4-27-15; Appeal Rights Coming to Some Medicare Issues by Shawn Biery, JD, MSCC, IME Docs--Never Send an Examinee Away Due to Language Barriers: Lindsay Vanderford, JD on Municipal Settlement Battle...

Synopsis: Appeal Rights Coming to Medicare Second Payer Issues Tomorrow!—Will It Work as Well as All Other Federal Programs!!  Analysis by Shawn R. Biery, J.D., MSCC.

 

Editor’s comment: The Centers for Medicare & Medicaid Services (CMS) issued a final rule implementing certain provisions of the Strengthening Medicare and Repaying Taxpayers Act of 2012 (the SMART ACT). With this final rule, a formal appeals process is established for applicable plans (liability insurance—including self-insurance, no-fault insurance, and workers’ compensation laws or plans) in situations where Medicare Secondary Payer (MSP) recovery is sought directly from an applicable plan. It is important to note—the rule is effective tomorrow April 28, 2015, and applies to demand letters issued on or after April 28, 2015. See below for a link to register for tomorrow’s CMS webinar if you want to learn more.

 

By way of recap, you may recall Medicare is a secondary payer to liability insurance (including self-insurance), no-fault insurance, and workers’ compensation laws or plans for injuries claims which may be the responsibility of one of those types of "first" payers. Medicare might make "conditional" payments, if they lack knowledge of the first payer or if payment for items or services has not been made promptly or may not be expected to be made promptly by the applicable plan. The payment creates the expectation these payments will be reimbursed to the appropriate Medicare Trust Fund if there is a settlement, judgment, award, or other payment (hereafter referred to as "settlement"). This includes situations where Ongoing Responsibility for Medicals (ORM) exists and once there has been a settlement, Medicare pursues recovery of its conditional payments.

 

If an MSP recovery demand is issued to the beneficiary as the identified debtor after April 28, 2015, then the beneficiary has formal administrative appeal and judicial review rights. There was no formal administrative appeal rights or judicial review previously and CMS' recovery contractor addressed any dispute raised by the applicable plan, so prior to this final rule there was no multilevel formal appeal process for applicable plans.

 

The appeals process established in the final rule parallels the existing process for claims-based beneficiary and other appeals for both non-MSP and MSP, and will be used for appeals involving both pre-payment denials as well as overpayments.

 

PROVISIONS OF THE FINAL RULE: 

The formal appeals process applies to MSP recovery demand letters issued directly to applicable plans as the identified debtor on or after April 28, 2015. Receipt of a courtesy copy (“cc”) of a MSP recovery demand letter by an applicable plan does not necessarily mean the applicable plan has the ability to file an appeal.

 

There will be a formal multilevel appeal process for applicable plans where MSP recovery is pursued directly from the applicable plan. The MSP recovery demand letter and any subsequent appeal determination will specify any timeframe or other requirement to proceed to the next level of appeal. The process then moves forward as such:

 

Ø  An “initial determination” (the MSP recovery demand letter),

Ø  A “redetermination” by the contractor issuing the recovery demand,

Ø  A “reconsideration” by a Qualified Independent Contractor,

Ø  A hearing by an administrative law judge (ALJ),

Ø  A review by the Departmental Appeals Board's Medicare Appeals Council, and

Ø  Judicial review.

 

It is important to note the applicable plan is the only entity with appeal rights/party status when Medicare pursues recovery directly from the applicable plan. The beneficiary is not a party to applicable plan appeals. However, CMS is required to provide notice to the beneficiary of the applicable plan’s intent to appeal and will provide such notice if the applicable plan files a request for a redetermination.

 

Proper proof of representation must also be submitted in writing prior to or with a request for appeal in order for an attorney, agent or other entity to file an appeal on behalf of an applicable plan or act on behalf of an applicable plan with respect to an appeal that has been requested. Appeal requests without proper proof of representation will be dismissed. Proper proof of representation may be submitted with a request to vacate the dismissal, however the strongest course of action is to make sure proper proof of representation has been submitted when requesting a redetermination. It is also important to note separate proof of representation is required even where an applicable plan may have identified an agent for recovery correspondence as part of the Medicare, Medicaid & SCHIP Extension Act of 2007 Section 111 reporting process.

 

The applicable plan may appeal:

 

Ø  the amount of the debt and/or 

Ø  the existence of the debt. 

 

The regulation does not permit applicable plans to appeal the issue of who is the responsible party/correct debtor. Requests for appeal on the basis the applicable plan is not the correct debtor will therefore be dismissed. Medicare’s decision regarding who or what entity it is pursuing recovery from is not subject to appeal.

 

Tomorrow, CMS will be presenting a webinar on “Applicable Plan” Appeals which will include: an introduction to the appeals process (as the process is new to applicable plans), information on the appeals process specific to applicable plans, and tips/suggestions to applicable plans regarding the recovery process, including appeals. Anyone interested can take part:

 

Ø  Date: April 28, 2015

Ø  Start time: 1:00 PM Eastern time.

Ø  URL: https://webinar.cms.hhs.gov/r2g9kffqc46/

 

They ask you begin logging in approximately 15 minutes before the start time, due to the large number of participants anticipated.

 

It is still to be determined how well the appeals process will work, however we will follow the process closely and identify those cases in our office in which an appeal may be appropriate and test the process aggressively. If you have any cases which may have the potential, KCB&A has several MSCC certified attorneys to consult with. This article was researched and written by Shawn R. Biery JD, MSCC who can be reached at sbiery@keefe-law.com with any comment or question.

 

                ------------------------------------------------------------

 

Synopsis: Note to IME Docs—Never Send Examinees Away Because They Need an Interpreter—Just Call and Get One!!

 

Editor’s comment: We had an IME doctor send away an examinee last week because the worker didn’t speak conversational English and the IME doc was not comfortable with having a family member interpret. The doctor didn’t call our office and wanted a “no show” fee due to the problem. We feel IME’s cost a lot of money and no show fees are also expensive—let’s not waste money and time when this issue can be so easily corrected.

 

Please note the defense team at KCB&A sets around 150-250 IMEs every year. Due to that volume of IME’s that we are handling, we are not strongly aware of the language abilities of the claimants who will be attending examinations. We don’t meet the claimants and we cannot talk to them unless we have prior consent from their attorneys. We also note it is very rare for a Petitioner attorney to contact us prior to an IME and let us know the language abilities of claimants.

