8-11-14; IL WC Rates Keep Climbing--To Track Them, You Need Shawn Biery, J.D.'s New IL WC Rate Sheet; Tips/Tricks on Closing IL WC Claims Faster; E-Billing Is Coming to a Claim Near You and More

Synopsis: If You Handle IL WC Claims, the Rates are Finally Updated so get the updated version of Shawn R. Biery’s Rate Sheet.

 

Editor’s comment: The new IL WC minimums and maximums have been posted and our updated KCB&A IL WC Rate Sheet is now available via email or snail mail if you prefer the fancy laminated version. We note rates continue to increase based upon the reported increase in the statewide average weekly wage however the increase was not as significant as the last. The reality on the streets still doesn’t seem to match the increase however as noted in the past, since the 1980’s, the IL WC Act provides a formula which effectively insures no matter how poor the IL economy is doing, your WC minimum rates keep climbing.

 

We caution our readers to pay attention to the fact the IL WC statutory maximum PPD rate is not updated until January 2015 and will then change retroactively from July 1, 2013 to present. The new PPD max rate becomes retroactively effective when published. If this isn’t clear, send a reply or email IL WC rate wiz, Shawn R. Biery at sbiery@keefe-law.com.

 

The current TTD weekly maximum is $1,341.07. A worker has to make over $2,011.61 per week or $104,603.46 per year to hit the new IL WC maximum TTD rate. 

 

The new IL WC minimum death benefit is 25 years of compensation or $502.90 per week x 52 weeks in a year x 25 years or $653,770.00! The new maximum IL WC death benefit is $1,341.07 times 52 weeks times 25 years or a lofty $1,743,391.00 plus burial benefits of $8,000. These numbers make it very important to keep your workplace safe and free from hazards.

 

The best way to make sense of all of this is to get Shawn Biery’s awesome and easy-to-understand IL WC Rate Sheet. If you want one, they are free so simply reply or email Shawn at sbiery@keefe-law.com  and we will send it along. If you would like fancy laminated copies, copy Marissa at mpatel@keefe-law.com and let her know the number of copies and your MAILING ADDRESS!

 

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Synopsis: Closing WC Claims in Illinois Faster Than Your Competition.

 

Editor’s comment: Our motto at KCB&A is “The Only Good File is a Closed File.” One great thing about IL WC is you can close WC claims effectively forever, if you know the rules. Here are some thoughts on closing IL WC claims, full and final, faster than your competition.

 

First, you have to investigate the accident with intensity needed to match the severity of the injuries. We can’t tell you how much to investigate but the more severe or questionable events require more intense investigation—you have to make the informed call on how much is needed. If you want our investigative forms, send a reply. We call a poor or ineffective accident investigation the equivalent of being on the high seas in a boat without a rudder. You may stay afloat for a time but you have little control of your destiny.

 

Second, get a signed HIPAA-GINA compliant release to facilitate review of medical records and histories. If you need our form, send a reply. When you review and compare medical histories to the accident investigation, you should be able to tell if you have an accepted loss or not. If the histories mix properly with your investigation, you need to accept and pay the claim. If they don’t, consult with a defense attorney to consider controverting the claim.

 

Third, when you start to manage an accepted claim—always project the beginning, middle and end. Set targets for your outcomes. Then push hard to make those targets occur.

 

Fourth, timely pay and process all necessary and related medical bills. If you decide to dispute medical care, use UR and/or IME’s or tough defense counsel from KCB&A to do so. Please remember, you can’t close/settle/try most IL WC claims without a determination by a doctor that Petitioner is MMI and all medical bills are processed and paid under our IL WC Medical Fee Schedule.

 

Fifth, get Petitioner back to charity/light/medium or regular work—like number Four above, you can’t settle, full and final, until Petitioner is back to some sort of work.

 

Sixth, when you have the medical bills paid and Petitioner is back to work, make an offer of settlement. Don’t ever ask the other side what they want—do your homework or ask a defense team member at KCB&A for their evaluation and make an offer.

 

Seventh, if you have made a fair offer and the other side won’t take it, start to push for closure with the rest of the tools available.

 

o   Engage the employer to convey the offer to the worker and push for closure;

 

o   Engage the Arbitrator assigned to seek a  pretrial and push for closure;

 

o   Don’t agree or allow your assigned defense attorney to agree to continuances—attend the trial settings and ask everyone to push for closure.

