12-9-13; When Can an Employer Sue an Employee?; Simple, Clear Thoughts on the Illinois “Pension Reform”; Understanding How a Concomitant Release/Resignation Works and more

Synopsis: When Can an Employer Sue an Employee?

 

Editor’s comment: Following up on our KCB&A Update article of last week about when an employee can sue an employer, we wanted to provide the counterpoint—when can you sue one of your workers?

 

Employee Negligence Causing Damage or Injury to Others

 

As a practical matter, employees are generally not held liable to their employers for ordinary negligence or carelessness in the performance of their duties. Instead, an employer accepts the risk of employee fallibility/negligence and may be forced by the courts to take that into account in the costs of doing business.

 

Practical considerations aside, however, the common law does not necessarily bar negligence actions against an employee. For example, the Washington State Supreme Court explained the following:   

 

Common law property damage actions by an employer against its negligent employees are uncommon. . . . [I]n cases where there is no insurance coverage, suing an employee who negligently causes extensive property damage is ordinarily a useless act because of the limited funds and income available to the employee. Further, as noted by the trial court, employees are often included within an employer's insurance coverage, thereby barring litigation between the two.

 

Nevertheless, unless otherwise barred, it is well settled that an employer has a common law right of action against its own employees for property damage arising out of ordinary acts of negligence committed within the scope of employment.

 

Stack v. Chicago, Milwaukee, St. Paul, & Pacific Rail Road Co., 94 Wash. 2d 155, 158 (1980) (citing supporting cases from various jurisdictions); see also Restatement (Second) of Agency § 401 (1958) (“[I]f a paid agent does something wrongful, either knowing it to be wrong, or acting negligently, the principal may have either an action of tort or an action of contract. This is true when an agent negligently harms a chattel of the principal, or, by negligence or fraud, causes a principal to be liable to a third person, exceeds his authority in selling goods, or violates a duty of loyalty.”)

 

Please note this might be a way to counter repeated safety violators who cause damage to equipment or property. In the Interstate Scaffolding v. IWCC claim, the worker on light duty allegedly was spray-painting slogans on scaffolds in the workplace. If the employer were to have both fired and then sued the employee for the cost of remediation of the graffiti, the WC litigation may have settled more favorably or been dropped. We are not aware of any legal rule or statute that would block such a lawsuit against the worker.

 

In our view, employers should consider being much stronger about countering WC claims involving unsafe or negligent acts, causing injury or death with civil suits. There was a famous ruling in Oklahoma where a truck driver picked up a hitchhiker and may have been romantically distracted by the hitchhiker and, without slowing, ran right into a moving train. The crash resulted in a complete loss of the tractor-trailer, customer load and massive destruction of the moving train, including a six-figure environmental clean-up. In our view, the trucking company should have considered countering the WC claim with a civil action against the estate of the decedent who violated many safety rules and several laws in causing the damages.

 

Other Civil Actions by an Employer Against an Employee

 

In addition to negligence actions, there are several other scenarios where an employer can sue an employee, including causes of action for indemnity, breach of contract, and intentional torts. For example, some permissible causes of action an employer can bring against an employee are outlined below (please note this list is not exhaustive or all-inclusive):  

 

  • Claims for indemnificationWhere a third-party sues an employer for damages caused by an employee’s negligence (i.e., under the doctrine of respondeat superior), an employer can bring a counterclaim against an employee for damages to be paid to a third-party as a result of the employee’s negligence.

 

  • Breach of contractAn employer can sue if an employee fails to perform his or her obligations under a contract—for example, by breaching a non-compete or non-solicit agreement.

 

  • Breach of duty of loyaltyEmployees have a common-law duty to act solely for their employer's benefit regarding all matters within their employment. This duty exists regardless of whether there is an employment contract. Please note this duty is distinct from an officer’s or director’s heightened fiduciary duty to the employer.  

 

  • Conversion/TheftAn employer may sue an employee for the intentional wrongful possession or disposition of the employer’s property. The employer may sue to recover the property itself or for the value of the property. Conversion also covers the intentional destruction of property.

 

  • Intentional interference with contractual relations and/or advantageous business relationshipThis includes actions against a former employee for interfering with an employer’s relationships with current employees.

 

  • DefamationTo win, the employer must prove the statement harms the employer's reputation, is false, and was publicized with the requisite degree of fault.

 

Of course, even if an employer is successful in any of the above actions, some employees may lack the assets to satisfy a judgment. Then again, a successful lawsuit against an employee may be valuable even if no money is recovered—for example, by sending a message to other employees and by deterring similar wrongful acts in the future.

 

This article was researched and written by Chris St. Peter, J.D. and your editor. Please feel free to provide your thoughts and comments to Chris at cspeter@keefe-law.com.

 

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Synopsis: Simple, Clear Thoughts on Illinois “Pension Reform” of Last Week.

 

Editor’s comment: We have never seen so much misinformation and misdirection from all sides of a multi-billion dollar issue. We don’t think any news source got it completely right. We are sure the state government unions continue to foster a combination of public relations spins, fabrications and propaganda for all to read. We ask our friends, clients and readers to please stop using the word “pensions”—it is just post-employment income. Let’s try to dumb this down a bit.

 

1.    Illinois Taxpayers are now forced to guarantee lifetime income for all state government employees and local teachers who make the requisite “contributions” during their required employment tenure. There may be as many as 800,000 such folks.

 

2.    We don’t have any problem with the concept, we just want the three sources of this form of “lifetime income”

 

a.    Contributions from the participants;

b.    “Matching contributions” from taxpayers and

c.    Investment income

 

to come from those three sources while a worker is working. Right now, the system is “unfunded” to the tune of about 60% which means 60 cents of every “pension” dollar paid is coming from you and me, as taxpayers, to pay the post-employment income of people like former Governors Jim Thompson and Jim Edgar. Those folks haven’t worked for the state in over a decade but they are again being paid, as if they were active employees.

 

3.    Right now, the three sources in letters a-c above don’t meet the requirements of current system participants by about $100B! We don’t feel current system participants should be shorted matching contributions while they are working for the state or local governments. We also don’t feel the state should be allowed to borrow money/issue bonds to silently fill the gaps. If you don’t have enough money to pay your bills, cut staff until you have enough money.

