6-24-13; Please Join Us!!!; Soap-reaching is Now an Accident in IL WC, analysis by Ellen Keefe-Garner JD, RN; The IL WC Community Mourns Barb Kalobratsos and Sandi Usselmann and more

Synopsis: JOIN US!! Please join KCB&A By Adding Your Company Name To Our Amicus Curiae Brief to the IL Supreme Court!

Editor’s comment: The “traveling employee” concept is soon to take over and insure wildly increased WC coverage and costs for all IL employers. As we have advised our readers, the Venture-Newburg-Perini Stone and Webster ruling along with a similar ruling in Mlynarczyk have set a new standard for WC coverage in this state. The rulings provide global WC coverage for any “traveling employee”—the worker doesn’t have to be “traveling” at the time of the injury; they simply have to have a job where they don’t work “on the premises of their employer.” Anyone who doesn’t work on the “premises of their employer” gets global WC coverage for any injury, including injuries resulting from their own negligence when they are performing any “reasonable and foreseeable” task from the moment they leave the door of their home until the moment they return home.

Claimant in Venture-Newburg-Perini was a pipefitter who was going to work at a nuclear power plant and was injured in a motor vehicle accident as a passenger while traveling from his motel to the jobsite. He wasn’t on the clock nor had he appeared at the plant for a single minute of work—the employer or insurance carrier may have to pay over $1M in medical benefits for a claim that may eventually be worth over $2-3 million in value.

In Mlynarczyk, Claimant was a cleaning lady walking to her own vehicle to return to work after her lunch break. She slipped and fell on snow in her own driveway and fractured her left wrist. The employer or insurance carrier will now have to pay substantial WC lost time, medical and PPD benefits. Please note her potential negligence in cleaning ice and snow from her own driveway and failing to apply salt is now the “fault” of her employer.

In the third such “traveling employer” ruling, the same panel in Kertis v. Workers’ Compensation Commission considered a Claimant who was a bank branch manager for WaMu® or Washington Mutual®. He fell in a pothole on admittedly public walkway. This manager had to “travel” between two bank branches. The Arbitrator, IWCC and Circuit Court denied the claim, asserting the potential of stepping in a pothole in a street was a risk common to the public. The Appellate Court, Workers Comp Division has unanimously reversed and awarded substantial benefits.

In Kertis, the appellate panel ruled, as a matter of law, bank managers covering two work locations now are covered for all “reasonable and foreseeable” injuries, even those arising from their own negligence, from the moment they leave home until they return home. Their logic indicates bank managers covering one location would not receive such IL WC coverage. No other state does this--only in the IL WC system does that make any sense. Don’t take our word for it, please read http://www.illinoiscourts.gov/Opinions/WorkersComp/2013/2120252WC.pdf.

 

Please note the term or phrase “traveling employee” doesn’t appear at all in the IL WC Act or Rules—it has all been defined by our Commission and courts in what many critics feel is “judicial legislation.” Our hearing officers and courts can make it up as they feel best and leave the rest of us to guess where they will take the concept. For one example, we are wholly uncertain what the “premises of the employer” might be. Isn’t a truck driver driving in the company vehicle working on the premises of the employer? Does the employer have to own the “premises” or can they lease it? Can construction companies force their workers to move to and live in trailers on their job sites to avoid this expanded coverage and risk? Are municipal workers traveling within the municipality on the “premises of the employer” or does that only include City Hall? What if the cleaning lady in Mlynarczyk works most of the time cleaning her employer’s premises but then goes to your house or my house later in the day—is she a “traveling employee” all the time or some of the time?

 

The “traveling employee” concept was supposed to be for workers being sent overnight to odd and potentially dangerous foreign places. When they arrive, they would face unusual food, currency, kidnapping, disease and other extraordinary risks—our clients understand the reasons to expand WC coverage for such high-risk workers. What is now happening in IL WC is we are extending extraordinary WC coverage afforded to folks who variously face the risks of extraordinary travel to folks that may not even be “traveling” and don’t face any unexpected risks. We assure our readers virtually all members of the municipal/government, construction, road building and transportation industries will be provided this unusual and wildly expanded “traveling employee” WC coverage. Most members of the legal industry travel to courts, other hearing locations and client meetings and will also receive the expanded coverage. At-home workers will also get such coverage which may cause IL employers/TPAs/insurance carriers to seek at-home workers from other states to avoid the increased WC coverage and heightened costs—are IL at-home workers covered under WC the moment they wake up until they return to bed? If they fall out of bed but do so thinking about work, are they covered?

 

We don’t feel any of this will be good for IL business in this rotten economy. We also feel Illinois will soon have the most expensive of all WC state systems, if this concept remains IL WC law. Local and state taxes may have to be increased. WC premiums and reserves are certain to dramatically rise. We have already predicted a “WC fraud-fest” because the injuries don’t have to occur in the workplace or while traveling—a miscreant who injures their ankle playing ball with their friends can simply say it happened in their driveway while going to work a la Mlynarczyk.

 

Finally, as the “arising out of” and “in the course of” requirements are being discarded for millions of IL workers who don’t work on “the premises of their employer,” we assert all aspects of IL WC law and practice will have to change as the “stip sheet” and Commission decision forms and their IWCC handbook will have to change to include this new game-changing “traveling employee” concept.

 

We seek your corporate participation to allow us to add your name as a party amicus to the IL Supreme Court brief due on July 3, 2013. There is no charge to be added—we are simply trying to support the great attorneys who seek to get the IL Supreme Court to reverse or greatly modify the Venture-Newburg-Perini Stone and Webster ruling and return Illinois to the rules we have followed for 104 years. We appreciate your thoughts and comments; please post them on our award-winning blog.

 

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Synopsis: How Can Reaching for a Soap Dish Become an Accident When Petitioner’s Story isn’t “Squeaky Clean?” Analysis by Ellen Keefe-Garner, J.D., R.N.

Editor’s comment: We feel the IL Appellate Court, Workers’ Compensation Division overlooks inconsistent evidence to arrive at the conclusion indicating the injury arose out of employment when the employee felt pain supposedly reaching for a soap dish. We have seen different outcomes in prior cases involving claimants reaching and moving in normal ways. For instance, see Hansel & Gretel Day Care Center v Industrial Commission in which a teacher’s assistant injured her leg standing up from a chair. 

In Accolade v. The Illinois Workers' Compensation Commissionissued May 30, 2013, a caregiver at an assisted-care facility claimed she suffered a neck injury from reaching to remove a soap dish while helping a resident shower. More than a year after the incident, Claimant testified at trial she felt something in her neck pop when she reached out to remove a soap dish because she was concerned about it causing a “safety risk” since the resident might slip on suds while showering. Documents and testimony admitted at trial revealed very different and often inconsistent histories of how her pain had begun.

For instance, claimant’s incident report—which had been completed on the day of the alleged event--did not mention any safety concern caused by the soap dish and instead merely stated claimant felt pain and popping in her neck while assisting a resident with a shower. On another part of the same incident report, the manager in the facility also did not record any safety concern and instead recorded claimant felt a popping sensation when she simply moved her head. Similarly, Claimant’s Form 45 merely stated, “She [claimant] turned her head and something popped.” In a like manner, one day after the alleged incident, a doctor’s history indicated claimant felt pain in her neck when she had “reached” at work the previous day. Notably again, there was nothing in the doctor’s history about reaching for a soap dish or about protecting a patient.

