6-30-2014; SB3287--Can We Counterattack?; Important ECA Ruling with analysis by Pankhuri Parti-Shawn Biery; Kevin Boyle Reviews Title VII Ruling of note; Matt Gorski on WCLA Presentation and more

Synopsis: SB3287 Makes Safety Consultants and Maybe You Liable for Safety Advice—Can We Counterattack?

 

Editor’s comment: We are asking for our readers thoughts and comments. SB3287 strips away the exclusive remedy protection for independent safety consultants when someone gets injured at work after they have provided safety advice. On top of that, no one has any idea what “safety advice” might be or how it will be defined moving forward. We are now concerned all workers’ comp participants/vendors other than employers, insurance carriers and brokers might get hung out to dry and be sued for doing their normal day-to-day work in handling claims. By that we mean, safety consultants, lawyers on both sides, third party administrators and their adjusters (who arguably aren’t “insurance carriers”), treating and IME doctors, surveillance operatives, physical therapists and others all are arguably providing “safety advice” and might get drawn into litigation.

 

In short, we feel this is a very irritating new law. To the extent it makes provision of safety services more difficult and expensive, we feel it is anti-social and counterproductive. It is our reasoned legal opinion there is significant new liability for many WC vendors of whatever nature to provide safety consulting services or advice in the Illinois workplace moving forward. The lead claim which led to the passage of SB 3287 was a safety consultant who looked at/examined a manlift in a building. A female worker later used the lift and fell and became paraplegic. She died from her injuries about seven years later. Plaintiff’s counsel argued the safety consultant should have noticed an OSHA-required railing should have been installed. It wasn’t there. Although workers’ comp benefits were paid, the civil case was dismissed under the old law but the new law would have allowed it to proceed against the consultant.

 

The last paraplegic claim that went to a jury in Illinois resulted in a verdict of $64,000,000. One might assume if you provide any “safety advice” and someone is seriously injured or killed, you may have significant liability now that you didn’t have prior to June 5, 2104 when our current Governor signed this troublesome bill into law.

 

At present, it is our reasoned legal impression whenever someone is moderately/seriously injured or killed in an Illinois workplace, Plaintiff’s counsels are going to send the employer written interrogatories about who the non-employee consultants/claims handlers and other WC vendors that provided any advice for the premises or processes leading to injury. Anyone listed as a “consultant” is certain to be sued with high exposure. While there will be defenses, it is going to be challenging and expensive to deal with such suits.

 

Here are some thoughts for folks that might be traditionally identified as “safety consultants”

 

·         Become an LLC or limited liability corporation and don’t carry any insurance—if you get sued, fold the LLC. Right now, there is no provision in the law which allows Plaintiff to “pierce the corporate veil” to allow you to be sued as an individual. Please consult with your own lawyer or our defense team at KCB&A about the strengths and weaknesses of this approach before following this model.

 

·         Perhaps a middle ground, consider becoming an LLC and get a moderate amount of liability coverage—perhaps $100K. If you get sued, tender the $100K and then fold the LLC. Unlike typical workers’ comp settings, there is no requirement of which we are aware that a safety consultant have any specific level of liability insurance coverage. If you have some coverage but not a lot, you might be able to get out of a claim rapidly and avoid higher levels of liability—again, discuss this approach with counsel or reply to set a meeting with our experts at KCB&A.

 

·         Reach an agreement to literally become an employee of the company you are consulting for and get paid on a W2 with other employee benefits. Even if you only work for the company on a part-time basis, if you are an employee of the employer where someone later gets hurt, you will hopefully have the exclusive remedy protections from Section 5. The IL WC Act, as amended, doesn’t say anything about full-time or part-time employment status for in-house consultants.

 

Here are some thoughts for non-traditional “safety consultants”

 

Considering the situation of lawyers on both sides, third party administrators and their adjusters (who arguably aren’t “insurance carriers” per the amended IL WC Act), treating and IME doctors, surveillance operatives, physical therapists and others, we recommend you start routinely using disclaimers. KCB&A has just made the following adjustments/additions to the disclaimers in our email tag-lines and fax cover sheets—see the bolded language at the end:

 

CONFIDENTIALITY NOTICE AND DISCLAIMERThis e-mail message, including any attachments, is for the sole use of the intended recipient(s) and may contain confidential and privileged information or otherwise be protected by law. Any unauthorized review, use, disclosure or distribution is prohibited. If you are not the intended recipient, please contact the sender by reply e-mail and destroy all copies of the original message. Any advice or recommendations provided in this document are solely legal advice. Keefe, Campbell, Biery & Associates does not provide safety advice or consulting services. If such services are needed, a licensed safety expert should be contacted.

 

In our view, all workers’ comp vendors across the state have to do their jobs. By that we mean claims handlers at TPA’s have to handle claims. Attorneys have to fight for their clients. Treating doctors, IMEs and physical therapists have to work their magic. Some of what we do might be called “safety advice” by a rabid Plaintiff lawyer but we have to hope judges and justices in this state are going to let us do our jobs and not expand our liability exponentially for doing so. We hope disclaimers will work but have no way to guarantee it.

 

We are also asking the many legal, medical and claims experts among our readership—do you have any thoughts on this new challenge? Is there any way to effectively counterattack and defend ourselves from this nutty new law? Please reply with your thoughts and best strategies.