 

The defense team at KCB&A wants our readers to understand IL WC Arbitrators are committed to timely closure of files when the defense industry does their job, gets medical bills processed and paid and insures injured workers are back to work. We can help with any and all of it.

 

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

 

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Synopsis: Electronic Medical Billing to Hit IL WC System Some Day.

 

Editor’s comment: We are sure this change is going to keep coming at the WC claims/risk industry and we are all going to have to adapt. Having withdrawn its rules on e-billing in 2013, the Illinois Insurance Department is trying, trying again to adopt rules that will require insurers and employers to accept, process and pay electronic medical bills.

 

The 2011 Amendments to the IL WC Act “required” the IL Insurance Department to adopt rules for e-billing by January 1, 2012. Like many things our legislature does with the IL WC Act, there is no penalty for not following the legislative fiat, other than occasional embarrassment which is readily shrugged off by the administrators. The plan was all insurance carriers and employers would accept electronic medical payment claims no later than June 30, 2012. Oops, it appears those dates came and went.

 

Following enactment of the 2011 Amendments, the e-billing standards were finally published in November 2012 and were then withdrawn in 2013, to supposedly be replaced by more updated rules. Those new rules have been published and we will all have to consider following them. At some point, we assure our readers you are going to have to accept and process bills following the e-billing rules.  

 

At present, the IL Insurance Department is soliciting comment from anyone interested about the new rules they have promulgated—you have 45 days from August 8, 2014 to do so. The comments need to be directed to Joe Clennon, Ass’t General Counsel of the IL Insurance Department, 320 West Washington St., Springfield, IL 62676.

8-4-14; Can Chairman Latz Throw the Money Lenders Out of the Commission?; Gov. Quinn Mistakenly Cites Advisory Rates But IL WC is Better-for-Business; Mike Shanahan Reviews ADA Ruling of Note and more

Synopsis: Can the Current IWCC Chairman Throw the Money Lenders Out of the Commission?

 

Editor’s Comment: This week WorkCompCentral.com reports Lisa Rickard from the U.S. Chamber Institute for Legal Reform has written IWCC Chairman Michael Latz, Governor Quinn and Illinois Attorney General Lisa Madigan about the craziness that is lawsuit lending in Illinois workers’ compensation. The letter was sent prior to the Fourth of July. Since then, it appears nothing has happened. We note the IL WC Commission has nine members plus the Chairman and lots of other lawyers on staff, all who appear to be ignoring this request and it is starting to appear embarrassing during an election year. To paraphrase Ms. Rickard’s main points

 

Lawsuit lending is an important public policy issue for the U.S. Chamber Institute for Legal Reform or ILR and a national coalition of business groups. ILR is an affiliate of the U.S. Chamber of Commerce dedicated to making our nation’s overall civil legal system simpler, fairer and faster for all participants. It came to their attention various lawsuit lending firms are marketing and providing loans to injured workers compensation claimants in Illinois. They point out the Illinois Workers Compensation Act expressly prohibits assignment of any payment, claim, award or decision. (see 820 ILCS 305/21) In their view, any lender issuing loans in return for present or future payments from Illinois Workers Compensation claims is doing so in violation of the Illinois Workers Compensation Act. They formally asked the IWCC conduct an investigation and review of this potential violation by consumer credit lenders.

 

We strongly agree with their overall focus. If you want to read the language we have paraphrased above and attachments, see http://www.instituteforlegalreform.com/uploads/sites/1/ILR_on_Lawsuit_Loans_to_Workers_Compensation_Claimants.pdf

 

From the Petitioner’s Side of the Bar

 

Let’s take a stroll down memory lane. You may recall a very prominent central IL WC lawyer got into problems when he lent one of his claimants some money in anticipation of a future WC award or settlement. When Claimant finally got his money from his WC claim, he didn’t want to make good on the loan provided by his lawyer. The lawyer sued Claimant for the money and the whole matter made it up to the reviewing courts. In a simultaneous rebuke, the higher courts found the loan to be against public policy and dismissed the claim. They also made it clear Plaintiff/Petitioner lawyers couldn’t lend money to their clients as part of the services provided.