 

4.    The reforms of last week are designed to end the “unfunded status” of our “pension” programs in year 2044. Please note the government unions are fighting in court to stop even that from happening and basically continue to rip-off taxpayers indefinitely. What Senate President Cullerton promised in opposition to the reforms was more and more taxes, as he confusingly but accurately asserted our State government can’t file for bankruptcy. In response, we point out any business that can’t timely pay its bills is arguably “bankrupt” and, by that definition, our State government under Senate President Cullerton has been bankrupt for at least a decade because we are always several billion behind in payments to hundreds of state vendors and everyone other than government union and salaried workers.

 

5.    All aspects of the so-called “pension” plans have lots and lots of continually moving parts that are just about impossible for busy taxpayers to follow—by that we mean our legislators and governor constantly change how much participants contribute, how much government matches, how much participants are paid, how long participants have to be in the system to qualify or “vest”, how much they have to contribute and various other parts.

 

6.    Please note only 4 out of 5 Illinois government pension programs were “reformed” in last week’s legislation. The Judicial Retirement System can’t be “reformed” by the legislature—this plan is contained in the IL Constitution. Our Judges/justices continue to have “pensions” or post-employment income that requires them to pay as little as $100,000 over a very short eight-year vesting period and, upon retirement, they can receive post-employment income well into the millions. For one example, Justice Tobias Barry, who penned the landmark ruling in Edward Hines Lumber v. Industrial Commission, contributed less than $100K during his years of service and has cashed “pension” checks for over $2,000,000 to date and still counting.

 

7.    When you hear “pension” proponents arguing they contributed “their fair share,” please remember the math above. Please also remember some state government workers do contribute a “fair” amount, if they work for years and years. In contrast, lots of them contribute a mere fraction of the overall lifetime cost of their pension and the gap has to be made up by taxpayers in current tax dollars. This anomaly and uncertainty is the main issue we have with the whole government “pension” concept.

 

8.    For that reason, we assert the whole thing should be the subject of a constitutional amendment. If we are going to stay with this overall “reform” concept, we feel the current reforms along with a concomitant reform to the IL Judicial Retirement System should all be sent to voters in the form of a constitutional change that will clearly withstand any court challenge.

 

9.    We watched in horror to see a recent television report where IL government workers qualified for their pensions, left employ to get their pensions and later returned to the same job at what is then 180% of pay. To our understanding, that may be legal if you follow the rules to do so. We feel the legislators who created such rules should be tarred and feathered. If you don’t feel that potential is akin to stealing from taxpayers, you don’t need to read the rest of this article.

 

10. Illinois state government has not one but five different, duplicative and redundant “pension” systems. There are five different boards of trustees, five different “independent” auditing groups, five different websites and five different staffs. We hope some day they may buy one of those new-fangled “computers” and bring that number down to, duh, one.

 

11. Please also note one of Governor Pat Quinn’s toughest battles has been his strident efforts to bring this goofy “pension” concept into line in the face of fierce union opposition. He was booed off the stage at the Illinois State Fair by government unions. AFL-CIO President Michael Carrigan was quoted in the Chicago Sun-Times as claiming “Mr. Quinn can’t win in 2014 until he makes peace with public-sector unions.” We hope Governor Quinn tries to make peace with all IL taxpayers first. We salute our plucky Governor for not caving to the threats and personal attacks he has faced.

 

Or our state should cut all this silliness and simply phase in a 401K plan. In doing so, government workers would make contributions and own them. Their investment choices would not be run by crooks; oops, we mean people that donate to politicians. As the government workers’ 401K plan assets grew, they would know what they would get when finished. We feel this is the only predictable and fair way to provide retirement programs for these workers. Trust us, this won’t happen unless and until all IL taxpayers/voters get together and see the financial mess our government is in from years or out-of-control “pensions.”

 

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

 

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Synopsis: Understanding How a Concomitant Release/Resignation Works in the Workers’ Comp Setting.

 

Editor’s comment: Of great concern to the workers’ compensation professional is the legal effect of resolution of the workers’ compensation claim when the employee simultaneously resigns at the time the workers’ compensation claim settlement is approved. Coincidental resignation by an employee can occur as a combination of a multitude of factors including a personal decision not to return to work, the effects of the workers’ comp injury, labor disputes with the employer, fellow employees or the union or loss of job due to plant or company closing.

 

A prudent workers’ compensation professional must understand workers’ compensation benefits are only one of a variety of benefits or claims which an employee might have as part of the employment relationship. If one resolves only the worker’s compensation claim, you may be leaving all of the employee’s other rights, benefits or claims ‘unresolved.’

 

An excellent example of this concept occurs when an employee resigns as ‘part’ of claim settlement. Your concern is the employee might later claim they were was ‘coerced’ into the resignation to receive any settlement at all. While we have not yet seen a reported case on a claim for retaliatory discharge as a result of a coincidental resignation, your organization does not want to have to litigate the issue as a matter of first impression in the Illinois courts.

 

Second, an employee may have labor disputes of any nature pending. These disputes might be pending at the local grievance level or at a national level as a result of an appeal of local determination. Obviously, a resignation as part of a workers’ compensation settlement leaves such labor disputes ‘pending’ without a proper resolution.

 

Also, it is important to recognize workers’ compensation benefits arise from state statutes. The settlement of a state workers’ compensation claim has no direct impact on the employee’s federal rights. There are a plethora of federal statutes which impact an employee’s rights while working and the employee’s rights at the time of termination and resignation. These include the American with Disabilities Act, Title VII of the Civil Rights Act, the Fair Labor Standards Act, the Age Discrimination in Employment Act, the Older Workers Benefit Protection Act, the Employment Retirement Income Security Act and the National Labor Relations Act, to name a few.

 

The obvious response of the WC professional when presented the above list is to remark, “what does that have to do with my claims?” The reply has to be that your organization pays you to recognize and anticipate claim-related problems and to forestall them, if at all possible.

 

Therefore, it is our recommendation you do not ignore an employee’s claim or rights with regard to any common law or statutory claim whether it is a federal or state statute. When the employee resigns as part of a workers’ compensation settlement, we recommend you obtain a common law release as part of that resignation which specifically outlines both federal and state rights and ‘terminates’ (or in some instances, reserves) rights at the time of resignation/settlement. Use your knowledge and expertise to control the situation as much as possible.

