11-24-14; Cover Your Cough at Work, Folks--Exotic Travel with Exotic Disease = Death Benefits; EEOC Sues Employer over Pre-Employ Testing/Question; Rauner-Watch + IWCC News and more

Synopsis: Eight Years Later, Death Benefits Under IL OD Act Finally Provided for Creepy Ebola-like Disease. “Cover-Your-Coughs” at Work, Folks!

 

Editor’s comment: There are two odd things about this ruling. First, your editor was asked for and provided a detailed opinion about defending this death claim in 2006. There were a couple of defense firms who were asked their thoughts. We wrote up a detailed analysis and told the employer and their claims people it was a compensable death claim and to either settle amicably or just pay the widow. Almost everything you will read in the decision was predicted in our analysis—it was clear to us and we feel most veteran claims handlers would also see this unusual and exotic infection would be ruled to have occurred during Decedent’s distant travels, which were unquestionably part of his job. How would you feel if your boss sent you to Asia/South America and you came home sick with a horrifying strange disease and your employer denied your claim?

 

We are chagrined to see a hapless defense firm advised the employer it was a fight they could win but lost badly. The firm was able to “un-defend” the death claim for eight years. In our view, the defense attorneys were lucky to avoid what would have been a substantial award of penalties and fees to drag out an expensive claim such as this with nothing being paid to the widow for over eight years—we estimate the current amount due to the widow to be more than $500,000 plus judgment interest at 9%. She will receive benefits for about 12 more years—we feel the KCB&A defense team could have amicably and favorably settled for a lump sum years ago.

 

Second, as a purely technical issue, it appears the widow didn’t appear before the IWCC/reviewing courts or present the claim as a ‘widow.’ She presented the claim as the wife and “special administrator” of something. Section 7 of the IL WC Act and the parallel section in the IL OD Act don’t provide any benefits for a “wife” or a “special administrator.” To the extent she is supposed to meet the requirements of the relevant legislation, our advice to attorneys on both sides is have the claim and caption match the Act under which you will proceed. Obviously, the IWCC and the venerated members of our Workers’ Compensation Division of the Appellate Court weren’t strongly concerned with the legal standing of the widow to proceed with the claim under whatever legal title she or her attorney chose.

 

In Omron Electronics v. IWCC and E. Belinda Bauer, our Illinois Appellate Court, WC Division affirmed an award of death benefits to the widow of an executive who died after contracting Neisseria meningitides. Neisseria meningitides is routinely confused with the more commonly known bacterial condition of meningitis--they are related diseases. Meningitides is often referred to as meningococcus; it is a bacterium that can cause meningitis and other forms of meningococcal disease such as meningococcemia, a life-threatening sepsis. N. meningitides is a major cause of illness and death for childhood in industrialized countries and has been responsible for large-scale epidemics in Africa and in Asia.

 

Yes, N. meningitides is a yucky and aggressive killer, just like Ebola and can be contracted from someone coughing on you. For safety/risk managers and others, as a safety thought, we recommend you require everyone in your facilities to “cover their coughs” by sneezing into the elbow. You might want to go a step further and make “cover your cough” part of safety training and an enforced safety rule. For the past five years, the Centers for Disease Control and Prevention, most doctors and safety managers have been encouraging everyone to cough and sneeze into their elbows. Plan B is to cough/sneeze into a tissue and dispose of it quickly. The reasoning makes sense, as we touch a lot of things at work including our mouths, and most workers don’t run to the bathroom to wash their hands every time they cough or sneeze.

 

To our recollection, at the time of the infection, Decedent Bauer was the president of Omron Electronics. As part of his job, he would travel all around the work on what were effectively sales calls. He became infected apparently while on a business trip to Sao Paolo, Brazil. The Appellate Court, WC Division ruling noted the parties offered conflicting medical evidence about the infection and rapidly ensuing fatal condition. The unanimous IL Appellate Court ruling followed longstanding law to confirm it was within the sound province of the IL Workers’ Compensation Commission to resolve such conflicts and make a determination as to the scientific opinions and weight of expert testimony and reports.

 

The widow’s experts opined Sao Paulo, Brazil was a well-known area where there was an increased incidence and prevalence of Neisseria meningitides. While the disease was considered somewhat rare, even in Sao Paulo, the endemic rate there was at least twice the rate of the condition in the United States. There was no dispute the Omron executive became rapidly and visibly ill and then quickly passed within a few days of returning to his family from Brazil. Prior to the trip to Brazil, the executive had traveled to Japan and China where medical experts indicated he likely contracted bronchitis that made him more susceptible to the deadly strain of Neisseria meningitides. The employer’s defense counsel countered the incubation period for the disease was two to ten days, pointing to a time before the executive traveled to Brazil. They also asserted there was no direct evidence showing the executive had come in direct contact with anyone carrying the disease germs while in Brazil. The Appellate Court, WC Division clearly disagreed, noting the executive had been in public places and evidence supported the Commission’s findings.