 

The other nuance you might miss is this sort of lawsuit lending can lead to a tawdry type of “auction” where an injured worker might go to two or more firms and sign an attorney representation agreement with the lawyer willing to lend the most money. If claimant wanted even more money, he/she might borrow a substantial sum from one Plaintiff/Petitioner lawyer and then fire that lawyer to borrow even more money from the second, third or fourth lawyer.

 

What came into Illinois and many states were independent or “third-party” lawsuit lenders who are more than willing to lend moderate amounts of money against WC claims in exchange for high interest rates as high as 60%. The loans allow the rates to compound with interest being charged on interest. In some situations, the entire settlement can quickly be owed to the lawsuit lender.

 

From these abuses, about three years ago, the New York City Bar Association outlined these pitfalls with litigation lending:

 

1.    Illegality: The litigation lending agreement itself may be illegal. As outlined above, we agree with the U.S. Chamber’s Institute for Legal Reform to note the IL WC Act prohibits assignment of WC claims in this state. We feel the IWCC or courts should enforce the IL WC Act as written. There is no question these contracts outline or create a voluntary and impermissible assignment of workers’ comp benefits.

2.    Attorney as Advisor: If asked to recommend a source for such financing, or review or negotiate such an agreement, the attorney should candidly advise the client of the costs and benefits of such arrangements and suggest alternatives. Costs may include fees that are “excessive relative to other financing options, such as bank loans.” On the other hand, a benefit may be the client’s ability to cover expenses and avoid the need for funds forcing the client into a premature (and lower) settlement.

3.    Conflicts of Interest: The lawyer must be wary of conflicts of interest. For example, when may the lawyer accept a referral fee from the financing company? How does the lawyer advise the client objectively about financing when the client cannot afford the litigation without it and might drop a valid claim?

4.    Waiver of Privilege: Disclosure of certain information to a litigation lending company may waive the attorney-client privilege, and the “common interest” privilege may not apply. A lawyer should obtain informed consent from the client before disclosing privileged information to the litigation lending company.

5.    Control Over the Proceeding: Attorneys must guard against the litigation company exerting undue control over the legal proceeding.

 

We are aware of many challenging ethical issues for Petitioners’ firms in handling and dealing with such loans. To our understanding Petitioner firms are asked and provide some sort of estimate of future “value” of Petitioner’s claim. They also agree to let the litigation lender know when the settlement or decision is being paid.

 

From the Defense/Risk Side of the Bar

 

Why don’t businesses and their defense teams, like KCB&A want litigation lending? We are advised as many as 40% of IL WC claims involve litigation lenders. The impetus for some work injury claims are fast money and litigation lenders provide it. Insurance carriers, self-insured employers and others see questionable claims that might not even start without such lending. We also see claims run on for years because no one wants to tell claimant they are not going to get any money at the end of the claim because the shylocks will now get it all.

 

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

 

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Synopsis: IL WC Advisory Rates Not Big News in IL Governor’s Race—Expect the Real News in October.

 

Editor’s comment: Late last week Gov. Pat Quinn announced a 5.5 percent drop in IL WC rates for 2015 was being recommended by the National Council on Compensation Insurance. The Quinn administration said if enacted it would represent a cumulative 18 percent cut in the ethereal advisory rates since the IL work comp reforms were enacted by the current administration in 2011.

 

However, the latest IL WC advisory rate announcement keeps with the same silly trend we have seen once a year at the IWCC for decades. Just last November, we addressed this annual announcement in which NCCI recommended lower advisory rates for WC insurance should drop. One funny thing we have seen once every year for decades and decades is an annual announcement in August about the stat-rats at NCCI recommending advisory rates for WC insurance should drop, by either a little or a lot. We consider this to be similar to selling stock in the Golden Gate Bridge—it sounds good but it isn’t worth anything to anyone. Last fall, the PR mill at the IL WC Commission just dropped this WC advisory rate hot flash:

 

NCCI files for 4.5% decrease in 2014 WC advisory insurance rates-The National Council on Compensation Insurance filed for an 4.5% decrease in voluntary advisory insurance rates, effective January 1, 2014, following the 3.8% decrease in 2013.