 

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Synopsis: In another ruling we consider positive for Illinois business if they take the proper steps in hiring venders, the Illinois Appellate Court 1st District confirms the Employee Classification Act is not an avenue for a subcontractor to seek personal benefits from a contracting company via the ECA. Analysis by Pankhuri Parti, JD and Shawn R. Biery, JD MSCC.

 

Editor’s Comment: In a positive decision which guides employers who contract with parties to perform services in the State of Illinois, the Illinois Appellate Court in Michael v. Pella Products, Inc., 2014 IL App (1st) 132695 (June 25, 2014) affirmed lower courts had properly granted summary judgment to Defendant window company since facts confirmed the window company contracted with a residential contractor who was a bona fide corporation under Department of Labor administrative regulations, and thus the Illinois Employee Classification Act did not apply.

 

By way of confirming the facts of the case, Michael incorporated RJM in 2007 and entered the business of residential contracting. RJM first entered into a contract with Pella in 2008 to provide window and door installation services and then again in 2009. Both the agreements were signed by Michael as “owner” of RJM. As part of the agreement, RJM was to provide sufficient labor to perform the work required by Pella to be judged by Pella’s specification, standards, and expectations. The contractual relationship between RJM and Pella ended in December 2009 and in 2012 Michael filed a putative class action complaint claiming Pella improperly classified him and others similarly situated as independent contractors instead of employees in violation of the Employment Classification Act. The trial court granted summary judgment to Pella finding Michael had performed services for Pella through a “bona fide corporation” and not as an individual. Michael appealed.

 

The purpose of enacting the Employee Classification Act was to address the business practice of misclassifying employees as independent contractors in order to avoid paying payroll taxes, unemployment insurance contributions, workers’ compensation premiums, and minimum wage and overtime payments in the construction industry. While the Act does not define an “individual” it does create a rebuttable presumption an individual performing services for a contractor is an employee unless it is shown the individual was effectively operating independently from the contractor. Additionally, the Department of Revenue has also promulgated regulations which exclude bona fide corporations from the purview of the Act.

 

In his appeal Michael did not dispute RJM constituted a bona fide corporation as defined by the Act and he was an employee of RJM. Instead Michael alleged because he performed services in his individual capacity for Pella, he must also be considered an employee of Pella – the contractor and is thus protected by the Act. In essence Michael asked the court to expand the purpose of the Act to include individual claims by employees of a subcontracting bona fide corporation against the contractor itself.

 

However, the Appellate court disagreed and refused to expand the purpose of the Act in this manner. According to the Court, Michael could not prove he served Pella in an individual capacity because it was RJM who performed those services under the subcontractor agreement. As a result the trial court did not err in deciding Michael did not have an individual claim under the terms of the Act. The Court reasoned the concerns underlying the Act were not implicated in this situation because RJM had properly classified its own employees, complied with the tax laws, paid its employees (like Michael) wages and provided them with benefits. The Court reasoned it was the intent of the Act to exclude bona fide corporations from the purview of the Act because the individuals working for these subcontracting corporations were already employees and could seek wages, benefits, and any additional claims from those corporations. As Michael, an employee of RJM was already receiving wages and benefits from RJM, he could not claim to be misclassified under the Act.

 

The Court was also unimpressed by Michael’s attempts to show this interpretation of the Act yielded absurd results as a corporation could classify its employees as independent contractors and then those individuals would have a claim against a contractor like Pella. However, the Court clarified in this hypothetical the misclassification claim under the Employee Classification Act would lie against the employer – RJM – and not the contractor. Similarly the contractors could not circumvent the Act by insisting on the creation of a corporate entity with which to contract as in this case the entity created would not be a bona fide corporation.

 

In its holding the Appellate Court explained since it was the subcontracting company (RJM), and not the individual employee (Michael) who rendered services to the contractor (Pella), the employee was not an "individual performing services" for the contractor under the terms of the Act and therefore was not protected by the ECA. The impact for employers is an affirmed ability to contract with companies for certain services without fear the individual employees of the subcontracting companies would be classified as their employees when some issue arises which may create disputes.

 

This article was researched and written by Pankhuri Parti, JD who has now successfully transitioned to attorney after clerking for Shawn R. Biery while matriculating at DePaul Law. Feel free to contact Pankhuri about this article at PParti@keefe-law.com or Shawn atSBiery@keefe-law.com.

 

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Synopsis: Important Seventh Circuit Title VII Ruling with analysis by Kevin Boyle, JD.

 

Editor’s comment: An African-American substitute janitor alleged he was subjected to harassment over a two-and-a-half week period by co-workers at an elementary school in Michigan City, Indiana. Nichols v. Michigan City Plant Planning Dept., 2014 WL2766776 (7th Cir. 2014). 

 

Although it was a “close call,” the Seventh Circuit affirmed the Northern District of Indiana’s grant of summary judgment for the employer, and against the pro se plaintiff, ruling any harassment was not severe or pervasive enough to create a hostile work environment in violation of Title VII.  Further, the Seventh Circuit ruled the elementary school did not discriminate in its decision to replace the substitute janitor with a permanent janitor. 

 

·         ALTHOUGH A CLOSE CALL, THE PRO SE PLAINTIFF LACKED THE EVIDENCE TO PROCEED TO A JURY TRIAL

 

The alleged harassment included a co-worker's alleged one-time use of the "black n----r" racial epithet, which she purportedly directed at Plaintiff. The Court held although deplorable and inappropriate in the workplace, it was not severe enough to trigger liability. There were also several other incidents of alleged harassment including the co-worker saying "where that boy at?" without knowing Mr. Nichols was within earshot; a co-worker bringing Mr. Nichols food but slamming the tray into his chest; other employees allegedly not telling Mr. Nichols the location of the janitor's closet; other employees making a mess for him to clean up; and other employees baiting him to steal a purse and money from an open register. 

