice McCullough was the longest serving judge in Illinois history, serving 50 years on the bench.

 

Our issue with writing about his passing is he was one of the folks who participated in numerous IL WC Appellate Court rulings considered by Illinois business leaders to be anti-business and mildly to wildly pro-labor. At present, we consider current contested WC appellate rulings to have a ratio of 20-1 or higher for Illinois labor. That said, we assure our readers Justice McCullough was professional, business-like and very honest. He was also the leader of a crucially important judicial panel that led the Illinois workers’ compensation system to where it needed lots and lots of reforms to bring it to remain the fourth most expensive WC system for employers in the entire country. It is our hope the next presiding justice of this important Appellate panel steers the members of the Court closer to the mainstream and takes on a focus of fair/reasonable benefits paid to injured workers by cost-conscious Illinois business and government bodies.

 

For the two decades we have been publishing this Update, KCB&A repeatedly and respectfully criticized the appellate panel Justice McCullough headed for any number of issues we felt were unusual and deserving of comment:

 

  1. This WC appellate panel used to issue many of its decisions in secret. In any ruling of a controversial nature, the Appellate Court, Workers’ Compensation Division could follow Illinois Supreme Court Rule 23 and “non-publish” their rulings, keeping them out of the eyes of the public. Most important, such rulings were kept out of the eyes of the practicing bar. This was supposed to only apply when their ruling was mundane and routine—turns out lots and lots of critically important and lengthy rulings were “non-published.” In our opinion, no one on other side of the bar could tell why or when that might happen.

 

What the “regulars” or lawyers who practiced at the IWCC a lot learned to do was to quietly pass along the secret rulings to each other to allow them to know what the members of the Appellate Court were thinking when faced with an important situation. We also consider it amusing to see the Illinois State Bar Ass’n would “publish” articles analyzing “non-published” Appellate Court decisions; in our view, such publications would openly contradict the Justices’ determination their ruling was to be kept from “publication.” What is also odd is non-published rulings are now posted on the Appellate Court’s website, making them “published but non-published” rulings!

 

  1. Another odd proclivity of the rules governing the Appellate Court, Workers’ Compensation Division was the members’ singular ability to decide when to make the panel’s rulings “appealable.” If you aren’t sure, the panel continues to have that power, although the Supreme Court rules now require not just one but two of the panel members to certify their ruling for further appeal. We always felt this ability presented was to display a pro-labor bias to the rulings of the panel. What one would see was pro-labor rulings awarding benefits left to be non-appealable by the panel while any defense ruling denying benefits would be certified for further appeal in the hope that our highest Court might reverse. We remain chagrined to remember this Appellate panel didn’t have to certify rulings like Sisbro and Twice Over Clean where they wrote brilliant decisions initially denying benefits. We also will always be amazed to note the panel certified the Interstate Scaffolding v. IWCC ruling for further appeal by our highest Court when the total amount at stake was a mere $5,000 in TTD—cases involving hundreds of thousands of dollars wouldn’t be similarly certified for further appeal.

 

  1. We remain intrigued to recall a lengthy and thoroughly analyzed ruling where the five-member panel decided to issue a “non-published” ruling indicating the decision was somehow routine but all five members of the same Appellate panel certified the same ruling for appeal as critically important for further consideration by our Illinois Supreme Court.

 

  1. Another ruling where Justice McCullough and the appellate panel might be subject to criticism was William G. Ceas & Co. v. Industrial Commission, issued in 1994. The Appellate Court initially issued an initial favorable decision for the defense, resulting in denial of a death claim. For reasons no one may ever know, the members of the Court quickly withdrew it. If you aren’t sure, it is very, very rare for an Appellate Court panel to withdraw a ruling they take the time to vote on, research, write up and then issue for public review. By very, very rare, your editor will assert in more than thirty years of practice and having read literally every published ruling by Justice McCullough’s panel, we can only recall this single ruling where a final decision of the panel was recalled and the majority completely reversed itself. In Ceasthe Court issued a “corrected decision” and a majority of the panel overturned its original denial and awarded full benefits to Petitioner. The only three reasons we can think of for the 180-degree turn around by all the members of the Court would be politics, politics and more politics.

 

  1. Finally, we recall the article written by your editor and Shawn R. Biery, our brilliant law partner in 2008. We analyzed the odd ruling in Smalley Steel Ring where a claimant made a claim for injuries on unquestionably fraudulent grounds—he filed the WC claim in the name of a dead person and the insurance carrier/employer did not learn of the fraud until after the time to appeal had run. The defense side screamed for justice confirming the IL WC Act says the Commission’s ruling is not supposed to be conclusive unless it is issued “in the absence of fraud.” Most observers, including my parents feel it might be fraud to come into court and raise your hand and swear an oath to tell the truth all while using a dead person’s name—do you think that is fraud? Does the legislature have to pass a law stating it is fraud to do so?

 

The Appellate panel headed by Justice McCullough made the reasoned determination to adhere precisely to the “English language” version of the IL WC Act and allowed the lower court ruling to stand. Shawn and I chronicled how the “English language” was arguably and repeatedly “bent” by our justices in various pro-labor rulings such as DurandGeneral Tire and Rubber and First Assist. In Smalley Steel Ring, Justice McCullough adhered to a strict construction of the law and wrote “[s]uch deficiencies in the Act should be remedied by the legislature.” With respect to this long-time hearing officer, we feel it would have been easy to openly affirm this august Court and its members shouldn’t have allowed benefits for an unquestioned swindler who clearly had an attorney appear for him, as part and parcel to his unquestioned deceit on the Commission and our courts. With respect to the members of the Court, we wouldn’t metaphorically defer and deflect the duty of dealing with such fraud as the job of the legislature and not the courts.