 

What this IME doc and many of our readers were unaware of are the online and “real-time” available services to get telephonic interpretation of hundreds of languages almost instantaneously. If you contact:

 

·         Transcend Services has qualified and great interpreters waiting for your call and can handle over 200 languages. Take a look at Transcend’s website online at http://www.transcendservice.com/Translation-Interpretation-Services.cfm or on a 24/7/365 basis, call 877-838-3032;

 

·         AccessOnTime has an established national network of credentialed linguistic specialists, AccessOnTime provides clear, fast and accurate translation and interpretation services. You can find out more at: http://www.accessontime.com/language-services.shtml or call 888-745-7575.

 

So, as an IME doc that isn’t comfortable about your discussions with an examinee or at any other time anyone in our industry needs rapid and accurate translation, give us or the adjuster a phone call to discuss and then contact one of these great companies.

 

            --------------------------------------------------------------

Synopsis: Are We Settled Yet? In an important ruling as it relates to municipality settlements, the Illinois Second District Appellate Court held a settlement was not final and binding since the City Council did not approve it. Thoughts and Analysis by Lindsay R. Vanderford, JD.

Editor’s comment: In a recent opinion, the Illinois Second District Appellate Court in essence affirmed the Circuit Court of Winnebago County’s denial of a motion to enforce a settlement agreement with the City of Rockford. The Appellate Court took the matter pursuant to Illinois Supreme Court Rule 308 on certified questions from the Circuit Court. The certified questions center around the Illinois Municipal Code and the local ordinances of Rockford related to settlement of pending litigation with the approval of the City Council. 

On the eve of trial, Plaintiff Meade, and Rockford reached a settlement agreement at a pre-trial conference, and consequently, the trial date was stricken. Subsequently, Plaintiff signed a written settlement agreement drafted by Rockford. However, when the settlement was presented to the City Council a few weeks later, that body (including some of the council members whom had been present at the settlement conference and had approved the settlement offer at that time) voted to reject the settlement agreement. Plaintiff moved to enforce the settlement agreement, and the Circuit Court of Winnebago County denied the motion but certified certain questions for the Appellate Court to answer. The Appellate Court answered all the certified questions in the negative. Pursuant to Rockford’s Ordinance, settling with Rockford for over $12,500 requires City Council approval, and signing a settlement document agreed to by all parties does not constitute a promise that approval will be consistent when the votes needed to approve the settlement before the City Council are taken.

Plaintiff alleged she was injured on May 10, 2009, when she was standing on the parkway near a street in her Rockford neighborhood, and the ground gave way, causing her to fall into a sinkhole. She filed suit against Rockford in 2010 seeking damages stemming from her injuries. Trial was set to begin on January 27, 2014. After numerous attempts at negotiation, $600,000 was offered by Rockford’s attorney and accepted by Plaintiff. Accordingly, the Circuit Court docketed the case as settled and struck the trial date. The settlement agreement did not state it was subject to approval by the City Council. When the settlement was presented to the City Council for approval, two of the council members who had previously approved the settlement changed their votes. The vote of the City Council was  seven (7) to five (5) against approving the settlement. It is undisputed that, if all City Council members had been present at the meeting and had voted consistently with their earlier positions, the settlement would have passed.

Although the Appellate Court opinion appeared to disapprove of the result of the proper application of legal precedent to determine the settlement agreement could not be enforced, it reiterated the Circuit Court had tools for dealing with parties disregard for its time and the time of all parties involved. In that same vein, the Appellate Court discussed using sanctions pursuant to Illinois Supreme Court Rule 219 for conduct demonstrating a willful disregard for the orders and deadlines set by the trial court or that unnecessarily and vexatiously multiplies the cost of litigation borne by the other party. The Appellate Court went on to describe the circumstances presented in the Circuit Court as ripe for a possible finding of Rockford’s conduct as sanctionable. It is obvious the Appellate Court disapproved of the City Council’s tactic in approving and subsequently disapproving of the settlement.

The analysis and writing of this article was performed by  Lindsay R. Vanderford, JD.  Lindsay can be reached with any questions regarding general liability, municipal defense, and workers’ compensation at lvanderford@keefe-law.com.

4-20-15; Campbell on IL WC "Turnaround" by Gov. Rauner; IL Supreme Ct on Appeal Bond by Pankhuri Parti, JD and Larry Kahan, PhD on "Drive-By" Voc Rehab and more

Synopsis: Gov. Rauner Proposes More Changes to IL WC Act. Can/Should He Get Them Enacted by Our General Assembly? Thoughts by John P. Campbell, Jr., J.D.

 

Editor’s Comment:  Governor Rauner endorsed a number of “turnaround” changes to the Illinois Workers’ Compensation Act which are clearly intended to save money for Illinois business and cut benefits to Illinois workers. You can read it online at this link: https://www2.illinois.gov/gov/Documents/CompiledPacket.pdf Our Governor has made no secret of his plan to make Illinois “more competitive” with our sister states to attract and keep business and lower gov’t WC costs. The goal itself is commendable--nobody argues with that general premise, as jobs keep leaking out of our state. You may note the WC changes are a small portion of the 44-points outlined. For our industry, the question is, how many WC cuts should we see? What will be the immediate and long-term effect of such changes?

 

A little historical background is in order. We saw changes in 2005-2006 to our statute which increased the schedule of benefits to injured workers in Illinois. From our perspective, this was entirely unnecessary in a State with perfectly adequate benefit system for injured workers. The 7% increase in the schedule for PPD values only  served to increase the cost of doing business in Illinois. With the economic downturn hitting our nation just a few years later, our IL State Chamber led a charge for changes to the Act which were intended to save money for business and local governments. In 2011, a slashing of the medical fee schedule reimbursement was enacted and we also saw the introduction of AMA impairment ratings which, for the first time, were to be used as one of the factors to determine PPD value. It was recently reported the use of AMA impairment ratings brought down WC trial awards by about 12.5%. We note many Petitioner attorneys feel the actual reduction is even more steep, in the 17% range. We feel this was the intended purpose of introducing impairment ratings; to pull back the generous benefits a bit and also, insert some objective measure to the value of IL WC claims. On these two fronts, we believe the 2011 changes to our IL WC Act produced the intended results and we will continue to see PPD settlements and awards go moderately down in the years to come.

 

Now, Governor Rauner has proposed further changes to the Act, the most significant of which  include

 

(1) Implementing strict adherence to AMA impairment ratings to exclusively determine PPD value;

(2) Further cuts to the IL WC Medical Fee Schedule;

(3) New language supposedly increasing the standard on causation; and

(4) Legislative language to better define and reign the reviewing courts in on the ever-changing “traveling employee” concept.