 

Nonetheless, the Court held the totality of the incidents were not pervasive enough to trigger liability; that one racial epithet was not severe enough to trigger liability; that a reasonable trier of fact would not conclude that all of the allegedly harassing comments were directed at him; and the employees were not necessarily trying to ensnare him on account of his race when someone left a purse. The Court also noted Mr. Nichols was never physically threatened, the alleged harassment did not interfere with his work performance, and it was doubtful all of the comments were directed at him. Accordingly, the alleged incidents were insufficient to show such an offensive nature to constitute actionable conduct. 

 

Lastly, the Court also affirmed summary judgment for the employer and held Mr. Nichol’s termination did not violate Title VII. Particularly, the Court reasoned Mr. Nichols failed to prove discrimination in his employer’s decision to terminate him through the direct or the indirect method. Overall, Mr. Nichols failed to proffer sufficient evidence to defeat his former employer’s motion for summary judgment. Thus, he was unable to present his Title VII claims to a jury. 

 

·         EMPLOYERS NEED FIRM POLICIES FOR REPORTING AND INVESTIGATING ALLEGED WORKPLACE RACIAL HARASSMENT TO PROPERLY PROTECT THEMSELVES

 

Although the employer defeated this claim through an expensive summary judgment motion, properly written and applied policies can help to limit an employer’s liability. Ultimately, the record from the court proceedings appears to be devoid of any written policies for reporting any alleged racial harassment. Although Plaintiff reported the alleged incidents of harassment to the principal, nothing in the record demonstrates what individuals Mr. Nichols should have reported the incidents to. Particularly, a clearly outlined policy for reporting the alleged harassment and follow-up investigation under the policy would allow for an employer to demonstrate its active involvement in preventing and halting any alleged racial harassment. Ultimately, although the pro se plaintiff failed to recover here, these types of incidents should not be considered acceptable behavior between co-workers. 

 

This article was researched and written by Kevin Boyle, JD. Kevin is our Indiana Defense Team Leader and is licensed in Indiana, not Illinois. He is available for answers to any questions about general liability, employment law or workers’ comp in Indiana atkboyle@keefe-law.com.

 

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Synopsis: The IL Workers’ Comp Lawyers’ Ass’n CLE’s for the IL WC Industry—Notice Defense, Myth or Reality. Thoughts and Analysis by Matthew G. Gorski, JD.

 

Editor’s comment: On June 19, 2014, different IWCC cases in which notice defenses were at issue was presented by WCLA in a continuing legal education format. We again tell our readers statutory notice remains a requirement in IL WC. Some of the key issues presented at this WCLA presentation are discussed below.

 

(1)  Sufficiency of Notice

 

Some things to keep in mind with the sufficiency of notice is a claim is only barred if no notice whatsoever has been given and it is an issue of fact, not law. In Raymond v. Indus. Comm’n, 354 Ill. 586 (1933), the employer was aware the employee was sick even though the employee did not officially give notice to the employer. This illness was unknown as to the cause, and he eventually had to quit work because of the illness. The Commission in this case ruled the Legislature did not intend to require employees to inform their employers of an illness they did not know about in the first place.

 

This is something for employers to look out for. This would be a prime issue in asbestos cases, where an employee has been exposed, but did not know they were sick. The Commission in this case is saying it is impossible for the employee to give notice if he does not know he has been exposed to asbestos and suffered from its sequalae. 

 

(2)  Notice in Repetitive Trauma Claims

 

As we all know, the date of accident in a repetitive trauma case is the date the condition manifests itself. Oscar Mayer & Co. v. Indus. Comm’n, 176 Ill.App.3d 607 (1988), set out two ways the date of injury manifests:

 

(1) the time at which the employee can no longer perform his job; or

(2) the onset of pain which necessitates medical attention.

 

In Three “D” Discount Store, 198 Ill. App. 3d 43 (1989), the Commission set out the diagnosis date as the manifestation date, where an employee was examined by an orthopedic surgeon and prescribed surgery. Petitioner continued to work for another month after the diagnosis, but was still constrained to the diagnosis date as the manifestation date.

 

Employer’s need to be on the lookout for both of these factors, and use them to their advantage. If Petitioner receives a diagnosis and continues to work, Petitioner will have to give notice within 45 days of the diagnosis, and not the date the employee can no longer perform his job.

 

Also, please note the 45 day notice requirement in 8(j) cases does not begin to run until payments have been cut off. So, be wary of those situations when Petitioners have been receiving benefits under the group plan.

 

This article was researched and written by Matthew G. Gorski, JD. The opinions Matt is voicing are his and not those of any member of WCLA or its board. Matt can be reached 24/7/365 for questions about WC at mgorski@keefe-law.com

 

6-23-14; No-Fault Attendance Policies Will Put You In The "Danger Zone", analysis by Bradley Smith, JD; HIPAA Fines To Soar, analysis by Ellen Keefe-Garner, JD; June is PTSD Awareness Month and more

Synopsis: No-Fault Attendance Policies May Put Your Company in the “Danger Zone.” Analysis by Bradley J. Smith, JD.