 

An appropriately drafted general release, based upon appropriate consideration (in lay terms, money), should effectively defeat or block an employee from maintaining any suit or claim following resignation. We do not feel that you are sufficiently protected in obtaining a resignation with a release if it is not supported by consideration.

 

There may be rights which you want to survive the resignation

 

At the time the employee resigns, there are three major issues which you should certainly address as you may want to work with the employee and not extinguish all of the employee’s rights when he or she resigns.

 

The most important of these rights are pension benefits. An employee may be part of a pension or profit sharing plan which he or she should certainly be entitled to due to contributions by your organization and the employee. We have generally advised there is a West Coast decision which ruled a general release blocked an employee’s pension claim--a result which may have been unintended by either employee or employer and which would certainly result in a fountain of litigation. Where an employee has pension rights or benefits available to him, it would seem appropriate to preserve such rights at the time of resignation. The general release should be tailored to cover the possibility.

 

A more delicate issue is unemployment benefits. With the recent changes in this law, such benefits may provide substantial benefit to an employee who has left employment. However, such benefits allow the employer to dispute such a claim following application by the employee.

 

If you are willing to allow the employee to make such a claim and not contest the question of resignation versus termination, you are placing your organization in a contradictory position. If you want the employee’s unemployment benefits to be treated as if he or she resigned and thereby render the employee unable to obtain benefits until after the waiting period for a resignation, it should be clearly outlined in the general release. Therefore, it is our suggestion that such a determination be made in conjunction with counsel and all matters should be covered in settlement negotiations. Be certain to confirm the final decision on unemployment benefits is up to the applicable state agency.

 

When should a general release/resignation be utilized?

 

Any time an employee is leaving your employ for any reason and is simultaneously entering into a workers’ compensation settlement, we recommend that a combined general release/resignation strategy be considered. As a workers’ compensation professional, even if you settle a “small” claim where a petitioner is changing jobs, it is a prudent idea to consider obtaining a common law release and resignation. The worst nightmare of any workers’ compensation professional would have to be resolving a total and permanent disability claim with a coincidental resignation.

 

Immediately following completion and payment of the settlement, petitioner indicates he/she is withdrawing the resignation and seeks accommodation consistent with the Americans with Disabilities Act, claiming he or she was unaware of disabled status and the requirement the employer accommodate them. Even worse would be a claim the employer coerced them into the resignation as part of settlement to take advantage of his disabled status and thereby retaliatory discharged him.

 

These are just two of the examples which might conceivably occur. There are a variety of other potential scenarios which could just as easily develop which might leave the workers’ compensation professional in an embarrassing or annoying position.

 

Your highest priority must be to insure once you have settled the workers’ compensation claim with a coincidental resignation, every effort is made to insure the resignation ‘sticks.’ You do not want petitioner to return with any sort of litigation or benefit claim which you have not contemplated and have ‘allowed’ him or her to make (such as the claim for pension benefits outlined above). Every possibility should be considered as part of settlement negotiations. It is our recommendation the only way to insure this has taken place is to obtain a general release/resignation with appropriate consideration to support same.

 

One caveat: workers’ compensation lawyers may not be well-versed in employment law

 

One interesting aspect of utilizing a general release in conjunction with a workers’ compensation settlement is the workers’ compensation attorney is not typically retained to provide advice with regard to the wider range of employment law issues and may be ill-informed with regard to same. Workers’ comp attorneys are retained by their clients pursuant to a specific statutory language on a Commission approved form. This form sets out the narrow scope of the attorney’s retention and limits the fee to the workers’ comp claim only. It is an open question as to the amount of the fee that the attorney might receive on monies paid to support the general release/resignation. Many workers’ compensation lawyers will balk at being asked to review the broader employment law issues if you tender a general release and resignation at the time of the worker’s compensation settlement. It becomes incumbent upon you to insist the attorney provide the client/employee with appropriate legal advice or refer the matter to an employment lawyer competent to advise the employee.

 

Remember the workers’ compensation lawyer when settling a total and permanent disability claim typically receives a hefty fee. As part of the services which earn that fee, the lawyer should be equipped to fully and properly advise the client with regard to the bundle of rights which may be affected by the settlement of the workers’ compensation claim along with relinquishment of employment coincidental thereto.

 

If the attorney gives you any indication they are unable or unwilling to properly advise the client, you should insist it is their responsibility to do so to avoid any claim by the employee that he/she did not receive effective representation by counsel. Do not allow the workers’ compensation lawyer to claim ignorance or apathy and utilize it to the benefit of his client. You have to insist and insure that the attorney has fully advised petitioner of the rights he is preserving or giving up to avoid later confusion or litigation.

 

A note of caution in setting up the settlement with a release/resignation

 

When you present the settlement to opposing counsel, it is our suggestion you do so by first splitting the workers’ compensation settlement and monies reserved to support the general release. For example, if it is your intention to settle the case for a total of $150,000 to include monies to support the release/resignation, present the settlement to counsel by indicating you will pay $145,000 to settle the workers’ compensation case. You should also indicate you will provide an additional $5,000 to support the general release and resignation.

 

The purpose of bifurcating the finds in advance is to avoid the suggestion that you are intimidating or coercing the employee to settle the worker’s compensation case and that part of that plan was that you would not pay any monies in settlement unless petitioner was forced to resign. You want to present the monies to give legal effect to the resignation and release to be “fresh money.”

 

Your overall goal in obtaining a release/resignation

 

The goal of the workers’ compensation professional in settling a claim where petitioner/plaintiff has left the employ of respondent is to be certain the employee does not come back. You also want to be similarly satisfied you have no exposure to litigation or administrative claims subsequent to the resolution of the employment status.

 

We strongly suggest that you consider a strategy employing a general release/resignation in conjunction with the workers’ compensation settlement to insure this necessary result. We also strongly caution you should always discuss this with counsel whether petitioner is represented by an attorney or not.

 

We appreciate your thoughts and comments.

 

12-2-13; When Can IL Employers Get Sued by Employees for a Work Injury?; IL WC--When Is It Fingers vs. Hand?; WC Ain't Pawn Stars and much more

Synopsis: When Can an IL Employer Get Sued in Circuit Court by an Employee for a Work Injury? How Does That Impact Claims?