 

Their ruling is on the web at: http://www.state.il.us/court/Opinions/WorkersComp/2014/1130766WC.pdf

 

Please note we aren’t telling our readers that OD cases can’t be fought and won—each claim has to be weighed on its merits. While this one appeared to be a loser to us, the defense team at KCB&A has won many OD disputes or resolved them very favorably. If you need assistance on defending such claims, please send an email with the relevant facts and we will provide our best thoughts.

 

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

 

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Synopsis: EEOC Sues IL Employer for Using Screening Exams and Questionnaires to Avoid Hiring Carpal Tunnel Claimants.

 

Editor’s comment: We saw this one on the web and want our readers to know about it, particularly if you are doing pre-employment medical screenings. We are familiar with the chipper-grinder position and we assure our readers it is a very challenging job with a high incidence of CTS—we understand why an employer would want to minimize the risk of the condition. We have some thoughts for employers about the best approach and will provide them if you send a reply. That said, we feel confident this is not the optimal path. Either way, we feel one of the worst things that can happen to a U.S. employer is to be sued by our federal government, as the feds have basically an unlimited budget.

 

In EEOC v. Amsted Industries and Amsted Rail, the Feds filed suit under ADA and the Civil Rights Act to correct allegedly unlawful employment practices on the basis of disability and to provide relief to a class of job applicants who were denied employment opportunities because Defendants regarded them as disabled and / or because they had a record of a disability, carpal tunnel syndrome. The EEOC alleges Defendants violated the ADA when they refused to hire a class of qualified applicants for employment as chippers because of this alleged disability.

 

One Plaintiff filed a charge with the Commission alleging violations of Titles I and V of the ADA by Defendants. On February 28, 2013, the EEOC found reasonable cause to believe Defendants discriminated against a class of similarly aggrieved job applicants in violation of the ADA. Conciliation efforts required by law occurred and were unsuccessful.

 

The EEOC alleges Defendants engaged in unlawful employment practices at their Granite City facility due to medical evaluations of applicants for chipper/grinder positions. A chipper uses a chipping hammer or grinder to remove metal protrusions from steel castings. Defendant Employers require applicants for the position of chipper to undergo a medical evaluation as part of the application process. The medical examination consists of the completion of a medical questionnaire, taking of the applicant’s vital signs, and administration of a nerve conduction test and physical agility tests.

 

The complaint indicates Midwest Occupational Medicine was under contract with Defendants to perform medical evaluations of applicants for the chipper position. Dr. Dirker owns Midwest Occupational Medicine and is board certified in internal medicine. The allegations outline Dr. Dirker relied on the nerve conduction velocity test results without any further inquiry or examination of applicants before making a decision about candidates’ qualifications for hire.

 

The EEOC specifically alleged the nerve conduction test results used by Defendants and Midwest Occupational Medicine during the hiring process do not reliably predict applicants’ likelihood of developing carpal tunnel syndrome. The Feds further claim Defendants did not rely on the most current medical knowledge in using only nerve conduction tests and / or applicants’ prior record of carpal tunnel syndrome in concluding that particular applicants were medically unqualified for chipper positions. The allegations indicate the most current relevant published medical literature does not support the use of nerve conduction test results alone nor the use of prior history alone to predict the development of carpal tunnel syndrome. The Feds feel such tests are considered largely ineffective at predicting a person’s current ability to perform the essential functions of a position which requires repetitive hand motion such as the chipper position.

 

In effect, all workers were sent to the same doctor who examined them, asked them to fill out a very detailed and lengthy medical history and they would then be given the NCV test. If either the history included anything about CTS or the NCV indicated any findings positive for CTS, the worker was not hired. We are simply reporting the existence of this lawsuit and cannot comment on its merits.

 

The EEOC is seeking a permanent injunction stopping the whole process, normal damages for the class members and punitive damages. We will keep you posted on developments.

 

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Synopsis: Rauner Watch and Illinois WC News of Note.

 

Editor’s comment: Here are recent developments we consider of importance.

 

1.    Will Bruce Rauner toss the IL WC system under a bus?

 

To our understanding, no. Our new Gov-elect Bruce Rauner has learned what a smoking mess things are in IL State Gov’t in Springfield. He has learned there are more feudal fiefdoms than Medieval Europe. There is a reason our much-too-entrenched government leaders have already borrowed and spent $110B of our money—chaos. We have heard rumors to indicate there are several hundred different state government accounting systems and few of the systems interact. Our new leader is going to have to work with the deeply rooted legislators who created the mess. We are told Gov-Elect Rauner is seeking assistance from execs in the private sector to help with the transition--we are happy to assist in any and every way, if we receive direction from his transition team on how to do so.

 

To the various Petitioner/Plaintiff lawyers who consider any change to be the end of our workers’ comp system, we point out IL WC claims are down by more than half because hundreds of thousands of jobs and people have left our state. If state taxes have to dramatically go up again to keep paying for unnecessary government payrollers with unfundable pensions, redundancy and waste, even more private jobs will move. As we tell our kids, you have to fix things or the world may fix them for you.