Strangely, an x-ray report from the same day (the day after the alleged incident) gave an entirely different and conflicting history, indicating claimant felt a popping sensation with pain when she lifted a patient under the shower yesterday. A few days after the alleged incident, another doctor noted claimant had a “long history” of neck and back pain. This doctor used an MRI to diagnose the presence of a large C6-7 disc herniation with severe radicular symptoms. He referred her to a neurosurgeon for possible surgery and admitted her to the hospital the same day. Again, the neurosurgeon’s history from the claimant makes no mention of any soap dish or patient safety concerns and instead indicates claimant experienced a popping feeling with radiating pain into the right arm when she simply bent over at work. After Claimant underwent discectomy/fusion surgery, claimant’s attorney arranged an IME during which claimant for the first time asserted she had slipped and twisted her back helping a resident in the shower at work. During a subsequent IME performed at the request of her employer, claimant reported yet another story indicating the pain had developed as she bent over in the shower to reach for a bar of soap. 

So, which one is it? Did claimant slip, twist, fall, lift, bend, reach, feel spontaneous popping or pain, or did she suffer from chronic spinal abnormalities? No one will ever know since despite all of the inconsistent and contradictory evidence, the Arbitrator subsequently concluded Claimant sustained an injury that arose out of and in the course of her employment. Ignoring the evidence which indicated the pain had arisen spontaneously and from normal bodily movements, like bending or reaching, the Arbitrator’s decision discussed the position of the soap dish under the shower head and how the location of it could or did allegedly create an increased risk to which the general public is not exposed.   

The pivotal question on appeal was whether the act of reaching for a soap dish (the risk) was a risk to which this employee was exposed to a greater degree than the general public. The employer rightly noted if the injury arose from a hazard or risk to which the employee would have been equally exposed apart from her employment; the injury did not arise out of the employment. Defense counsel for the employer categorized the reaching as “not in any way peculiar to her [Claimant’s] employment.” Furthermore, respondent emphasized the documentary evidence-- which had been created on the date of the incident--was entirely and completely without any mention of any holding of the resident, lifting, reaching or moving in an awkward fashion.

Ultimately, the Appellate Court, Workers’ Compensation Division focused on the fact the soap-dish-reaching occurred while the claimant was allegedly trying to protect a resident from falling. Ignoring the same reaching would have occurred while doing numerous activities both inside and outside of work, the Appellate Court affirmed the award in favor of Claimant. Notably, in arriving at its conclusion for Claimant, the Appellate Court admitted it had to ignore the inconsistent renditions of events in the various documents created on the date of the alleged incident. The Appellate Court explained away these inconsistencies by stating it was within the province of the Commission to judge the credibility of the witnesses, determine the weight to assign the testimony, and resolve conflicts in evidence. Ultimately the Appellate Court indicated the inconsistencies in the documentary evidence were not sufficient to overturn the Commission’s decision. With respect to the members of this appellate panel, we feel the issue isn’t the obvious dispute over the facts, it is whether reaching for a soap dish can be defined as an accident when it is such a commonplace activity of daily life. We also cannot fathom how a worker can significantly herniate a disc when simply reaching for soap. Taking a broader view of this court, it is our view that if the appellate panel wants to affirm an award of compensation, they focus on the facts and confirm the manifest weight requires affirmance. If they want to reverse a denial to insure benefits are awarded, they appear to disregard the manifest weight of the evidence standard.

This article was researched and written by Ellen Keefe-Garner, J.D., R.N. who is our resident KCB&A lawyer-nurse. Ellen is licensed in both Illinois and Michigan. Feel free to contact her with questions or concerns at emkeefe@keefe-law.com.

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Synopsis: The IL WC Community Mourns the Passing of Barbara Kalobratsos, J.D. and Sandi Usselmann, R.N.

Editor’s comment: Barb Kalobratsos was a brilliant defense lawyer and will be missed by hearing officers and attorneys on both sides of the practice. Barb received her Juris Doctor degree from The John Marshall Law School in Chicago, Illinois. While in law school, Ms. Kalobratsos participated in an internship with the Honorable Alexander White, Cook County Circuit Court Judge, Workers' Compensation Division. As an intern, her duties included researching and analyzing the law pertinent to workers' compensation matters, drafting judicial opinions and monitoring the various legislative proposals and their effect on the Illinois Workers' Compensation Act.

Throughout her career, Ms. Kalobratsos concentrated her practice in the defense of workers' compensation matters and subrogation claims. She also had vast experience in cases involving automobile negligence and product liability. As a seasoned trial attorney, Ms. Kalobratsos defended complex workers' compensation cases including death, heart attack and psychological stress-related claims at the Industrial Commission with favorable results. She has also handled cases in the Circuit Court of Illinois and in Federal Court, representing clients in both workers' compensation and civil matters. Her professional affiliations included the American Bar Association, the Chicago Bar Association, the Workers' Compensation Lawyers Association and the Hellenic Bar Association.

Barbara Kalobratsos was the beloved wife of Peter Wachowski and loving mother of Philip, Christina & William. Visitation is today from 3-9 pm Nelson Funeral Home 820 W. Talcott Rd. Park Ridge. Funeral Tuesday lying in state 9:30 am until time of service 10:30 am at St. John the Baptist Greek Orthodox Church 2350 E. Dempster St. Des Plaines. In lieu of flowers donations to www.wackywarriors.org will be appreciated.

Sandra Kay Usselmann was a nurse who worked with and for Illinois injured workers in the 35 years of her tireless work. She dedicated her life to assisting individuals in receiving quality medical care. Sandi owned Paragon Health Services and helped thousands of people return to work through her services. She touched and healed many more with her friendship, love, and tender loving care. Sandi battled breast cancer for approximately one and a half years.

Preliminary visitation arrangements are tonight Monday, June 24, 2013 at Valhalla Funeral Home. The website is: http://www.dignitymemorial.com/valhalla-gaerdner-holten-funeral-home.com It is located at 3412 Frank Scott Parkway West, Belleville, Illinois  62223. Sandi will be buried tomorrow Tuesday, June 25, 2013 at Green Mount Cemetery in Belleville, Illinois.

God bless and keep both of these great women and consummate professionals who lived and thrived in the IL WC system. We hope their family and friends find comfort in remembering their great work and achievements.

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Synopsis: KCBA welcomes general liability, employment law and litigation defense specialist Chris St. Peter from the law firm of Winston & Strawn LLP.

 

Editor’s comment: Keefe, Campbell, Biery & Associates proudly announce the addition of Christopher H. St. Peter, J.D. to our legal team. Chris joins us from Winston & Strawn LLP, where his practice involved all aspects of complex commercial litigation in state and federal court.  Chris graduated with honors from Chicago-Kent College of Law, where he was an executive articles editor of the Chicago-Kent Law Review and an extern for the Honorable Magistrate Judge Arlander Keys in the U.S. District Court, Northern District of Illinois. Chris will focus his practice on a full range of defense work, including general liability, employment law, product liability, and contract disputes.  Chris can be contacted at any time at (773) 301-7244 or cstpeter@keefe-law.com.