 

Before we start popping champagne corks and tossing confetti, we recommend everyone calm down. We have no true idea what advisory rates might be and why anyone thinks they are news. If rates dropped as much as NCCI says they should, WC insurance should be free in this state! Every year, year in and year out, NCCI recommends decreases in IL WC advisory rates. In the 2009 IWCC annual report, the IWCC heralded the fact advisory rates dropped 33% from 1990 to 2008. The IWCC indicated the massive reduction in advisory rates was calculated using advisory rates filed annually by the National Council on Compensation Insurance, a rating organization authorized to file rates on behalf of companies pursuant to Section 459 of the Illinois Insurance Code (215 ILCS 5/459).

 

Blah, blah, blah. In 2012, IL WC advisory rates dropped 3.8%.

 

http://insurance.illinois.gov/newsrls/2012/08/DOIReviewsReductionOfWorkersCompRate.pdf

 

In 2011, IL WC advisory rates dropped 8.8%. Starting to notice a trend?

 

http://www.insurancejournal.com/magazines/features/2011/09/19/216159.htm

 

Please don’t tell us any more about IL WC advisory rates and how they are dropping. Advisory rates are clearly trumped by actual WC insurance premiums. The every-other-year analysis by the State of Oregon is the best source for the actual WC premium ranking that we were advised will be again published this October::

 

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

 

There is nothing advisory about these metrics—the State of Oregon looks at what IL business is actually paying and, when last published we were number 4 in the country. By number 4, they mean fourth highest or, to be more blunt, fourth worst. premiums. Yes, folks; we care about actual premiums; not advisory and ethereal rates. Let’s hope IL WC has moved back to the middle of the pack and gotten out of the top ten worst.

 

As good news, we do feel significant progress has been made at the IL WC Commission. IL WC Medical reimbursements are dramatically lower. There is no question PPD values have dropped in a solid but fair fashion. We feel the IL WC Arbitrators are professional, knowledgeable and very sensitive about claims involving WC fraud or over-reaching. We still feel our Arbitrators and Commissioners can make improvement in getting claims to hearing or reasonable settlement but we are also sure they might have their own recommendations for the attorneys who appear before them. In contrast to the IWCC hearing officers, we don’t feel the reviewing courts have any concerns at all about the cost-effectiveness of their “activist” or liberal rulings.

 

Perhaps this year's announcement of a recommended drop in advisory rates is only compelling because it precedes the upcoming Illinois gubernatorial election. Work comp costs are an emerging election issue. Both candidates continue to address this issue. If Oregon's October 2014 report shows little or no improvement, Mr. Rauner may have proof that the reforms did not go far enough. If that's the case, support for Mr. Rauner may certainly increase his lead over Mr. Quinn, who is already shown to be behind as much as fourteen points in a July poll. Regardless of the election and all politics aside, the KCB&A defense team is hopeful this new study will show improvement for the State of Illinois. Decreasing work comp rates and premiums will only help Illinois' work comp system and our business environment become more competitive with other states in our region.

 

This article was researched and drafted by Jennifer Maxwell, J.D. along with your editor. You can reach Jenn to discuss this and other defense issues at jmaxwell@keefe-law.com.

 

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Synopsis: Jewel Companies Dodges Bullet on Challenging Down Syndrome Worker’s ADA Beef--Important Seventh Circuit ADA Ruling with analysis by Michael L. Shanahan, J.D.

 

Editor’s Comment: The Seventh Circuit Appellate Court in Reeves v. Jewel Food Stores granted summary judgment in favor of Jewel Food Stores on an Americans With Disabilities Act (“ADA”) failure to provide a reasonable accommodation claim because the Plaintiff’s parents did not make reasonable efforts to determine what accommodations were necessary. This decision appears to be a victory for employers as it promotes joint responsibility for developing and providing reasonable accommodations to disabled workers.

 

EMPLOYERS MUST ENGAGE IN AN “INTERACTIVE PROCESS” TO ARRIVE AT A REASONABLE ACCOMMODATION

 

The centerpiece of the ADA—in terms of workplace rights—is the right to request a reasonable accommodation. A reasonable accommodation is a change to the work environment, in the workplace, the job itself, or process that would allow a person with a specific disability to apply for a job or perform the essential functions of the job once in the position.

 

Under the ADA, it is illegal for an employer to discriminate against any employee who requests or needs a reasonable accommodation. After the employee requests or the employer learns the employee needs a reasonable accommodation, the employer and employee should discuss possible solutions and try to arrive together at an accommodation that works for the employee. This discussion is formally known as the “interactive process.”  However, the employer does not have to provide a reasonable accommodation if it requires significant difficulty or expense.  Nonetheless, whether a reasonable accommodation requires significant difficult or expense is a factual intensive inquiry that is beyond the scope of the instant article.