Editor’s Comments: Taking aim at No-Fault Attendance Policies, the EEOC takes action against auto parts retailer AutoZone for Its alleged failure to accommodate in their policy pursuant to the ADA. To fix the problem, we feel you need to consider implementing a “some-fault” policy because a blind or “no-fault” policy sounds good and easy to implement but is sure to get you into unwanted litigation.

Generally, when it comes to employer attendance policies, application of the policies should be applied the same across a broad range of employees. This allows the employer’s attendance policy to be applied without the impression of discrimination. In other words, you are applying the attendance policy fairly to all employees regardless of religion, color, race, gender, or any other protected category under applicable Federal and State law. Nonetheless, the opposite may be true when considering the Americans with Disability Act’s (“ADA”) failure to accommodate provision. Consequently, in EEOC v. AutoZone, Inc., the Equal Employment Opportunity Commission (“EEOC”) is taking aim at AutoZone Inc. regarding its no-fault attendance policy for allegedly failing to accommodate certain disability-related absences and further for retaliation for engaging in protected activities. EEOC v. AutoZone, Inc., No. 1:14-cv-03385 (filed May 9, 2014). Initially, the EEOC unsuccessfully attempted to reach a pre-litigation settlement with AutoZone through its conciliation process. Subsequently, the EEOC brought the suit under the ADA, which prohibits disability discrimination in employment and retaliation for reporting such discrimination. The EEOC claims for a period of approximately two (2) years, AutoZone assessed its employees and distributed points for absences. The EEOC further alleges AutoZone created no general exceptions for disability-related absences. Thus, any employee who violated AutoZone’s twelve (12) point attendance policy regardless of the reason for the absence was terminated. The EEOC alleges qualified employees with disabilities with minimal disability-related absences were fired. In further opposition to the no-fault policy, the EEOC argues reasonable accommodations should have been made for these employees. In essence this claim is a disparate impact claim as it relates to the no-fault policy, along with a disparate treatment claim as it relates to the individual instances of failure to accommodate and retaliation.

As an example, the EEOC asserts an Ottawa, IL employee with Type 2 diabetes was fired because he/she had to leave work early occasionally because of insulin reactions. The Complaint also alleges an employee was discharged in retaliation for objecting to the attendance policy and filing a charge with the EEOC.

Can Your Company Provide Light Work But Only for Work-Related Injuries?

This action by the EEOC also brings up the continuing question in the workers’ comp arena whether U.S. employers can offer temporary light work for work-related injuries but not offer similar accommodations for non-work-related problems and issues. If your company only offers medically modified work for work-related injuries, you may want to contact the author to discuss that delicate issues.

A reasonable accommodation under the ADA is one that would enable an employee with a disability to enjoy an equal opportunity for benefits and privileges of employment as are enjoyed by employees without disabilities. However, employers do not have to provide an accommodation if doing so would cause undue hardship to the employer. Undue hardship means the accommodation would be too difficult or too expensive to provide, in light of the employer’s size, financial resources, and the needs of the business. Generally, whether the accommodation creates an undue hardship relates to the job duties and descriptions of the position. However, employers cannot deny an accommodation because it will incur some costs.

Consider an Absence Committee

One way to avoid the uncertainty and litigation in this situation is to have your employees get points for absences but, in lieu of termination, have their chart moved to a management committee for review and final decision. In this fashion, you aren’t providing a “no-fault” approach and could make careful accommodation to avoid rancor. The committee can keep records of their decisions and all of this would be the sort of evidence needed to defend any EEOC or state discrimination charge.

Burden of Proof is on the Government But The Costs are on U.S. Employers

The author notes the EEOC may have a difficult time in proving AutoZone failed to reasonably accommodate the alleged disabled employees, but may likely reach a jury trial on the issues. The EEOC will initially need to demonstrate the individuals allegedly discriminated against suffered from a disability under the ADA. Although the EEOC would likely not bring the case if there was no evidence that the individuals suffered from disabilities, this element will need to be proven. Second, the EEOC will need to establish AutoZone was actually aware of the employees’ disabilities, as required to sustain a failure to accommodate claim under the ADA. Although this element is a prime area for summary judgment, in the event there is no dispute AutoZone was unaware of the disabilities, it is highly likely this area will be factually disputed by the EEOC and the individuals. In other words, at a minimum, if the EEOC can establish there is a factual dispute as to whether AutoZone had actual knowledge the disabilities, then the case will proceed to a trial. Nonetheless, to finally prevail on the ADA failure to accommodate claim, the EEOC will need to prove the employer failed to reasonably accommodate the employee’s disability. Of course, if the EEOC fails to demonstrate AutoZone’s actual awareness of the alleged disabilities, then consideration of whether AutoZone failed to reasonably accommodate the individuals will be unnecessary. Despite the EEOC’s difficulties, the case will likely proceed to trial without any early disposition.

As for the ADA retaliation claims, the EEOC will need to prove AutoZone retaliated against certain individuals for asserting their ADA rights and/or engaging in protected activities. Thus, the EEOC must evidence that AutoZone discharged its employees for filing their claims with the EEOC, an action all employees should have the right to engage in without fearing termination.