 

2.    Are we going to have a new IWCC Chairperson?

 

We vote for continuity in Current IWCC Chair Mike Latz and his team but we are unsure if that will happen. We feel he would effectively input any changes, including budget cuts, if recommended by the current Governor. Chairman Latz will also be a transition point for all Commissioners and Arbitrators. Gossip abounds with about six different defense lawyers suggested as the new Chairperson. We have no idea if there is a selection process ongoing or if it is already a done deal. If we get news that is fit to print, we will let our readers know.

 

3.    IL WC Arbitration territory changes in 2015.

 

As of now, all Collinsville/Belleville cases are set in Collinsville. The IWCC has not been able to reserve the Belleville location during the trial cycles. If that changes, they will announce it. Zone 4 now consists of New Lenox, Ottawa, and Kankakee, a new site. Zone 6 now consists of Geneva, Wheaton, and Elgin, another new hearing site. A new accident location table has been posted. All Chicago cases that were assigned to Zone 6 arbitrators will be reassigned to new Arbitrators Bocanegra and Fruth. To fill out the new arbitrators' caseloads, other Chicago cases will be reassigned as well.

 

4.    2015 Arbitration calendars posted.

 

The 2015 Arbitration calendars are now online. The Commissioners' calendar will be posted on the IWCC’s great website as soon as it is ready.

 

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Synopsis: Sharpline Allocations, Our Favorite U.S. MSA Provider.

 

Editor’s comment: One of the great vendors in Vegas last week is the team from Sharpline Allocations. Sharpline Allocations is a customer service and relationship driven provider of Medicare Compliance and Settlement Planning services. At Sharpline, they understand each client’s unique needs, and deliver customized services that allow the claims professional to have complete certainty that each claim is in full compliance with Medicare Secondary Payer regulations.

 

The main differentiator between Sharpline and their competitors is great service and their hands on approach. They not only make recommendations, but provide assistance and follow up on with adjusters, risk managers, nurse case managers, Plaintiff/Defense counsel and other vendors to follow through on suggestions to reduce exposure and the potentially high cost of an MSA. They stay with the MSA until settlement, as opposed to moving on from the MSA once completed.

 

They are also piloting a new MSA Intervention program with one of their National accounts that has significant exposure at this time. The idea is that as soon as a Medicare eligible claimant reaches MMI, the file is referred to Sharpline for early intervention/bird’s eye view of any issues and to make recommendations to prep the claim for future settlement with closure of medical rights, and dramatically reduce MSA exposure by that time. This will potentially reduce the future MSA exposure and reserves. It will also drive claim costs down as the client will be able to settle and get the claim closed faster, rather than waiting to address issues at the time of MSA.

 

They can discuss this concept further if you are interested or to address any questions/ concerns. If you want more information, go to their great website at http://www.sharplineallocations.com/

 

11-17-14; Hello from the National WC Conference in Vegas, Baby; Tom Nyhan, RIP; Phony Burn, Real Criminal Charges; Sharpline Allocations for MSA Advice and more

Synopsis: Hello from the 23d Annual National Workers’ Compensation & Disability Conference & Expo in Chilly Las Vegas.

 

Editor’s comment: Your editor and several thousand WC folks from the across the U.S. and Canada are in freezie Vegas wondering what happened to the heat, sunburns and fun in the desert. As you read this, we have several interesting developments to report for folks at the largest WC conference in the U.S.

 

For the IL WC delegation, last week our new Fearless Leader IL Governor-Elect Bruce Rauner sent the WC industry on its heels when he reported it was his goal to trade an increase in the Illinois minimum wage against “business-friendly” changes to the IL WC Act. In our view, such changes

 

·         Should have been discussed during the election campaign or

·         Should be presented to the Governor-Elect’s “transition team” that is knowledgeable about workers’ comp issues;

·         We hope the first meeting of the supposed WC transition team may meet before the soon-to-be-Governor is running for his second term.

 

Conference attendee and WC blog-master Mark Walls confirmed his view that “casual” or causal connection may be the major IL WC reform issue—Mark advised the State of Tennessee just moved to a requirement the work be a “major cause” of the work-related condition to be compensable and their WC insurance premium and cost savings have been dramatic. Mark and your editor have no idea if that is the basis for the new suggested changes in IL WC.

 

Chicago Mayor Rahm Emanuel was quoted as asking what Rauner’s “pro-business” changes might be. We assume both Speaker Madigan and Senate President Cullerton may be asking the same questions. We assure our readers no one has any idea what might be on the Republican WC legislative table. If you have any notion or inside information that is fit to print, please send it along. As we have said for as long as this KCB&A Update has published, we dislike and feel it is appropriate to criticize the WC process when it is run by secret-powers-that-be from either the Republican or Democratic side of the matrix. We are saddened and chagrined to hear the man who was selected to “shake up Springfield” is falling into the same secretive patterns of his predecessors.