 

In Reeves, the employee worked as a bagger at Jewel and suffered from Down Syndrome. When Plaintiff was initially hired, Jewel provided a job coach, an individual training program on the daily tasks, and a supervision policy in tandem with the employee’s parents. Additionally, the employee was exempt from certain duties such as collecting shopping carts from the parking lot.

 

Over the course of Plaintiff's employment, there were several instances where he cursed at managers or fellow coworkers in front of customers and on one occasion where he took a pin without realizing they were for sale. However, despite these incidents, the Plaintiff was not terminated. Following the pin incident, the Plaintiff's parents requested Jewel hire a job coach again, but Jewel thought it was unnecessary and Plaintiff's parents no longer persisted. Ultimately, Plaintiff was terminated after an outburst where he cursed and yelled at a fellow coworker in front of customers.

 

In granting Jewel summary judgment on the merits, the Court found Plaintiff's parents did not make reasonable efforts to decide and convey what reasonable accommodations were necessary. It appears the Court relied heavily on the fact Plaintiff's parents did not press the job coach issue further, they did not request an alternative accommodation, and they did not indicate that said coach could have prevented future profane outbursts. Furthermore, the Court found the request was made after the pin incident, which did not imply an accommodation for inappropriate verbal outbursts.

 

This decision is an indication that the “interactive process” is more than simply a request.  Instead, the “interactive process” requires a meaningful discussion with specific recommendations and suggestions by both the employer and the employee (or in this case, the parents on behalf of the disabled employee/Plaintiff).

 

Nonetheless, despite Jewel’s victory, employers would be wise to investigate reasonable accommodations requested by their employees with diligence. Notably, if the request by Plaintiff’s parents was related to the cursing and yelling repeatedly committed by Plaintiff, then Jewel likely would have had to engage in an “interactive process” to review whether they could have provided the reasonable accommodation as requested.

 

This article was researched and written by Michael L. Shanahan, J.D. He is available for answers to any questions about general liability, employment law, or workers’ compensation at mshanahan@keefe-law.com.

7-28-14; To the Labors of Motherhood May Come New Civil Rights--Illinois and Federal; EEOC Issues New Guides about Rights of Pregnant Workers; IL WC Medical Fee Schedule Goes Up and much more

Synopsis: To the Labors of Motherhood May Come New Illinois Civil Rights Protections and More Challenges for Business and All Illinoisans.

 

Editor’s comment: HB 8 was hurriedly rushed through the IL House and Senate and on June 26, 2014 it was sent for Gov. Quinn’s signature. If he signs it, the bill won’t become effective until January 1, 2015. In our view, it is more unneeded regulations for Illinois business. We feel the public relations impact for our legislators to “take care of pregnant women” was too hard for them to turn down. You may note 32 legislative sponsors of this bill were women. The bill arguably promotes workplace fairness for pregnant workers by requiring employers to make reasonable accommodation for conditions related to pregnancy, childbirth, lactation and related conditions, unless the employer can demonstrate the reasonable accommodation would impose an undue hardship on the ordinary operation of the employer’s business—just as employers do for reasonable accommodations caused by other conditions.

 

What Was Wrong with Federal ADA and PDA?

 

The bill is supposedly modeled after the Americans with Disabilities Act, the Pregnancy Discrimination Act and analogous state law. We ask the rhetorical question, why not simply rely on the ADA and PDA? Proponents assert HB 8 was necessary because state and federal law and enforcement was supposedly unclear—as you will see below, the EEOC just changed their guidelines. Proponents further claim courts and employers continued to deny pregnant workers the kinds of job modifications they routinely offered to other employees who are similar in their ability or inability to work—we have no idea what rulings were being referred to. We know of one jury verdict against a well-known Chicago restaurant where a pregnant employee recovered $300,000 along with her attorney’s fees and costs for alleged employment discrimination due to pregnancy. There is no question Illinois state employment laws and federal law require employers to provide pregnant workers the same treatment and benefits provided other workers who require temporary accommodations.

