9-22-14; Is the IL Gov't Apocalypse Drawing Near?; Big Cat Dodges Employment Law Bullet; How IL Judges-Legislators Can Make $1M Per Year of Service and more

SYNOPSIS: Is the Illinois Government Apocalypse Starting? Analysis by John P. Campbell, Jr., J.D.

 

EDITOR’S COMMENT: Illinois citizens willingness to perpetually fund spiraling government pensions through higher and higher taxes is hitting an apex. We recently saw the Village of North Riverside, IL seek a declaratory judgment allowing them to do away with their Municipal Fire Department. We feel this may be a sign of things to come in our state where municipalities can’t keep up with generous and ever-increasing government “pension structures. We assure our readers many other Illinois municipalities may be starting similar litigation for the same reasons.

 

When we reviewed the recent lawsuit filed by the Village of North Riverside in Cook County Chancery Court we learned they are seeking a declaratory judgment from the Court permitting them to “outsource” fire protection and thereby, do away with their fire department. Crazy? Unsafe? Reckless? Well, when you peel back the onion and see the massive pension funding problem faced by the Village, you may come to realize that they have no choice.

 

It goes without saying, we all want readily available fire/police/emergency services for ourselves and our loved ones. However, there are reasonable alternatives, and as the pleadings in this case appear to accurately outline, a 540% increase in pension funding obligations over the past 10 years is simply unsustainable for North Riverside or any fiscally responsible village/city/municipality. The annual pension outlay per firefighter went from $8K per year in 2003 to $45,474 per year in 2013!

 

Why? Well, more firefighters are retiring and living longer; well out-pacing their earlier pension contributions. It’s simple math. You can’t fund your personal 401K with $7,500 per year for 20 years and then “withdraw” $40,000 each year for the next 30 years –your 401K would dry up long before. This is, in effect, what is happening to government pensions in North Riverside and many, many other Illinois communities. Something has to give at some point.

 

Aside from the safety concern with eliminating the department, the Firefighters Union no doubt will argue the “right” to the pension for members. While it sounds nice to have a “right” to endless pension dollars, we can’t help draw a parallel to private bankruptcy, where pension and 401K money is lost where the money simply runs out (Does Enron ring a bell?).

 

Why is a public pension like a firefighter union pension different? Well, they will be quick to point out the town is not really out of money, they just need to generate more money to feed the pension monster via either

 

(1) Significant program cuts in other municipal areas or

(2) Greatly raise real estate or other taxes, both now and in future years.

 

However, most municipal budgets are as lean as they can get since the economic downturn in 2008. As defense counsel for a number of municipalities, we know budgets have been trimmed to the extent possible while still providing basic services to citizens. So what’s left? Your tax dollars folks!

 

In effect, the only way to “bailout” the pension crisis is to dramatically raise taxes to cover costs. What happens with that solution if folks move away or don’t move to that Village/City due to the high tax cost? This “solution” also pits public employees with these pensions against the remaining private workforce, who will be asked to kick in more of their paycheck to cover someone else’s pension. The private sector worker may pause and think “wait a minute, I don’t have a guaranteed pension for life. Why should I pay into yours?” Not a pretty situation at all. The reason we feel this may be an apocalyptic change is to consider the next 10 years where the cost of such firefighter pensions might follow the same financial curve where the annual pension outlay per firefighter could be $100K or more. We again ask political leaders who support the current status quo, just how we are going to keep this house-of-cards afloat? Last year, both House Speaker Madigan and Senate President Cullerton sent letters to State union leaders for their plan on how to make financial sense of state pensions; we are unaware of any substantive response.

 

Let’s make one thing clear as well; a good portion of Illinois’ public pension crisis was not caused exclusively by over-generous pension structures demanded by unions. State, County and Local Governments have to look in the mirror as well and honestly ask whether they have adequately met their pension funding obligations over the past two decades or more. This is a lesser advertised but very real problem. One thing not addressed in the pleadings of this case that we reviewed is any mention of the equitable contribution to the pension by the municipality over the past 10-20 years. We would be curious to know if North Riverside met a realistic pension contribution schedule to sustain the health of the fund. This is often a source of great debate and will likely be argued as part of this litigation.

 

Is there a solution? Well, there are certainly options. The Village of Glencoe, Illinois for example, has had a combined “public safety” workforce for the past 17 years. Their firefighters are trained as police and vice versa. They recognized tremendous savings with this structure and this relatively affluent community has no reported complaints of deficient police/fire coverage. Glencoe may be the model for other Illinois communities struggling with these pension costs like Riverside. Unfortunately, it may take a protracted legal battle to forge such change. We will report on the Village of North Riverside’s efforts down the road.

 

This article was researched and written by John P. Campbell, Jr., J.D. Please send thoughts and comments to John at jcampbell@keefe-law.com.

 

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Synopsis: Is it wise to fire an employee who has made multiple, at times well founded, complaints with regard to harassment by co-workers? You may be surprised at the answer. Analysis by Shawn R. Biery, J.D.

 

Editor’s comment: We consider this an intriguing federal case which provides excellent guidance both to the extent that strong legitimate investigation can provide an excellent basis for multiple protections in defending future related litigation.

 

In Muhammad v. Caterpillar, Inc., No. 12-1723 (September 9, 2014) the Seventh Circuit affirmed the District courts grant of defendant-employer’s motion for summary judgment in a Title VII action alleging defendant had failed to take appropriate steps to stop plaintiff’s co-workers from subjecting him to sexual and racial harassment and claims for damage after subsequently suspended plaintiff in retaliation for complaining about said harassment.

 

By way of background, Warnether Muhammad alleged his coworkers at Caterpillar, Inc., created a hostile work environment by subjecting him to sexual and racial harassment and further argued his supervisor retaliated by suspending him after he complained about it. He was provided a right-to-sue letter from the Equal Employment Opportunity Commission, resulting in the suit discussed here. The federal district court however granted summary judgment for Caterpillar noting the company reasonably responded to the complaints of harassment, and no evidence suggested Caterpillar suspended Muhammad because he complained.