 

As we indicate above, we have no idea what Governor-Elect Rauner is seeking or if the other side will accept his proposals but we are sure he has no way to effectively change the IL WC Act without approval by the other legislative side and the rabid Petitioner-Plaintiff lawyers from the Illinois Trial Lawyers Ass’n. Our worry for our political neophyte is our view that he needs veteran help in making any changes to the IL WC Act or they may agree to and make lots of “changes” that don’t change anything or actually make things better for the other side. It is his call on whether to ask for help and avoid the sort of errors made when the 2005 Amendments to the IL WC Act were passed which led to the 2006 corrections. Our vote is a confab to discuss important changes, as if we were what some observers call a “democracy.”

 

On a similar note, we were advised Chairman Latz may be on the way out and his successor is a solid and veteran defense lawyer from a Chicago-based WC defense firm. We think Chairman Latz is a great administrator and we would rather see him keep his current position but we understand the vagaries of political winds. If he is going to be replaced, we assure our readers we haven’t been consulted and have no idea how the successor may have been vetted and then selected. Again, we hate to see a new Chairman be selected as part of a secret and clandestine process. Lots of other states treat such jobs like real jobs and not political appointments—why not interview the top candidates and see who might be the best person?

 

Gene Keefe is a speaker at the Convention about Ethics in Claims Handling this Thursday—if you are in town and want to attend, send a reply. We appreciate your thoughts and comments on the issues above. Please post them on our award-winning blog.

 

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Synopsis: Tom Nyhan, Rest in Peace.

 

Editor’s comment: We received news that Thomas D. Nyhan was at rest on Friday, November 7, 2014 while at his home with his family at his side. Tom was born December 26, 1929 in Chicago. Tom nobly served in the U.S. Navy during the Korean Conflict and was the founding partner of the law firm Nyhan, Bambrick, Kinzie & Lowry in Chicago. The roots of Nyhan, Bambrick, Kinzie & Lowry, P.C. go back to the late 1950's when Thomas D. Nyhan joined the now-defunct Chicago law firm of Pope, Ballard, Shepard & Fowle to assist a veteran attorney in handling workers' compensation claims for General Motors Corporation. Tom Nyhan's "helping out" turned into a 35 year journey as he became one of the premier workers' compensation attorneys in the State of Illinois.

 

Mr. Nyhan was one of the founders, as well as Executive Secretary, of the Illinois Self-Insurers’ Association which acts as a marketing unit for their firm. Tom also served as President and as a Board Member on the Executive Board of the National Council of Self-Insurers. Tom Nyhan served for many years as the workers’ compensation counsel to the Illinois Chamber of Commerce. He was active in numerous professional organizations and served on the Illinois Supreme Court Attorney Disciplinary Commission.

 

In our view, Tom Nyhan for the defense and Irv Greenfield for the claimant side worked out the Illinois workers’ compensation system that we have today. Tom Nyhan was a strong proponent and implemented the concept of proposed decisions on Arbitration—prior to the creation of that concept, IL WC Arbitrators could simply issue summary decisions without any basis for their reasoning/rulings. Whether an Arbitrator rules for or against either side, we feel it is a solid idea to that the reasoning laid out clearly and with some detail. Tom’s daughter Suzanne Nyhan is the tireless editor and publisher of the Q-Dex that is a listing of decisions of Arbitrators and the Commission and is a guide for everyone in the IL WC process.

 

Tom Nyhan was your editor’s first WC mentor and teacher. Like many of the men and women on both sides of the Illinois WC bar, Tom was a great lawyer, a good father and a kind man. Tom understood the need for lawyers to aggressively advocate for clients while also respecting your opponent. He will be forever missed. We send our condolences and best wishes to his family and friends.

 

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Synopsis: Woman “Un-burned” Due to Faking Hot Coffee Burn Injuries! A woman in Victorville, California is charged with allegedly faking second-degree coffee burns from her McDonald’s cup of joe. Analysis by Bradley J. Smith, J.D.

 

Editor's Comment:  A woman in California has been indicted by the San Bernardino County district attorney with twenty-one (21) felony counts of insurance fraud and workers’ compensation fraud. The woman allegedly bought coffee from McDonalds at the drive-through window, and claims that coffee spilled on her right hand when she was handed a cup of coffee with an unsecured lid. The woman allegedly was attempting to obtain $10,000.00 from McDonalds for her injuries. However, the insurance company became suspicious of the woman’s claims and referred the case to state investigators, who launched an investigation.

 

As evidence of the alleged burns, the woman provided pictures of second-degree burns on what purported to be her hand. However, upon further investigation, those photos and medical bills were allegedly false. Investigators state the photos were actually taken from the Internet of real burns, albeit from another unknown individual’s hands. In fact, investigators determined the photos were from a hospital website. Even more damning, the woman’s medical providers advised authorities that she had not received any medical treatment.