 

 

6-17-13; Massive Employment Law Muddle Might Be Different With Veteran WC/EPLI Defense Approach; Joe Needham on Important Positional Risk Ruling; Shawn R. Biery on Double-Dip PPD Award and much more

Synopsis: IL Employment Law Muddle—When Is a Claim WC, EPLI or a Circuit Court battle? Our vote is to consult with our KCB&A defense team that can handle all such issues in your companies’ best interests.

 

Editor’s comment: We saw two very different outcomes in two very similar actions across our state in the last couple of weeks. The legal battlefield and potential costs have to make IL risk, safety and HR folks bewildered.

 

In Holland v. Schwan’s Home Service; No. 5-11-0560, issued May. 30, 2013, Plaintiff alleged his erstwhile employer Schwan's Home Service, Inc. (Schwan's) terminated his employment in retaliation for “exercising his rights” under the Illinois Workers' Compensation Act. After a seven-day trial, a jury returned a verdict in Holland's favor on his retaliatory discharge claim, awarding him a total of $4,260,400 in compensatory and punitive damages. The punitive damages portion of the award was $3.6 million. We consider that amount to be comical, ludicrous—you pick the adjective. Throughout the trial court proceedings in one of Illinois’ notoriously anti-business judicial areas, Defendant Schwan's denied Plaintiff Holland's assertion Schwan’s terminated his employment. Instead, Schwan’s maintained when Holland recovered from his work accident and was ready to return to work, it offered him an available position at the facility where he previously worked but he refused to report for work. At several stages of the lower court proceedings, Schwan's requested the Circuit Court decide the issue of whether it had terminated Holland in its favor as a matter of law, rather than letting the jury decide.

 

Prior to the trial, Schwan's made this request in a motion for summary judgment the Circuit Court denied. After the conclusion of Plaintiff Holland's case in chief, Schwan’s made the request for a directed verdict. Again, the Court denied the motion. In denying Schwan's motion for directed verdict, the Circuit Court found Holland presented sufficient evidence for the jury to conclude he was terminated. The Court noted Schwan's was "free to argue to the jury" Holland was not terminated but it was "up to the finder of fact to make that determination." Finally, after the jury considered the evidence and entered a verdict in Holland's favor, Schwan's raised this issue again in a post-trial motion requesting the Court enter judgment notwithstanding the jury's verdict and the lower court again denied Schwan's request.

 

Please note the attorneys or risk managers handling this matter appear to have a challenging understanding of IL WC claims handling. If you look on the IWCC website, Larry Holland settled his WC claim against Schwan’s amicably for a relatively meager 7.5% BAW in 2009. Obviously, they didn’t get a release/resignation as part of that settlement, leaving the option open for Plaintiff to seek millions. If there were disputes about TTD and return to work issues, they should have been compromised as part of that approved settlement. Actually, as you are reading this, we remain puzzled why defense counsel for Defendant Schwan’s haven’t raised that WC settlement as a bar to this seven-figure verdict and judgment. In our view, every aspect of this complaint and law suit presented issues that should have been heard by the Illinois Workers’ Compensation Commission. Return to work issues and the nature of a job offer being bona fide are decided in a routine fashion by our Arbitrators and Commissioners on a routine and daily basis. We cannot tell from the ruling whether that defense was presented to the lower or appellate court. If it wasn’t, it should have been.

 

Defendant Schwan's appealed the multimillion-dollar judgment entered on the jury's verdict to the Fifth District Appellate Court. They argued their many motions should have been granted. To no one’s surprise, the Fifth District followed the Circuit Court and ruled Plaintiff is entitled to over $4 million dollars despite the strong evidence of a job offer. We hope the IL Supreme Court will consider this appeal. We again urge all of our readers to understand this dispute should have been resolved at the IWCC.

 

In a starkly contrasting ruling that more closely follows our legal entreaties, in Schroeder v. RGIS; No. 1-12-2483, issued June 7, 2013, Plaintiff Schroeder asserted he suffered from intentional infliction of emotional distress because he was being treated poorly by supervisors due to the fact he is gay. Various epithets are contained in the records and we aren’t going to repeat them here. Defendant RGIS filed a combined motion to dismiss, brought pursuant to section 2-619.1 of the Illinois Code of Civil Procedure, arguing, among other reasons, Plaintiff Schroeder's complaint must be dismissed pursuant to section 2-619 of the Code because his claim of intentional infliction of emotional distress was preempted and, thus, barred by the Illinois Human Rights Act and by the exclusivity provision of the Illinois Workers' Compensation Act.

 

The First District Appellate Court noted the following issues were:

 

(1)  Whether Plaintiff was able to establish, independent of any duties created by the Human Rights Act, the elements of the tort of intentional infliction of emotional distress; and

(2)  Whether the exclusivity provision of the Workers' Compensation Act barred Plaintiff's claims.

 

The Appellate Court ruled the Circuit Court properly dismissed plaintiff's second amended complaint because his tort claim of intentional infliction of emotional distress was inextricably linked to a civil rights violation. They further ruled Plaintiff's claim was preempted and, thus, barred by the Human Rights Act. They also held Plaintiff's alleged injury was compensable under the Workers' Compensation Act. Therefore, Plaintiff's claim was also preempted and, thus, barred by the Workers' Compensation Act.

 

Our vote for our readers is don’t necessarily assume expensive defense counsel at $300-600 per hour are doing you a favor when the right WC/EPLI defense counsel could get the matter resolved rapidly as part of any resolution of the WC claim. Both of these cases should have the same outcome—resolution of the WC claim should resolve all other possible claims, if at all possible. The great defense team at KCB&A can provide such advice and counsel at rates less than $200 per hour.

 

We appreciate your thoughts and comments. Please post them on our award-winning blog.

 

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Synopsis: Illinois Appellate Court, Workers’ Compensation Division denies benefits for worker struck by errant vehicle as a neutral risk, while suggesting positional risk evidence may have altered the outcome. Analysis by Joe Needham, J.D.

 

Editor’s comment: When stray bullets are risks incidental to employment but a cashier’s injuries from being struck at her post by a car driven by the employer’s vendor is not, something is odd about the adjudication of WC liability in Illinois. Is positional risk becoming the new IL WC theory of compensability? 

 

In 95th Street Produce Market v Illinois Workers Compensation Commissionthe facts involved a cashier at a produce market who was struck and injured when a vehicle driven by a vendor crashed through a store wall and into Petitioner’s work area. A co-worker and three customers were also injured. The facts of the occurrence were not disputed and the only question at trial was whether Petitioner’s injuries were sustained in the course and scope of employment as the consequence of a risk incidental to the employment, or whether it resulted from a risk common to all.