 

The court was clear to confirm they recite the facts in the record in the light most favorable to Muhammad. Suffice it to say, the offensive comments were both racially and sexually charged and came from three different employees, however they appear to have resulted in remedial action by the company after investigation. The company also responded to offensive comments which were scrawled on the walls of the bathroom nearest Muhammad’s with swift action being taken to immediately contact a third-party provider of painting services to have the graffiti painted over on several occasions. As part of the reporting, there was a discussion with Muhammad regarding following the chain of command in submitting complaints. The graffiti problem further was remedied by discussing it with all of Muhammad’s coworkers at a shift meeting, with another incident resulting in each person on Muhammad’s line being individually warned that anyone caught defacing the walls would be fired immediately. No more graffiti appeared.

 

Roughly six weeks later, an incident occurred that resulted in Muhammad’s suspension.

 

On that day, Muhammad left his work station during a non-break time to use the restroom, and checked the bid board for postings before returning to his station resulting in suspension pending the investigation of the alleged misconduct by the company. After that internal investigation, the suspension of Muhammad was deemed appropriate. Muhammad filed a grievance through his union representative and was allowed to return to work however was then later suspended a second time and then terminated based on his conduct with his coworkers upon his return. Following the settlement of his grievance of the termination, he returned to work at Caterpillar with no back pay, and was laid off due to a reduction in force in April 2009. He was later rehired at Caterpillar where he remains employed.

 

Based on incidents of August-October 2006, Muhammad filed his charges of harassment and retaliation with the EEOC, and in June 2009 he received his right-to-sue letter. Shortly thereafter he filed this suit, alleging that he was harassed with offensive comments about his perceived sexual orientation and his race and that Edwards suspended him in retaliation for reporting the offensive graffiti.

 

The federal district court granted summary judgment for Caterpillar. In rejecting the claim of sexual harassment, the court relied on the decision in Spearman v. Ford Motor Company, 231 F.3d 1080, 1085 (7th Cir. 2000), which held the Title VII prohibition on discrimination based on sex extended only to discrimination based on a person’s gender, and not that aimed at a person’s sexual orientation. The district court also ruled Caterpillar was not liable for any racial harassment by coworkers because, in the court’s view, the company’s responses to Muhammad’s complaints of harassment were reasonable. Finally, the court concluded Muhammad lacked evidence Edwards retaliated against him for complaining about the harassment.

 

The Court noted Muhammad’s argument, made for the first time on appeal, that his coworkers would not have harassed a female for her sexual preferences was speculation. At summary judgment, Muhammad did not produce evidence to support his assertions. They also noted that even if they set that problem aside, another more fundamental obstacle blocked Muhammad’s claim Caterpillar was liable for sexual and racial harassment: Caterpillar reasonably responded to Muhammad’s complaints. The evidence suggested there was only one secondary offensive remark and Muhammad admittedly did not report that secondary remark.

 

As for the graffiti, Caterpillar responded quickly each time Muhammad reported it, and stopped the problem permanently. Muhammad conceded the graffiti never reappeared after the individual warnings. The court accurately noted Title VII requires only that employers take action reasonably calculated to stop unlawful harassment; that requirement does not necessarily include disciplining the employees responsible for past conduct.

 

With those decisions, it left only Muhammad’s retaliation claim. Title VII also prohibits employers from retaliating against employees for their opposition to unlawful employment practices. However Muhammad only alleged the initial suspension constituted retaliation against him for his complaint of harassment. Caterpillar maintained Muhammad was suspended because he left his work station during a non-break time to check the bid board and when the supervisor Edwards attempted to discuss the impropriety of that action and other concerns with Muhammad, Muhammad responded disrespectfully, refused to talk with him, and walked away from him as he was speaking.

 

The federal court noted Muhammad made no effort to establish an admission of animus or to otherwise present direct evidence of it, and he failed to present evidence that rises above the type of speculation that is insufficient to survive summary judgment. Muhammad acknowledged he left his workstation during a non-break time to use the restroom, and he checked the bid board to see what jobs were posted in the plant before returning to the station. He conceded Edwards confronted him concerning his use of non-break time to check the bid board. Although he stated he did not walk away while Edwards was speaking to him, his testimony is vague as to what happened. He acknowledged in his testimony he did not want to discuss the situation with Edwards without union representation, and in his response to the motion for summary judgment he appears to employ that as a justification for his refusal to continue the conversation. Whether or not Muhammad walked away, it was undisputed Edwards approached Muhammad with a concern about his work performance, and some conflict arose in the course of discussing the matter.

 

The evidence submitted by Muhammad indicating the suspension was retaliatory in violation of Title VII was minimal. The court noted there was virtually no evidence, other than the possible temporal proximity, the conversation played a role in the suspension, and the courts have repeatedly held mere temporal proximity is rarely sufficient. There is no indication in the record the chain-of-command conversation was anything more than a reminder as to the proper procedures of the workforce. In fact, when asked in his deposition why he was suspended, Muhammad repeatedly stated either he did not know or he was told it was because of poor performance, not because of his complaint to Johnson. He later stated he believed it may be related to his decision to complain to Johnson directly about the harassment, but that was nothing more than speculation on his part.  Accordingly for multiple reasons, the federal appeals court ruled the district court did not err in granting summary judgment on the retaliation claim as well.

 

The goal in any similar situation is to ensure the allegations are investigated and to take appropriate action if applicable. A side note derived from a study of this claim is the knowledge that additional protections provided by such appropriate investigation and action can avoid damages for claims which may then be filed in retaliation if the employee is not satisfied with a result or if the investigation reveals some inappropriate behavior by the complaining employee. The decision may be tempered somewhat by the fact this plaintiff returned to work for the employer, however I prefer to believe the court simply decided appropriately on the facts at hand. This article was researched and written by Shawn R. Biery, J.D, MSCC. Shawn can be contacted at 312-756-3701 or sbiery@keefe-law.com.