 

In closing, we want our readers to understand Justice John McCullough brought his best to the bench every day of his 50-year-career. While we didn’t always agree with him, we remain confident he didn’t always agree with us—that is what creates the need for our judicial system. We had the highest respect for Justice McCullough as performed his sworn duties and handled his post. The lawyers and staff of Keefe, Campbell, Biery & Associates extend our deepest condolences to Justice McCullough’s family and friends across our state.

 

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Synopsis: Illinois Supreme Court recognizes the tort of “intrusion upon seclusion” and holds an employer liable for acts of an outside private investigator; analysis from Joseph D’Amato, J.D.

 

Editor’s Comment: We consider this a very important ruling for all Illinois employers and risk managers to be aware of. We are also confident surveillance operatives and investigators across the state should read this case. On October 18, 2012, the Illinois Supreme Court handed down what we believe to be an important decision for Illinois employers who use surveillance to investigate their workers.

 

In Lawlor v. North American Corporation of Illinois, 2012 IL 112530, issued October 18, 2012, Plaintiff Lawlor filed a claim against Defendant North American Corporation of Illinois (North American) for “intrusion upon seclusion” (more generically known as “invasion of privacy”), alleging her former employer hired investigators to obtain her private phone records.

 

The ruling indicates in 2005, Plaintiff Lawlor was working as a salesperson for Defendant North American when she accepted a position with Shamrock Companies, a North American competitor. North American became concerned Plaintiff was contacting its customers, possibly violating a non-competition covenant.

 

In order to investigate whether Plaintiff was communicating with its customers, North American hired a private investigator to obtain her phone records. North American provided the investigative firm with Plaintiff’s phone number, date of birth, social security number and other unique identifiers. The private investigator then engaged in a course of behavior the Court termed “pretexting.” In short, the private investigative firm used the unique identifiers provided to it by North American and pretended to be Lawlor in order to obtain her home phone records from AT&T and her cell phone records from U.S. Cellular. North American then used that information to determine whether Plaintiff had, in fact, contacted its customers.

 

Plaintiff asserted she “vomited,” suffered “anxiety,” changed her locks and installed an expensive home security system when she learned her phone records were accessed without her authorization. None of these facts were disputed at trial.

 

Prior to this decision the Illinois Supreme Court had never formally adopted the tort of intrusion upon seclusion, although all five Illinois Appellate districts adopted the theory of liability. In recognizing the tort, the Court adopted the definition given to it by the Restatement (Second) of Torts § 652B (1977). §652B states "One who intentionally intrudes, physically or otherwise, upon the solitude or seclusion of another or his private affairs or concerns, is subject to liability to the other for invasion of his privacy, if the intrusion would be highly offensive to a reasonable person."

 

North American did not argue Plaintiff’s privacy had not been violated. Rather, North American asserted it could not be held liable for the actions of its private investigative firm, as it was unaware how Plaintiff’s phone records were obtained. Furthermore, North American argued it had no control over the way its investigators obtained the material.

 

The Illinois Supreme Court agreed there was no direct evidence North American knew exactly how its investigators obtained Plaintiff’s phone records. However, the Court held by providing investigators with non-public information about Plaintiff (including her social security number and other unique identifiers) and asking them to obtain her phone records, a jury could reasonably infer North American was exercising control over the actions of its private investigators, thus creating a principal-agent relationship. As such, the Court reasoned North American could be held vicariously liable for the admittedly tortious actions of its private investigators.

 

We think this ruling holds important lessons for any Illinois employer utilizing the services of a private investigating firm, lest they face liability for the actions of their investigators.

 

      Be cognizant of giving out personal and sensitive employee information such as social security numbers and telephone numbers;

 

      Clearly consult with your investigators as to what types of activities they can lawfully engage in. Although it may seem obvious, make sure your investigators know it is now actionable to impersonate an employee in order to obtain their personal information, as doing so inevitably leads to a clash between your legitimate need for information and an employee’s protected privacy rights and

 

      Confirm your instructions and discussions with your investigative team in writing. Clear and concise written instructions may help shield you from liability in the event an investigator violates your explicit instructions and unreasonably infringes on the privacy rights of your employees. 

 

This article was researched and written by Joseph D’Amato, J.D. He can be reached for questions or comments at jdamato@keefe-law.com.

 

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Synopsis: Watch out employers with Fitness for Duty requirements!!! Wisconsin Appellate Court affirms an award of workers’ compensation benefits to an off-duty police officer injured doing push-ups in his basement.

 

Editor’s Comment: We consider the theory and ruling in the claim to be shocking and misguided. In a government WC setting, such cases again demonstrate how poorly governments continue to be treated in the WC arena—we assure our readers “global WC coverage” of any injury occurring while off work is going to greatly increase WI WC costs and may cause taxes to rise to pay for the new unexpected costs.

 

In City of Appleton Police Department v. LIRC and Nofzinger, No. 2011AP2008, Patrol Officer Michael Nofzinger alleged a rotator cuff injury as a result of performing push-ups while off-duty and at his own home. There was no true “accident,” the officer just felt a pull in his shoulder. He argued he was preparing for a mandatory physical fitness test which required him to perform this specific exercise. The Wisconsin WC Commission concluded the injury occurred in the course of Nofzinger’s employment as required by WIS. STAT. §102.03(1)(c).

 

This section of the Wisconsin Workers’ Compensation Act contains limited guidance regarding what constitutes “service growing out of and incidental to …employment”, but one of the few areas in which the statute provides additional guidance is in reference to an employee’s participation in “well-being” programs, events, or activities:

 

An employee is not performing service growing out of and incidental to employment while engaging in a program, event, or activity designed to improve the physical wellbeing of the employee, whether or not the program, event, or activity is located on the employer’s premises, if participation in the program, event, or activity is voluntary and the employee receives no compensation for participation.