 

Photographic and testimonial evidence established the exterior of the 95th Street Produce Market and its relation to the roadway. Concrete parking blocks separate a span of pavement abutting the storefront from the parking lot, but were not bolted down and moved when struck by vehicles. Petitioner testified drivers occasionally drove their cars in this paved area abutting the storefront despite it not being a roadway, mistakenly thinking they could leave the parking lot by this route. Upon realizing their error, some drivers simply drove over the grassy parkway to exit the area while others attempted to reverse course by “go[ing] forward, back up, forward, back up, so they can turned [sic] around to go back where they got in through.” Essentially, drivers frequently mistake their avenue of egress and instead drive upon an asphalt area abutting the storefront. Further evidence revealed the offending vehicle properly left the premises and was traveling Eastbound on 95th Street when the driver lost control of the vehicle, left the roadway and drove across the store lot and into the storefront, striking Petitioner and others.

 

Relying on Brady v. Louis Ruffalo & Sons Construction Co., the Arbitrator denied benefits, finding Petitioner failed to establish her risk of injury “was incidental to her employment or that the work environment increased the risk so that she would be subject to such an accident to a greater degree than that to which other persons on the premises were exposed.” Petitioner was one of five people injured, three of whom were customers. The injury in Brady involved a single employee injured at his work station when an errant vehicle left an adjacent highway and struck the employer’s building. In the absence of evidence the work environment exposed the employee to an increased risk greater than the general public’s exposure, the Brady court found the denial of benefits proper. The knowledgeable Arbitrator followed suit.

 

Petitioner appealed and the Commission reversed, finding Petitioner’s injury the consequence of a risk incidental to her employment in that it resulted from traffic of the employer’s vendor, present on the premises to facilitate the employer’s business. Because Petitioner’s job duties “required her to spend virtually the entire workday in the front of the store….  the location within the store where [claimant] performed her job duties, namely, in front of the store and in close proximity to large glass windows facing Respondent’s parking lot, exposed her to a greater risk of injury compared to the general public.” That determination was affirmed by the Circuit Court, and the employer appealed.

 

The Appellate Court, Workers’ Compensation Division reversed the award of benefits, agreeing with the Arbitrator the injury was not sustained in the scope of employment. While acknowledging Petitioner was clearly in the course of employment at the time of the injury, the First District Court found the manifest weight of the evidence affirmed the risk of injury was outside the scope of Petitioner’s employment, and reversed the lower courts to deny benefits to Petitioner. Noting a risk of injury must be peculiar to the work or must be a risk to which the employee is exposed to a greater degree than the general public as a consequence of the employment, the Court identified three categories of risk to which an employee might be exposed: (1) risks distinctly associated with the employment; (2) risks personal to the employee; and (3) neutral risks which have no particular employment or personal characteristics. Illinois Institute of Technology Research Institute v Industrial CommissionCitingIllinois Institute of Technology Research Institute, the Court noted:

 

·         Risks distinctly associated with the employment are universally compensated, and include “the obvious kinds of industrial injuries” that comes to mind when we think of a work injury.

 

·         Personal risks include non-occupational diseases, injuries caused by personal infirmities, and injuries caused by personal enemies. While personal risks are generally not compensable, they me be compensated where the employment increased the risk of injury (Id) such as aggravations of systemic disorders like carpal tunnel and myocardial infarction.

 

·         Finally, neutral risks include stray bullets, dog bites, lunatic attacks, lightning strikes, bombings, and hurricanes; injuries resulting from neutral risks do not arise out of the employment and are compensable only where the risk to which the employee was exposed was greater, as a consequence of the employment, than the risk to which the general public was exposed. Id.

 

In assessing the type of risk to which Petitioner was exposed, the Court found the facts of the case rendered the risk neutral - errant drivers pose a risk to the public generally -  necessitating Petitioner establish the employment rendered her risk of the specific injury greater than the risk shared by the general public. Because Petitioner presented no evidence on this issue, the Appellate Court found Petitioner failed to establish her neutral risk was heightened by her employment. In denying Petitioner’s employment increased her exposure to the neutral risk of a wayward vehicle crashing through the storefront beyond that to which the public is exposed, the Court discounted Petitioner’s argument the fact the offending vehicle was the employer’s vendor rendered the risk particular to the employment. The Court reasoned because the offending driver had reached the adjacent roadway and entered its stream of traffic before losing control of the vehicle and crashing through the storefront windows, he was no different than any other driver on the roadway and therefore presented a risk no greater than all other drivers on the road and did not present a risk incidental to the employment. Assessing the facts, the Appellate Court agreed with the Commission Arbitrator Petitioner’s risk of injury was not within the scope of Petitioner’s employment.

 

Distinguishing this case from Illinois Institute of Technology Research Institute v. Industrial Comm’n, and Restaurant Development Group v. Hee Suk Oh, each of which involved claimants working in high-crime areas struck by a stray bullet that breached the work station, the Court noted the 95th Street Petitioner presented no evidence the location of the employment presented an increased risk of injury rendering the neutral risk of an errant vehicle heightened to the point of presenting an employment risk. The court distinguished 95th Street Produce Market from the earlier rulings on the basis each of those claimants presented evidence to support a finding the location of the employment increased the risk of injury to the employee beyond the risk presented to the general public. In both cases claimants submitted police records or testimony showing an increased rate of crime in the area. Because those claimants produced evidence their places of employment were in high crime areas subject to gunfire, the Court reasoned those claimants presented evidence of a neutral gunfire risk specifically heightened by the employment. Essentially, claimants in Illinois Institute of Technology Research and Restaurant Development Group both established the location of their employment presented a heightened risk of injury, and the 95th Street Petitioner did not. While we agree completely with this result, we take issue with the logic employed to reach it.

 

Here’s our basic problem with the contrast between 95th Street Produce Market and the Illinois Institute of Technology Research and Restaurant Development Group cases. They are essentially the same risk as compared between employees and the area’s general public, with Petitioner denied benefits in 95th Street Produce Market for a risk that is clearly as foreseeable and possibly more-directly related to the employment than the injuries found compensable in the earlier rulings. Both of the earlier rulings involved employees injured as the result of an unforeseen errant bullet, while the risk which injured the 95th Street Petitioner was not only foreseeable based on prior errant vehicles in that very area, but possibly not even unlikely to occur for that same reason. This distinction overlooks what we believe to be an inconsistency in the reasoning to find crime in high-crime areas presents a risk of injuries to employees to a greater degree than the general public. If the employment is in a high crime area, isn’t the employment risk of being struck by a stray bullet in that area just as common as the risk to residents of the area? If the area is one of high crime, how can the employment present a greater risk of injury from that crime than the risk presented to the public? With no evidence as to how the employment created a greater risk of the employee being struck by an errant bullet than to residents and inhabitants in the area, how does the employment increase the neutral risk to an employment risk? And what if evidence established the claimant lived in a higher-crime area than he worked; would that then render the risk of being shot lower as a consequence of the employment? Would the risk fluctuate depending on from where the employee hails?

 

Our criticism isn’t with the Appellate Court’s determination the 95th Street Petitioner’s risk of injury was not increased beyond the general public’s exposure - it is clear the risk of errant vehicles is common to all in the area, and we submit significantly less common to individuals employed within brick and mortar structures than to those on the roadways and walkways adjacent to the roadway - but with their willingness to find the risk heightened by the employment if Petitioner had presented some evidence the location of the employment offered a heightened risk of injury from an errant vehicle. What about the customers in the store, the pedestrians present and all members of the public in the area; were they not exposed to the same risk regardless of the location of the employer’s shop? How can the risk be greater to the employee than to the customer standing beside her?