 

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Synopsis: How Illinois Judges and Legislators can make more than $1M per each year of service. Do We Want to Pay This Much for Government Workers at Any Level?

 

Editor’s comment: Our readers asked and here are the answers. Please note everything we outline in this article is completely “legal” but in our opinion, shocking. Right now, Illinois’ full Circuit Court judges with their constitutionally guaranteed annual 3% increase will make $203,770.66. Four years from now, they will be making $222,592,62. In 14 years, their annual judicial salaries will be $299,145.87. 25 years from now, they will be making $414,087.84. This “spiral” won’t stop until the IL Constitution is changed. A traffic court judge can make more than our Governor, Attorney General or any statewide official.

 

For all the fanfare, you may want to also note only 3 of the 5 Illinois pension programs were “reformed” last year. Nothing about the IL pension “reform” bill passed last year, not a word, made any change to these painfully generous judicial or legislative “pensions.” In fact, the IL legislature couldn’t touch judicial pensions because their pensions are guaranteed in the IL Constitution and require a constitutional amendment to be modified. IL Judges/Justices are vested in their pensions in only 9 years of service. We have no idea who picked that odd number or why. If they vest and get out of the jobs after the vesting time period, neither our judges or legislators put in one full year’s salaries to then be entitled to lifetime “retirement” benefits. Would you contribute $100K to then get $9M back over your lifetime—who wouldn’t? The reason we put “retirement” in quotes above is very few of IL judges or legislators stop working, they just start getting money from us and move into other jobs.

 

Both retired IL judges and legislators will go through their entire “pension” contribution amount in less than one year after retirement. Upon retirement, a full Circuit Court judge and legislator gets 85% of their highest salary in annual pension payments. Therefore full Circuit Court judges currently retire at pensions of approximately $170,000 per year. In four years, that starting annual pension number will be $178,074.09. In 14 years, $239,316.69. Once their contribution and the state’s match is quickly used up, their pensions are “unfunded” or “de-funded” which means they return to our current taxpayer-paid payroll even though their work is long over.

 

So, Here is How An IL Judge Can Get $1M For Each Year of Service

 

·         As we outline, take as an example judge who gets his/her post at age 51.

·         They start working for us on a salary of $170K and rapidly come up to $203K. In nine years of service, they will receive just under $2M in salary.

·         When they retire, they will retire at about $170K or 85% of $203K. In the first ten years of “retirement or from age 60-70, they will receive $2M or so. Total income from us is now $4M.

·         In the next ten years, or from 70-80 years old, they will receive about $2.5M. Total income from us is now $6.5M.

·         If they live from 80-90 years of age, and lots of judges are living that long, they will receive more than $3M in that decade.

·         That means they will have received more than $9M for nine years of judicial work.

 

Please also note all retired judges and legislators receive fully paid lifetime medical coverage from our tax dollars. The IL Supreme Court just ruled that post-employment benefit is protected by the IL Constitution and can’t be touched for existing/vested retirees. To our understanding, this healthcare benefit is simply a “freebie” on your dime—retirees don’t contribute a penny to this expensive lifetime benefit. Here is a link to consider. Please note the judges/justices in this link retired some time ago; new retirees will get lots and lots more: http://www.chicagonow.com/dennis-byrnes-barbershop/2012/05/retired-illinois-judges-raking-in-gluttonous-pensions/

 

Please note the vast majority of the money to pay retired judges/justice is coming from you and I and our current tax dollars—yes, we are paying for judges and legislators who retired 10, 20, 30 years ago. Less than 30% of the money for these pensions is coming from the paltry contributions from our past and current judges and legislators. IL Auditor General William Holland confirmed both the judicial and legislative “pension” systems cost IL taxpayers over $100M each in current dollars. We also have to pay the cost of the interest on the money the State is borrowing to fund the “unfunded” amounts. We assure you the $105B in pension debt is gone/spent and will have to be paid back by you, me, your grandkids and their grandkids. That number continues to rise dramatically.

 

This isn’t sustainable and can’t be made sustainable—who will/can reform it?

 

We vote all the Illinois government pensions come under scrutiny or investigation. We don’t see that coming from Governor Quinn who we understand is strongly supported with millions in campaign cash coming from folks that want IL taxpayers to keep paying billions for fake pensions for former gov’t workers. Governor Quinn has been in office for six years and the pension deficit was less than $50B when he got the job—it is over $100B and could be over $200B if he is elected and no changes are made to these current and lucrative plans. Governor Quinn’s campaign website makes no mention of needed reforms to improve this pension mess.  Challenger Bruce Rauner is a successful and hard-working businessman and we hope his plans for moving new government workers into 401K plans is strongly considered. This crucial election is in 43 days, folks.

 

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

9-15-14; What Happens When WC Medical Care is Ruled Wholly Unnecessary?; Should IL Nursing Homes Have Security Cameras?; New Ruling on Municipal Liability for Snow Removal and more

Synopsis: What Happens When The IWCC Finds Medical Bills Unreasonable/Unnecessary?—Thoughts and Comments for IL Claims Handlers/Risk Managers. Thoughts and Analysis by Lindsay R. Vanderford, J.D.

 

Editor’s comment: We consider this an interesting and positive legal trend in IL WC Law and Practice. Last week there was an excellent WCLA (or IL Workers’ Comp Lawyers Ass’n) Symposium on current issues and rulings involving medical bills. If you have concerns and tough questions about how to best counterattack unnecessary and unreasonable medical care in the IL WC system, send a reply. Some of the key rulings are reported below.

 

(1)  Implications of Section 8.2(e) – What Happens When the IL WC Arbitrator or Commission Completely Denies Medical Bills?