 

Editor’s comment: We were recently asked this question and have to admit we needed to research further. Please note the IL WC Act has an apparent conflict where one Section says an injured worker can’t sue in Circuit Court--other Sections of the Act that outline the right to sue in tort.

 

It appears the accurate answers are:

 

1.    An injured worker can sue their employer in Circuit Court for injuries resulting from intentional acts;

2.    An IL worker can sue their employer in Circuit Court for work injuries when the employer does not have valid workers’ compensation insurance in place on the date of injury.

3.    Where the injury is not compensable under the IL WC Act;

4.    Where  the injury involves an illegally employed minor (upon the minor’s waiver of his or her rights under the Act);

5.    Where the employer acts in a dual capacity, i.e., when the employer also maintains a second and separate legal relationship with the injured party, the employer may be sued in the second, non-employer capacity if it is this separate relationship or entity that is responsible for the injury.

 

Number 1 above is mildly controversial but only in the sense that it may be challenging to accurately define an intentional injury or wilful act by an “employer.” In our view, if an employer sets out to injure a worker for whatever reason and is successful, there is no defined reason to “protect” such an employer with the provisions of the IL WC Act. We also don’t feel typical WC insurance can or should cover intentional acts leading to insure—such coverage would typically be considered a violation of public policy. Our advice to all clients and readers—if you get hit with a claim for intentional actions leading to a workers’ comp injury, seek advice from a KCB&A defense counsel and report it to your WC and GL carrier--let the pros handle it.

 

Failure to have Valid WC Insurance Now Opens the Circuit Court Box!

 

The legal concept outlined in Number 2 above took us mildly by surprise. When reading about recent amendments to the IL WC Act, we didn’t notice this seminal change to our law. That said, we assure our readers on both sides of the IL WC matrix that a lack of WC insurance provides the injured worker or their counsel the right to sue in Circuit Court to recover for the injuries suffered. The applicable provision in the IL WC Act is Section 4(d) which now says:

 

Employers who are subject to and who knowingly fail to comply with this Section [requiring WC insurance] shall not be entitled to the benefits of this Act during the period of noncompliance, but shall be liable in an action under any other applicable law of this State. In the action, such employer shall not avail himself or herself of the defenses of assumption of risk or negligence or that the injury was due to a co-employee. In the action, proof of the injury shall constitute prima facie evidence of negligence on the part of such employer and the burden shall be on such employer to show freedom of negligence resulting in the injury. The employer shall not join any other defendant in any such civil action. Nothing in this amendatory Act of the 94th General Assembly shall affect the employee's rights under subdivision (a)3 of Section 1 of this Act. Any employer or carrier who makes payments under subdivision (a)3 of Section 1 of this Act shall have a right of reimbursement from the proceeds of any recovery under this Section.

 

An employee of an uninsured employer, or the employee's dependents in case death ensued, may, instead of proceeding against the employer in a civil action in court, file an application for adjustment of claim with the Commission in accordance with the provisions of this Act and the Commission shall hear and determine the application for adjustment of claim in the manner in which other claims are heard and determined before the Commission.

 

This is a fairly sweeping provision and provides lots of challenges for risk managers, claims handlers, attorneys and safety folks to be aware of. While it is an ostensibly simply statutory provision, it may create literally hundreds of legal concerns and is something of a “Gordian Knot” that may be endlessly unraveled.

 

Trust us, a Plaintiff lawyer or a group of Plaintiff lawyers wrote these provisions and the defense side monitoring such legislation missed them:

 

§  An employer shall not avail himself or herself of the defenses of assumption of risk or negligence or the injury was due to a co-employee—this strips out most major defenses in a Circuit Court claim for work injuries for uninsured employers;

§  Proof of the injury shall constitute prima facie evidence of negligence on the part of such employer and the burden shall be on such employer to show freedom of negligence resulting in the injury. From our reading, this makes for strict liability in a Circuit Court claim against an uninsured employer.

§  The employer shall not join any other defendant in any such civil action. This provision leaves the uninsured employer basically “hung out to dry” for the negligence of any other employer, product manufacturer or arguable tortfeasor in such claims.

 

This Legislative Provision Looks Simple But Is Fraught with WC Claims/Coverage Land Mines

 

How would that happen? Well, let’s try to look at the definition of “employer” and what it means to be “uninsured.” We assure most plant managers and other fixed-site employers it isn’t too exciting—you either have WC insurance for your workers or you don’t. However, you have to then take a very careful look at your vendors and support team. If you have a work site and you hire a company or vendor to come to your facility to perform any work at there, you want them to be truly “independent” of your workers’ comp coverage. The only method to insure they are “independent” is to be certain they have WC coverage for every single worker that crosses your door.

 

However construction and real estate risk managers have the ability to create a legal status known as “statutory employees.” Statutory employees are folks who build, remodel and maintain commercial properties. If you don’t have WC insurance to cover them, they are your employees and it would appear they can now sue you directly in Circuit Court for unlimited damages.

 

Let’s assume you hire Sam and Sara Sample’s Lawn Service to mow your lawn for the entire year of 2014. Sam and Sara Sample provide you with a COI or certificate of insurance for their workers. Their company is now required to insure they have appropriate workers’ comp coverage for all of his employees. There are three concerns crucial to good claims management, in light of the changes to Section 4(d) of the IL WC Act we highlight above.

 

v  First, Sam and Sara Sample can “opt out” of WC coverage for themselves as principals or owners of the company and save the premiums needed to cover their own WC injuries. Right now, they might be considered “uninsured employees” of yours and might—note we said might—be able to sue you in Circuit Court for injuries they cause.Never, ever let anyone who works for you “opt out” of WC coverage. You can always expect litigation if such folks are seriously injured or killed at work—the risk and cost of defense are not worth the risk.

 

v  Second, who are the employees of Sam and Sara Sample that are covered by their COI—can they have two employees or twelve doing work for you? What if they have four workers cutting down one of your trees and then bring four more due to the size of the project? Without any question, if Sam and Sara don’t have valid WC coverage for all of them, they can sue you—we don’t know and can’t predict what a court will do about the lack of WC insurance coverage in this setting. Don’t let your subcontractors bring unknown workers onto your property, ever.