 

As our team at KCB&A are defense attorneys for IL business and local governments, we can appreciate the less our clients pay in WC costs, the more profitable they would be and the more attractive our State would be for new business and also save gov’t cost. Awards based only on AMA ratings are predicted to be much, much lower than current case values. This would save Illinois business and local government bodies money, without question. However, we can all agree IL WC benefits for significant injuries should not be zero either. Let’s remember, injured workers have no right to sue their employer for negligence when seriously injured in the workplace. A parent of three young children who can no longer play with their kids is not going to be fairly compensated for that loss when you see what some AMA impairment ratings bring for an operated shoulder or spine. In exchange, we have a system designed to replace the benefits which would otherwise be derived from expensive-to-resolve civil claims, and part of our workers’ compensation system is designed to reasonably and rapidly compensate the injured worker for all aspects of an injury and not simply loss of range of motion on a goniometer.

 

We can all agree some compensation should and must be paid for significant injuries. The question is, what is truly “fair” value for injuries in a state like Illinois with some of the highest wages/taxes and cost of living in the nation? Many would argue higher benefit rates and awards are appropriate in a region with similarly higher costs to live and work. From the injured worker’s perspective then, strict adoption and sole use of AMA impairment ratings to set PPD would severely reduce recovery from traditional values and some would argue such awards are inadequate compensation when faced with the much higher cost of living, particularly in the greater Chicagoland area.

 

AMA impairment ratings are a good tool to measure physical impairment based on nationally recognized medical criteria, but such ratings do not, in our view, translate strictly into an exact value for compensation of any injury. Petitioner attorneys would argue strict adherence to a medical impairment rating could lead to awards that are severely low for serious injuries. For example, a white collar worker who is seriously injured but capable of returning to his/her job due to the moderate physical demands may incur a relatively low impairment rating, even after serious/multiple surgeries. If this worker must later work in a more physically demanding job, he/she could be restricted or even unqualified due to a prior work injury. For this reason, the Petitioner’s bar (and their clients) would argue strict adherence to an AMA impairment rating  to determine PPD value is unfair to those injured at work. So who’s right?

 

In our view, it’s all about striking the best balance folks; and we have that in place right now. Prior to consideration of impairment ratings for PPD value, there was no real objective measure for an injury, other than the precedent of thousands of prior awards compiled in the Q-Dex publications. When asked “why is an operated knee worth 22.5% of the leg?” our answer was “because lots and lots of arbitration awards are in that range.” So before 2011, there was no true objective test used at all. However, with the implementation of AMA impairment ratings as one of the factors to consider when ruling on case value, IL Arbitrators have a tool of medical measurement to consider. In  our view, it is also important the same Arbitrators are able to consider a multitude of other factors in each case, including the age,  the physical demands of the job, income earning capacity after the injury, as well as other medical evidence. We find this combination of factors to be the most favorable approach, as it allows Arbitrators to truly “judge” a case based on the totality of facts, which are unique to each case. For this reason, we endorse the current statutory construction which provides for consideration of AMA impairment ratings, but does not restrict a hearing officer from appreciating the relative severity of an injury based on all the facts in the  case. We also note the Arbitrators and Commissioners now “report” to Gov. Rauner and can be replaced in three-year terms—this may also lead to lower awards as more conservative minds are at work. As we have said since Gov. Rauner was elected, some of this takes time but things will get better for IL business and government for years to come.

 

It is also reported the Rauner camp is advocating further cuts to the IL WC Medical Fee Schedule. This remains somewhat of an enigma to most in our industry; it is very hard to measure “savings” from additional reductions in medical reimbursement. While the 30% reduction in medical reimbursement enacted in 2011 must have resulted in savings for business and local governments, we are told crafty billing practices by some providers are navigating around the intended savings. If that is truly the case, why then, should we just implement further cuts onto those providers who are paying honestly? We are also concerned about the phenomenon that happened about a decade ago in State of Hawai’i WC claims where they made the medical reimbursements so low, doctors and hospitals started refusing WC patients all across the state. It was fairly embarrassing for the Hawai’i legislature to have to go back to the drawing board and raise reimbursements to more reasonable levels. Let’s strike a fair balance, folks.

 

On the issue of changing the causation standard, we have told Gov. Rauner’s team that isn’t needed. Whatever new legislative standard is implemented on causation can be skirted or completely ignored by a liberal to very liberal hearing officer. We need the Arbitrators and Commissioners to use better common sense in making rulings on the issue of causation and they are doing so as you read this. The crazy rulings from the Marion Correction Center on carpal tunnel from supposedly turning keys in locks weren’t changed by legislation—the new, well-informed and highly professional hearing officers started issuing lots of zeroes and the claims stopped.

 

The same thing happened on the “traveling employee” concept and we don’t feel legislation is strongly mandated but it might be prudent because of shocking stuff on this topic that randomly comes out of our “activist” courts. The Florida WC Act has simple language requiring a traveling employee to be doing something for their employer when injured for the injuries to be compensable. We suggest that may be a solid idea for our general assembly to consider. If you want the applicable language of the Florida WC Act, send a reply.

 

Any Better IL WC Ideas?

 

As we have advised our readers, there needs to be some initiative to get injured government workers at the state and local level off our dime and back to work on modified work. We consider it close-to-criminal to see state and local workers not being provided “reasonable accommodation” under ADA and allowed to remain out on TTD for months and years to then get monster WC “loss of trade” settlements off your tax dollars. Like lots of other WC concepts in our state, the words “loss of trade” aren’t in the Act and you can make up any meaning or value that you like. We hope Governor Rauner’s team starts to address this secret scandal.

 

Back to the medical field in IL WC, we have always struggled with litigated WC claims where medical providers actually refuse to accept group health payments for treatment on disputed WC claims, only to hope the WC case is favorable for claimant. If so,  the medical provider will then recover more money under the IL WC Medical Fee Schedule than what the group health plan allows. Of course, Petitioner attorneys will tell you how terrible this is for their client if the WC case is denied by the arbitrator. Then, the claimant is stuck with the bills and the medical provider already refused the group payment! Believe us, this happens more than you would think.

 

In our view, the solution is to have a WC reimbursement fee that is equal to the average of the top three group health insurance providers in the State. This could be revised/adjusted every few years to keep it accurate and up to date. Such a system would end the debate over the alleged “windfall” payments to providers under workers’ comp. It would also serve to insert predictability of cost no higher or lower than major group insurance carriers. By the way, this should also deter doctors from playing lawyer, and trying to advocate for WC compensability just to make more money under the WC fee schedule. This also occurs more than you would think.  Perhaps our representatives wrestling with these  concept could consider such an alternative to this ongoing issue.