 

§102.03(1)(c)3. (emphasis added). The WI Appellate Court noted the logical corollary is an employee is performing services growing out of and incidental to employment if the employee’s injury occurs while participating in a well-being program, event, or activity that is not voluntary or for which the employee is receiving compensation. The Court cited previous case law and noted when the applicability of this section is in question there is a three-part test and the court must ask if:

 

v  The employee is engaged in an activity designed to improve [the employee’s] physical well-being,

v  [The employee’s] participation is voluntary, and

v  [The employee] receives no compensation for participation.

 

Only if all three elements are met will the employer prevail. There was no serious dispute element one was satisfied as Office Nofzinger was participating in a well-being program or activity. The issue on appeal involved whether participation was voluntary. The Court upheld the Commission’s decision where it concluded Nofzinger’s push-ups were not voluntary and as such did not address whether he was compensated as all three of the elements must be met for the employer to prevail.

 

The pertinent facts which were not disputed are as follows:

 

v  Nofzinger was required to undergo a physical fitness test twice per year;

v  The test included a component measuring how many push-ups he could perform;

v  He received points for each component and a cumulative score;

v  If he failed to maintain an adequate score, he could be subject to disciplinary action; and

v  He was injured while performing a twelfth or thirteenth successive push-up in preparation for one of the tests.

 

It was held the act of performing push-ups was precisely the type of activity he was required to be tested on and failing to prepare would subject him to discipline. The Court further noted Nofzinger was required to participate in a physical fitness program and it was reasonable to conclude he was complying with this requirement when he was injured.

 

Please remember the challenge of an “at-home” injury is investigation. In this claim, we do not feel most folks would suffer a rotator cuff tear doing standard push-ups. Risk managers have to carefully investigate and document any claim where the event occurred in the home or away from the workplace.

 

We find the decision unsettling considering exercising at home or in one’s spare time is something each and every one of us should be doing for our general health. We point to the specific facts of this case and the particular section of the Wisconsin WC Act to hopefully avoid a ripple effect in expanding WC coverage for all injuries which may be found compensable. We assert Officer Nofzinger would make the same claim bowling, playing golf, shooting pool, any off-duty activity where he had a physical problem could possibly be alleged to now be compensable. If you are an employer requiring Fitness for Duty testing you should consider on-duty test preparation time and on-site preparation facilities to limit liability for off-site injuries when preparing for such tests.

 

This article was researched and written by Matthew Ignoffo, J.D., M.S.C.C. licensed in IL and WI who can be reached at mignoffo@keefe-law.com.

 

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Synopsis: Welcome aboard, Tim O’Gorman.

 

Editor’s comment: Keefe, Campbell, Biery & Associates proudly announce the addition of Tim O’Gorman, J.D. to our legal team. Last week, Tim was sworn in as an IL lawyer and will focus his practice on defense of folks like you who face the enormous challenge of keeping your company’s costs and reserves low in aggressively defending your workers’ compensation, general liability, employment law and motor vehicle defense. Tim is up for the challenge—feel free to contact him at togorman@keefe-law.com.

 

10-29-12; IL WC Reforms Help Premium Costs a Bit; New IL WC Dental Fee Schedule Posted; WARN May Be Needed to Change to Staffing Co and much more

Synopsis: Illinois WC Reform Results Not So Great but Hope for the Future Remains When PPP’s Start.

 

Editor’s comment: The State of Oregon WC Premium Rankings are out. Illinois is ranked as the 4th highest premium in 2012 rankings, pegged at 151% of the median states of Georgia & New Mexico. If you are keeping score, we moved from No. 3 in 2010 down to No. 4 and are now better than wildly expensive Alaska, Connecticut and California. Many of our readers are happy to hear things didn’t get worse and we have to work for more improvement in the future.

 

If you care about cutting WC premium costs, we invite you to attend the IL State Chamber’s Annual WC Conference on October 25, 2011 and see what President Doug Whitley and his top-notch staff and sponsors like KCB&A are doing to help improve our state for WC costs—send a reply for details on registration or surf to their website at: http://ilchamber.org/illinois-chambers-4th-annual-workers-compensation-conference/

 

One motivating factor for the 2011 Reforms to our IL WC Act was the annual WC premium rankings from the State of Oregon. Illinois law actually included a provision for our state to create competing rankings—doesn’t appear that is going to happen any time soon. Oregon’s every-other-year Workers’ Comp Premium Ranking by State is out and can be located on the web at:

 

http://www.cbs.state.or.us/external/dir/wc_cost/files/report_summary.pdf

 

This biannual report ranks the WC premiums of all 50 states and the District of Columbia. The workers' compensation premium rates used for the study are from January 1, 2012, or late 2011 depending on the state, so they do not appear to include any of NCCI's current recommended rate changes for various states.

 

Texas is by far most improved, jumping 26 spots to finish in the top 15. Many observers feel they will make the Top 10 best in 2014. Their WC premium improvement has been remarkable, and puts them on another level compared to the other big population states/centers.

 

Illinois WC made some changes last year but the biggest and best should have been the WC Preferred Provider Program or WC PPP option. Right now, the WC PPP option for Illinois employers is sort of like looking through the glass at the candy in a candy store—it is nice and shiny and smells great but you can’t touch it. Despite the fact our Governor signed the 2011 WC Reforms last June, they still haven’t approved the rules to allow implementation. We expect the final approval of PPP’s to hit your WC program in mid-December 2012 but certainly no later than January 2013.

 

IL Department of Insurance Terminology Changed

 

When the IDOI submitted its proposed WC PPP regulatory modifications, it updated or clarified the preferred provider program terminology.