 

v  Third, what about independent contractors of Sam and Sara Sample? What if they have a lawnmower break down and they bring a different repair contractor onto your property to fix it and the lawnmower repair person doesn’t have coverage, cuts off a finger by mistake and sues you??? In our view, vendor auditing take on a whole new look when you start to consider this new exposure. Don’t let your subcontractors bring unknown subs onto your property, ever.

 

We strongly suggest you don’t allow any vendor on your premises unless and until you have certain they have full WC coverage for themselves and all their employees that may work on your sites. Please understand lack of valid WC coverage may now result in multi-million exposure for significant injuries, resulting in disability and death of workers that may not be yours!

 

We appreciate your thoughts and comments. This article was researched and written by Chris St. Peter, J.D. who can be reached at cspeter@keefe-law.com and Eugene F. Keefe, J.D. Please feel free to reply to either of us with any concern.

 

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Synopsis: Okay, IL WC Adjusters—When Is It LOU Fingers and When Is It LOU Hand?

 

Editor’s comment: We received a question from one of our clients who was confused when a Plaintiff/Petitioner Attorney was working with her on a claim involving undisputed and severe injuries to two fingers. She was trying to best understand why counsel wanted 60% of each of the affected digits along with 30% LOU hand.

 

What is mildly confusing is the IL WC Act says injury to two or more fingers can be treated as LOU hand:

 

The loss of 2 or more digits, or one or more phalanges of 2 or more digits, of a hand may be compensated on the basis of partial loss of use of a hand, provided, further, that the loss of 4 digits, or the loss of use of 4 digits, in the same hand shall constitute complete loss of a hand.

 

In our view, the language provided above doesn’t mean you treat the claim as LOU hand AND LOU fingers. It was also our view, Plaintiff/Petitioner’s attorney was not treating the adjuster with a lot of respect to make such a demand. We felt the attorney may have been trying to take advantage of the confusion that comes from the way the IL WC Act is written.

 

Please don’t be fooled. You may note the IL WC Act provides 205 weeks for complete loss of use of the hand for injuries after Feb. 1, 2006. The combined values of 76 weeks for the thumb, 43 weeks for the index finger, 38 weeks for the long finger, 27 weeks for the ring finger and 22 weeks for the little finger equal almost the same value—the combined number of weeks is 206.

 

I am not in a great spot to do the math but let’s say you can settle the claim for

 

v  60% LOU index finger or 25.8 weeks and

v  60% LOU long finger or 22.8 weeks.

 

The combined value is 48.6 weeks, by our calculation. This combined value of 48.6 weeks is the equivalent of 23.71% LOU hand. In our view, you can enter into a settlement for the fingers OR the hand would work and such a settlement would be approved. It is also our reasoned legal view, putting them together or paying 60% LOU of each finger AND 23.71% LOU hand would be double-paying the claim. Don’t pay for the fingers AND the hand.

 

If you got an impairment rating, you would probably get a lower value for settlement than traditional values. Our vote for the top northern and central IL doctor to obtain a solid and reproducible impairment rating for finger/hand injuries is Dr. Michael I. Vender of Hand to Shoulder Associates. http://www.handtoshoulders.com/ For central and southern IL claims, we are happy to make recommendations—send a reply.

 

Please also note one important thing—never rely solely on legal advice you receive from Plaintiff/Petitioner attorneys. As we have told numerous innocent claims adjusters and other risk managers over the years, their ethical responsibilities are not to you; they have to aggressively represent their clients and get the most money from you possible. On a 24/7/365 basis, if you aren’t sure the information or legal advice you are receiving is 100% accurate, send any KCB&A lawyer an email, like this wise adjuster did. We will give you solid research and accurate answers that you need as rapidly as we possibly can. This service is free--you do not have to send us the entire file to get rapid responses to intricate WC or GL claims questions in IL, IN, WI and MI.

 

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Synopsis: Workers Comp Ain’t Pawn Stars®, Folks. Don’t Ask for Settlement Demands—Make Offers!!

 

Editor’s comment: We love the hi-jinx at the World Famous Gold and Silver Pawn Shop in Las Vegas, NV, featuring patriarch Richard "Old Man" Harrison, his son Rick Harrison, Rick's son Corey "Big Hoss" Harrison, and Corey's childhood friend, Austin "Chumlee" Russell. Lots of our readers and clients have seen the way they negotiate. Their approach is to review the product for sale or pawn and then ask the customer what they are looking for.

 

There is a major league problem with using that negotiation approach in workers’ comp claims across the United States. What Rick or Corey or Chumlee are doing in asking for a demand or inquiring as to what the customer is “looking for” is to see if they will accept a lot less than the claim is worth. In our view, that approach to negotiation doesn’t work in the workers’ comp arena.

 

The reason that won’t work in almost all states of which we are aware, along with federal WC claims handled by the OWCP, you have to get the settlement approved by a hearing officer. If the other side asks for much too little money, the friendly Arbitrator or hearing member won’t approve the settlement. This makes it much more important to do your homework and come up with a reasonable settlement value.

 

Therefore, unless an adjuster or risk manager tells a KCB&A lawyer to do so, we don’t ask for demands. We also don’t want to wait endlessly to the response requesting a settlement demands. In our view as veteran defense lawyers, asking the other side to make a settlement demand is lazy and counterproductive.

 

Please understand if you are selling an old car, antique gun or widget and you ask the buyer what they will pay, they won’t offer much. That is human nature—they are assuming you might be stupid and will hold the cards close to the chest.

 

On the other side of negotiations, if you are buying an old car and you ask the seller what they want for it, they will almost always ask for too much. In doing so, they are setting the “bracket” high to move the negotiations in their favor.

 

In any negotiation of any kind, the party that makes the first offer or demand sets the bracket and has a large advantage. The person that responds to the offer or demand is always at a disadvantage. Don’t let the other side have the advantage—as adjusters, claims handlers and for us as your defense lawyers; do your homework, figure out a reasonable value and where appropriate, make the first offer.

 

If you really want to move the matter along, do your homework and have your defense lawyer draft the settlement paperwork and send it to you and the other side. That way, all the other side has to do with a fair and reasonable offer is to have their client sign it. If they want a little more money to close quickly, your admin team should be able to rapidly modify the settlement contracts and then resend.