 

The first case discussed was Hernandez v. Illinois Tamale Co. in which Petitioner, a line worker was injured when she slipped and fell in soapy water. Petitioner began treatment 2/2/09 and ended treatment 2/11/09 only to re-enter treatment at some point in April 2009. Petitioner underwent an IME on 5/11/09 wherein Dr. Trotter opined Petitioner had reached MMI and could work full duty. This injury occurred before the 2011 Amendments to the Act, but the Arbitrators decision was issued after the Amendments became law. Based on Petitioner’s testimony that she had worked full time during treatment and the findings of the IME doctor, the Arbitrator awarded no TTD and 6% MAW. The Arbitrator found Petitioner was entitled to medical care through 5/11/09, the date of Petitioner's IME. The Arbitrator adopted the opinions of Dr. Trotter that additional medical treatment subsequent to 5/11/09 was not necessary. Regarding medical care subsequent to the IME, the Arbitrator found such “medical care was neither necessary nor causally-related to the January 29, 2009 accident . . . The Arbitrator denied all medical expenses incurred subsequent to the Independent Medical Examination. [The Arbitrator specifically ruled] neither Petitioner nor Respondent shall be liable for these bills.”

 

There was no express statement in the Arbitration award that treatment was excessive or unnecessary under Section 8.2(e). The question is whether IL WC Arbitrators are now impliedly using Section 8.2(e) when there is a finding treatment is unnecessary and/or neither party is responsible. In pertinent part Section 8.2(e) reads, “Except as provided under subsections (e-5), (e-10), (e-15), and (e-20), a provider shall not bill or otherwise attempt to recover from the employee the difference between the provider's charge and the amount paid by the employer or the insurer on a compensable injury, or for medical services or treatment determined by the Commission to be excessive or unnecessary. (2011 Amendment emboldened). As a result, two related medical providers filed a civil suit against their patient in a breach of contract claim in Marque Medicos Fullerton, LLC and Medicos Pain & Surgical Specialists, S.C. v. Bertha Hernandez. This claim is pending before the Circuit Court and we assume but we can’t confirm the Arbitrator’s ruling will be pled and technically effective as a defense in the matter.

 

Transportation Expense isn’t a Reasonable and Necessary IL WC “Medical Expense”

 

In Horacio Perez v. Metro Staff Inc., Petitioner alleged a back injury following lifting a 45 pound box and that he felt a pulling sensation and immediate pain. Date of accident was 11/15/10 (pre-amendment). Petitioner was seen by company clinic, given light duty and physical therapies. An MRI was ordered showing DDD, protrusions and mild left lateral recess and neuroforaminal stenosis at L4-5 and borderline left neural frontal stenosis at L5-S1. Petitioner was referred to Dr. Babak Lami, who opined Petitioner was not a surgical candidate. Petitioner began treatment with Marque Medicos in March 2011. Dr. Erickson later recommended surgery and it was performed 6/29/11 and Petitioner was released to full duty thereafter. The Arbitrator found a causal relationship between accident and the onset of symptoms and subsequent condition of ill being.. Respondent was found liable for all unpaid medical bills related to the injury, specifically treatment from Elite PT, Dr. Erickson, Lake County Neurosurgery, Prescription Partners, Specialized Radiology, Quest Diagnostics, Marque Medicos, Marque Medicos Pain & Surgical Specialists and Ambulatory Surgical Care Facility. TTD was awarded and nature and extent was determined to be 22.5% MAW.

 

Respondent filed a Petition for Review. The Commission affirmed but found Petitioner failed to prove $4,758.00 in “transportation charges” by the medical provider were reasonable and necessary “medical expenses.” They reduced the award for medical expenses by $4,758.00 but remaining bills were to be paid pursuant to Section 8.2 of the Act. The decision made no specific reference to 8.2(e). The 8.2(e) standard requires only a finding of excessive or unnecessary medical services or treatment. Having looked online, we don’t see the patient was sued in civil court for this expense.

 

Surgery After MMI Findings May Be Risky for Petitioner

 

In Maria Gomez v. Speedway Super America LLC, Petitioner alleged injury to her low back lifting a 30 pound box of chicken 1/10/11. On 1/28/11, Petitioner completed an accident report and was seen at MacNeal ER. Petitioner began treating with Alivio Physical Therapy Chiropractic. Petitioner continued to treat with Alivio, with noted improvement. By 6/6/11, decreased pain in her lower back was recorded and Petitioner reportedly “felt no pain today.” Alivio PT notes indicated their patient had reached MMI. Petitioner attended an IME with Dr. Goldberg on 5/13/11, who noted normal exam findings. He read the MRI to show no significant pathology and only mild disc protrusions. He concluded Petitioner suffered a lumbar strain, recommended no further care and placed her at MMI. In contrast, Petitioner had an initial consultation with Dr. Ronald Michael on 6/6/11, who noted back pain worse than her bilateral leg pain, pains were severe with sitting, standing and walking; he noted numbness and tingling bilaterally in the lower extremities. Dr. Goldberg issued addendum report stating injections were not necessary, no change in opinion 9/16/11.

 

On November 10, 2011, in spite of the negative MRI, the MMI finding by Alivio PT and same MMI finding by the IME with Dr. Goldberg, Petitioner underwent posterior lumbar interbody fusion with hardware and discectomy.

 

Following surgery, Dr. Carl Graf performed another IME on 2/27/12. He concluded there were multiple inconsistencies, no disc herniation on MRI and no acute findings. He opined any and all care and treatment was not related to an injury. Respondent also produced UR reports decertifying injections, discogram, surgery and work conditioning.

 

The Arbitrator found Petitioner sustained an accident and reached MMI for the accident on 6/6/11, relying on the opinions of Dr. Goldberg, Dr. Graf and Dr. Barnabas placed Petitioner at MMI. The Arbitrator found the 6/6/11 visit inconsistent with Petitioner’s visit on that same date with Dr. Michael, who recorded severe low back pain. The Arbitrator awarded medical expenses only up through 6/6/11.