 

Health Care Preferred Provider Program (HC PPP) Administrator

 

Formerly referred to as the Preferred Provider Program Administrator (PPA). The HC PPP is a new term for the current/traditional PPOs and PPAs, which applies to both group health and workers’ compensation without WC employer direction networks.

 

The IDOI already updated its website to reflect this change in terminology:

Approved Health Care Preferred Provider Program Administrators; if you click on this link you will find all of IL HC PPP Administrators.

Provisionally Approved Health Care Preferred Provider Program Administrators--"Provisionally approved" refers to previously approved companies with renewal applications submitted to the IDOI.

 

Workers’ Compensation Preferred Provider Program (WC PPP) Administrator

 

Created by HB 1698/Public Act 97-18. This term refers to the new workers’ compensation designation that allows employer direction into an IDOI-Approved WC PPP network. Please note simply by offering an approved WC PPP network, employers will cut their employees’ choice of healthcare providers in half.


Approved Workers’ Compensation Preferred Provider Program Administrators; if you click on this link, you will find all of the IL WC PPP Administrators.

IWCC’s WC PPP Notification Form

 

For any employer with a designated IDOI-approved WC PPP, an employee must receive the IWCC’s official Notice of Preferred Provider Program for Workers’ Compensation Medical Care. That official form is available on the IWCC website in either English or Spanish. All IWCC forms, including optional WC PPP notification forms, are located in the Forms Section of the IWCC website.

Our recommendation for the top HC PPP or WC PPP source is Guy Swanson or Dave Kolb at HFN, Inc. They have been using a similar WC PPO concept for 25 years or more and they should be able to ramp that up quickly and smoothly to provide WC PPP services for your organization, once the rules are approved. If you need contact information, send a reply or simply surf to their great website at www.HFNInc.com.

 

We appreciate your thoughts and comments. Please do not hesitate to post them on our award-winning blog.

 

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Synopsis: IL WC Dental Medical Fee Schedule now posted—IL WC adjusters should note the effective date for covered dental services starts on 6-20-12.

 

Editor’s comment: In the new tradition of globally controlling WC Medical costs, we salute our IWCC for posting a new dental schedule for folks who injure their teeth at work and require related dental care.

 

The IWCC updated its website this week with the effective date of the new schedule. The IWCC dental fee schedule will apply for all dates of service on or after June 20, 2012. 

Their fee schedule for dental services covers work-related dental services provided on or after June 20, 2012. Bills should be paid at the lesser of the actual charge or the WC dental fee schedule amount.

As part of the changes instituted by HB 1698/PA 97-18, the Illinois legislature directed the Illinois WC Commission to create this dental fee schedule. It is our understanding the schedule came together due to the combined work of the

 

      IL Workers' Compensation Medical Fee Schedule Advisory Board and

      Illinois State Dental Society who obtained and analyzed needed data.

 

We are certain attorneys on both sides will want to bring dental fee schedule-coded dental bills to disputed hearings. If you need assistance in getting dental bills coded, send a reply.

 

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Synopsis: Be Fore-“WARN”-ed; Proper WARN Notices may be a Prudent Choice for HR Managers Switching to Staffing Companies.

 

Editor’s comment: We recently saw this class-action lawsuit while looking up other things and wanted to share it with our readers who may be considering changing your workforce.

 

On July 16, 2012, workers at Progressive Gourmet in Wilmington DE were told they had to reapply for their jobs through a temporary employment agency that would not provide health insurance and other benefits they received as former employees of the specialty food-distribution company. Those who refused to agree were quickly let go. In all, more than 70 workers or about one-third of the company's workforce lost their jobs due to their refusal to re-apply.

 

These claims are now part of a class-action lawsuit filed in U.S. District Court in Boston, alleging Progressive Gourmet violated the federal Worker Adjustment and Retraining Notification Act or WARN by not giving employees 60 days' notice of the layoff. The workers also filed a complaint with the National Labor Relations Board saying Progressive Gourmet's move was aimed at thwarting employees' efforts to form a union.

 

The Worker Adjustment and Retraining Notification Act of 1988 (WARN) is a United States labor law which covers employees by requiring most employers with 100 or more employees to provide sixty-calendar-day advance notification of plant closings and mass layoffs. Employees entitled to notice under the WARN Act include managers and supervisors, hourly wage, and salaried workers. The WARN Act requires notice also be given to unions, if any,  the local chief elected official (i.e. the mayor) and the state dislocated worker unit. Damages can be significant but are avoidable if the appropriate notices are provided. Our readers should also understand the cost and uncertainty of defending these actions in Federal Court can be moderately high.

 

The claims in the lawsuit may represent a trend in which many employers have increasingly used staffing companies to cut costs. This may be one of the first times a U.S. company has required all existing employees to reapply as temporary workers in such a transition. In other similar settings, workers who were asked to reapply with the staffing company were guaranteed a job for stated period with comparable salary and benefits. This may be a strong alternative to avoiding the raucous litigation and public relations impact of such a change.

 

KCB&A has no interest in the lawsuit reported above and we do not intend to affect its outcome. We appreciate your thoughts and comments.

 

10-29-12; Voc Rehab Rules for IL WC; Brogan/Biery review IL Supreme Ct acceptance of "mailbox rule" dec; Can't Stop Politics-as-usual at IWCC; Linda Van Dillen recommends PMP to Cut Narcotics and more

Synopsis: Will Illinois Voc Rehab Providers Ever Learn and Adhere to the Law that Governs Them?

 

Editor’s comment: We remain amazed at the utter lack of understanding of the statutes, rules and case law by many certified voc rehab providers who provide counseling services, create reports and appear to testify at hearings in our state. Here is an outline of it for training and future use. We also feel very few insurance adjusters and risk managers know and closely adhere the rules and requirements of the law.