 

This prosecution comes after the over twenty (20) year old verdict of $2.9 million to a 79-year-old woman who was badly burned after hot coffee from a McDonald’s restaurant spilled into her lap causing severe and delicate burns. That case is history, but clearly not forgotten.

 

Insurance fraud is an obvious and ever-present problem that effects not only insurance and related companies, but also befalls normal individuals paying insurance premiums every day. In the event of observing insurance fraud, it should immediately be reported to the insurer and their attorneys. As premiums are always on the rise, anything that can be done to prevent false and fraudulent claims aids in a goal that is common both among insurers and insureds, lower premiums. 

 

The lawyers at Keefe, Campbell, Biery & Associates, LLC always investigate and report suspected insurance fraud to the appropriate authorities in order to protect their clients and the general public from any foul play. We are happy to share our expertise and training to insure you pay the claims you owe and fight the phony claims you should fight.

 

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

 

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Synopsis: Sharpline Allocations, Our Favorite U.S. MSA Provider.

 

Editor’s comment: One of the great vendors in Vegas this week is the team from Sharpline Allocations. Sharpline Allocations is a customer service and relationship driven provider of Medicare Compliance and Settlement Planning services. At Sharpline, they understand each client’s unique needs, and deliver customized services that allow the claims professional to have complete certainty that each claim is in full compliance with Medicare Secondary Payer regulations.

 

The main differentiator between Sharpline and their competitors is great service and their hands on approach. They not only make recommendations, but provide assistance and follow up on with adjusters, risk managers, nurse case managers, Plaintiff/Defense counsel and other vendors to follow through on suggestions to reduce exposure and the potentially high cost of an MSA. They stay with the MSA until settlement, as opposed to moving on from the MSA once completed.

 

They are also piloting a new MSA Intervention program with one of their National accounts that has significant exposure at this time. The idea is that as soon as a Medicare eligible claimant reaches MMI, the file is referred to Sharpline for early intervention/bird’s eye view of any issues and to make recommendations to prep the claim for future settlement with closure of medical rights, and dramatically reduce MSA exposure by that time. This will potentially reduce the future MSA exposure and reserves. It will also drive claim costs down as the client will be able to settle and get the claim closed faster, rather than waiting to address issues at the time of MSA.

 

They can discuss this concept further if you are interested or to address any questions/ concerns. If you want more information, go to their great website at http://www.sharplineallocations.com/

 

11-10-14; Winner, Winner--How Do We Help Illinois New Leader?; New Rules Hit Your WC Claims for Hydrocodone, Vicodin and Other Narcotics; Litigation Management Ruling, analysis by Brad Smith and more

Synopsis: Winner, Winner!!—How Do We Help Illinois’ New Leader?

 

Editor’s comment: After more than a decade of watching Illinois descend into a financial morass, we are happy to report Bruce Rauner is the Governor-Elect of Illinois! We do feel you as our readers and KCB&A as a defense firm played a role in helping him get the nod and we want to continue to assist him whenever and wherever we can. Mr. Rauner is the first Governor in IL state history to volunteer to do the job without compensation—this symbolizes the fact he genuinely wants to cut government costs and lower your tax bills. To our further understanding he and his top aides are among our readership. We have a couple of important thoughts for him to consider and we are asking for your best thoughts, as he plans and prepares for his tenure as Illinois Governor.

 

First and foremost, pension reform should be front-and-center. In this regard, we recommend he make a pretty important phone call to IL Supreme Court Chief Justice Rita Garman and ask her to put their crucial pension reform ruling on the front burner. The Supreme Court is considering the viability of pension reforms proposed by outbound Governor Quinn and while they are doing their important work, Illinois taxpayers are watching the $105B+ pension deficit skyrocket. In the event the Supreme Court tosses out all proposed pension reforms, we hope Plan B can start moving into place. Whatever they do, we consider the Illinois-gov’t-seven-fake-pension-programs crisis to be the biggest challenge our new Governor will face. Please give us any solid thoughts about how he should best attack it.

 

Please remember the reforms under Supreme Court consideration affected only three of the five IL pension programs. The unbelievably lucrative and massively unfunded judicial and legislative pension programs were not “reformed” at all. We strongly agree with the Chicago Tribune about completely ending the legislative pension program altogether. http://www.chicagotribune.com/news/opinion/editorials/ct-pension-illinois-general-assembly-edit-jm-20140908-story.html Legislators do not work full-time and they aren’t supposed to be getting hundreds of millions from taxpayers after they “retire,” as they currently are. We suggest pay out the current retirees (because you have to under the law) but end the “winning lottery tickets” for new and future legislators. We also hope someone takes a look at judicial pensions and reforms a program that can pay former judges over a million dollars a year for each year of service if they live long enough.

 

So What About Workers’ Compensation in Illinois under Governor Rauner?

 

Workers’ compensation hits Illinois state government and all taxpayers in three separate ways.

 

ü  First, you have the cost of the IWCC or workers’ comp administrative/hearing costs.