 

Petitioner filed a Petition for Review. The Commission specifically found all treatment, including but not limited to, treatment with Dr. Harsoor, Alivio, Rogers Park One Day Surgery Center, Dr. Michael, Metro South, and Oak Park Medical Center was excessive and unnecessary. Pursuant to Section 8.2(e), they found these providers shall not bill or otherwise attempt to recover from the Petitioner for medical services that have been determined to be excessive or unnecessary. The Commission discussed at length the medical evidence suggesting additional care and surgery was not medically indicated and ruled Dr. Michael’s medical opinions unsupported by evidence. The decision specifically referenced Section 8.2(e) in support of its decision to hold harmless both parties. The Commission decided against the providers for treatment prior to 9/1/11.

 

In our opinion, this is an area of law ripe for review. Arbitration or Commission decisions either to apply 8.2(e) retroactively may have swung the doors to the Circuit Court wide open. With no place to go to collect unpaid medical expenses as these decisions hold neither Petitioner nor Respondent liable, medical providers are seeking other legal avenues to pursue payment. One has to wonder if the same Petitioner attorneys who handled and lost the IWCC claims are going to then represent their clients when civil litigation is started, as part of the outcome of their handling and advice in the claim.

 

(2)  Payment for Services Not Deemed Covered or Compensable – The Scope of IWCC Settlement Contracts

 

More often than not, rather than undergoing a full-blown hearing, Petitioners and Respondents may negotiate an agreement to settle the claim. In Kline v. Rovery Seek Company, Inc. (08 WC 050971) just such a settlement was reached. Of note, UR of medical care was completed after the contracts were signed.

 

After the settlement was entered and approved, in Tiburzi Chiropractic v. Kline, the medical provider for Petitioner Kline filed a small claims suit for non-payment of related medical expenses. In turn, Petitioner filed a 19(g) petition in Circuit Court to arguably enforce the settlement contracts. The Circuit Court judge found the employer made full payment pursuant to the terms of the settlement contract and pursuant to Section 8 of the Act. Thereafter, a November 2012 bench trial was held on Tiburzi’s suit against Kline. Tiburzi argued the private pay agreements of the parties superseded the fee restrictions of the Act in that the Act did not apply in the context of the parties’ contractual relationship and was allowed by the Act. The trial court found that Tiburzi and Kline had a valid and enforceable agreement that was controlling “if allowed under the law.” Trial court awarded Tiburzi $2,010.00 for past due unpaid medical bills, and Kline appealed.

 

Defendant Kline argued the trial court erred in awarding Tiburzi’s unpaid medical bills because those bills were subject only to the IL WC Act. Tiburzi argued Section 8.2 (e-20) supports the trial court’s ruling that non-compensable bills could be collected from the patient directly. Our IL Appellate Court held Section 8.2(e-20) does not allow for provider to recover for compensable services in excess of the fee schedule but the provider could recover for medical services “not compensable.” In this case, the insurance carrier had paid nothing for 20 cold packs, each billed in the amount of $10. Therefore, Tiburzi was entitled to judgment in the amount of $200 plus costs.

 

We appreciate your thoughts and comments. This article was researched and written by Lindsay R. Vanderford, J.D. The opinions Lindsay is voicing are hers and not those of any member of WCLA. Lindsay can be reached 24/7/365 for questions about WC at lvanderford@keefe-law.com.

 

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Synopsis: Will the Proposed IL Nursing Home Camera Law Help Protect Illinois Nursing Home Residents and Workers? Analysis by Bradley J. Smith, J.D.
 

Editor’s comment: On September 8, 2014, Illinois Attorney General Lisa Madigan held a news conference to gain initial backing for a law designed to place monitoring cameras in nursing home rooms. This law would make Illinois the sixth state in the country allowing family members to put cameras in their relatives’ rooms.

 

Specifically, the proposed law would allow for video and audio monitoring in nursing home rooms. The law would require consent from the residents and their roommates for camera monitoring. Illinois Senator Terry Link (D) Waukegan will draft the bill and is looking for co-sponsors. During the aforementioned news conference, Senator Link indicated he did not believe there would be much opposition to the proposed law. The Health Care Council of Illinois drafted a statement disclosing their desire to protect nursing home residents in any and every way possible. Nonetheless, in opposition, the Health Care Council of Illinois also brought up the issue of HIPAA and privacy violations as they will relate to the proposed video camera law.

 

Unfortunately, statistics demonstrate the elderly are allegedly abused and neglected at an alarming rate in the United States. With the elderly population growing at a faster rate than any other segment of the population, this means that a significant percentage of United States population is arguably at risk of being abused or neglected on a daily basis. Similarly, there are also many work injuries that come from nursing home staff members.

 

Determining whether the proposed nursing home camera monitoring law will be successful in curtailing the obvious issues posed requires weighing both the negatives and the positives. On the one hand, the nursing home video camera law might aid families and comfort them by allowing monitoring of their loved ones. Additionally, the cameras might serve as a deterrent for those individuals and staff in nursing homes that might make the poor decision to abuse a resident. Further, the camera law may serve to protect nursing homes in defense of any unfounded claims of abuse and/or neglect. This could limit the nursing home’s liability if a camera can demonstrate exactly what happened in a given situation. Consequently, this could aid in nursing home defense litigation as there is no “outside of the scope” of employment argument for nursing home staff under the Illinois Nursing Home Care Act, 210 ILCS 45/1-101, et seq.

 

In contrast, the proposed legislation could also be associated with negative consequences. First, Plaintiffs could have issues with pursuing a cause of action when a video recording of the resident demonstrates the alleged abuse or neglect never occurred. Also, Defendants could have a clear liability issue if the video recording demonstrates a lack of attentiveness and possible abuse/abandonment of a resident. An obvious negative would be the invasion of privacy issue to residents, employees, and visitors. In fact, these cameras will likely degrade residents by recording intimate moments of exposure during bathing, medical examinations, or diaper changes. The cameras could also exacerbate the issue of finding qualified nursing home staff as some positions provide lower pay and employees may likely resent the constant supervision. Lastly, the video surveillance could cause an issue with HIPAA, as the video and audio recording devices would record all activities happening within a resident’s room and then be subject to being viewed by people unknown to the resident.