 

Little Illinois Companies and Large Illinois Employers May Have to Learn and Implement This New Legislation

 

In our view, this bill may apply to your home-based nanny, cleaning lady, babysitter, dog-walker, any single person you hire to work for you. If it becomes law, the new Public Act amends the Illinois Human Rights Act and defines "pregnancy" as pregnancy, childbirth, or related conditions. It now defines an "employer" to include any person employing one or more employees when a complainant alleges civil rights violation due to unlawful discrimination based upon pregnancy. It doesn’t make a distinction between part-time or full-time workers.

 

The provisions regarding pregnancy are applicable regardless of the source of the employee's inability to work or employment classification or status, including part-time, full-time, or probationary. The bill also provides it is a civil rights violation for an employer, with respect to pregnancy, childbirth, or a related condition:

 

(1)  not to make reasonable accommodations, if so requested, unless the employer can demonstrate that the accommodation would impose an undue hardship on the ordinary operation of the business of the employer;

(2)  to deny employment opportunities or benefits to or take adverse action against an otherwise qualified job applicant or employee;

(3)  to require a job applicant or employee to accept an accommodation the applicant or employee chooses not to accept; or

(4)  to require an employee to take leave under any leave law or policy of the employer if another reasonable accommodation can be provided.

 

Can You “Misclassify” a Pregnant Worker to Try to Avoid the New Law?

 

One potential way around the new law might be to hire a “business” to provide small-scale services needed, like house-cleaning and dog-walking. What we mean by “misclassify” is to treat anyone you hire as a separate company. When you hire one person to perform a service like housekeeping, can you treat them as a “business” and issue a 1099 for payments made to them. What if the “business” you hire is a sole proprietor? We aren’t recommending creating ruses or participating in fraud to avoid the new laws—we just want our readers to better understand if you hire one worker, the new state law appears to come with employment status. On the other hand, if you hire a business to provide a service for you, the business is supposed to reasonable accommodate the pregnant worker. We have no idea is a sole proprietor of a dog-walking business has to accommodate herself if she is a business versus just a dog-walker! For larger companies, you risk the IL Department of Labor coming after you when you misclassify workers.

 

Do the Civil Rights Protections for Pregnant Workers Start When They Learn They are Pregnant and End with Childbirth?

 

No—the protections start when reasonable accommodation of pregnancy starts and end with the cessation of lactation or other medical sequalae of the pregnancy. For some mothers, this might be several years. If you aren’t sure about whether you need to accommodate at any time, send a reply and a KCB&A defense team member will give you our best thoughts.

 

Can an Illinois Business or Individual “Drug Test” to Confirm Pregnancy?

 

Some time ago, we had a client who wanted to terminate an ineffective worker—when the client talked to her worker, the troubled employee indicated she was pregnant. Our client tried to reasonably accommodate the worker for several months to then have the employee quit without notice and basically disappear. Our client felt she was bamboozled and she felt the employee completely faked her claimed pregnant status. The client asked a reasonable question—in the future, if another worker advised of pregnant status, could the client ask the employee to drug test to prove she was pregnant? It would seem reasonable under either state or federal law for documentation of status to be part of due diligence in handling all claims.

 

We have asked this question of many of our closest readers and friends and the uniform answer was not to require a pregnancy test. Instead, our readers/friends of the firm felt a much better approach was to ask the worker to provide a note from an OB-GYN or other similar physician to confirm

 

·         The fact of pregnant status and

·         The needed reasonable accommodation due to that status.

 

In taking that approach, you basically are following a much more effective model or process. You are also setting up a path for continued documentation of accommodation needs. We are happy to consider your best thoughts on this issue.

 

An IL Employer Can’t Force a Pregnant Employee to Stay Off Work

 

We know the City of Chicago sends pregnant workers in some departments home from work for a full year, whether the worker wants to work with accommodation or not. The reason you don’t hear much about this practice in the press/media is relatively few women will turn down and fight over a year off work with full pay and benefits. Both state and federal law make such practices an actual or potential violation of a pregnant worker’s civil rights. We hope City administrators stop that practice and try instead to keep hard-working employees in jobs with accommodation.