 

This article was researched and written by John P. Campbell, Jr, J.D. with a little help from your editor. Please direct questions or concerns to John at jcampbell@keefe-law.com. Please also feel free to post them on our award-winning blog.

 

                ----------------------------------------

 

Synopsis: IL Supreme Court Requires our State Treasurer to Post an Appeal Bond to Appeal IL Work Benefit Fund Fight. Thoughts and Analysis by Pankhuri K. Parti, JD.

              

Editor’s comment: The Supreme Court of Illinois ruled in Illinois State Treasurer v. Illinois Workers’ Compensation Commission et al, the Illinois  State Treasurer acting as the custodian of the Illinois Workers’ Benefit Fund is required to post an appeal bond pursuant to Section 19(f)(2) of the IL WC Act in order to involve subject matter jurisdiction of the courts to review a decision entered by the Workers’ Compensation Commission against the Fund. This ruling will have relatively limited scope.

 

In the present case Claimant, a home healthcare provider, was injured when she fell down the stairs at the home where she worked. Claimant filed an Application for WC benefits against her employer – the patient she cared for – and because he lacked workers’ compensation insurance at the time of her injury Claimant and her counsel also looked to Illinois’ Injured Workers’ Benefits Fund for relief. At the arbitration level the Arbitrator found Claimant had been injured in an accident which arose out of and in the course of her employment and awarded her temporary total disability benefits, medical expenses, and compensation for permanent partial loss of both her hands. This award was made against the Fund under Section 4(d) of the Act because of the employer’s failure to pay benefits. The decision was appealed by the Treasurer, as the Fund’s custodian, and the Commission unanimously affirmed and adopted the decision. Again in its capacity as the custodian, the Treasurer appealed the decision to the Circuit Court and then to the Appellate Court. While initially the Appellate Court reversed the Commission’s decision, Claimant filed a petition for rehearing arguing for the first time the Courts lacked jurisdiction.

 

This sets up the odd and seemingly contradictory scenario where the IL Appellate Court, WC Division first ruled it wasn’t a valid WC claim and then, on rehearing, found they couldn’t decide the claim, resulting in benefits being awarded.

 

Claimant’s petition for rehearing was based on two premises. First she contended her claim against the Fund was actually against the State of Illinois and the award in her favor was not subject to judicial review; however, this was immediately rejected by the Appellate Court. Claimant also argued judicial review was barred because the Treasurer had not filed an appeal bond, a statutory prerequisite for invoking the Circuit Court’s jurisdiction. The Appellate Court agreed with Claimant and ruled the Treasurer should have posted the bond if he wished to seek a review and since no such bond was posted, there was no subject matter jurisdiction to allow the courts to hear the appeal. This ruling of the Appellate Court was challenged to the Supreme Court of Illinois.

 

In the appeal the Treasurer argued the Workers’ Compensation Act should not be construed to impose the jurisdictional requirements of the posting an appeal bond upon their office as it would be contrary to the language, purpose, and history of the statute and would result in consequences which the legislature did not intend. The Court, however, rejected Treasurer’s claims the language of section 19(f)(2) was ambiguous and specifically directed towards only employers and insurers, with there being nothing to show the statute reflected an intent to include the Treasurer. According to the Court, this interpretation was not only incompatible with the principles of statutory interpretation, but also attempted to inject ambiguity into the statute when none existed. The Court further explained the legislature had used the terms employers and insurers throughout the Act as well as in Section 19, and if the legislature intended to confine the bond requirement to those specific groups, it could have easily done so by using the same terms.

 

The Treasurer also argued it was anomalous for the legislature to exempt cities and other governmental entities from the bond requirement, while expecting him to post a bond. However, our highest court held the Treasurer was treated differently because the Act made clear for the governmental entities to be exempted only when they were the actual employer of the injured workers. Hence, the Court explained, if the Treasurer was claimant’s actual employer, he would not be subject to the bond requirement by virtue of being a government entity. Because the Treasurer was involved in the litigation solely by virtue of his responsibility as Fund’s custodian, it was a function for which there was no analog among the entities exempted by section 19(f)(2). It was also the Court’s opinion if the legislature disagreed with this decision and believed the understanding of the Act was one which it did not foresee or intend, it could amend the law with respect to future cases.

 

This article was researched and written by Pankhuri K. Parti, JD. Pankhuri can be reached 24/7/365 for questions about WC at pparti@keefe-law.com.

           

            ----------------------------------------

 

Synopsis: Why “Drive-By” Vocational Rehabilitation is Hurting the Reputation and Role of the CRC in the IL Workers’ Compensation System. Guest article by Larry Kahan, PhD, CRC.


Editor’s comment: Having worked as a Certified Rehabilitation Counselor (PhD, CRC) for many years in the IL workers’ compensation system, it never ceases to amaze me to observe the lackluster, unprofessional approach taken by a few bad apples in our voc rehab industry. Yet, these are the very “so-called professionals” who are creating an untenable situation for the rest of the decent vocational counselors who are challenging the previously-held assumptions about compliance and its relation to the overriding system abuses we see every day when we see half-measures taken by injured workers who have zero intention of ever getting back to gainful employment! It’s time to treat your profession as a CRC with integrity rather than a coffee break at Starbucks®.

 

Case in point: How many times do we work with injured workers who are merely going through the motions in their job search activities; perhaps doing just enough to avoid a label of non-compliance or outright sabotage of the job search process? Unfortunately, in my experience, the exception tends to prove the rule. It has become so commonplace for some individuals to dodge, omit, engage in half-measures, and seek to subtly (and often not-so subtly) derail the job search process, that to work with a claimant who truly wants to get back work and displays the integrity to make that happen is almost nonexistent in my world. From a defense standpoint, certainly taking into account the practice of ethics we are called as professionals to adhere to, we need to start by understanding our role.