Notably, this is not the first time that the EEOC set its sights on AutoZone. In 2009, a consent decree resolved an EEOC claim that AutoZone allegedly failed to promote a visually impaired employee and further denied his/her use of a service animal. (EEOC v. AutoZone, Inc., No. CV-06-1767 (D. Ariz)). That decree awarded the employee $140,000.00 and required the company to conduct ADA training in all of its Arizona stores. In yet another case in 2001, a central Illinois jury found that AutoZone refused to accommodate a sales manager’s disability by requiring the employee to mop of floors, which led to additional injuries. (EEOC v. AutoZone, Inc., No. 07-cv-1154 (C.D.Ill.)). The case resulted in a $424,000.00 judgment against AutoZone. Moreover, in 2012, the EEOC claimed that AutoZone fired an employee rather than accommodating her lifting restriction. (EEOC v. AutoZone, Inc., No. 12-cv-303 (E.D. Wis.)). This case is currently proceeding to trial.

Summary

Essentially, the EEOC is attempting to force AutoZone to alter its nationwide no-fault attendance policy—and in doing so, to set an example—to account for individuals with disabilities needing “reasonable accommodations” related to their attendance at work. Although this is not a novel concept, employers and their insurers need to be aware no-fault attendance policies must leave room to accommodate for known disabilities, as long as those accommodations will not create an undue hardship on the employer. In other words, having clearly mandated policies and detailed written job descriptions, and further application of the same, can alleviate the stress of future litigation and expensive attorneys’ fees and costs. Thus, if employers provide a strong legal foundation for their policies and procedures, employers can avoid becoming the EEOC’s target.

It is not our intention to comment on the merits of the claim reported above—our goal is to inform our readers of these important developments. This article was researched and written by Bradley J. Smithwho is our employment law defense team leader. Fully ready to service your legal defense needs, Mr. Smith also manages the firm’s general liability department. Feel free to contact Bradley about this article at bsmith@keefe-law.com.

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Synopsis: News from Washington D.C., HIPAA Fines are Skyrocketing. Analysis by Ellen Keefe-Garner, RN, BSN, JD.

Editor’s comment: It has long been known failure to comply with HIPAA can result in civil and criminal penalties (42 USC § 1320d-5). Our recommendation to all our readers in the WC industry is to get an HIPAA-GINA compliant release signed by the claimant whenever/wherever possible. If the release is later withdrawn, you can then rely on the WC “exception” to HIPAA-GINA but you are much better protected to have a signed release in your files. If you need our draft HIPAA-GINA compliant release for your use, send a reply and we will email it to you, no charge. Either way, when you come to the end of handling a workers’ comp file, it has to be appropriately and securely stored and then shredded.

Civil Penalties

 The “American Recovery and Reinvestment Act of 2009”(ARRA) that was signed into law on February 17, 2009, established a tiered civil penalty structure for HIPAA violations (see below).  The Secretary of the Department of Health and Human Services (HHS) still has discretion in determining the amount of the penalty based on the nature and extent of the violation and the nature and extent of the harm resulting from the violation.  The Secretary is still prohibited from imposing civil penalties (except in cases of willful neglect) if the violation is corrected within 30 days (this time period may be extended).

HIPAA Violation

Minimum Penalty

Maximum Penalty

Individual did not know (and by exercising reasonable diligence would not have known) that he/she violated HIPAA

$100 per violation, with an annual maximum of $25,000 for repeat violations (Note: maximum that can be imposed by State Attorneys General regardless of the type of violation)

$50,000 per violation, with an annual maximum of $1.5 million

HIPAA violation due to reasonable cause and not due to willful neglect

$1,000 per violation, with an annual maximum of $100,000 for repeat violations

$50,000 per violation, with an annual maximum of $1.5 million

HIPAA violation due to willful neglect but violation is corrected within the required time period

$10,000 per violation, with an annual maximum of $250,000 for repeat violations

$50,000 per violation, with an annual maximum of $1.5 million

HIPAA violation is due to willful neglect and is not corrected

$50,000 per violation, with an annual maximum of $1.5 million

$50,000 per violation, with an annual maximum of $1.5 million

Criminal Penalties

In June 2005, the U.S. Department of Justice (DOJ) clarified who can be held criminally liable under HIPAA. Covered entities and specified individuals, as explained below, whom "knowingly" obtain or disclose individually identifiable health information in violation of the Administrative Simplification Regulations face a fine of up to $50,000, as well as imprisonment up to one year.

Covered Entity and Specified Individuals

The DOJ concluded that the criminal penalties for a violation of HIPAA are directly applicable to covered entities—including health plans, health care clearinghouses, health care providers who transmit claims in electronic form, and Medicare prescription drug card sponsors. Individuals such as directors, employees, or officers of the covered entity, where the covered entity is not an individual, may also be directly criminally liable under HIPAA in accordance with principles of "corporate criminal liability." Where an individual of a covered entity is not directly liable under HIPAA, they can still be charged with conspiracy or aiding and abetting.

Enforcing Agencies

The DHHS Office of Civil Rights (OCR) enforces the privacy standards, while the Centers for Medicare & Medicaid (CMS) enforces both the transaction and code set standards and the security standards (65 FR 18895). Enforcement of the civil monetary provisions has not yet been tasked to an agency.

No Private Cause of Action

While HIPAA protects the health information of individuals, it does not create a private cause of action for those aggrieved (65 FR 82566). State law, however, may provide other theories of liability.

The Office of Civil Rights (OCR), a division of the U.S. Department of Labor, investigates potential HIPAA violations. Since 2013, the Department of Health and Human Services (HHS) has recovered more than $10 million from health care entities and business associates for alleged violations of HIPAA. During a American Bar Association conference, in mid-2013, Jerome Meites, Chief Civil Rights Counsel for the HHS predicted future awards for HIPAA violations will be increasingly larger than in the past. Mr. Meites supported his prediction with the premise that HHS’s Office of Civil Rights is attempting to send a strong message that entities should comply with HIPAA or face steep penalties.