 

From the perspective of IL workers’ comp claims handling, IL WC Arbitrators love to hear you have made a reasonable and fair offer to the other side. In our view, it is one of the strongest tools to move claims forward and avoid delays.

 

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

 

11-25-13; Obamacare Causing Major Medical Confusion; WC Fall-Down Reversed Without Mention of "Traveling Employee" Rule; Jim Egan JD Analyzes Important Child Support Decision and more

Synopsis: Obamacare is Causing Major Medical Confusion—It Is Certain to Impact WC Claims.

 

Editor’s comment: We were mildly amazed to hear Abbott Laboratories CEO Miles White quoted last Tuesday to confirm there are "clear incentives for companies to drop their health care plans and move people onto the [federal health insurance] exchanges." Basically, what U.S. executives are starting to understand is they may cause millions of unexpecting American workers to be blindsided with the news they'll be forced into this dysfunctional government online marketplace. If and when this might happen, many U.S. workers and their families will face higher healthcare premiums or dramatically higher deductibles. All such workers will be required to share private medical and financial information on a website with a questionable security firewall, opening their personal and health information to frauds, hackers and scam artists.

 

Abbott Labs CEO White also confirmed his view most employees of his companies will be very unhappy to be cut adrift from corporate healthcare coverage they have enjoyed for decades to then be forced to figure out these national exchanges. When this occurs, the outcry against our current President and Democratic leaders may hit a fevered pitch. Most people employed by large companies are used to having the coverages laid out by the veteran and experienced HR managers who understand the nuances of healthcare coverage(s). If/when that ends, we are all going to have to figure out the best plan from these creaky and confusing federal healthcare exchanges with little assistance. We are confident lots of folks are going to make a mess of things and not understand what they have signed up for until they are injured or sick.

 

President Obama's "fix" last week would allow insurers to renew old individual healthcare policies for one year, if state insurance regulators are on board. Last Friday, Illinois insurance officials announced they would allow the temporary remedy to leave existing programs in place for the time being. Now we'll see how Illinois healthcare insurers may respond. Whatever happens, this move is merely stalling for a real answer and to quiet lots of screaming voices, for now. Many observers are confident a complete renovation of the sweeping federal law is still urgently needed.

 

Many observers also note workers who gain coverage through smaller employers, like law firms, TPA’s, nurse case management companies and physician’s offices are at risk of getting cancellation notices next year. Here's why--businesses with 50 employees or less buy healthcare coverage in the small-group market. These plans can temporarily keep offering coverage that doesn’t meet expensive Obamacare requirements. When that ends next year, though, many employers may cancel policies because Obamacare coverage may shockingly boost group healthcare coverage costs for employers and the opt-out penalties aren’t a sufficient disincentive.

 

As medical providers, hospitals and large clinics are bracing for significant financial turbulence, they note out-of-pocket deductibles for treatment, surgeries and diagnostics are dramatically rising. Workers will find themselves liable for more of their medical bills before healthcare insurance even starts coverage. In past experience, U.S. hospitals could count on healthcare insurers to pay 80-90 percent of most medical costs—the 10-20% balance would then become a reasonable cost for patients and their families. For patients who will now be dealing with high-deductible government exchange plans that may cost workers as much as $6,000 per year, the healthcare insurer's share of many medical procedures may drop as low as 60 percent on average.

 

Workers who have healthcare coverage through large American companies are benefiting from a one-year reprieve from the Obamacare mandate to provide coverage or pay penalties. The reprieve ends by 2015 and employers like CEO White of Abbott are already carefully calculating what to do. Some employers may cut jobs or workers' hours to avoid the requirement of offering costly insurance coverage. Other companies may dump everyone into the federal exchanges and pay penalties that are almost certain to be less than what coverage would cost.

 

What Does All This Mean to Workers’ Compensation?

 

      Always remember WC medical coverage is close to being every human’s impossible dream—injured workers want 100% on-demand coverage of unlimited medical care for work injuries and illnesses. There are no deductibles, contributions or co-pays in WC medical care. Workers who suffer injuries or illnesses on the job are also provided lots of information and choices on how to get the best possible care; you don’t have to figure it out for yourself. In major and medium WC claims, employers/insurance carriers may assign telephonic or on-site nurses to provide hard-fought expertise and assist with all aspects of medical care and bill processing.

 

      As a limiting factor to the basically unlimited, on-demand WC treatment model, the IL WC PPP network is a program designed to provide some cost-sharing and limitations on medical care. We have no idea what the downside to this approach might be and we feel ACA is going to put lots more pressure on WC adjusters and claims. If you have interest in joining an IL WC PPP network, please send a reply.

 

      We are also predicting lots of “repetitive working” claims for employers in IL and across the other states where we provide defense—Wisconsin, Michigan and Indiana. The reason we feel such claims will arise is to force employers to pay medical benefits under WC that they won’t owe under ACA. The high deductibles of the Affordable Care Act are going to push workers to try to seek the unlimited, on-demand WC coverage of questionable illnesses and injuries. If you need help defending “repetitive working” claims, send a reply.

 

      In further contrast, many WC observers felt there might be less utilization of workers’ compensation medical treatment because ACA requires group coverage for pre-existing conditions. However, the expansion of such coverage under ACA is clearly offset by dramatically higher deductibles that may push more pre-existing conditions back into the workers’ comp arena so workers aren’t faced with paying those initial costs. We also feel workers may choose to obtain WC medical handling of their care because it comes with a great deal more certainty in providers, coverage and cost.

 

      The coming changes in Medicare reimbursement levels are expected to result in cost impacts for those states that use Medicare as a basis for reimbursements in their respective state workers compensation fee schedules for medical treatment/billing. For our Illinois readers, this won’t have any direct impact on our state or its WC medical costs.

 

      Another result of ACA is in the Black Lung Benefit Entitlement provisions which will make it easier to file claims for and to obtain benefits; increases the benefits payable for such claims; and will increase future insurance premium costs for affected industries. As higher costs hit, premiums are certain to go up.

 

      Further, promotion of wellness initiatives under ACA may reduce the incidence and duration of workers’ compensation claims. We hope our IWCC and reviewing courts don’t make every bump and bruise in a wellness program work-related but we will have to wait and see what our “activist” reviewing courts may do with this concept. If you need a document confirming participation in such programs is voluntary and hopefully non-work-related consistent with Section 11 of the IL WC Act, send a reply.