 

This article was researched and written by Joseph Needham, J.D. Please direct complaints/criticism and kudos to Joe at jneedham@keefe-law.com.

 

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Synopsis: Two Accidents Now Seem to Provide a “Double-Scoop” of PPD for IL Claimants. This controversial ruling appears to further extend the intention for Illinois employers to pay, pay, pay. Analysis by Shawn R. Biery, J.D., MSCC.

 

Editor’s comment: While Illinois courts have already found PPD can be awarded for separate accidents, in the case of National Freight Industries v IWCC et al., 1-2004-3-WCpublished June 13, 2013, the Illinois Appellate Court Workers’ Compensation Division awarded what we feel is “double-PPD” for an old injury to the lumbar spine at L3-4 which was not MMI due to a new injury at L3-4 and L4-5 with a new employer.

 

In brief summary as noted in the opinion, on December 31, 2008, claimant, Andrew Smith, filed an application for adjustment of claim (08 WC 56873) seeking benefits for injuries sustained in a motor-vehicle accident on December 4, 2008 while in the employ of National Freight Industries. That same day, claimant filed a second application for adjustment of claim (08 WC 56874) alleging the occurrence of a work-related accident on November 6, 2006 (prior to the accident alleged in the first application), while in the employ of Fischer Lumber. Following a consolidated Section 19(b) hearing, the arbitrator determined claimant’s current condition of ill-being was not a natural consequence of the November 6, 2006 injury and the accident of December 4, 2008, constituted an independent, intervening accident that broke the chain of causation—and thus denied Fischer Lumber’s liability for TTD and medical expenses after December 4, 2008. The arbitrator further held National Freight liable for TTD benefits and medical expenses for the period from December 5, 2008, through the date of the arbitration hearing. The arbitrator also determined Petitioner was not entitled to PPD against Fischer Lumber because he had not reached maximum medical improvement prior to the date of the second accident.

 

The Illinois Workers’ Compensation Commission affirmed and adopted the decision and the circuit court of Madison County confirmed the decision of the Commission. Petitioner and National Freight filed separate appeals, which were consolidated with National Freight arguing the Commission’s finding the December 4, 2008, accident broke the chain of causation from claimant’s prior work accident was both contrary to law and against the manifest weight of the evidence. In his appeal, Petitioner argued the Commission’s finding that he was not entitled to a permanency award from Fischer Lumber was against the manifest weight of the evidence.

 

The court didn’t agree with National Freight’s argument which argued the motor-vehicle accident merely aggravated the injuries claimant sustained as a result of his initial work injury, while employed by Fischer Lumber—arguing the chain of causation from the November 6, 2006 accident was not completely broken. The Appellate court concluded the record supports a finding the December 4, 2008 motor-vehicle accident, which indisputably occurred while claimant was in the scope of his employment for National Freight, constituted an independent, intervening accident which broke the chain of causation between claimant’s original work-related injury and his current condition of ill-being noting the difference in complaints and distinguishing this case from the Vogel case (which in this writers opinion is mostly distinguishable because Petitioner Vogel didn’t have another employer to pay).

 

The Appellate Court also cited the language of Section 19(b) as their rationale for awarding permanency with the circular logic that Section 19(b) does not bar further hearing to determine permanency so it wasn’t technically denied. The IL WC Act states in pertinent part…. “The Arbitrator may find that the disabling condition is temporary and has not yet reached a permanent condition and may order the payment of compensation up to the date of the hearing, which award shall be reviewable and enforceable in the same manner as other awards, and in no instance be a bar to a further hearing and determination of a further amount of temporary total compensation or of compensation for permanent disability, but shall be conclusive as to all other questions except the nature and extent of said disability.”

 

As such, the Appellate court indicated they were sending the case back to award permanency as they had found it had been improper to address the propriety of permanency with respect to the injury claimant sustained while claimant was employed by Fischer Lumber at that stage of the proceedings and they found it would be inconsistent to determine the injury claimant sustained while working for National Freight constituted an independent, intervening cause and award no permanency for the injury claimant sustained while working for Fischer Lumber. The Appellate Court affirmed the findings that  the motor-vehicle accident in which claimant was involved while working for National Freight constituted an independent, intervening cause was based on the finding the second accident resulted in a change to claimant’s symptoms, the pathology of claimant’s condition, the type of surgical intervention, and his ability to work. In other words, the Appellate Court concluded that the second accident did not simply represent a continuation of the injury resulting from the first accident. Rather, it caused a separate and distinct injury that broke the causal chain. Since claimant suffered separate and distinct injuries arising from two different accidents, he should be allowed to seek a permanency award for each accident.

 

While confusing, the claim finds support for both parties arguments in case law and it is interesting to note our office recently argued a Central Rug case before an Arbitrator and were provided with a distinctly separate opinion than the Appellate Court found here. A jaded observer may see the contrary rulings as the continued reach of the Illinois WC system to provide benefits at a higher level than contemplated by the initial intention of Workers’ Compensation Acts when initially installed over a century ago. This article was researched and written by Shawn R. Biery, J.D. MSCC. Email Shawn at sbiery@keefe-law.com for a copy of this case or with any questions.

 

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Synopsis: KCBA welcomes general liability, employment law and litigation defense specialist Chris St. Peter from the law firm of Winston & Strawn LLP.

 

Editor’s comment: Keefe, Campbell, Biery & Associates proudly announce the addition of Christopher H. St. Peter, J.D. to our legal team. Chris joins us from Winston & Strawn LLP, where his practice involved all aspects of complex commercial litigation in state and federal court.  Chris graduated with honors from Chicago-Kent College of Law, where he was an executive articles editor of the Chicago-Kent Law Review and an extern for the Honorable Magistrate Judge Arlander Keys in the U.S. District Court, Northern District of Illinois. Chris will focus his practice on a full range of defense work, including general liability, employment law, product liability, and contract disputes.  Chris can be contacted at any time at (773) 301-7244 or cstpeter@keefe-law.com.

 

 

 

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6-3-13; "Insane in the Membrane" IL WC Legislative/Judicial Update; Star Wars Robot Suits May Be Coming to WC Claims; Nathan Bernard on Line of Duty Pension Ruling and more

Synopsis: Is the State of Illinois “Insane in the Membrane?”

 

Editor’s comment: With respect to our judiciary and legislature, we think you can make a compelling case that Illinois’ government has gotten odd past kooky beyond silly. Last Friday, the spring legislative session ended with three arguably crazy examples:

 

·         Our IL legislature just passed a law legislatively reattaching the shoulder to the arm (duh??);

·         Our IL courts just ruled a cleaning lady who fell in her own driveway or on a public sidewalk while admittedly not on the clock but on the way to work is covered under IL WC as a matter of law;

·         Our IL legislature didn’t do anything about a public employee pension deficit that is growing at a rate of $1B every sixty days and is certain to be over $105 billion by next year—we are paying more money and will owe more money for “salaries/compensation/pensions” for government workers who aren’t working ever again than we are paying for active state employees. At present, IL taxpayers are seeing one out of every four current tax dollars going to pensions—this is squeezing out and sweeping up money that could be used for medical care for the poor, schools/universities and everything else the State does. The situation is certainly going to get worse and worse until something is done someday but we can expect the secretive government union bosses will remain in the background while fighting and fighting any reduction.