 

Despite these issues, as previously stated, similar laws were passed in Washington, Oklahoma, Texas, New Mexico, and Maryland. We suspect the Illinois Legislature will attempt to mirror the laws in these five states. The laws in those states allow residents or their guardians to monitor the room of the resident through the use of electronic devices. They also allow residents to choose where in the room the cameras are mounted as well as when they are turned on and off. The statutes further require express written consent of the residents or their guardians as well as the consent of any roommates. Additionally, they include a release in the consent forms absolving the facilities of any liability from the invasion of privacy resulting from the monitoring devices. Lastly, those laws require notice of the surveillance be provided at both the entrance to the facility and the entrance to the resident’s room.

 

We are of the opinion the legislature will face major hurdles in implementing the proposed camera laws. Particularly, Illinois lawmakers will have to surmount the privacy concerns to mandate video surveillance in nursing homes where requested by a resident or a resident’s family. Moreover, the moderate cost of installing a video surveillance system would place the burden on the nursing home facility and the Assisted Living Facility (“ALF”), and ultimately, on the residents and their families in higher monthly rates. Regardless, since most nursing home and ALF residents are on Medicare and Medicaid, the burden may eventually rest with the taxpayers. Lastly, the potential of unreasonably priced insurance for nursing home facilities and ALFs as a result of any legislation that requires video camera monitoring will likely impact the nursing home facilities and ALFs. If nursing home facilities and ALFs are unsustainable, then this private provision of care could disappear.

 

The research and writing of this article was performed by Bradley J. Smith, J.D. Bradley can be reached with any questions regarding Nursing Home and ALF defense and any other general liability defense questions at bsmith@keefe-law.com.

 

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Synopsis: Sidewalk Obstruction! Obstruction! Read all about It! Important Illinois Appellate Court ruling on Illinois Municipal Immunity under the Tort Immunity Act. Analysis by Daniel J. Boddicker, JD.

 

Editor’s Comment: In a decision which clearly effects Illinois Municipalities, the Illinois Appellate Court in the First Judicial District reversed and remanded the trial court and held where a plaintiff alleges a municipality breached its duty to use ordinary care to maintain its property and the public entity invokes section 3-102(a) of the Tort Immunity Act (“TIA”) as a defense, the issue of whether plaintiff was an intended and permitted user is to be determined based upon the property for which the city is alleged to have breached its duty rather than the place where the injury occurred.

 

In Pattullo-Banks v The City of Park Ridge, Plaintiffs, Lorraine Pattullo-Banks and her husband filed to recover damages for personal injuries she suffered when she was struck by a car while attempting to cross the street. Plaintiff alleged she was walking on a city of Park Ridge sidewalk when she encountered an unnatural accumulation of snow and ice that obstructed her pathway. She further alleged the city of Park Ridge created the obstruction during snow removal operations when it plowed snow from the public streets onto the sidewalk, and consequently, made the sidewalk impassable. Plaintiff alleged because the sidewalk was obstructed, she was forced to cross the street at the point of the obstruction where there was no marked crosswalk. As a result, Plaintiff was injured when she was struck by a car attempting to cross the street.

 

In defense to the lawsuit, Park Ridge filed a motion for summary judgment based on section 3-102(a) of the TIA arguing it was immune because Pattullo-Banks was not an intended or permitted user of the street where her injury occurred. The trial court agreed and granted summary judgment. The trial court found there was no marked or unmarked crosswalk where Pattullo-Banks was injured. The trial court reasoned a city does not owe a duty to a pedestrian crossing the street outside of any crosswalk pursuant to section 3-102(a) of the TIA.

 

Upon de novo review, the Appellate Court reasoned the issue of whether plaintiff was an intended and permitted user is to be determined based upon the property for which the public entity is alleged to have breached its duty (the sidewalk) rather than the place where the injury occurred (the street). As a result, the Appellate Court reversed and remanded the matter back to the trial court.

 

It is important to follow this and other similar rulings that affect the way a municipality should monitor its efforts in the winter to clean its streets and sidewalks. Piling shoveled snow on the sidewalk and obstructing it could subject a municipality to liability for any injury occurring as a result, whether the injury occurs on the sidewalk, or elsewhere. We recommend contacting our firm to discuss your potential liabilities and/or defense of any litigation regarding injuries occurring on your city streets and walkways.

 

This article was researched and written by Daniel J. Boddicker, JD. Dan can be reached with any of your questions or concerns regarding municipality defense and or general liability defense at dboddicker@keefe-law.com.

9-8-14; Desperate Gov. Quinn Hits IL Insurers/Insured with New Stealth Tax on Captives; Four New IWCC Arbitrators Appointed; Dealing with Dog Attacks and Bug Bites in WC and more

Synopsis: Desperate Governor Quinn hits IL Insurers and Insured with New Stealth Tax on Captive Insurance.

 

Editor’s comment: When you have to actively pay billions for Illinois’ seven “Fake Pension” programs and you are already over $100B in debt, you have to start squeezing out new taxes/tolls and fees everywhere. Under Gov. Quinn, we have the second-highest real estate taxes in the U.S.; we dramatically raised highway tolls and three years ago, Illinois reinstated our estate tax. Gov. Quinn wants state income taxes to be 5%, House Speaker Madigan wants our state income tax to top off at 8%. Now we see another new tax quietly enacted.

 

In a move we consider completely surprising during a heated election, Governor Quinn quietly signed SB 3324 a couple of weeks ago. SB 3324 imposes a new and unprecedented tax on Illinois-based companies that self-insure their risk in captive insurance programs. The new law, which amends the IL Insurance Code was confusingly promoted by the IL Department of Insurance as a technical bill designed to close “loopholes” created by the federal Dodd-Frank Act. We assure our readers it wasn’t a “loophole” the way the federal law worked created an advantage for Illinois companies in relation to other states. God forbid Governor Quinn and his minions would allow Illinois business to have an advantage compared to pro-business climates in all our surrounding states.