 

      We are also sure provisions making generic drugs more available sooner in the process may result in lowered pharmaceutical expenses in workers’ compensation claims. Please note this is the area of medicine that is rising fastest in overall cost.

 

      We are also certain new taxes are expected to be levied on drug manufacturers, medical device manufacturers, and health insurance companies—when the new taxes land, there can be an expected trickle-down to employers and consumers.

 

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

 

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Synopsis: Wow, Are We Confused—IL WC Fall-Down Reversed to Provide Benefits to Worker With NO Mention of “Traveling Employee” Concept.

 

Editor’s comment: In Suter v. Illinois Workers' Compensation Commission, 2013 IL App. 130049WC, issued November 14, 2013, our Appellate Court, Workers’ Compensation Division was faced with a denial on Arbitration, denial before the IWCC panel and denial at the Circuit Court level. Despite the earlier denials, the Appellate Court unanimously reversed, finding the fall-down compensable “as a matter of law.”


Claimant Suter was a staffing worker from Manpower. She was loaned to the State of IL by that temporary services company. While exiting her car to go to into her workplace, she slipped and fell on ice on a parking lot. Both the building and the parking lot were being rented by the State of Illinois but were not owned or managed by the State. There is no question the building manager provided a specific parking space for this worker at her request.

 

Please note assigned parking spots or even assigned parking areas aren’t a good idea, if you want to avoid IL WC coverage of parking lot fall-downs. We advise our clients not to assign spots and let folks park wherever they want, rather than face expanded coverage for fall-downs. Our advice to IL Attorney General Lisa Madigan moving forward—tell all the building managers for properties rented by State government to immediately stop assigning parking spaces and avoid this exposure. We provide parallel advice to any staffing company risk manager that reads this article—tell your accounts not to assign parking spaces on their parking lots to your staffing workers. If you let them park wherever they want, you may avoid WC liability.

 

In this claim, the IL WC Appellate Court ruled claimant's ability to use the parking lot was derived from her status a temporary State of IL employee. They also noted use of the parking space was customary and permitted. Accordingly, injuries caused by the fall-down arose out of claimant's employment as a matter of law.

 

What is mildly to wildly unusual is this is a Manpower temporary worker who clearly would not have been working on Manpower’s premises. That makes her a “traveler” in relation to her main employer. Please also note the State of IL was dismissed as a party to the appeal, as WC claims against the State cannot be appealed past the IWCC. You may also note the facts of the accidental injury in this claim closely parallel the fall-down suffered by Claimant Stanislawa Mlynarczyk in her fall-down-going-to-work-but-not-on-the-premises-of-her-employer claim that was ruled compensable in Mlynarczyk v. IWCC by the same five members of the Appellate Court panel in the unanimous ruling. Feel free to compare:

 

http://www.state.il.us/court/Opinions/WorkersComp/2013/3120411WC.pdf

 

As Claimant Suter was a “traveler” in relation to Manpower only, she would be covered without any of the arguably challenging analysis involved in this “We-are-Illinois-and-any-parking-lot-fall-down-involving-an-assigned-space-is-covered-as-a-matter-of-law” ruling. We don’t know why they wouldn’t simply deem Ms. Suter to be a “traveler” and thereby cover her under that much more sweeping concept and not worry about any issues, like “arising out of and in the course of employment.” We are also starting to become concerned the august members of this Court want to end all WC litigation with their new “matter of law” WC coverage approach to lots of formerly fact-based legal concepts.

 

We can only guess to think the members of this Court know what the Supreme Court may be doing with the hotly-expected ruling in Venture-Newberg-Perini Webster & Stone v. IWCC but we find it difficult to contemplate they don’t even mention their four prior “traveling employee” rulings that would apply to these facts and dramatically streamline their ruling in this case.

 

On a final note, please remember we are strong, strident and respectful opponents of the “traveling employee” expansion of IL WC benefits. In our view, almost all staffing workers are covered for all reasonable/foreseeable injuries and illnesses all day during travel to and from work and on all breaks because 99% of them don’t work “on the premises of their employer.” It is our strongest hope this unsustainable workers’ compensation coverage concept is abandoned by our courts or forever eliminated by our IL General Assembly. In rulings such as this where the members of what is typically our highest WC reviewing court don’t even mention this sweeping and game-changing coverage concept, it leads to confusion and chaos. We feel it becomes impossible for Arbitrators, Commissioners, lower courts, adjusters, risk managers and attorneys on both sides to accurately predict what to do in handling, trying, settling and otherwise resolving such claims.

 

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

 

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Synopsis: Strict Compliance Required to Compel Child Support Withholding and Initiate the Daily $100 Penalty. Analysis by James F. Egan, J.D.

 

Editor’s comment: In Schultz v Performance Lighting, Inc., the Illinois Supreme Court ruled individuals seeking to compel IL employers to withhold child support under the Income Withholding for Support Act, 750 ILCS 28/35 (West 2010), must strictly comply with the notice requirements of the statute. Failure to do so could leave Plaintiff, in this case the mother, left without child support.

 

Under Section 35 of the IWSA, an employer who fails to withhold to meet its employee’s court-ordered child support obligations may face a $100/day penalty if the employer knowingly fails to withhold income after receiving notice under the Act. This penalty applies to payment of workers’ compensation benefits, including both TTD and settlements.

 

The payments must be made to the IL State Disbursement Unit if the party seeking support meets the unequivocal statutory requirements for supplying notice to an employer. While the instant matter did not involve a workers’ compensation case, at KCB&A we routinely advise our clients to act with great caution and consult our defense team when settling any GL, WC or EPLI matter with an outstanding child support lien or withholding child paying benefits from TTD payments in an ongoing matter. If you aren’t sure about whether to deduct child support in an ongoing claim, send a reply.

 

In Schultz, the wife alleged her ex-husband’s employer knowingly failed to make child support payments to the State Disbursement Unit, so Plaintiff filed a lawsuit under the Act. She contended Defendant’s breach triggered the daily penalty. Unfortunately Plaintiff had failed to supply the social security number of her ex-husband and other pertinent information in court documents served on the employer.