 

Statutory definition of Vocational Rehabilitation is addressed in two Sections of the Illinois Workers’ Compensation Act

 

·         Section 8(a) provides in part: The employer shall also pay for treatment, instruction and training necessary for the physical, mental and vocational rehabilitation of the employee, including all maintenance costs and expenses incidental thereto.

·         Section 6(d) further indicates: Every employer shall notify each injured employee who has been granted compensation under the provisions of Section 8 of this Act of his rights to rehabilitation services and advise him of the locations of available public rehabilitation centers and any other such services of which the employer has knowledge.

Injured workers and employers in Illinois may agree these sections of the Act provide very little guidance as to what vocational rehabilitation may be and what the worker would be entitled to in receiving this benefit—we are not aware of any employer who advises their injured workers of the “rights to rehabilitation services or locations of available public rehabilitation centers” as Section 6(d) requires. Like many statutory provisions in IL WC, it is a legislative command without any sanction for non-compliance.

In 2005, our IL Legislature added this language to Section 8(a):

Any vocational rehabilitation counselors who provide service under this Act shall have appropriate certifications which designate the counselor as qualified to render opinions relating to vocational rehabilitation. Vocational rehabilitation may include, but is not limited to, counseling for job searches, supervising a job search program, and vocational retraining including education at an accredited learning institution. The employee or employer may petition the Commission to decide disputes relating to vocational rehabilitation and the Commission shall resolve any such dispute, including payment of the vocational rehabilitation program by the employer.

In 1983, a provision regarding vocational rehabilitation was made part of the IWCC Rules. Specifically, the provision appears in the Rules Governing Practice before the Illinois Workers Compensation Commission in Section 7110.10 as follows:

a)    The employer or his representative, in consultation with the injured employee and, if represented, with his representative, shall prepare a written assessment of the course of medical care, and, if appropriate, rehabilitation required to return the injured worker to employment when it can be reasonably determined that the injured worker will, as a result of the injury, be unable to resume the regular duties in which he was engaged at the time of injury, or when the period of total incapacity for work exceeds 120 continuous days, whichever first occurs.

b)    The assessment shall address the necessity for a plan or program which may include medical and vocational evaluation, modified or limited duty, and/or retraining, as necessary.

c)    At least every 4 months thereafter, provided the injured employee was and has remained totally incapacitated for work, or until the matter is terminated by order or award of the Illinois Workers Compensation Commission, the employer or his representative in consultation with the employee, and if represented, with his representative shall:

a.    If the most recent previous assessment concluded that no plan or program was then necessary, prepare a written review of the continued appropriateness of that conclusion; or

b.    If a plan or program had been developed, prepare a written review of the continued appropriateness of that plan or program, and make in writing any necessary modifications.

d)    A copy of each such written assessment, plan or program, review and modification shall be provided to the employee and/or his representative at the time of preparation, and an additional copy shall be retained in the file of the employer and, if insured, in the file of the insurance carrier, to be made available for review by the Illinois Workers Compensation Commission on its request until the matter is terminated by order or award of the Illinois Workers Compensation Commission or by written agreement of the parties approved by the Illinois Workers Compensation Commission.

e)    The rehabilitation plan shall be prepared on a form furnished by the Illinois Worker’s Compensation Commission.

The form identified above is Form IC31. The Form is on our IWCC’s excellent website at: http://www.iwcc.il.gov/forms.htm#CM

Rule 7110.10 was written in 1983. This is the same year the IL Supreme Court decided the landmark case detailing the factors which determine if vocational rehabilitation is appropriate, National Tea Co. v. Indus. Comm’n. We consider that ruling required reading for all certified voc counselors—if you don’t know anything about it, by definition you are unprepared to handle your job in this state. The legal factors identified in National Tea are:

1.    Proof the injury caused a reduction in earning power;

2.    Evidence rehabilitation would increase earning capacity,

3.    To restore the employee to his previous earning level if at all possible;

4.    The employee’s potential loss of job security;

5.    The likelihood that the employee would be able to obtain employment upon completion of his training;

6.    The relative costs and benefits to be derived from the program;

7.    The employee’s work-life expectancy;

8.    The employee’s ability and motivation to undertake the program;

9.    Evidence that the employee underwent similar rehabilitation in the past;

10.  Evidence the employee may have received training under a prior rehabilitation program which would enable the claimant to resume employment; and

11.  Whether the employee has sufficient skills to obtain employment without further training or education.

We feel all certified voc rehab providers should know and follow the law and rules in which they operate. Of those various factors in National Tea outlined above, we feel the one most often omitted from any voc rehab analysis is number 8—is the employee highly motivated to do what they are taught and actually locate work? We feel all voc rehab counselors should start and finish any report with that factor first. As lawyers and observers of this system, we are certain many employees don’t obtain new positions for one overriding reason—they don’t want to do so in order to gamble for Illinois’ highest WC benefits—wage loss differential benefits or the confusing and extra-statutory concept of “odd lot” total and permanent disability benefits. We call the second “odd lot” benefit “extra-statutory” because our reviewing courts simply made that one up about three decades ago—the words “odd lot” don’t appear in the IL WC Act or Rules and can be defined at one’s whim. The IWCC and reviewing courts have tried to delineate or refine the words over the years but we assure you their guess at what the words mean is as good as yours.