 

The tax aspects of this new law were not debated in a legislative committee and the bill’s sponsor, Senator William Haine was unaware the bill imposed a new tax on captive insurance plans when it was called for a vote. The new tax will cost Illinois business 3.5% on the premiums paid for captive insurance. All 47 IL House Republicans signed a letter to the Governor asking him to veto this bill. They also confirmed:

 

·         The new and unprecedented tax established by SB 3324 has one of the United States’ highest rates for a self-procurement or direct placement tax and will fall solely on the shoulders of businesses headquartered in Illinois.

·         SB 3324 will eliminate a long-standing benefit of being an Illinois-based business. Under the Non-admitted and Reinsurance Reform Act of 2010, which was enacted as part of the federal Dodd-Frank Act, only a business entity’s home state may tax “industrial insureds” –businesses that are not required to purchase insurance from an authorized insurer because they meet certain employment-force size or minimum annual gross revenue amounts. To date Illinois has wisely chosen not to tax industrial insureds or companies that choose to establish their own insurance program which provides an important advantage over other states. Oops, that ends January 1, 2015.

·         Regulatory oversight of self-insurers is not needed. SB 3324 is not needed for the purpose of regulatory oversight. Revenues from our existing insurance premium taxes are intended primarily to fund Department of Insurance oversight of the insurance industry for the purpose of protecting individual consumers from faulty insurance products or other fraudulent or deceptive activities. Illinois-industrial companies that self-insure or use captive insurance companies assume only their own insurance risk --they do not sell to consumers and no government oversight of their activity is necessary. Such companies rely on professional risk managers to assess their insurance needs and to manage their own insurance programs.

·         SB 3324 acts as a tax disincentive for self-insured companies to use actual cash set-asides and captive insurance companies to ensure that they have sufficient funds to address any unanticipated liabilities. This is an activity that should be encouraged to assure the ongoing fiscal stability of our Illinois-based companies. SB 3324 would now penalizes this responsible corporate behavior.

·         SB 3324 has not been adequately vetted by members of the General Assembly. Quite simply, it flew under the radar and many members of the General Assembly did not realize that they had voted to impose a new tax on Illinois headquartered companies.

 

Our problem with the new law is Governor Quinn, his staff and election supporters are desperately in need of cash to pay for the Fake Pensions and will try to find it anywhere they can. They have to in order to pay the seven Fake Pensions Illinois offers to “retired” government workers. We always wonder why taxpayers don’t treat such largesse with the same disdain accorded to welfare payments, as government workers contribute a miniscule amount to get these generous and ever-increasing lifetime benefits. Please also remember, the “pension fix” for only three of these Fake Pensions sponsored by Governor Quinn is almost a lock to fail when our Supreme Court rules on the constitutionality of the reform legislation. The Seven Fake Pensions include:

 

1.    The hundreds of state workers out on “odd-lot” workers’ compensation total and permanent disability claims who could be brought back to work and get off our dime today. We regularly point out the term “odd-lot” doesn’t appear in our IL WC Act and was created by our courts. If Governor Quinn would use vocational rehabilitation and job retraining and find such folks new government positions, they would be back working and actually earning a living, as the rest of us do. These benefits cost IL Taxpayers a minimum of $26,150.80 each year and currently cap at $69,735.64 per year. The benefits are tax-free. These workers also get COLA increases via the Rate Adjustment Fund that is a levy on IL business and local governments.

 

2.    The line-of-duty disability pay to firefighters and police officers who can and will work after becoming “disabled” only from working as a firefighter or police officer. That legal standard is based upon a very strained version of applicable law and, in our view, it was also created by our Courts. If a supposedly disabled IL firefighter or police officer can work and make $50,000 or $100,000 a year or more, it is hard to understand how and why they need taxpayer’s money for this Fake Pension. We have no problem with provision of such benefits when such workers can never work anywhere again but our courts created a loophole to only require the workers be unable to work as firefighters or police officers to get lifetime pay with COLA increases.

 

3.    The other five “Fake Pensions” are

 

a.    The State Employees' Retirement System (SERS),

b.    The Judges' Retirement System (JRS)—this plan can pay a judge/justice over $1M per year for each year of judicial service if they live long enough—if you don’t believe this, send a reply.

c.    The General Assembly Retirement System (GARS)—this plan can pay a legislator over $1M per year for each year of legislative service—again, if you don’t believe it, send a reply.

d.    The Teachers' Retirement System (TRS), and

e.    The State Universities Retirement System (SURS).

 

4.    All of these Fake Pension programs are hilariously de-funded—by that we mean the money for Fake Pension payments aren’t from employee contributions, matching state money or investment income. At the end of last year, IL State Auditor General William Holland pointed out the State has about 40% of what is needed to make required Fake Pension payments—during this year, IL taxpayers are going to have to spend $7B from current tax dollars to make the needed Fake Pension payments to folks who don’t work for the State any more.

 

5.    Please also note all of the Fake Pensions have very generous COLA provisions that require us to quickly pay more to the retirees than they made while working for us. If a state retiree lives long enough, it is possible their pensions could be more than double what they made while working.

 

If you aren’t sure, every TV commercial you see for Governor Quinn, including his quaint and silly “beer-powered” lawnmower commercial is being paid for by the folks that want to keep these Fake Pensions in place. The debt we all owe on the Fake Pensions is well over $100B now. Please also remember this same debt was $54B in 2009 or just five years ago. It is going up exponentially. If it simply doubles in the next five years, we will be looking at more than $200B in pension debt alone. They are clearly running out of money. At some point, they are certain to run out of money, like the Titanic was certain to sink.

 

If we don’t make some changes in Springfield, please assume we are going to continue to see more and more taxes, tolls and fees coming at Illinois business from every angle. The new 3.5% tax on IL captive insurers’ premiums is a sad note for our clients and the overall business environment in this state.

 

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

 

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Synopsis: Didn’t Know They Were Hiring—Four New Arbitrators Appointed to the IWCC.