 

IL Employers Will Have to Change Your Workplace Notices and Handbooks Next Year

 

It will be a civil rights violation for an IL employer to fail to post, keep posted, or fail to include in any employee handbook information concerning an employee's rights under the Act, a notice, to be prepared or approved by the Department of Human Rights, summarizing the requirements of the Act and information pertaining to the filing of a charge, including the right to be free from unlawful discrimination and the right to certain reasonable accommodations. The bill also provides it is a civil rights violation to retaliate against a person because he or she has requested, attempted to request, used, or attempted to use a reasonable accommodation. HB 8 does not require employers to create new jobs or to fire, transfer an employee with more seniority, or promote an unqualified employee. The theory is to provide pregnant employees with reasonable, temporary accommodations to increase worker productivity, retention, and morale, decreases re-training costs, and reduces health care costs associated with pregnancy complications.

 

As we outline above, the bill was sent to the Governor on June 26, 2014. Assuming the Governor signs it and every indication is he will, the bill will become effective on January 1, 2015. If you need help implementing the new law or seek assistance with defending pregnancy claims, contact our defense team leader Brad Smith at bsmith@keefe-law.com. To read the new law, click here:

 

http://ilga.gov/legislation/billstatus.asp?DocNum=8&GAID=12&GA=98&DocTypeID=HB&LegID=68233&SessionID=85

 

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

 

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Synopsis: The U.S. Equal Opportunity Commission has released new guidelines for the enforcement of laws prohibiting workplace discrimination against pregnant women.

Editor’s comment: These are the first new federal guidelines on pregnancy discrimination in more than 30 years. The document, titled EEOC Enforcement Guidance on Pregnancy Discrimination Related Issues, seeks to clarify or better outline federal rules on discrimination against pregnant workers under both the Pregnancy Discrimination Act and the Americans with Disabilities Act.

The EEOC is responding to an increase in Pregnancy Discrimination charges/complaints; They also feel the Federal Courts are leaving both sides confused in their rulings

The guidelines were issued following a rising number of complaints regarding pregnancy discrimination in the workplace, as well as differing interpretations of existing law by different courts. The U.S. Supreme Court recently agreed to hear a pregnancy discrimination case during its October 2014 term, in part because of lower courts' differing views of the existing law.

New EEOC Guidelines Clarify Their View of Pregnancy Discrimination

The EEOC's new guidelines seek to make things fairly clear, emphasizing workplace discrimination against pregnant women is a prohibited form of sex discrimination. For U.S. employers and risk managers, please remember the EEOC has virtually unlimited funds and can and will sue employers over their view of what should be U.S. law. While most of these charges/claims settle, the EEOC then can force employers to accept and pay for discrimination counseling for years to come. They will also audit to insure you are complying.

Here are the important facets of the new guidelines:

Ø  Pregnancy-related conditions are considered disabilities under the ADA, which require employers to provide reasonable accommodations as they would for any other medical disability.

Ø  Employers may not fire, demote, or refuse to hire women based on a current or potential future pregnancy or any other pregnancy-related medical condition.

Ø  Lactation is a medical condition and has to be afforded "reasonable break time" to address lactation-related needs.

Ø  Women may not be forced to take leave during or following a pregnancy if they can still adequately perform their assigned tasks.

Ø  Women may not be treated differently or restricted from doing certain jobs, such as those that may expose them to hazardous chemicals, solely based on their ability to become pregnant.

Ø  An employer may not inquire about whether a woman intends to become pregnant, as such inquiries will be generally regarded as evidence of pregnancy discrimination in the event of any future unfavorable action.

The new EEOC guidelines on pregnancy discrimination take effect immediately, and can be read online in their entirety at the EEOC's websitehttp://www.eeoc.gov/laws/guidance/pregnancy_guidance.cfm

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Synopsis: The Illinois WC Commission Increases WC Fee Schedule Payment for Medical Evaluation and Management Procedures Such as Office Visits. Analysis by Pankhuri Parti, J.D.

 

Editor’s comment: While the purpose of the Order seems innocuous enough – ensuring the injured workers still have access to doctors willing to treat their work injuries, we fear the consequence of this new order may be to overburden the employers, who already face an uphill battle in the Petitioner friendly workers’ compensation system of Illinois.

 

How the IL WC Medical Fee Schedule at the Illinois Workers’ Compensation Commission Works?