ü  Second, you have the State of Illinois as a large employer with its own workers’ comp claims.

ü  Third, you have the IWCC, its decision-making and its impact on other smaller governments and private businesses in setting costs with awards and settlements for work-related accidents and diseases.

 

1.    IL WC Administrative Costs

 

In dealing with the first of the three concepts, we recommend Governor Rauner and Lieutenant Gov. Sanguinetti memorize five letters “ATBBC” or Across-the-Board-Budget-Cuts. We recommend our new leaders consider 10% Across-The-Board-Budget-Cuts for all state agencies, including the Illinois Workers’ Compensation Commission. Why 10% cuts?—well, it is a great start on a new and never-before-seen concept in Illinois state government. We feel it might work in a bipartisan setting, if the Democrat state legislative majority will sign on. We find it hard to believe Multimillionaire House Speaker Mike Madigan and Senate President Cullerton would fight reasonable budget cuts when our state is always billions behind in paying “our bills.” If ATBBC could be put into place for all state agencies, we might not need the Madigan-Hates-Millionaires Tax and we might not need to bring IL income taxes up to almost 9% as Senate President Cullerton said he wants/needs to pay “our bills.”

 

We want IWCC Chairman Michael Latz and the other Commissioners and the various boards to take a hard look at agency expenditures. The defense team at KCB&A is happy to participate in the cost-cutting process or any open hearings about it. We note the 2013 Annual Report for the IWCC is on the web at http://www.iwcc.il.gov/annualreport13.pdf. The report indicates they spent $23,546,547 during fiscal year 2013. We are sure they can get by on 10% less or about $21M. We also strongly suggest the Rate Adjustment Fund, the Second Injury Fund and the “Settlement Fund” all come to a close after hearings and discussion. That is a complex discussion that we won’t outline here but there are millions of wasted business tax dollars in all three funds.

 

2.    IL WC Government’s Own WC Claims Program

 

Aside from the Commission’s administrative function, our own State’s workers’ comp claim management has plenty of room for improvement.  A couple of years ago, there were over 25,000 pending state WC claims with about six people to adjust them. Their computer program was about twenty years old and was a great way to hide incompetence because you couldn’t get anything of value out of the mainframe.

 

We are sure the state gov’t WC claims program was such a complete mess the departing Governor’s administration brought in a California-based company, TriStar to try to pull the program apart and put it back together. To highlight how poorly thought out that process was, State administrators “replaced” the adjusters with TriStar but didn’t get rid of the folks TriStar replaced! As you read this, we are sure the outside legal defense teams have not been independently bid or vetted for the best service in many years. We would suggest proper staffing internally, as well as proposals be accepted for the best legal defense teams to tackle the disputed litigated claims.

 

In short, we salute great local administrators like Mayor Mike Houston of the City of Springfield and lots of other local governments who open their books and bring in consultants and fight to save WC costs for our taxpayers. Please take a look at this link: http://www.sj-r.com/article/20130224/News/302249938. We have never seen anything like that happen in the Illinois state government’s workers’ comp claims program and we hope to start seeing it under our new Gov. Bruce Rauner.

 

3.    IWCC Impact on WC costs for Local Governments and Private Industry

 

As we advised our readers over the last year, the silly “WC advisory rates” have nothing to do with progress in cutting WC costs for Illinois business. The proper metric to review workers’ compensation costs is the State of Oregon Every-Other-Year WC Premium analysis. We feel that report is accurate and scientifically accurate. The current IL WC news is great and getting better. The biennial report by the Oregon Department of Consumer and Business Services indicated Illinois recorded the sharpest reductions in workers’ compensation insurance premiums in the entire nation over the last two years.

 

The Oregon study, online at http://www.oregon.gov/DCBS/docs/news_releases/2014/workers-comp-rate-study-14.pdf ranks all 50 states and the District of Columbia by the amount insurance premiums rose or dropped in the last two years. It highlights that Illinois had the steepest reduction in workers’ compensation rates when compared to the median, with an estimated rate drop of 24 percentage points between 2012 and 2014 compared to the national median reduction of only 2 percent. The report shows Illinois employers workers’ compensation premiums dropped from $2.83 per $100 of payroll in 2012 to $2.35 in 2014. We are certain this means hundreds of millions of dollars in savings for Illinois businesses.

 

Please also note the current Oregon study measures changes through the beginning of 2014. We are sure the strong cost-saving impact of the 2011 Amendments to the IL WC Act didn’t start until we had new claims beginning on September 1, 2011. We feel we are safe to advise our readers the trend in IL WC is costs are dropping and will continue to drop, as the years roll on. We are sure all Illinois Arbitrators and Commissioners got Senate President Cullerton’s message to give every WC claim a “haircut.” The “haircutting” remains ongoing with professional and experienced Arbitrators who are carefully considering all evidence and trying to reach a reasonable middle-ground wherever possible. We are also sure our administrators are strongly concerned about ethics and stopping WC fraud when/if they see it.