In addition to the potential onus of huge financial penalties for a HIPAA violation, Mr. Meites informed many more investigations of possible violations were already planned. He explained portable media devices used for storing health care information have caused a huge number of complaints about breaches of protected health care information. In addition, Mr. Meites indicated the failure of an entity to perform the required HIPAA investigation—called a comprehensive risk assessment—has been a factor in most of the data breach cases with which HHS has been confronted.

The warnings given by Mr. Meites about the proposed upswing in the number of investigations was intended to cause health care entities and their business associates (including attorneys, law firms and insurance claims managers) to take a closer look at their policies and procedures related to HIPAA protection. The warnings were intended to force entities to analyze how and when they will investigate a potential HIPAA violation. Needless to say, a strong message was sent to indicate that all entities should carefully scrutinize their policies for protecting data in relation to portable media devices, devices which are or could be used to store private health care information of patients.

This article was researched and written by Ellen Keefe-Garner, RN, BSN, JD who is our health law defense expert, along with handling numerous defense roles. Feel free to contact Ellen about this article at emkeefe@keefe-law.com.

 

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Synopsis: PTSD Continues to Vex Workers’ Comp Managers.

 

Editor’s comment: In order to bring greater awareness to the issue of posttraumatic stress disorder (PTSD), the United States Senate designated June 27th as National PTSD Awareness Day. In addition, June has been designated as PTSD Awareness Month by the National Center for PTSD.

 
PTSD is an anxiety disorder resulting from exposure to a single traumatic event or multiple traumatic events, such as assault, natural or man-made disaster, and work- or war-related combat stress. Symptoms of PTSD include persistent intrusive thoughts and distressing dreams about the traumatic event, triggered emotional responses to reminders of the trauma, efforts to avoid thinking or talking about the trauma, and persistent hypervigilance for cues that  indicate additional danger or trauma re-occurring. Indeed, according to estimates published by The National Center for Post-Traumatic Stress Disorder, some 7.8 percent of Americans will experience post-traumatic stress disorder (PTSD) at some point in their lives. Statistics indicate women are twice as likely to suffer from the condition than men.

 

Because the employer supposedly takes the “egg-shell” employee as it finds them, employers, claims administrators, and insurers view PTSD as an ongoing and difficult challenge to claims management and administration. Some industry experts are taking action to assist employers to identify if and confirm when a worker might be at risk of PTSD. Prevention and early identification of PTSD as an important part of their overall risk management.

 

One caveat we always tell our readers, clients and friends, always remember if someone is seriously injured or killed in the workplace, you have to handle the injury/death but also have to consider potential PTSD claims from everyone around the event. Be sure to offer counseling or medical care to your entire workforce, as needed. If you want assistance in finding such counselors, send a reply.

 

The “Double Whammy” of Dealing with PTSD Claims

 

·         PTSD usually lurks in the shadows, only to become present when the employee is confronted with a slow-developing or sudden physical or psychic trauma.

 

·         PTSD doesn’t have open scars or surgical sites--like other mental injury conditions, this condition has a significantly subjective component. The problem with all “soft-tissue” WC claims is when to give the worker the benefit of the doubt and when to shut the claim down.

 

Current Status Illinois and Indiana WC Mental Claims, Including PTSD

 

Mental conditions resulting from physical injuries are almost always compensable. The extent of care required is going to be an issue for litigation, like all other IL and IN claims.

 

Mental stimulus-mental reaction cases are compensable, but only if the stimulus is “unusual.” Our research indicates Colorado, Illinois, Iowa, Louisiana, Maine, Mississippi, Missouri, New Jersey, New York, North Carolina, Oregon, Pennsylvania, Rhode Island, South Carolina and Vermont fall within this group. In most of the decisions “unusual” means unusual for a typical person holding the claimant’s job. Thus, a police officer or firefighter is expected to handle some levels of stress within his or her ordinary duties that would be deemed “unusual” for someone else in the general public. However, please compare the recent City of Montgomery ruling where a police officer faced with an orange-tipped toy pistol was provided line-of-duty disability benefits for a confrontation that didn’t result in injury. We feel the Illinois Workers’ Compensation Commission is more conservative in handling PTSD claims than our much more liberal reviewing courts.

 

Similarly, where the level of stress faced by the employee is objectively quite ordinary, although subjectively quite the opposite, the bulk of the jurisdictions, , either through court decision or actual statute, deny compensability for mental injury claims, including those related to PTSD. We have always felt attorneys on both sides don’t like to deal with psych claims and we hope that trend continues.

 

If you need experts or consultation on best practices in handling/defending PTSD claims, send a reply.

 

SynopsisGene Keefe, JD and Joseph D’Amato, JD to Speak about the future of workers’ compensation at American Insurance Ass’n in Washington DC tomorrow.

 

Editor’s comment: As you read today’s KCB&A Update, we are leaving for O’Hare to participate in a panel discussion on where the IL WC system has been and where we hope it is going under future administrations. If you have thoughts or comments you would like us to make to this important national association, please send them along.