 

Editor’s comment: We remain amazed to see how the secret WC hiring process continues under this administration. We regularly check to see the IWCC’s “jobs” link and note Arbitrator’s job openings never seem to make it there. The IWCC has announced the appointment of four new arbitrators

 

Ø  Maria Bocanegra who was with the Katz, Friedman firm representing Petitioners. Her photo and resume are online at: http://www.kfeej.com/maria-bocanegra/

 

Ø  Stephen Friedman formerly of Rusin, Maciorowski & Friedman, Ltd. He is one of the top WC defense lawyers in our state. His photo and lengthy resume is at: http://www.rusinlaw.com/attorneys/stephen-friedman/

 

Ø  Steven Fruth who is leaving the legal department at the CTA or Chicago Transit Authority. We assume he is used to handling a high number of claims. An interesting article and photo of new Arbitrator Fruth from five years ago are online at: http://www.oakpark.com/News/Articles/8-18-2009/Two-Oak-Parkers,-one-judge's-seat/

 

Ø  Michael K. Nowak of Becker, Paulson, Hoerner & Thompson, P.C. New Arbitrator Nowak’s photo isn’t online but his extensive resume can be found at: http://bphtlaw.com/nowak.html

 

It appears these choices may have been somewhat political but you can also readily argue these are some of the better WC lawyers in our state and will bring extensive experience, legal knowledge and professionalism to the IWCC. While the choices were made in secret, they appear to be solid selections.

 

We wish the new IL WC Arbitrators all the best as they take over their new roles.

 

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Synopsis: Dog Bites Man--Dealing with Bug Bites, Dog Attacks and Claims Coming from Contact With Animals/Pets in Workers’ Comp.

 

Editor’s comment: Animal attacks on humans are not uncommon events. In a typical year, about 4.7 million dog bite incidents occur, and something like 800,000 of such attacks require medical attention or result in death. In 2011, there were 31 fatalities in the U.S. due to dog attacks.

 

Please remember subrogation may be a factor in some animal attack claims. A person injured by an animal would have a legal case against the animal’s owner, or possibly against the owner of the premises where the attack occurred. Workers’ comp law in most states provides medical, lost time and possibly permanency for a person injured by an animal attack, if the risk of the attack is heightened due to work. As defense lawyers advising our clients and their adjusters, the key measure is demonstrating an “increased risk” of accidental injury versus a “risk common to the public” in dealing with bug-bites and animal/pet attacks.

 

We know that any worker can be vulnerable to any type of injury while on the job, but each type of injury has its own distinctive incidence pattern. As workers’ comp defense lawyers we find these sorts of workers most vulnerable to insect stings, animal bites, and pet attacks:

 

  • Building workers. Construction workers may encounter nests of stinging or biting insects in the course of employment, as well as raccoons, opossums, rats, skunks, or other wild animals adapted to urban living.
  • Delivery Workers. Such workers may be required to enter other peoples’ homes, where they can be bitten by dogs or other household pets. Wasps, fleas, mosquitoes, hornets, and other stinging and biting insects can present a threat to delivery workers as well.
  • Nursing professionals. Home health care workers and nurses who visit home-bound patients may be injured in animal attacks. They are also exposed to insect bites and stings.

 

Bite injuries are the most common result of an attack by a household pet. Attacks by dogs and other large pets can inflict severe and even deadly wounds to disable or disfigure the victim. Serious on-the-job injuries, infections, and complications caused by insects and animals include:

 

  • Infected wounds. Pets’ mouths and claws typically teem with bacteria. A bite or scratch injury can spread bacterial diseases or parasitic diseases. The rise of antibiotic-resistant bacteria makes such infections potentially deadly.
  • Cat scratch fever. Bacteria causes cat scratch disease, which can be transmitted to humans from a feline bite or claw scratch. Typical symptoms include swollen lymph nodes, fever, headache, fatigue, and listlessness.
  • Insect and spider bites. A few varieties of insects and spiders have a venomous bite that can cause dangerous-or even fatal-reactions in some vulnerable persons. A few species of biting insects carry bacterial or viral pathogens that can be transmitted to humans during a bite; these infectious agents are responsible for grave diseases, including Lyme disease, West Nile disease and encephalitis.
  • Lyme disease. Another bacteria is responsible for Lyme disease. Ticks carry the bacteria from animal hosts-dogs, horses, or rodents are the most common-to humans. Many people who are exposed have no symptoms at all, and many get mild effects: a distinctive “bull’s eye” rash, muscle or joint aches, fever, and headaches.
  • Rabies. A bite from an infected animal can transmit the rabies virus to humans. Unfortunately, the disease is usually fatal once those symptoms are evident.
  • Rocky Mountain spotted fever. Tick bites transmit this disease from infected dogs to humans. The earliest symptoms of Rocky Mountain spotted fever develop in a week or two: rash, chills, fever, muscle pain, and confusion.
  • Toxins from stinging insects. Bees, hornets, wasps, and some ants have stings at the end of their abdomens. These stings inject a venom that can paralyze or kill other insects, but would normally be only a mild irritant to humans. For some people, exposure to an insect toxin can trigger a severe allergic reaction, ranging from hives to life-threatening anaphylactic shock. Yellow jackets-a variety of wasp-are responsible for most of the stings to humans.
  • West Nile virus. This viral disease is transmitted by bites from infected mosquitoes. Most people who contract West Nile virus have no symptoms at all, but about one-fifth of all human cases will involve fever and intense flu-like symptoms. For about one percent of the people who are exposed, the disease can trigger life-threatening neurological complications, including meningitis and encephalitis. There is no treatment for West Nile virus other than palliative care for the symptoms. For some people with serious reactions to the pathogens, symptoms can persist for as long as five years.

 

If your workers have been injured on the job from a stinging-biting insect or a larger animal attack, it is important to get them to immediate medical care. Then try to document, document and document what happened and why. You need to lock in evidence when possible so take statements and investigate thoroughly, if it is a severe injury.

 

If you need help in determining compensability or investigating an animal attack or insect bite claim, send a reply any time to ekeefe@keefe-law.com.