 

Three main eccentric developments (or lack of development) occurred last week; all of them arguably incongruous and peculiar, in our minds.

 

First, without much fanfare, the 2013 Amendments to the IL WC Act were passed by both houses of the IL Legislature and will move to Governor Quinn for his signature. Please watch this spot for news on when and if he signs it. Our amazement should be recorded because we have no idea who, how and why these anomalous changes were presented and passed. We note the only state-wide organization that reported on it was the gurus from our IL State Chamber of Commerce. The Illinois Workers’ Compensation Commission didn’t report the proposed legislation on its solid and informative website. We don’t see where the IWCC, as an administrative body or the IL WC Advisory Board debated or recommended these significant changes to our legislative leaders. We didn’t see either the IL Workers’ Compensation Lawyers Ass’n or the IL Self-Insurers Ass’n debating/discussing/promoting them.

 

What is mildly nutty, in our view, is this “stealth” bomb that just hit all of us in the IL WC industry, started as legislation to amend the IL Condo Property Act on the issue of solar and wind energy (???). Then a Senator who has little to do with the WC industry proffered amendments to our IL WC Act. The following is analysis from Shawn R. Biery, JD, MSCC and your editor on what just hit IL WC claims handlers and risk managers. We are finalizing a PowerPoint presentation for training purposes and we are happy to present on a formal or informal webinar basis—if you are interested, send a reply. Please remember the legislative changes aren’t effective until the Governor signs them—the information below is NOT yet law but we assume he will sign them in the near future.

 

A.    The first legislative change is basically obtuse and makes little sense to us--it eliminates the ability of an injured worker to bring suit against an insurer, broker, service organization that is wholly owned by the employer, WC insurer or broker that a provides safety service, advice or recommendations for the employer or the agents or employees of any of them for injury or death sustained by any employee while engaged in the line of his duty. We are completely baffled by this new legislative provision and have no idea who it might affect—does anyone know a company in IL that had a wholly owned insurer or broker or safety organization that was sued due to injuries to a worker? Does anyone know of two such companies? Was there a crying need for this legislative change?

 

B.    Whew, the shoulder has been legislatively reattached to the arm--for purposes of awards under Section 8(e) of the IL WC Act, injuries to the shoulder shall be considered to be injuries to part of the arm. This amendatory Act of the 98th General Assembly is declarative of existing law and is not a new enactment. We view this new provision as a legislative “smack-down” of the Forest Preserve District of Will County v. IWCC ruling where the reviewing court grabbed a dictionary or two to rule the “arm” was the part of the body between the shoulder and the wrist. We assure our readers the goal was to strip out credit for prior awards for loss of use of the arm for later injuries to the same body part. We remain concerned our courts may grab new dictionaries to again try to redefine what “shoulder” and arm might mean.

 

C.   Impairment awards suddenly are to become “ordered?” The new law requires in determining the level of permanent partial disability, the Commission shall base its determination on the following factors: (i) the reported level of impairment pursuant to subsection if such an impairment report exists; (ii) the occupation of the injured employee; (iii) the age of the employee at the time of the injury; (iv) the employee's future earning capacity; and (v) evidence of disability corroborated by the treating medical records. No single enumerated factor shall be the sole determinant of disability. In determining the level of disability, the relevance and weight of any factors used, including the level of impairment reported by the physician, must be explained in written order. We feel this provisions might water down impairment ratings by making the Arbitrator statutorily “explain” the PPD ruling. They are not to include an impairment rating if they don’t have an impairment rating report—again, we consider this mildly kooky and don’t feel Arbitrators should start concocting impairment ratings on their own.

 

D.   Employers to provide free interpreters for pro se settlement hearings--if a pro se settlement claimant cannot speak English, the employer/insurer/TPA have to provide qualified, independent interpreters for pro se settlements at their expense. Again, it is hard for us to believe the legislators had to address this issue. KCB&A gets 10-20 pro se settlements approved every month of every year and we have never experienced such an issue.

 

E.    More unfounded and unfair IL WC Arbitrator bashing—The new law requires each arbitrator appointed after June 28, 2011 to demonstrate in writing his or her knowledge of and expertise in the law of and judicial processes of the Workers' Compensation Act and the Occupational Diseases Act. Can someone in Springfield please give our Arbitrators a break? If we are going to require written documentation of their expertise, can we extend this to every lawyer who walks into any IL WC Commission office to include the Chairman, the Commissioners, the Arbitrators, the law clerks for the Commissioners, the attorneys in the IWCC’s compliance section, your editor and all Petitioner and Defense attorneys? Does anyone want to take a shot at our workers’ compensation law school final exam? If not, can we set up an “expertise-detector” for all of them? If we aren’t going to make this a global requirement, please stop picking on the arbitration staff!

 

F.    IL WC Commission to continue to publish a WC handbook and put it on its website? The new law requires the IL WC Commission to continue to do what it has done for years--publish a handbook in readily understandable language in question and answer form containing all information as to the rights and obligations of employers and employees under the provisions of this Act. The IWCC’s handbook will remain confusing, loosely follow the law, make workers want to find lawyers and remain available free of charge to the general public. All of it now has to be maintained on the Commission's Internet website. We have no idea why this is now in our law.

 

G.   Limits on Petitioner’s attorney's fees can now be waived?? At present, such fees shall not exceed 20% of the sum which would be due under this Act for 364 weeks of permanent total disability based upon the employee's average gross weekly wage prior to the date of the accident and subject to the maximum weekly benefits provided in this Act. Now our law may allow the employee or his or her dependents, as applicable, waive in writing the 364-week limit on attorney's fees or unless further fees shall be allowed to the attorney upon a hearing by the Commission fixing fees. An employee or his or her dependents, as applicable, may waive in writing the 364-week limit on attorney's fees in death cases, total disability cases, and partial disability cases. We want to be there when an employee can waive the attorney fee limit in his/her own death claim—that might be international news! We also wonder why the law doesn’t include “widows” in death claim waivers but only mentions dependents. All of this goes back to an interesting issue—were there lots of claimants asking to pay more money in fees? Can politically connected Petitioner lawyers now get 30%, 40% or 49% attorney’s fees for their accepted and undisputed major claims?

 

H.   Some new Gobbledygook about appeals from the IWCC to the Circuit Court. It shall be the duty of the Commission upon receipt of the summons from the Circuit Court, to prepare a true and correct copy of such testimony and a true and correct copy of all other matters contained in such record and certified to by the Secretary or Assistant Secretary thereof. We have no true idea how this changes prior law and/or why the legislature cared about it and changed it.