6-16-2014; IL Appellate Court Upholds Coal-Miner Denial, analysis by Jim Egan, JD; Does IL WC Still Have a Notice Defense?; IL Supreme Court to Rule on Need for IL Treasurer to File WC Bond and more

Synopsis: In a Ruling We Consider Positive for Illinois Business and the Coal Mining Industry, the IL Appellate Court Upholds Denial of Coal Miner’s Claim under the Occupational Diseases Act. Analysis by James F. Egan, JD.

 

Editor’s Comment: In a positive decision which effects numerous employers in the State of Illinois, the Illinois Appellate Court, Workers’ Comp Division upheld the IWCC’s denial of benefits based upon the Statute of Limitations. In Carter v IWCC, the Appellate Court upheld the Commission’s denied of a claim for COPD or chronic obstructive pulmonary disease under Section 6(c) as time-barred as it was not filed within the three-year Statute of Limitations. In Carter, the claimant was a 22-year coal miner who had worked mainly underground during that period. The mine in question closed on September 24, 2004 which was also the claimant’s last day at the mine and last exposure to coal dust. While he told his foreman he was having breathing problems/congestion, he never mentioned that he had black lung or coal workers’ pneumoconiosis. Claimant filed an Application for Adjustment of Claim with the IWCC on September 3, 2008, nearly four-years after the last claimed exposure.

 

Competent medical evidence presented by Respondent, which included chest x-rays negative for coal workers’ pneumoconiosis  revealed the claimant was diagnosed with COPD. While the diagnosis did confirm Mr. Carter’s COPD was secondary to the inhalation of coal dust along with his smoking history, there was no diagnosis of pneumoconiosis. It is important to note claimant’s own treater also diagnosed COPD and not pneumoconiosis.

 

In March 2009, the Department of Labor issued an SSAE in connection with Mr. Carter’s concurrent claim for federal black lung benefits indicating he did not have coal workers’ pneumoconiosis and did not have a totally disabling respiratory or pulmonary impairment caused in part by pneumoconiosis. Clearly the DOL had no other logical alternative upon reflection of the medical evidence. Accordingly the DOL denied federal benefits.

 

The Arbitrator denied benefits under the IL Occupational Disease Act as untimely as the Act places a three-year Statute of Limitations on benefits with an exception for pneumoconiosis which extended the Statue to five-years. 

 

Pursuing benefits under the Occupational Disease Act, Petitioner presented a case in chief in which his expert opined no distinction could be made between COPD and coal workers’ pneumoconiosis and argued that as such one could not deny the claim as untimely. Claimant argued that based upon this argument the five-year Statute must include COPD caused by exposure to coal dust.

 

The Appellate Court, WC Division disagreed; holding the plain terms of the exception to the Statute of Limitations was for coal miners’ pneumoconiosis and not COPD. The Court held the exception clearly does not apply to all disabilities caused by exposure to coal dust and had the legislature intended to include all disabilities to do so, they could have done so.  The Court went on to distinguish claimant’s expert noting that his doctor had not provided any scientific reason to apply different limitation periods to coal miners alleging COPD, as opposed to pneumoconiosis and that claimant’s own doctor agreed with Respondent’s expert in his diagnosis.

 

The Court also rejected an equal protection argument that by setting the Statute of Limitations as it has been set, miners with COPD were being treated differently that “similarly situated” miners with coal workers’ pneumoconiosis. The Court held that the two diagnosis were clearly shown to be different and therefore claimant was not similarly situated as with workers’ with pneumoconiosis.

 

The author notes this to be a solid decision in which the IL WC Appellate Court upheld the plain reading of the Section 6(c), rather than re-interpreting the legislative intent. The decision also appears to continue a recent, positive trend in which the Commission, the Circuit Courts along with the Appellate Court have resisted an urge to reverse well-thought out opinions by Arbitrators which are supported by the manifest weight of the evidence.

 

This article was researched and written by James F. Egan, JD who is our coal mining defense expert, along with handling numerous defense roles. Feel free to contact Jim about this article at jegan@keefe-law.com.

 

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Synopsis: Does IL WC Still Have a Statutory Notice Defense?

 

Editor’s comment: Last week’s article about the IL Appellate Court, WC Division ruling in Tolbert v. Illinois Workers’ Compensation Commission, Plaintiff/Petitioner suffered an alleged and questionable occupational exposure to pigeon and sparrow droppings. The ruling appears to have led some observers to question whether our statutory notice requirement is still valid due to the strident pro-Petitioner tone of the Appellate Court’s ruling.

 

Unlike other states, our IL WC Act has relatively few statutory defenses. The “45-day” notice requirement in Illinois is one such statutory defense. Section 6(c) of the IL WC and OD Acts require the claimant to give notice of the accident or occupational exposure "to the employer as soon as practicable, but not later than 45 days after the accident." Section 6(c) further provides that "[n]o defect or inaccuracy of such notice shall be a bar to the maintenance of proceedings on arbitration or otherwise by the employee unless the employer proves that he is unduly prejudiced in such proceedings by such defect or inaccuracy."

 

In the Tolbert ruling, the unanimous majority ruling noted the Commission found Claimant's last day of work for the employer was August 31, 2010. Therefore, Claimant was required to give the employer notice of a work injury or exposure at least by October 15, 2010.

 

The Arbitrator and Commission found Claimant did not give requisite statutory notice until November 9, 2010, when the employer received a letter from the claimant's attorney well beyond the 45-day requirement of Section 6(c).