 

We remain concerned the IL Appellate Court, WC Division didn’t get the “haircut” message and still remains very pro-Plaintiff. With respect, we feel the “manifest weight” of the evidence isn’t very heavy when they want to reverse denials and award benefits. We feel appeals of more recent Commission decisions which were well-reasoned and adjudicated to reach the proper conclusion have been reversed by our Supreme and Appellate Courts based on interpretation of our statute. We would prefer to see the Commission have latitude to interpret facts/apply the law on a case-by-case basis without sweeping legal mandates by the reviewing Courts.

 

The Illinois Suggestion Box is Open, Folks!

 

We are sure new Governor Rauner and his transition team are readers of this KCB&A Update. We hope everyone understands the exciting opportunity present for everyone to start to change IL government for the better. We are asking you and all your friends to send us your best thoughts on how to cut costs in IL government without dramatically affecting needed services. We are hoping to work with incoming IL State Chamber President Todd Maisch and his team to come up with solid ideas for the new administration to bring down expenses and perhaps avoid the need for spiraling new taxes, tolls and fees. As we have advised, here are some common sense examples:

 

·         Get rid or combine the offices of the IL State Treasurer or Comptroller—everyone agrees the two offices are redundant and duplicative. The projected annual savings is about $15M. Taxpayers save even more money when the administrators don’t get their “de-funded pensions.”

·         Get rid of satellite offices—the IWCC has four satellite offices at hearing sites in Collinsville, Springfield, Peoria and Rockford. We do feel the hearing sites should be kept but it is our view the clerical staff there don’t perform enough tasks of importance so as to justify the cost. Actually, the IWCC only staffs three of the four offices, highlighting how unnecessary the expense for the other three offices is. The “offices” or more accurately, the nice ladies who work there don’t do much other than to answer the phone and print/hand out WC forms that are readily available online. Please note the IL Treasurer’s office recently shuttered six such satellite offices at a solid savings—do IL taxpayers need to spend several hundred thousand for printing WC forms?

·         Stop buying tow trucks that don’t tow trucks. Illinois has these expensive lime-green Minutemen trucks that sort of patrol our expressways. The drivers aren’t allowed to tow your car—why buy tow trucks? Why can’t our State Police provide these very limited services to motorists?

 

Remember we created these simple cost-saving concepts on the outside of government, looking in. We know we have readers on the inside and all around IL government. Now is the time for you to be heard—the money you save may be your own!! If you have state government cost-cutting thoughts or ideas, send them along, please. We appreciate your thoughts and comments. Please post them on our award-winning blog.

 

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Synopsis: Major Changes in Opioid Prescribing Hits Your WC Claims.

 

Editor’s comment: We feel claims handlers, risk managers and other industry participants need to be aware of the new rules that hit our entire country last month. Our federal government has stepped in to try and prevent addicts from getting easy access to otherwise legal narcotics. The U.S. Drug Enforcement Agency (DEA) announced combination drugs containing hydrocodone are now classified as Schedule II products, imposing on them the same restrictions that apply to pure hydrocodone, as well as oxycodone and morphine. The new rule will also make it more challenging for patients to gain access to Vicodin, which is a blend of hydrocodone and acetaminophen.

 

Your WC Claimants will now have to show up at pharmacies with handwritten prescriptions--no more call-ins from physicians or their staff. And continued use of these drugs will not be granted as many automatic refills.

 

Vicodin and similar products used to be grouped in the less restrictive Schedule III, but recent DEA research showed the drugs can be as addictive as pure opioids and "may lead to severe psychological or physical dependence.” The also indicate "Adding nonnarcotic substances like acetaminophen to hydrocodone does not diminish its abuse potential."

 

The DEA published a final rule moving hydrocodone combination products (HCPs) from Schedule III to Schedule II, starting about a month ago on October 6, 2014. The controversial scheduling change was recommended by the Assistant Secretary for Health of the U.S. Department of Health & Human Services (HHS) and supported by DEA’s own evaluation of relevant data. Under the final rule, Schedule II requirements will apply to “all pharmaceuticals containing hydrocodone currently on the market in the United States.” These requirements include, but are not limited to, requirements related to security protocols, labeling and packaging, inventory, and recordkeeping and reporting.

 

Only prescriptions issued before October 6, 2014, and authorized for refills may be dispensed, as long as such dispensing occurs before April 8, 2015. The DEA did state a practitioner may issue multiple Schedule II prescriptions to provide up to a 90-day supply of medication. The DEA cautioned, however, practitioners must make their own decisions “based on sound medical judgment and in accordance with established medical standards” about whether multiple prescriptions are appropriate for a patient.

 

For Illinois WC claims handlers and risk managers, the KCB&A defense team recommends using utilization review or UR to certify or non-certify the continued use of these drugs for your claimants. Following the 2011 Amendments to the IL WC Act, UR has a presumptive effect. We feel any claims handler who knows a claimant is using such drugs should start using UR within 45 days of the initial prescription. We recommend Genex and CID Management for UR on your pending and future claims. If you need a contact, send a reply.