 

I.      Thou shalt now authorizeth medical care or face the wrath of penalties! We consider this an important change for all IL WC adjusters and nurse case managers to know and understand. The new provision states: “[i]n a case where there has been any unreasonable or vexatious delay in the authorization of medical treatment or in the payment of compensation or an intentional underpayment of compensation, or proceedings have been instituted or carried on by the one liable to pay the compensation, which do not present a real controversy, but are merely frivolous or for delay, then the Commission may award compensation additional to that otherwise payable under this Act equal to 50% of the amount payable at the time of such award. Failure to pay compensation in accordance with the provisions of Section 8, paragraph (b) of this Act, shall be considered unreasonable delay.” We understand this to be legislation to statutorily “reverse” the Hollywood Casino v. IWCC ruling. Our problem with this new legislation is ascertaining how medical care was “non-authorized”—if the employer won’t pay for surgery, can they also be penalized for 50% of post-surgical care? We also feel it is a legislative provision that may push more employers to WC PPPs because we feel you probably have to authorize what your network recommends.

 

J.    Starting January 1, 2014, interest owed on unsuccessful defense appeals from the Arbitrators’ awards will be lots higher. Beginning January 1, 2014, decisions of the Illinois Workers' Compensation Commission reviewing an award of an arbitrator of the Commission shall draw interest at a rate equal to 3 percentage points above the average quoted prime rate on short-term commercial loans. We feel this is another reason to get rid of the third Commission panel, as there may be lots fewer appeals in years to come.

 

K.    Injured Workers’ Benefit Fund to be used for only for claims against such employers. To our understanding this limits the use of fines for uninsured employers to be used to pay claims for workers getting awards against them. If you think that is a solid approach, then this is a solid legislative change.

 

L.    Poor people to be afforded the rights and remedies of everyone else. If the Commission finds an injured workers is a poor person, they get fee subpoenas, transcript, copies of exhibits and written requests for summons at the expense of IL business because IL business funds the IWCC. Our problem with this concept is IL WC benefits are paid to folks who have jobs—how are you “poor” if you were injured at work and then provided benefits?

 

If you  have questions or concerns about the 2013 Amendments to the IL WC Act or if you want a copy of our PowerPoint presentation, please send a reply.

 

Second, we are looking for IL businesses large and small that want to join with us to try to stop the wild and unprecedented expansion of the “traveling employee” concept. We were thrilled to hear Ted Powers who is a very solid defense lawyer has received a positive response to his request for the IL Supreme Court to consider the ruling of the Appellate Court, Workers’ Compensation Division in The Venture-Newberg Perini Stone & Webster v. Ill. Worker’s Compensation Commission, No. 115728, 4th Dist. This case presents the judicial question as to whether trial court properly set aside the IWCC’s determination claimant was entitled to Workers’ Compensation benefits arising out of his accident, which occurred while claimant was riding in vehicle from a motel to jobsite. The Appellate Court, Workers’ Compensation Division in reversing the Circuit Court and reinstating the Commission's award, found claimant’s injuries were compensable under the IL Workers’ Comp Act as they felt claimant met requirements of the so-called “traveling-employee” doctrine where claimant was assigned to a jobsite that was not the employer’s “premises,” but rather was the premises of a client of his employer.

 

Claimant Daugherty was unquestionably not at work or working when injured; he was driving from a motel/lodge to work when the co-worker’s car slid on ice and hit a bridge. He has over $1M in medical bills. The Appellate Court ruled he was a traveling employee because he didn’t “live” in the area but traveled there to “live” temporarily in a “lodge/motel” to then go to the work site.

 

Once having designated him as a “traveling employee” the Court’s majority found WC coverage would lie for “anything he might reasonably be expected to do” during the whole time he was “traveling.” Please note at the time of the accident, Claimant Daughtery wasn’t on the clock. He wasn’t paid, trained or instructed on where to “live” or how to travel to the lodge or the work site.

 

That means if the guy had a bad dream and rolled out of bed and broke his arm, it would be work-related. We feel if he had a heart attack or stroke watching TV in the motel/lodge it could be work-related. No one in this state has any idea what this all might mean—it was all created in our Commission and courts. If you read the actual legislation and compare it to what happened, this accident clearly didn’t “arise out of” or occur “in the course of” work. The entire “traveling employee” concept was made up in our courts—the term “traveling employee” hasn’t been considered by the IL legislature and doesn’t appear in any statute or rule.

 

In the second such case to be ruled upon by the same panel, Mlynarczyk v. IWCCthe same Appellate Court panel reviewed a claim where the injured worker was a cleaning lady who either fell down going to a minivan to go to work. She was not working nor was she “on the clock” when she fell. She was either on her own driveway or on a public street when she fell. The Court’s members found she was a “traveling employee” and subject to the “risks of the street” and therefore the claim was compensable because what she was doing when she fell was “reasonable.”

 

No state in the United States offers WC benefits for injuries when the worker is clearly not working nor was she being paid. How do you truly investigate injuries in one of your employee’s driveways? We point out the words “traveling employee” are a judicially created concept that have no true legal meaning other than as the justices who use them provide it to us—the words/terms aren’t defined in the IL WC Act or Rules. Similarly, their legal terms “street-risk” or “hazards of the street” are similarly judicial legislation. Our legislature hasn’t included such terms in the statute or rules. If an Illinoisan is eaten by a polar bear, is that a “street-risk?” Where does “street-risk” start and stop? When is it a “street-risk” and not a risk common to the public?

 

We actually don’t know whether you have to be on a trip to be “traveling.” It is possible that a worker could occasionally be traveling and be a “traveling employee” even when not on a trip. We ask the question—if a cleaning lady is going to work in an office of the employer for a while and then go to a work-site not owned by the employer but will later report back to the employer’s work site, are they a “traveling employee” all day, some of the day or only when injured?

 

We are certain if you provide global coverage to everyone whether they are at work or not, Illinois is going to massively expand WC coverage and benefits. The savings in the 2005, 2011 and 2013 Amendments will be gone with the wind. These rulings, if they stand, are a complete WC game-changer. We urge all Illinois employers to join in the fight to reverse these impossible-to-understand rulings. If you are interested in putting your name on our amicus curiae brief, please send a reply.

 

Third and finally, the IL legislature couldn’t find a middle ground on our gigantic government pension crisis. Illinois government unions don’t appear to care about IL taxpayers and we are going to continue to pay billions to folks that don’t work for IL government any more. We are going to have to continue to tell current pension contributors they may never get any money because their money is being drained to pay current pensioners. Folks like Mike and Lisa Madigan and Pat Quinn are starting to understand how obstinate our government labor bosses are but don’t have a path to correct this mess—it clearly isn’t’ sustainable under any mathematical theory we are aware of. All of it is certain to get worse and worse. We are confident the mantra is going to be “tax the rich” to pay pensions to folks like former school district chiefs who are getting over $20K a month in pension benefits.

 

So there you have it readers. New stealth legislation, our courts providing WC benefits to people injured before they start work and government pensions completely out of control. Welcome to “Insane to the Membrane” Illinois. Please forward your thoughts and comments or post them on our award-winning blog.

 

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Synopsis: Are Star Wars Robot Suits Coming to Workers’ Comp Claims Near You?

 

Editor’s comment: A powered exoskeleton, also known as powered armor, exoframe or exosuit is a mobile machine consisting primarily of an outer framework, akin to an animal's exoskeleton, worn by a person and a powered system of motors or hydraulics that delivers at least part of the energy for limb movement. The main function of a powered exoskeleton is to assist the wearer by boosting their strength and endurance. They are commonly designed for military use, to help soldiers carry heavy loads both in and out of combat. In civilian areas, similar exoskeletons could be used to help firefighters and other rescue workers survive dangerous environments. The medical field, including your workers’ comp claims is another prime area for exoskeleton technology, where exoskeletons can be used .