 

Often a Petitioner attorney will attempt to point out in emphatic terms that our client is, in fact, the injured worker; thus the implication is the vocational counselor is brought in the protect the IW (according to the legal maneuvering playbook written by some Petitioner attorneys). Hogwash! If their client was a willing participant, showing through his/her actions from the outset they are truly committed to a serious job search, then I have no trouble spending many hours each week in assisting them to find the highest paying career possible. It is a truism that actions speak infinitely louder than words. Words coming from the attorney about just how incredibly motivated their client is to find work, that he/she intends to cooperate fully with an appropriate job search, ring hollow as soon as that very same client begins to become lackluster in documenting the job search. If the individual is doing a reasonable job search, both from a quantitative and qualitative perspective, it almost always shows up in the documentation and results. Thus it starts with a commitment to the following: Submitting job logs with appropriate detail, showing up for job placement meetings on time and dressed appropriately, maintaining a good attitude in the face of life challenges, having the willingness to do whatever it takes to market themselves in a positive light, and participating attentively to job-seeking-skills-training. This isn’t rocket science, and every person faces the socioeconomic considerations of the time. However, it the injured worker is willing to do what the mediocre are not; they WILL find a job.

 

Sabotage part 1: Interfering and disrupting how one is perceived by a prospective employer comes in all sort of packages. And, frankly, I know it when I see it. Where there is smoke, there is more often than not, fire. Here’s a few of the common attempts in the “playbook.”

 

  1. “Roll out the scroll” This is where the injured worker seeks to let the employer know more information than they want. All then employer wants to know from a physical standpoint is: Can you physically perform the job.” Yes or no. Simple as that. When the IW decides to roll out the scroll of his/her injury, including pictures (I swear), there’s a pretty good chance their intent goes beyond simple honesty. They will say things like, “Isn’t it best that I be completely honest with the employer.” They conveniently forget we are having them apply to jobs that are well within their restrictions. By bring up the details of the injury, the IW seeks to sabotage the hiring process before it ever gets off the ground. I suspect there may be 1 or 2 Petitioner attorneys who are strong advocates of this approach, claiming their client is just being honest. I call baloney here!
  2. “No shirt/shoes, no service.” Uh, thanks for coming, but no thanks! How often does an IW show up for an interview dressed like a bum? This is a surefire way to squash consideration as soon as you walk in the door. In fact, if you don’t shower, they don’t even need to see Mr. Sab O’Tage coming. Next!
  3. “Doctor Moe, Larry & Curly” At what point did the injured worker become their own doctor, diagnosing themselves and setting their treatment plan? I can tell you how often and injured worker looks me straight in the eye and claims they can’t drive. Bottom-line: If it’s not in the medical notes, not specifically mentioned as part of the restrictions laid out by a physician well-informed about the case, it is not part of the restrictions. Here’s a common line of nonsense: I’m taking XYZ medication and thus cannot drive. That is simply a falsehood! Yet, you may be surprised at how many vocational counselors take this admonition as gospel. No documentation, it doesn’t exist! Period.
  4. “The Application Blues” This type of sabotage goes like this: The applicant who’s playing the system decides they need to write a thesis on their injury on the employment application. The questions calling for the injury novel? “Please explain the reason you left previous employer:” Again, we need to be clear with the injured worker exactly how to answer that question in the manner it was intended. Perhaps they need to carry around a stamp which reads: THIS IS MY THIRD WORKERS’ COMP CLAIM IN 4 YEARS! 

 

Perhaps it goes with saying the vocational counselor needs to create clear expectations for an appropriate job search from the outset. Make sure this is spelled out in a Job Search Expectations Agreement document reviewed before you start the job search process. Let the Petitioner attorney and IW know you will hold the client accountable M-F, from 9:00AM-5:00PM, 8 hours per day to ensure you are providing the proper guidance to achieve the return-to-work goal as expeditiously as possible. Don’t be afraid to discuss mutual accountabilities. Further, let them know unequivocally you will be verifying every single activity the IW does in order to offer the best feedback possible. That way, there will be no surprises down the road.

 

Return to work is always the primary plan. We need to expeditiously get the injured worker the highest wage possible, as close to the pre-injury wage as we can. But, often times this isn’t possible due to the previously mentioned nonsense. In that scenario, we need to show very clearly with excellent documentation why, despite every bit of assistance offered to the injured worker, they are not finding a job thus far. It’s critically important we show what we’ve offered in the way of reasonable and appropriate training, job leads, ongoing coaching, and accountability parameters. Yet, despite all that, Mr./Ms. O’Tage is not securing interviews because he or she is not following the specific vocational rehabilitation plan customized for them. Further, we need to cite the Illinois Supreme Court’s landmark decision in National Tea v. Industrial Commission:


We do not mean to imply, by the foregoing discussion, that the Commission should consider only the interests of the employee in determining an appropriate rehabilitation program. Because the employer is required to "underwrite" the expenses attendant to rehabilitation, it is essential that any program selected be reasonable and realistic. Consequently, where rehabilitation is ordered, the Commission should establish boundaries which reasonably confine the employer's responsibility.

 

It is worth remembering the longer a capable injured worker remains in job placement without finding employment, the more likely we are assisting Petitioner’s attorney in laying out a legal foundational argument for an Odd-lot/Perm Total. Vocational placement should never last more than 3 months. Either the person is employed by that time; or they are almost always sabotaging the process. That’s why our vocational rehabilitation plan has to be well-thought out, documented in a way that leaves no wiggle room, and adhered to from the outset. No more drive-by voc! This article was researched and written by Larry Kahan, PhD, CRC. Larry can be reached via email at Lawrence_Kahan@corvel.com.

4-13-15; Gov. Rauner Takes Aim at the Supreme Court--Our Thoughts; MSDS Sheets Become SDS Sheets on June 1, 2015, Be Prepared; John Karis, JD Reports on WCLA AMA Rating Presentation and much more

Synopsis: Illinois’ Judiciary Isn’t Corrupt But There May Be Work To Do In Response To Gov. Rauner’s Challenging Comments—Here Are Our Thoughts.

 

Editor’s comment: We read comments from newly elected Governor Bruce Rauner complaining Illinois’ judiciary is

 

  • Corrupt because the lawyers who appear before them donate, sometimes heavily to their election campaigns and
  • A group of activists who want to be legislators.

 

We consider this debate vitally important for our readers and all Illinois taxpayers. Here are three main concerns in response to the Governor’s thoughts.

 

Do Grossly Unfunded Judicial Pensions have the Appearance of Being Corrupt? We Ask Our Highest Court to Hold Hearings on Judicial Compensation/Pensions to Open This Up to the Public and Fairly Address This State-Busting Issue

 

It is our view Illinois judges/justices are the highest paid government officials in our state and perhaps the nation—if they work only nine years to become vested, they can effectively “earn” about $600,000 of your money every year they wear the robes, if they play the “pension” system correctly. We assure you a nine-year IL judge can eventually make $1M per year if they live long enough. If you think we are kidding, please keep reading.