The duties of the employer and injured work in relation to vocational rehabilitation are a controversial topic in IL WC. We are all asked when to start vocational rehabilitation. The parallel question we receive from adjusters is when can they terminate TTD if voc rehab protocols are not followed by a given claimant. The Rules cited above outline the appropriate time is when it can be reasonably determined the injured worker will, as a result of the injury, be unable to resume the regular duties in which he was engaged at the time of injury, or when the period of total incapacity for work exceeds 120 continuous days, whichever comes first. We advise our clients if either factor is present, the Rules should be followed, voc rehab instituted with a certified counselor and a rehabilitation plan be completed and filed. If claimant doesn’t cooperate with the process, TTD should be terminated. Termination of TTD presumes you have documented close adherence to the Rules to avoid a claim for penalties/fees. If you aren’t sure about full compliance on the defense side, get the claim in front of an Arbitrator in a pretrial at the earliest opportunity to clarify your position and insure you won’t have exposure for penalties by adhering to and complying with the Arbitrator’s pretrial recommendations.

When should Voc Rehab start in an IL WC claim?

If the parties disagree, it can create controversy and litigation. According to Manis v. Industrial Commission, if petitioner or their counsel feels vocational rehabilitation is appropriate, at a minimum, petitioner has an obligation to make a formal demand for vocational rehabilitation. Failure to make a demand could result in a denial of vocational rehabilitation services as the issue may be deemed to have been waived. If you receive a demand for voc rehab services, be forewarned it may be problematic to terminate TTD without at least considering it.

Distinguishing Manisthe reviewing court in the later decision in Roper Contracting v. Industrial Commission indicated Section 8(a) sets forth the fiscal obligations of an employer under the Act, including an employer’s duty to provide “maintenance” benefits to an employee undergoing vocational rehabilitation. Please don’t be confused by the term “maintenance,” it is the equivalent of TTD. Further, neither Section 8(a) nor Rule 7110.10(a) places any burden upon employees to request vocational rehabilitation from their employer before maintenance may be awarded. In addition, the Rule places no duty on an employee to prepare a written assessment of the course of appropriate rehabilitation. The Roper Contracting court found neither section 8(a) nor Rule 7110.10(a), when read separately or together, require petitioner to request vocational rehabilitation before he was entitled to an award of maintenance. This is another problem with our reviewing courts in their analysis of the law and rules—they sometimes outline/state guidelines for the IL WC industry but may later contradict themselves in looking at the same law.

If petitioner does not receive vocational rehabilitation after demanding vocational assistance, petitioner should file a 19(b) and 8(a) Petition to have the issue decided by the Arbitrator and perhaps the Commission. Whether or not vocational rehabilitation is appropriate is a shifting burden. If petitioner can demonstrate he/she deserves vocational rehabilitation pursuant to National Tea, the burden shifts to the employer or insurance carrier/TPA to prove in a hearing a “reasonably stable job market exists for petitioner.” If the employer or insurance carrier/TPA believes it is appropriate to commence vocational rehabilitation, the services of a certified vocational rehabilitation counselor should be obtained and an initial assessment meeting should be scheduled. If petitioner fails to comply or attend the meeting, TTD may be terminated or the matter can be brought to the Arbitrator for pretrial or trial.

A challenging legal question arises as to whether a petitioner must be at maximum medical improvement prior to engaging in a vocational rehabilitation program. In our view, voc rehab can begin long prior to MMI being reached—getting back into the workforce should be part and parcel of the healing process. We don’t even understand why this debate goes on. Our Illinois Appellate Court in their 2002 ruling in Mobil Oil Corp. v. Industrial Commission compared the extent of the petitioner’s injury and the lack of a finding of maximum medical improvement to reverse the Commission’s award of vocational rehabilitation as inappropriate. Again, with respect to the members of our reviewing court, we don’t feel their determination closely adhered to the IL WC Act and Rules. We caution our readers, the members of the Court outline the law and we are simply court observers.

Does Anyone know a Certified Voc Rehab Provider Anywhere in IL that follows the Rules and fills out the IC31 Form and presents it for Arbitrator approval before starting counseling?

If both parties agree vocational services are appropriate and necessary, the intent of the Rules is for the parties to work together to create and sign the vocational rehabilitation plan outlined above--Form IC31. Rule 7110.10 requires the parties fill out the form and file it and present it to an Arbitrator with a vocational rehabilitation plan subject to their approval. The joint participation of the parties as well as the Arbitrator’s supervision are indicated. The Rule also outlines voc rehab plan is to be prepared and submitted on the form furnished by the Commission. We point out we are not aware of a single certified voc rehab provider that follows this Rule as it was designed and crafted by our IWCC rule-makers. We ask our readers if they are aware of any certified voc rehab provider that does follow the Rule.

Will Illinois Jumpy Arbitrators Push Claimants to be Motivated, Follow Voc Rehab Protocols and Get Jobs or Face a Loss of TTD?

One can’t truly blame Arbitrators for not knowing who their friends are—eleven Arbitrators have been fired in the last year, many without apparent reason. The remaining Arbitrators are looking over their shoulders, as they are in highly political jobs without civil service protections. In other states, when a claimant goes to the state rehab agency and doesn’t find work, they are told to “rub some dirt on it” and keep trying. Unlike our state, such claimants don’t get bigger settlements and don’t get more TTD. In this state, in over thirty years of practice before the Commission, we have never seen an Arbitrator caution an unmotivated claimant to get on their horse and find a job or face an irrevocable loss of benefits. You can’t blame the Arbitrators, the voc rehab consultants and many defense attorneys don’t bring the tough claims to them. And we feel many Arbitrators aren’t going to read the riot act to claimants for fear they would face sanctions or termination from getting tough on voc rehab compliance.

We feel vocational rehabilitation/maintenance plans should be presented to the Arbitrator, consistent with Commission Rule 7110.10, with evidence of entitlement, so that an administrative determination can be made, as opposed to claimants pursuing their own job search or obtaining vocational rehabilitation without the employer or insurance carrier/TPA knowing about it and without the Arbitrator’s approval. In claims where a demand for vocational rehabilitation was presented by claimant or their counsel and the employer/insurance carrier/TPA disputes the need for voc counseling, the Rules indicate claimant must bring the dispute to the Arbitrator to rule as to whether claimant can prove entitlement to voc rehab. As with all other disputed issues, It is claimant’s burden to prove the elements of any dispute by the preponderance of evidence, including the right to vocational rehabilitation benefits.