 

Working prototypes of powered exoskeletons by Lockheed Martin, both meant for military use, have been constructed but have not yet been deployed in the field or during combat. We are certain intensive research and development will continue and can only help non-combat implementation of this important tool for all of us.

 

Various exoskeleton problems remain to be solved, the most daunting being the creation of a compact and light power supply powerful enough to allow an exoskeleton to operate for extended periods without being plugged into external power.

 

In the rehabilitation world, robotic exoskeletons have moved from science fiction to reality over the last few years. There are several brands of devices on the market which allow individuals living with a spinal cord injury to stand up and walk. While research on clinical efficacy is still in the early stages, most rehabilitation experts expect the devices will become increasingly beneficial in the coming years as both a rehabilitation tool and as a device to improve or maintain overall heath and quality of life for chronically inured patients (improving cardiovascular health; reducing pain, contractures and spasticity; improving lower extremity bone density; etc.). Brands of functional exoskeletons on the market include Ekso™, ReWalk™, REX™ and others. At this point, these powered bionic suits are not yet available for personal use, and are only being used in rehabilitation facilities. 

 

QLI (www.QLIomaha.com), a specialized center for brain and spinal cord injury rehabilitation in Omaha, NE is the first non-hospital-based rehabilitation facility in the country to obtain an EKSO™, and have been utilizing the device with their patients for several months. Their team indicates appropriate patients are having positive results using these devices and their hard work continues in implementing this new space-age restoration instrument.

 

The devices are currently being used primarily as a rehabilitation tool, but as this technology evolves, it may become more widely used as a personal use prosthesis some may think of this invention as the wheelchair of the future. This exciting new product may basically rewrite the book on what “paralysis” might mean in the world of workers’ compensation and rehabilitation because some workers with such exoskeletons may return to full or greatly increased functionality. To see a news story about this emerging technology in use right now at QLI, click here: http://www.youtube.com/watch?v=bY105ZbHjic.

 

QLI or Quality Living, Inc. is a private, nonprofit corporation that was founded in Omaha, NE in 1987. They accept patients from across the globe and are a solid choice for your most serious WC claims from anywhere in the U.S. or Canada. Since their earliest days, QLI’s mission has been to promote purpose, privacy, dignity, and independence for individuals with brain injury, spinal cord injury or other severe physical disability. With this mission clearly in mind, QLI has grown to become the largest and most comprehensive center for post-hospital brain injury and spinal cord injury rehabilitation and care services in the entire United States.

 

For information about QLI, please contact Don Terry at (402) 573-2175  or email DTerry@QLIOmaha.com.

 

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Synopsis: "Just the facts, ma'am!" Res judicata and collateral estoppel is NOT an applicable defense to an alleged aggravation eleven years after "line of duty" disability benefits were denied.

 

Editor’s comment: Plaintiff Lori Lelis was hired as a Cicero police office October 16, 1986. On March 10, 1999, Lelis filed an application for "line of duty" pension benefits with the Pension Board alleging injury March 28, 1998, while lifting a dead body onto a stretcher. The Board denied the "line of duty" pension benefits on March 30, 2000, finding her not disabled at that time. The circuit court sustained the Board's decision March 30, 2000 and Plaintiff did not appeal.

 

The Cicero Police Pension Fund considered the matter resolved. But watch out!

 

Eleven years later on January 11, 2011, Lelis again requested "line of duty" disability benefits after a diagnosis in January 2010 of lupus, an internal chronic autoimmune disease affecting the joints and muscles. Lelis alleged lupus increasingly worsened the degenerative back injury from 1998 restricting her ability to perform duties as a police officer.

 

The Board characterized the application as a request to reconsider a previously adjudicated application for benefits involving the same operative facts denied in 2000. The Board held regardless of an alleged aggravation of a back injury due to lupus the doctrines of res judicata and collateral estoppel barred consideration of the 2011 request.

 

Res judicata is a final judgment on the merits rendered by a court of competent jurisdiction acting as an absolute bar to any subsequent actions between the same parties and involving the same cause of action. Collateral estoppel bars a subsequent action involving the same parties with a prior final judgment already entered on the identical issue raised in the subsequent action.

 

On June 5, 2012, the circuit court agreed res judicata and collateral estoppel barred the claim and dismissed the complaint.

 

In Lelis v. Cicero Police et al., the First District Appellate Court disagreed and remanded the case for a hearing to determine whether the aggravation of a prior injury was a disability, a non-duty disability, or not a disability. The diagnosis of lupus and alleged aggravation of a prior injury was not a request for reconsideration or rehearing of a prior denial but rather, the inclusion of additional and independent basis and a fact sufficient to allege a new claim.

 

In the instant case, neither party disputed the 2000 denial and subsequent ruling by the circuit court constituted a "final judgment" on the merits for the purposes of both res judicata and collateral estoppel. In addition, neither party disputed the same parties were involved in both proceedings. The contention was whether the same claim or transaction was involved in both the 2000 decision and new application eleven years later.

 

The Illinois Supreme Court adopted the "transactional" test as the exclusive test for determining whether identity of a cause of action existed for purposes of res judicata. Under the transactional test a claim is viewed in 'factual terms' and considered coterminous with the transaction, regardless of the number of substantive theories, or variant forms of relief flowing from those theories, available to the plaintiff; and regardless of the variations in the evidence needed to support the theories or rights.

 

It is all about the facts. Here, new material facts occurred after the prior judgment which may be taken alone or in conjunction with the prior facts, to form the basis of a subsequent action, not precluded by the prior adjudication on the merits.

 

Basically, the aggravation due to lupus was a fact not in the original claim and thus a different claim. The Board could not summarily deprive Lelis of a full hearing and an opportunity to make an aggravation claim. 

 

Nota bene! Understand, the finality of a decision may not be as conclusive as our readers may think. Just because an injury was not found a disability at the time of a hearing does not mean facts cannot change and the condition cannot become a disability at a later date.

 

To all our readers, you need expert counsel like attorneys at Keefe, Campbell, Biery and Associates to argue whether, when and to what extent aggravations contribute to previous injuries. Full hearing is necessary. It is not possible to summarily dismiss the matter on res judicata and collateral estoppel grounds – attempting to do so increases the time and cost of litigation.

 

This article was researched and written by Nathan S. Bernard, J.D. Please feel free to contact him at nbernard@keefe-law.com.

 

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Coming events from KCB&A

 

Our Illinois State Chamber of Commerce combines with KCB&A to provide workshops and webinars on IL WC for the beginner, intermediate and advanced risk manager/claims handler.

 

·        June 20, 2013 Springfield’s Workers’ Comp Workshop—save the date; details http://ilchamber.org/event/seminar-workers-compensation-workshop/

 

·        July 10, 2013 Holiday Inn Bolingbrook—save the date; details http://ilchamber.org/event/seminar-workers-compensation-workshop-2/

 

Email Laurie Silvey at lsilvey@ilchamber.org for details or to register.