 

How does that math work? Well, the actual annual salary for a full Illinois Circuit Court judge is now $203,000 each year which is higher than the Governor and any other Illinois politician. Yes, a traffic court judge who handles speeding tickets makes more than our Governor. How does their effective income reach $600K a year? Well, our judges only have to work nine short years to become fully vested in their “pensions” which then immediately pay a retired judge 85% of their highest pay with guaranteed 3% compounded annual increases for life. Their pension contributions for nine years don’t match one year of salary but when they retire, they are guaranteed to shortly be paid more than their highest salary with annual compounded raises for 10-50 more years. Trust us, being a lawyer in Illinois is a difficult and demanding job if you want to earn $200K to match what a Circuit Court judge makes. In contrast, being a Circuit Court judge for nine years is easier and lots less stressful. Many lawyers are taking notice of this and are spending lots more money on judicial campaigns and political consultants to try to ride this gravy train.

 

State Auditor General William Holland confirmed this “pension” program isn’t funded for even one-third of its annual cost to Illinois taxpayers. What that means is the minimum annual pension contributions by the sitting judges along with interest income and state government contributions don’t come close to the actual cost to you and me. That means when a judge retires, they stay on our payrolls and keep getting paid for not working. If you do the math on a nine-year-judge who retires starting at $175K a year with 3% compounded increases, the needed seed money would be about $400,000 for each of the nine years, creating a “pot” of about $3,600,000 from which to start paying the “pension” starting at $175K a year. Since we aren’t putting up the $400K a year in front of each judge’s retirement, we are “backloading” that much money to them so they are paid primarily from current tax dollars starting on the date of retirement to their eventual passing. Either way, we assure you they are making the lifetime equivalent of about $600K each year for nine years of work, if they choose.

 

As you read this, judicial “pensions” are guaranteed in the Illinois Constitution. No matter how shocking and expensive they are, judicial pensions are completely and fully legal but seem to many to appear to be “corrupt.” The current annual cost of the unfunded judicial pensions to Illinois taxpayers is about a quarter of a billion dollars and rising. The “pension reform” efforts and controversial Supreme Court appeal being considered right now do not include these pensions at all. The only possible way to change them and try to make them more financially sound is to amend the Illinois Constitution. It is hard for legislators and others to criticize or change judicial pensions and we ask the judiciary to “heal itself” in the best interests of our state. We ask the august members of our Supreme Court to hold hearings, open this up to public debate and find the right path to make their compensation fair, fully funded and comparable to other sister states.

 

Circuit Court Judges are Becoming the Highest Paid Workers in Many Counties Across Illinois

 

We also have no true idea why Circuit Court judges who are ostensibly county employees have salaries set on a state-wide basis. While $203K per year is good money in any county across the state, it is an amazing salary in smaller cities like Rockford or Collinsville. We would bet there are many less-well-to-do counties in Illinois where the Circuit Court judges are the best paid workers in the entire county—we don’t mean judges are just the best paid government workers; we mean they have the highest salary and benefits in the entire county. Has anyone ever thought about making IL Circuit Court judges back into county officials with the local County board to set/control their salaries, pensions and benefits? Should we consider creating a new strata of hearing officers for routine or simpler legal issues to get lesser pay but still provide important but cost-effective service to taxpayers—perhaps by creating a magistrate or justice of the peace position?

 

Don’t Hefty Judicial Campaign Contributions Give Our Judiciary the Appearance of Justice for Sale? Could an IL Judge Legally Start an In-Court Auction for Their Future Rulings?

 

Going back to Governor Rauner’s challenging remarks above, is it “corrupt” for Illinois judges and justices to accept hefty campaign cash from the lawyers who appear before them? A lot of Plaintiff/Petitioner lawyers contribute and assert they have every right to do so. On the other side corporations and businesses also legally contribute to judges/justices. We also want our readers to know multimillion-dollar Plaintiff law firms from outside Illinois regularly and legally donate to Illinois justices/judges’ election campaigns. As out-of-state lawyers and law firms on both sides have limited interest in our state other than to get beneficial court rulings, such donations may appear to be a purchase of judicial favoritism. What other conceivable reason would there be for such a donation? When current Supreme Court Justice Karmeier ran for his current post, the opposing candidate accepted millions in donations from wealthy Plaintiff lawyers all across the United States—those lawyers may have felt the campaign donations were an risky but needed investment in future court rulings. On his side, Justice Karmeier’s campaign accepted campaign donations from large businesses based outside our state.

 

We don’t know the answer to this challenging issue but we do know there are many judges who have made a personal decision not to accept campaign donations from any lawyer or company who might appear before them. We do feel any attorney who has donated a nickel to a judge’s campaign should have to routinely disclose that donation to any opposing attorney when they appear before the same judge—we cannot imagine how a judge can be fair if he has accepted $10,000 or $100,000 from one lawyer or law firm before him and didn’t get cash from the other lawyer at all—to us, that has at least the appearance of secrecy and possible bias. Try to imagine the farcical situation where a lawyer was doing poorly on a major court claim and took out a checkbook in open court and offered the judge a campaign contribution on the spot. Could the other side immediately match or exceed the donation? Some lawyers assert the potential for such an auction is perfectly “Illinois-legal” and therefore within their rights. We agree it might be under current law but we ask the rhetorical question: should it be legal? We look to our readers for your thoughts on this challenging subject.

 

In Our View, There is More Judicial Legislation in Illinois Workers’ Comp than Any Other Area of Law 

 

As to Governor Rauner’s comment about “activist” Illinois judges who want to be legislators—we have to agree with this is one of the defining features of Illinois workers’ compensation for anyone who reads our textbooks or attends a KCB&A presentation on the subject. You have to ask yourself, is judicial legislation in workers’ comp a good thing or a bad thing? Well, we feel it is one of the factors that makes Illinois workers’ comp so unpredictable and seemingly chaotic to risk managers outside our state and across the country. For a simple example, take Durand v. IWCC. In this claim, there was no question Petitioner was seeking benefits outside our 3-year statute of limitations. She basically admitted to doing so at all five levels of hearing and appeals. The Illinois Supreme Court effectively ended the concept of our Illinois’ workers’ comp statute of limitations by asserting they declined to “punish” her for filing the late claim as she supposedly had worked in pain until the statute would have ended her claim. As we said then and say now, what does “punish” have to do with workers’ comp benefits—aren’t the courts always “punishing” one side or the other to order benefits when they are due or denying benefits when the statute doesn’t provide them?