Who’s on First? Who Gets to Pick the Counselor? Which Party Owes the Cost of Voc Rehab Services?

Current legal authority suggests a claimant can select his or her own vocational rehabilitation counselor. In Copperweld Tubing v. IWCC, the IL Appellate Court decided the employer/insurance carrier/TPA must pay for the “reasonable vocational rehabilitation expenses” selected by petitioner or their counsel but also stated they had to pay for the petitioner’s voc rehab choice even though the employer or insurance carrier hired its own vocational rehabilitation counselor who met with and evaluated the claimant. However, Copperweld Tubing was limited to an initial assessment performed by petitioner’s choice of expert. The issue addressed in the decision was limited to the issue of petitioner’s earning capacity. We again assert this legal determination isn’t clearly outlined in the IL WC Act or Rules—we feel the reviewing court provided their thoughts on what they felt was a “best outcome” and now we all have to adjust.

From the language of the IL WC Act, it is quite clear Section 8(a) does not specifically require vocational rehabilitation, but the Act provides if vocational rehabilitation is ordered, the employer or insurance carrier/TPA is liable for payment of vocational rehabilitation. This is taken fromAmoco Oil v. Industrial Commission. The employer is not required to provide vocational rehabilitation where it is neither requested nor proven necessary. It is also possible for petitioner to create his/her own vocational rehabilitation plan but the Commission and courts discourage claimant-created vocational rehabilitation. In the Roper Contracting ruling cited above, the majority stated while our IL Supreme Court indicated disapproval of claimant-created, self-directed vocational programs there is no particular statutory prohibition or rule blocking claimant-created vocational rehabilitation.

What is at stake

The most expensive benefits in any WC claims office are a wage loss differential or “odd-lot” total and permanent disability claim. When faced with such claims, the employer and/or carrier/TPA are dealing with six and seven-figure exposures. When you are trying to defend them and get solid outcomes, you need voc counselors with savvy and moxie—they have to be willing to give great advice and face the reluctant claimants at a hearing. We continue to search for great voc counselors who know and follow the law/rules to get great outcomes. If you know any, please send a reply. If you have other thoughts and comments, please send them along or post them on our award-winning blog.

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Synopsis: HOLD EVERYTHING—Illinois Supreme Court to consider appellate denial of Mailbox Rule” for WC appellate filings of IWCC decisions.

 

Editor’s comment: As we reported earlier this year, the IL Appellate Court decided they didn’t have subject-matter jurisdiction for judicial review of an Illinois Workers’ Compensation Commission decision because they ruled said SMJ vests in the Circuit Courts upon filing of a request for issuance of summons and an affidavit of payment of the probable cost of the record, NOT upon the date of mailing.

 

In Gruszeczka v. Illinois Workers’ Compensation Commission, the Appellate Court, Second District, vacated the judgment of the Circuit Court of McHenry County as having been entered in the absence of subject matter jurisdiction as claimant failed to commence his action for judicial review within the 20-day period mandated in Section 19(f)(1) of the Workers’ Compensation Act. Specifically, Section 19(f)(1) provides a proceeding for judicial review of a Illinois Workers’ Compensation Commission decision shall be commenced within 20 days of the receipt of notice of the decision. We are not aware of any extensions or exigent circumstances that might allow for expansion of this limitation.

 

Claimant sought judicial review of the Commission’s decision—affirming the arbitration decision denying claimant benefits under the Act. They mailed a request for the issuance of summons and his attorney’s affidavit of payment of the probable cost of the record to the clerk of the Circuit Court of DeKalb County. Said paperwork was filed stamped by the clerk on May 24, 2009—24 days after the Commission’s decision was undisputedly received in the office of claimant’s attorney on April 20, 2009.

 

The employer successfully filed a motion to dismiss arguing the Circuit Court lacked subject matter jurisdiction to entertain claimant’s action for judicial review because it was filed more than 20 days after the Commission’s decision was received by claimant’s attorney. Claimant responded, arguing he fulfilled the jurisdictional requirement for filing by mailing all necessary documents to the clerk within 20 days of his attorney’s receipt of the decision. Attached to claimant’s response, were affidavits of claimant’s attorney and a clerk at the attorney’s office stating the necessary paperwork was mailed to the Circuit Court Clerk on May 4, 2009. There was no evidence of when the Circuit Court Clerk received the document. The Circuit Court denied the employer’s motion to dismiss for want of jurisdiction. Upon transfer of the matter to the Circuit Court of McHenry County, a motion to reconsider was also denied.

 

In reversing the lower court and dismissing the appeal, the Appellate Court refused to adopt the “mailbox rule”—i.e., the time of mailing is the time of filing for jurisdictional purposes—reasoning section 19(f)(1) of the Act was clear and unambiguous, should be given its plain and ordinary reasoning and must be strictly adhered to in order to vest the Circuit Court with subject-matter jurisdiction over a judicial review action under the act. Essentially they followed a plain reading of the Act and suggested the legislature should engraft the “mailbox rule” if it was intended to apply. The Appellate Court vacated the judgment of the Circuit Court and held claimant failed to commence his action for judicial review within the 20-day period prescribed by the Act.

 

This article was researched and written by Sean C. Brogan, J.D. Shawn R. Biery J.D. MSCC. We will advise of the update from the Supreme Court upon receipt to their ruling. In the interim, feel free to send questions and comments to Sean at sbrogan@keefe-law.com or Shawn atsbiery@keefe-law.com.

 

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Synopsis: IL WC Commission announces another “secret” political hiring.