 

The majority opinion confirmed the legal standard of whether a given claimant gave the employer timely notice required by section 6(c) of the Act is a finding to be made by the Commission which will not be disturbed on appeal unless it is against the manifest weight of the evidence. The Court’s members noted the purpose of the notice requirement is "both to protect the employer against fraudulent claims by giving him an opportunity to investigate promptly and ascertain the facts of the alleged accident and to allow him to minimize his liability by affording the injured employee immediate medical treatment." The requirement the employee provide notice is jurisdictional, and the failure of the claimant to give notice will bar the workers’ comp claim. However, a claim is only barred if no notice whatsoever has been given. If some notice has been given, but the notice is defective or inaccurate, then the employer must show they have been unduly prejudiced.

 

From our perspective, the Appellate Court majority then looks to an undisputed phone call that took place on September 1, 2010. In that call, the employee advised the supervisor he thought he had cancer. There was a significant factual dispute present. To the extent the Commission ruled against Plaintiff/Petitioner, we would assume the reviewing court would give deference to the IWCC’s findings. In our respectful view, we don’t feel that occurred. Actually, it doesn’t appear the supervisor was rude or disrespectful to the worker—when/if a report of cancer was provided, it would appear the supervisor would not typically feel that might be related to the normal work at Respondent and would not have inquired further.

 

However, we also note there are numerous mistakes and problems caused by the handling of this matter by the defense attorney assigned. As we advised last week, someone had to stipulate this seasonal worker was an “employee” for a date of exposure long after the worker left the employ of Respondent. As veteran defense lawyers, we would never enter into such a stipulation.

 

Similarly, it does not appear defense counsel was aware in presenting a statutory notice defense consistent with Section 6(c) of our IL WC Act, the employer may have an affirmative duty to demonstrate prejudice. In our view, demonstrating prejudice due to late reporting of an accident or exposure is a simple but necessary task. The employer or its supervisor should have been called at the hearing to testify to their accident/exposure reporting protocols and what they could or might have done if an appropriate report had been provided. It is hard to criticize the reviewing courts when the employer and its defenses were not properly presented in the first instance.

 

In summary, we feel the ruling provides an excellent review of the statutory notice defense and emphasizes it remains a vibrant and valid statutory defense. While we don’t agree with the outcome, we are sure there are many court observers who do. We appreciate your thoughts and comments.

 

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Synopsis: IL Supreme Court to Decide Bond Requirement for State Treasurer in WC Setting; analysis by Michael L. Shanahan, JD.

 

Editor’s comment: The Illinois Supreme Court will soon take up a workers’ comp case to determine whether the State Treasurer as ex officio custodian of the Injured Workers’ Benefit Fund is required to post an appeal bond for review of Commission cases.

 

To provide some background on Illinois State Treasurer v. Illinois Workers’ Compensation Comm’n., the claimant worked as an at-home care-giver for an elderly blind man. The claimant testified that she normally wore slippers around the house; however, she would change into regular shoes before walking downstairs. Claimant testified she was putting on her shoes at the top of the stairs when she fell, hit her head against a wall, and lost consciousness.

 

Claimant subsequently filed a workers’ compensation claim against her employer, the elderly man. Since he did not have workers’ comp insurance, the Illinois State Treasurer was named a co-Respondent as custodian of the Injured Workers’ Benefits Fund. The IWBF was created in 2005 to provide benefits to workers whose employers do not have insurance and it’s funded by penalties and fines collected by the Commission from uninsured employers.

 

At trial, the arbitrator found the injury to be compensable and awarded benefits. The Commission unanimously affirmed the arbitrator’s decision. The Treasurer appealed. Normally, section 19(f)(1) of the Workers’ Compensation Act (820 ILCS 305/19(f)(1)) requires the party seeking review to obtain an appeal bond. The appeal bond provides security to ensure payment on appeal. The bond also vests the circuit court with jurisdiction to review an award made by the Commission. However, the Act expressly exempts “every county, city, town, township, incorporated village, school district, body politics or municipal corporation against whom the Commission shall have rendered an award for the payment of money.” 

 

On review, the IL WC Appellate Court reversed the Commission’s decision after concluding the Claimant had “failed to present evidence supporting a reasonable inference that her injuries arose out of a risk associated with her employment.” However, Claimant filed a motion for rehearing and asserted the court lacked jurisdiction on two separate grounds. First, Claimant argued the Court was barred from review as it involves a claim against the state. Next, the court did not obtain jurisdiction since the Treasurer failed to file an appeal bond. The Appellate Court did not find the first argument persuasive but the second posed a more difficult question.

 

With regard to the failure to obtain a bond, the Treasurer argued it was exempt from the bond requirement under section 19(f)(2). The Court disagreed based on the plain language of the Act. Essentially, the Court found that if the legislature intended to limit the requirement to employers, it would have simply said so. Plus, since the Act specifically lists certain entities who are exempt, it is unlikely the Treasurer was an intended exemption as it was not specifically listed. Nonetheless, the issue will ultimately be decided by the Illinois Supreme Court.

 

At the outset, an appeal bond must be considered in terms of the strategy of litigation if an adverse decision is rendered. For us, this is a reminder of the importance of communication with our clients. If there is an adverse decision, we have twenty days to meet all of the preliminary requirements prior to taking the work comp fight to state court for review. The State Treasurer may very well have won in the Appellate Court; however, now the focus has shifted to whether the Treasurer is exempted from the bond requirement.

 

Please direct all questions or comments to Michael L. Shanahan at mshanahan@keefelaw.com