 

Through the 2005-2006 Amendments of the IL WC Act, the IL legislature ordered the IL WC Commission to create fee schedules for treatment provided on or after February 1, 2006. Under this approach the payment to the medical provider would be the lesser amount of either the actual charge or the amount deemed appropriate in the fee schedule. Section 8.2 of the Workers’ Compensation Act stated clearly the fee schedule set the "maximum allowable payment;" and the employer was expected to pay to the medical provider either the actual amount billed or the fee schedule amount, whichever was less. Inherent in this approach was the liberty granted to the parties – the medical provider and the employer – to contract for amounts different than the fee schedule rates and if the contracted/billed amount was less than the fee schedule rate then the employer would be bound to pay that amount. In all these situations the amount charged, the fee schedule amount, and the contracted amount, would represent full payment for the services rendered by the medical professional.

 

It is important to note the fee schedule only affects the amount of payment made to the medical provider by the employer. It has nothing to do with the question of whether or not the treatment being undergone by Petitioner is reasonable and necessary and covered by workers’ compensation. 

 

At the time the fee schedule was first implemented the maximum allowable payment was deemed to be 90% of the 80th percentile of charges and fees as determined by the IL WC Commission and based on the information on the provider billed amounts obtained from employers’ and insurers’ national database. The Commission was then to adjust these charges by the Consumer Price Index-U or Consumer Price Index-M. As a result of the legislation the Commission established fee schedules for procedures, treatments, and services for hospital inpatient, hospital outpatient, emergency room and trauma, ambulatory surgical treatment centers, and professional services. For the services for which the fees could not be calculated, the fees were set, by default, at 76% of the charged amount.

 

Changes in the IL WC Fee Schedule System over the Years

 

On February 2009 the IL WC Commission created new fee schedules for ambulatory surgical treatment centers, hospital outpatient radiology, pathology, and laboratory, physical medicine and rehabilitation services, and surgical services, and rehabilitation hospitals. Based on its work with the Workers’ Compensation Medical Fee Advisory Board, the Commission decided the change the reimbursement methods for certain services but later repealed this changed. Instead it was decided the treatment would be paid at the 65%-of-charge rule.

 

On June 28, 2011 Governor Quinn signed the House Bill 1698 and one of the provisions in the bill reduced all fee schedules by 30% and reduced the default pay 76% of charge to pay 53.2% of charge instead. Doctors and hospitals in our state started screaming at their lobbyists over these dramatic cuts. However, many observers still feel the discounted values remained higher than group health reimbursements.

 

On July 16, 2014 the Illinois WC Commission passed an order to increase the reimbursements for certain identified services to the recommended levels so as to increase the injured employees’ access to health care.

 

The New IWCC Order and Recommended Changes

 

The Commission passed this order under Section 8.2(b) of the Act which allows the Commission to change the CPI-U if it finds there is a significant limitation on access to quality health care in either a specific field or geographical location. The order was based on a December 2013 memo which highlighted concerns about some Illinois Workers’ Compensation fee schedule payments, claiming they were at rates which might limit access to medical care. The memo raised the possibility of healthcare providers ceasing to treat injured workers where payments were unreasonably low and identified the possible reasons as the influx of millions of new insureds into the healthcare market and the Affordable Care Act.

 

The analysis on which the decision was reached compared the fee schedule amounts after the 30% reduction in September 2011 with payments made to providers under Medicare and noted fee schedule amounts for many Evaluation and Management codes were less than that provided under Medicare. Additionally, the commercial payments were significantly above those deemed as appropriate in the fee schedule. Because the commercial payments were so much higher than the fee schedule and the Medicare payments were also higher in many instances, the memo concluded there was a reasonable chance of primary care physicians ceasing to treat injured workers when they could so easily fill their schedules with better insured patients.

 

As a result the purpose of the changes was to bring the payments under the fee schedule for evaluation and management services to a level comparable to Medicare. Some of the evaluation and management procedures identified for the purposes of increasing the reimbursements rates are: office/outpatient visit new, office/outpatient visit established, home visit new patient, and home visit established patient. The order accepts the proposed CPI percentage increase, the proposed dollar increase, and the proposed fee schedule amount recommended by the memo. The IWCC memo detailing the changes can be accessed at http://www.iwcc.il.gov/EMorder.pdf

 

We appreciate your thoughts and comments. Please post them on our award-winning blog. This article was researched and written by Pankhuri Parti, J.D. She can be reached for information or assistance with this and other defense issues atpparti@keefe-law.com.