 

Editor’s comment: Will we ever open up jobs at the Commission to folks that don’t have political patrons? The Commission has announced Amiel Harper, J.D. has joined the IWCC as Counsel to the Self-Insurers Advisory Board. He will also assist the Insurance Compliance Division on legal matters. Mr. Harper may be very well qualified for the job and we look forward to working with him. He holds a B.S. in Finance from Bradley University and a J.D. from Washington University.

 

Before coming to the IL WC Commission, he clerked for the Illinois Appellate Court, handled workers' compensation cases at the sometimes-Plaintiff and sometimes-Defense firm of Wiedner & McAuliffe, and served as Counsel for AGB Investigative Services.

 

What we didn’t see prior to Mr. Harper being hired was what Commissions/government agencies do in other states—advertise for the opening. The IWCC’s email blast and News section of their website didn’t say a thing about it—sssh, jobs aren’t open for the top candidate unless you have political pull to be the “best candidate.” Everything in the personnel area at the IL WC Commission remains a closely guarded secret and you still have to know someone’s-brother’s-cousin’s-uncle’s-sister to get a job there.

 

While we wish Mr. Harper every good thing in handling this new position, we hope someday the government jobs process becomes more open and less secretive.

 

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Synopsis: Why Use the IL Prescription Monitoring Program (PMP)?

Editor’s Comment: 19% of workers’ compensation costs are related to prescriptions and Oxycontin was the #1 WC drug prescribed in the U.S. in 2009. Hydrocodone with Tylenol is #3. Physicians are also prescribing more expensive drugs. Nearly 25% of all w/c drug costs are narcotics. One of the tools in the claims handler and case manager’s tool box is the PMP. Why should this tool be used?

At one point in the 1980’s and 90’s, physicians were told by the drug companies their patients could not get addicted to narcotic analgesics if they were in pain. In fact, with daily opioid use, physical dependence and tolerance can develop in days or weeks. (McQuay H. Opioids in pain management. Lancet 1999, 353: 2229-2232. and Baily CP and Connor M. Opioids: Cellular mechanisms of tolerance and physical dependence. Current Opinion in Pharmacology 2005; 5:60-80.) Also physicians were told patients who develop physical dependence on opioids can easily be tapered off. In fact, successfully tapering chronic pain patients from opioids can be difficult - even for patients who are motivated to discontinue opioid use. (Blondell RD, Ashrafioun L, Dambra CM, Foschio EM, Zielinski AL, Salcedo DM. A clinical trial comparing tapering doses of buprenorphine with steady doses for chronic pain and co-existent opioid addiction. J Addict Med 2010; 4:140-146.)

Most health care professionals don’t know the difference between chemical dependence, tolerance and addiction. Most don’t know how to assess opioid abuse or appropriateness. Most are uneducated regarding non-surgical pain-coping techniques and when they might be utilized instead of drug therapy. As a result, narcotic analgesics are being prescribed at an ever-increasing rate in the workers’ compensation arena, however with this increased use of narcotic analgesics; there is no proportional increase in functional capability of our injured workers.

As part of S&H Medical Management Services, Inc.’s initiatives to address Case Management strategies relative to one of the biggest cost drivers in W/C today we recently updated our IME procedures. S&H previously addressed this issue with our IL IME physicians by asking them to complete an online PMP review in cases when our IW were being prescribed Schedule 2 -5 drugs by the treating physician. At times our nurses encountered resistance from physicians who stated this was an encroachment on the injured worker’s privacy. From the perspective of KCB&A, this is another reason we recommend all of our clients obtain a HIPAA-GINA compliant medical release. We don’t know how an IME doc can do a valid IME when you don’t know what narcotics the examinee may be taking.

Further research has shown this is a nationwide initiative, not just something in IL physicians can ignore. The office of the President of the United States has written a paper addressing this epidemic with initiatives detailing how it is recommended the healthcare community respond to this crisis. So how do we educate our treatment providers and increase adherence to the request to review the PMP? S&H has developed a white paper that is attached to our IME letters to the physician. It discusses the issues our country is facing regarding prescription drug abuse and the need to address this issue. This attachment will go to all physicians that are requested to access the PMP when performing and evaluation of an injured worker. Hopefully this additional info will decrease the concerns previously expressed by the physician and increase adherence.

S&H also discovered most of the states in which they practice have a PMP or PDMP. The Federal government is proposing all states initiate a PMP.

What are the potential benefits of this intervention? As discussed earlier it has been shown that you can become dependent/progressing to addiction to narcotic analgesics within a very brief time – within days to weeks. Addressing this potential head on can prevent this type of situation from developing plus hopefully preventing issues such as drug diversion or outright abuse. Additionally, if this becomes a case that requires a MSA at time of case closure, preventing the need for prescription medications during active treatment will potentially save thousands of dollars over the life of the case. You may also be able to prevent the need for a costly drug rehabilitation program.

What are the considerations when scheduling an IME? Because access to the PMP is state specific, you do need to schedule the IME in the state in which you require the review. But there are other options for this review should your injured worker be located in an area where it is advantageous to perform the IME in a neighboring state. S&H has a URAC accredited UR partner that if utilized for the PMP and medication review in a state specific manner, would free you up for coordinating the IME across state lines when needed.

When do you request a PMP review? When your IW is located in a state that has a PMP or PDMP in place and the IW is being prescribed Schedule 2 -5 drugs by the treating physician.

This article researched by Linda Van Dillen RN, BA, CCM Executive VP/Partner at S&H Medical Management Services, Inc. If you have any questions regarding the states in which a PMP can be conducted, when a review is advantageous or how to coordinate with the IME - call Linda Van Dillen at 314-494-4179 or via email at linda.vandillen@SandHmms.com.