Would you like other examples?

§  Interstate Scaffolding v. IWCC where the Supreme Court accepted a petition for certiorari from a prominent ITLA member in a dispute over a mere $5K in TTD and then ruled in a fashion that some feel might reward inappropriate behavior for someone on light work who was fired for what would be criminal behavior;

§  E. R. Moore v. IWCC where our highest Court created the concept of “odd lot” total and permanent disability despite the fact the words “odd lot” aren’t in the statute anywhere and remain arguably indefinable;

§  Will County Forest Preserve District v. IWCC where the shoulder somehow stopped being part of the arm and became part of the body and

§  All the various rulings about including or not including overtime or part of overtime in the AWW when Section 10 of the IL WC Act still says overtime isn’t to be included in the AWW. The concepts of “regular and consistent” overtime and “mandatory” overtime aren’t contained in Section 10 of the IL WC Act.

 

You may note many of these issues are now the subject of legislative reforms to try to implicitly reverse the judicial legislation. We are sure the debate between Governor Rauner and our Supreme Court may rage on for years. We will keep our readers posted on the developments. We appreciate your thoughts and comments. Please post them on our award-winning blog.

 

            -------------------------------------------------

 

Synopsis: Out Go Your Old Material Safety Data Sheets, In Come the New SDS or Safety Data Sheets—It Will Start to Happen at All Your Facilities Effective June 1, 2015.

 

Editor’s comment: Those fun folks at OSHA adopted new HCS 2012 SDS standards on December 1, 2013. The new standards are supposed to synchronize material safety (or chemical) information with the new Globally Harmonized System (GHS), created by the United Nations to ensure uniformity in communicating information about hazardous materials around the world. Some U.S. employers know June 1, 2015 is a deadline of the new standard. Manufacturers have to discontinue sending the old material safety data sheets (MSDS) and start to issue their new SDS forms instead.

 

Chemical end users have until June 1, 2016 to respond to new SDS standards passed down from suppliers and manufacturers in the workplace. This one-year time period presents a challenging and short time frame in which an employer can respond to the new and updated information contained on potentially hundreds of SDSs and be fully compliant on or before June 1, 2016.

 

What is an MSDS, Soon to be SDS?

 

MSDSs are, actually were documents that travel with or ahead of chemical shipments, warning users of specific dangers of such products and guidance on their safe handling, storage and disposal. Evaluating chemical hazards and producing MSDSs and labels for downstream users are two of the key responsibilities chemical manufacturers and distributors have. Maintaining an MSDS and soon an SDS for every hazardous chemical and making them continuously available to employees are part of U.S. Right-to-Know provisions which says employees have the right to know about the chemicals to which they are exposed. This is one of five key responsibilities employers have. The other four key responsibilities employers have are:

 

  1. Maintaining  a hazard communication program detailing the plans in place for the safe handling of chemicals
  2. Maintaining a written chemical inventory of every hazard chemical in the facility to which employees are exposed
  3. Maintaining proper labels and warning signs associated with said chemicals
  4. Training employees on chemical hazards and necessary precautions

 

The New SDS Effect on Employer Safety Programs

 

Please remember you don’t want to use the new SDS and quickly toss or delete your existing MSDS files. Everything should be retained:

 

  • To demonstrate you were compliant with prior HazCom standards;
  • Prior MSDS sheets may be saved to defend workers comp and/or occupational disease claims by any of your workers alleging occupational diseases;.
  • Toxic tort claims that later arise may be defended using old MSDS records where your organization may have used products manufactured and sold by you or when you resell or distribute products to other companies.

 

There is no time like the present--the new SDS implementation allows U.S. employers the opportunity and window to update your safety training, hazard communication and safety procedures for all chemicals in your workplace. The new Safety Data Sheet incorporates sixteen separate sections, some of which are parallel or identical to existing MSDS sections. There are some important differences and compliance challenges—if you have questions or concerns, send a reply.

 

When enforcement for product or chemical manufacturers begins on June 1, 2015, OSHA will be carefully checking to see each manufacturer properly completed the new SDS forms and they will be checking to insure each manufacturer went through a procedure to identify new or recently discovered concerns. A year later, when enforcement against U.S. employers starts on June 1, 2016 in relation to new SDSs, OSHA will look to whether the employee has reviewed the SDSs to identify any new risks as well as whether it has evaluated its existing compliance programs in light of the sixteen requirements we mention above.

 

What Does This Mean to You?

 

The Hazard Communication Standards affect nearly every United States employer, from chemical manufacturers to retailers to the travel industry where your employees work with chemical cleaning agents. Employers need to be aware of their obligations to communicate hazards of any chemical substance and you need to develop a process for updating existing labels, hazard assessments and training programs to comply with HCS 2012.

 

For all these reasons, we suggest:

 

ü  You need to review the new SDSs as soon as you get them;

ü  If you do not receive a new SDS form from a product manufacturer, you have to communicate with each manufacturer to obtain an updated SDS for your complete file;

ü  You need to look at your workplace and compare the new SDS forms to identify hazardous chemicals and how your employees will use them and be exposed to them;

ü  If your employees regularly or even sporadically work with or around hazardous chemicals, you have to insure they review the updated SDS forms to assess what might be impacted by the new SDS form;

ü  You should insure your workers who work with or around hazardous chemicals are trained to recognize the pictograms and hazard warnings required under the new Hazard Communication Standard. 

ü  You want to be sure to document this safety training and develop mechanisms to confirm your employees understand the hazards of working with or around all chemicals in your workplace.

 

Brad Smith, J.D. is our OSHA defense team leader and can answer questions or concerns about any of this—simply send a reply. We appreciate your thoughts and comments. Please post them on our award-winning blog.

 

            -----------------------------------------------

Synopsis: The IL Workers’ Comp Lawyers’ Ass’n CLE Presentation on AMA ratings and their Impact on IWCC Decisions. Thoughts and Analysis by John A. Karis, JD.

Editor’s comment: On April 9, 2015 three cases, each concerned with AMA ratings, were summarized and presented by WCLA members in a continuing legal education format. When you read the summaries below, you may note the rulings analyzed don’t show much value in using AMA ratings. With respect to the WCLA presenters, we do feel AMA ratings have great value and we feel PPD awards and settlements continue to drop. Please also note there is a new Chairperson and new Commissioners who may more closely adhere to AMA ratings under our current Governor. Either way, some of the key issues are discussed below.