 

The IL Supreme Court determined the notice provision was invalid based on the omission of the required social security number from the notice and rejected Plaintiff’s position she had substantially complied with the notice provisions. Emphasizing the rules of construction, the court held, by singling out the lack of a signature as an omission that would not affect the validity of notice, the General Assembly had expressed its intent that the other 11 requirements of the statute absolutely were required. The Supreme Court also observed the statute provides a safe harbor for an employer complying with the withholding obligation only to the extent the notice contains the statutorily required information. The employer could face a Catch-22 if the statute were interpreted as Plaintiff urged; an employer faces civil liability for withholding wages unless the request to do so meets the statutory requirements.

 

The IL Supreme Court did note a troubling lack of communication between the party who sought but, for two years, did not receive payment, and the employer who had notice, albeit defective notice. Recent amendments to the statute requiring follow-up notice and response address this concern to some extent, requiring the recipient of support to timely contact the employer as to why support is not being withheld. This then triggers a required response from the payor to notify the obligee.

 

This article was researched and written by James F. Egan, J.D. Please feel free to contact Jim about it at jegan@keefe-law.com.

 

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Coming events from KCB&A

 

Happy Thanksgiving to All Our Readers and Clients! Be Careful Out There!!

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Synopsis: The KCB&A Monday law updates are archived on the KC&A blog!

Editor’s comment: If you are looking for any article previously written in this update, or just want to browse through a host of insightful articles dealing with our Illinois Comp system, stop on over to http://keefe-law.com/kcablog.html and take a look. The blog currently includes archived articles dating back to August 2008.

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Synopsis: Top Twelve Free (or almost free) and Truly Handy Claims/Risk Management Stuff from Keefe, Campbell, Biery & Associates to our readers.

Editor’s comment: We do lots of things for this industry that you may not know about. Let us know if you have interest in any of these services.

  1. First and most important, send your claims inquiries and toughest questions to ekeefe@keefe-law.com for 24/7/365 answers to your toughest Illinois claims questions. Give us 24 hours and we will get back to you with reasoned thoughts and suggestions, recommendations on pro se settlements and best practices in handling difficult and complex claims concerns.
  2. Next, take a look at actual winning results from the top defense firm in Illinois, Wisconsin, Michigan or Indiana by going to this link:

http://www.keefe-law.com/Successful_Decisions_Document.pdf

  1. Shawn R. Biery does a continuously updated and very handy Illinois Workers’ Compensation Rate Sheet. It is available to anyone upon request. If you want it, send a reply or email Shawn directly at sbiery@keefe-law.com.
  2. We have a one-page document free to the industry called Keefe, Campbell, Biery & Associates Rules of Thumb that provides a quick reference for adjusters and risk managers with Illinois claims. Again, if you have interest, send a reply.
  3. We have a free book on the 2005 Amendments to the Illinois Workers’ Compensation Act. It is also available in a condensed form. If you would like a copy, send a reply.
  4. We also have a free book on all aspects of Illinois Workers’ Compensation Law and Practice. If you are unfamiliar with the Act and Rules and want a resource book, please send a reply.
  5. We provide answers to questions adjusters have about appropriate reserves on your claims, usually within 24 hours. We employ WestLaw© research in rendering our evaluation for your complete file. If you have interest in a legal opinion to support your reserve calculations, email ekeefe@keefe-law.com.
  6. We obtain rapid approval of pro se settlements in Chicago for the low price of $250.00 and outside the Chicagoland area at $350.00. If you have interest in such services, again, email ekeefe@keefe-law.com. We can turn such approvals around in days with cooperation from claimant.
  7. We are happy to provide a free legal audit of up to ten of your worst litigated claims. Our goal is to advise how to best bring such claims to rapid closure within authority. We have had solid outcomes from such reviews. All of our handling is attorney-client privileged. If you have interest in a legal audit, send a reply to ekeefe@keefe-law.com.
  8. We have a strong list of medical, diagnostic, pharmacological, vocational, utilization review, nurse case managers, surveillance, accident reconstruction, ergonomics, safety and other top-notch experts for your consideration to use in Illinois workers’ compensation, general liability and employment law defense litigation. Such recommendations are free. We update such lists continuously. We can also provide research backing up the credentials of such experts. If you have a need for an expert, send a reply.
  9. We are the only defense firm that has several workers’ compensation law professors on staff—we have read and analyzed every single IL WC appellate ruling for over three decades. For any of our readers, if you have a complex (or even a simple) question about any aspect of Illinois workers’ compensation law and practice, please send a reply and we will advise within 24 hours. If you have interest in attending or auditing the best workers’ compensation course in Illinois at one of our top law schools, let us know and we will provide details.
  10. Need a calculator for your desk? Send a reply and we are happy to send a free one that works!

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Trivia corner

Last week’s questions with answers in red:

 

John Fitzgerald Kennedy passed away on November 22, 1963, fifty years ago this week. Here is some JFK trivia.

 

v  How many significant similarities are there between the passing of JFK and Abraham Lincoln? At least 16, many of them mildly eerie.

v  While John Kennedy was considered a very popular President, what IL politician was instrumental in helping him to win or what some observers felt was “steal” the 1960 Presidential election? Chicago Mayor Richard J. Daley who held the ballots until some veterans felt the ballot boxes were properly “stuffed.”

v  As our country seemingly refused to believe one misguided gunman could shoot our President in the fashion that it occurred, is there any compelling evidence to the contrary? Not that we ever heard—it is sort of like not believing the U.S. had a man on the moon; if you don’t believe it, that doesn’t mean it didn’t happen.

v  What building in Chicago helped make the Kennedy family zillions and helped to elevate several of them, including JFK to high political office? The Merchandise Mart that was developed by his father.

v  What was the 120-year curse for U.S. Presidents that ended with the passing of John Kennedy and was broken by Ronald Reagan?? Six Presidents, elected every 20 years, died in office. Ronald Reagan was shot but survived to break the weird curse.

 

This Week’s KCB&A Trivia questions. The first one to get them right, gets a $25 Starbucks Gift Certif:

 

Ø  What are we giving thanks for on “Thanksgiving?”

Ø  Is there actually a rock named Plymouth Rock and why do we still remember that place?

Ø  Why were the folks who landed in the U.S. in 1620 called “Pilgrims?”

Ø  What were the settlers of 1620 initially called?

Ø  What part of the Thanksgiving turkey is saved and snapped as a superstitious good luck custom?