 

Please also note the National Safety Council (NSC) released the 2014 edition of its resource named Injury Facts, which details the latest injury and fatality statistics and safety trends across the United States and worldwide. Among the more surprising statistics, the NSC found that poisonings, including those from unintentional prescription painkiller overdoses, were the leading cause of death in 18 states and Washington, DC. The increase in fatalities corresponds with the national increase in deaths from drug poisonings, including those involving prescription painkillers, says an NSC press release. According to the Centers for Disease Control (CDC), 100 people die each day in the U.S. from drug overdoses—the rate has more than tripled since 1990. The CDC points to “a growing, deadly epidemic of prescription painkiller abuse,” with three out of four prescription drug overdoses caused by opioid pain relievers.

 

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

 

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Synopsis: Don’t Overpay--Efficient KCB&A Defense Counsel is What You Need! Federal Court awards $108,350.87 in fees to Plaintiff’s counsel on a $2,000.00 jury verdict for Plaintiff. Analysis by Bradley J. Smith, J.D.

 

Editor's Comment: In a ruling that we believe is important as it relates to care and feeding of defense counsel to represent you in cases where attorneys' fees go to the victor such as Section 1983 claims, Federal Employment Law Claims, Illinois Nursing Home Care Act Claims, etc., the federal Seventh Circuit stated defense counsel should not engage in "scorched earth defense strateg[ies]." In Montanez v. Simon, the Seventh Circuit Court of Appeals affirmed the federal District Judge's award of $108,350.87 on jury verdicts of $1,000.00 for compensatory damages and $1,000.00 for punitive damages. The Appellate Court reasoned the District Judge's use of the "Lodestar" method was proper in reducing the fees from $217,110.50.

 

Please note the high attorney fee award was predicated on the wildly high attorney defense work created by the team selected by the City of Chicago. We wish the federal courts would publish the fee amounts billed by the defense team so taxpayers could see how badly this litigation was managed on both sides. We would guess the defense costs were probably over $200K and the “overwork” caused the embarrassing six-figure attorney fee award for Plaintiff. The federal appeals court wrote:

 

The award will be paid by the City of Chicago, and although it’s much less than requested, it’s still a huge sum—almost $110,000—in part because the City adopted a scorched-earth defense strategy. This simple civil-rights claim, overlitigated by both sides, took on all the protracted complexity of high-stakes commercial litigation, replete with hard fought discovery battles and even a mock trial. 

 

Plaintiff was arrested for consumption of alcohol on a public way. He was arrested by two reporting officers Fico and Simon. While in the squad car, Officer Fico allegedly punched Plaintiff in the face. Consequently, Plaintiff filed a claim under 42 U.S.C. §1983 lawsuit for excessive force against Fico and for failure to intervene against Simon. After a trial, a jury entered a verdict on the claim against Fico and found against Plaintiff on the claims directed at Simon. Thereafter, under 42 U.S.C. §1988, Plaintiff's attorneys brought a post judgment fee petition seeking fees of a whopping $426,380.00. Ultimately, the District Judge reduced the fees down to $108,350.87.

 

The District Judge used the "Lodestar" method to determine the proper fees by multiplying the number of hours reasonably expended by a rational hourly rate. In doing so, the District Court struck entries that were unnecessary, duplicative, excessive, or improperly documented. Specifically, the District Court reduced the hours from 1,021 to 869. Also, the Court reduced the hourly rate from $400-450 per hour for mid-level partners, to $385.00 and $175.00 for second and third year associates. Particularly, the District Court looked at reasonable rates throughout the Chicago marketplace for similar types of cases. The "Lodestar" fee ended up being $217,110.50, which is felt to be presumptively reasonable. However, under Hensley v. Eckerhart, other factors were reviewed to rebut "Lodestar." The degree of success achieved by the prevailing party is reviewed. Alternatively, when the Court cannot distinguish between work on successful and unsuccessful claims, an "across the board" reduction is sanctioned. In applying the above standards, the District Court found Plaintiff lost four of six claims and was awarded only $2,000.00 by the jury. Accordingly, the District Court reasoned there should be a fifty percent reduction of the "Lodestar" fees. On appeal, the Seventh Circuit agreed with the District Court's reasoning and affirmed the decisions on fees.

 

KCB&A's efficient and well-versed defense attorneys get strait to the point with their defense litigation strategy. Although they are always adaptable and further ready for the twists and turns of litigation, they always develop an early strategy to get to the logical conclusion of the case. Additionally, KCBA attorneys review the potential exposure for their clients (including the availability of attorneys' fees to the prevailing party) in their initial case assessments. In addition to Civil Rights Claims, KCBA attorneys' also handle Illinois Nursing Home Car Act cases wherein attorneys' fees are available to a prevailing plaintiff. 

 

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