The Weight of AMA Impairment Ratings – 6% AMA Rating Still Resulted in Award of 25% LOU.

One of the cases discussed was Frederick Williams v. Flexible Staffing. This case involved a 45-year-old welder who sustained a right distal biceps tendon rupture. Dr. Aribindi performed surgery. Petitioner returned to work full duty. Dr. Mark Levin assigned an AMA impairment rating of 6% UEI and 4% WPI. The Arbitrator’s decision was 30% LOU arm but was reduced by the IWCC to 25% arm. Respondent filed a Circuit Court review and the matter was remanded. On remand the Commission made the following clarification to support its conclusion, in response to Respondent's argument Dr. Levin's AMA impairment rating of 6% of the upper extremity was not given enough “weight” by the Arbitrator. The Commission stated “we do not agree with the great weight that Respondent wants placed on this rating because to do so would be to disregard the other factors and give them no weight at all. Section 8.1b of the Act requires the consideration of five factors in determining permanent partial disability.”

Section 8.1b also states, "No single factor shall be the sole determinant of disability. In determining the level of disability, the relevance and weight of any factors used in addition to the level of impairment as reported by the physician must be explained in a written order." We initially note the term "impairment" in relation to the AMA rating is not synonymous with the term "disability" as it relates to the ultimate permanent partial disability award. Based on the above, the Commission found the 6% impairment rating by Dr. Levin did not adequately represent Petitioner's actual disability in this case. When considering the other four factors, they found Petitioner's permanent partial disability was 25% loss of use of the right arm. The Commission stayed with their prior ruling to modify the Arbitrator's Decision and decrease Petitioner's permanent partial disability award from 30% to 25% loss of use of the right arm pursuant to Section 8(e) of the Act.

This decision may be making its way up to the Appellate Court, WC Division and we will keep an eye on it. This case is important because it is taking a look at the weight some IL WC Arbitrators are putting on impairment ratings. Respondent in this case did not believe the Arbitrator or IWCC put enough weight on the 6% AMA rating. What is the appropriate weight to put on impairment ratings? It appears to vary from cases to case. Some Arbitrators do not strongly align their decisions with the AMA impairment rating. On the other hand, some Arbitrators adopt the impairment rating without change for their trial award. An Appellate Court decision may shed some light on this important issue. We will update you with their decision when filed.

No Weight Given to AMA Rating At All – 17.5% BAW Affirmed by IWCC for Shoulder Surgery

The second case discussed was Steve Maynard v. Danville Housing Authority. This case shows an Arbitrator may place very little weight on AMA rating. After considering the issues of the nature and extent of petitioner's disability, and whether the award should be based on §8(e) or 8(d)2 of the Act and being advised of the facts and law, the Commission affirmed and adopted the Decision of the Arbitrator of 17.5% BAW for a shoulder with subacromial decompression & rotator cuff repair. Petitioner was judged by Respondent's medical evaluator to have a six percent (6%) AMA impairment rating of the upper extremity.

The Arbitrator had some issues with the impairment rating by Dr. Katz. The rating was premised on the Petitioner having a normal range of motion in the right shoulder and Dr. Katz reported such a finding. However, Dr. Katz only tested the Petitioner's right shoulder. The AMA Guides require the examiner to test both shoulders so as to accurately determine what is normal for each individual. See AMA Guide, Sixth Edition, Section 15.7 (a), p. 461. More important, Dr. Katz' numbers were inconsistent with those found on several occasions by Dr. Rotman, who did examine both shoulders. On January 28, 2013, Dr. Rotman found 140 degrees of flexion and abduction of me right shoulder and 150 on the left. He found 45 degrees of external rotation on the right shoulder and 60 degrees on the left. The Arbitrator could not see how Dr. Katz was able to produce 180 degrees of flexion and 90 degrees of external rotation during his exam. Those numbers greatly exceed those found by Dr. Rotman on the Petitioner's good arm. Therefore, Dr. Katz' range of motion findings were considered suspicious for the above reasons. The impairment rating used presumes a normal range of motion. For those reasons, the Arbitrator placed little weight on the rating.

This case demonstrates how an Arbitrator may not put any weight on the rating if they do not believe it was done correctly This rating was based on Petitioner having a normal range motion but the Arbitrator found this to be incorrect after looking at prior treatment records. Just because an impairment rating was done doesn’t mean an Arbitrator needs to place great weight on it in their decision. Claims handlers and defense attorneys need to make sure impairment ratings are done correctly in order for the Arbitrator to find it credible and use it in their decisions.

Section 8.1 and the 5 Factors – 17.5% BAW Award for shoulder surgery ignores 5% AMA Rating

The third case discussed was Terina Green v. PPG. This case gave a solid breakdown for each factor in its decision. Petitioner underwent surgery to her left shoulder which included a subacromial decompression, rotator cuff repair a proximal biceps tenodesis, and intra-articular evaluation, debridement, and removal of loose bodies.

1. The level of impairment: Dr. Atluri furnished multiple impairment evaluation reports. Most important is his last one which was based upon Petitioner having finally reached maximum medical improvement. Dr. Atluri found Petitioner's complaints to be credible at the time and he concluded her impairment was nine percent of the upper extremity or five percent of a whole person. Petitioner's Quick Dash score was 56.8 which he testified was at the higher end of moderate in terms of severity.

2. Petitioner's Occupation: Petitioner's occupation at the time of the accident was a factory worker. She had performed those duties for approximately six years prior to her accident. At the time of arbitration Petitioner was unemployed as her last employer, G & D Integrated, had shut down. Petitioner voluntarily left her employment with Respondent to work for G & D. The job for G & D was supervisory in nature and, by Petitioner's description, less physical than her job for Respondent. Petitioner is left hand dominant. No direct evidence was presented to show Petitioner's current unemployment status is attributable to her work injury. However, based upon Petitioner's credible explanation of her former job duties for Respondent, the Arbitrator reasonably inferred it would be challenging for Petitioner to engage in the type of factory work in light of her injury.

3. Petitioner's Age: Petitioner was thirty-nine years old at the time of her accident. No direct evidence was presented by either party as to how Petitioner's age impacts any disability. However, the Arbitrator noted Petitioner may reasonably be expected to live and work with the effects of her injury for a longer time than an older individual and, therefore, her permanent partial disability may be greater than an older individual.

4. Future Earning Capacity: While Petitioner testified to a reduction in pay after her accident, she did not prove by a preponderance of the evidence the reduction was related to her injury.

5. Evidence of Disability corroborated in the treating records: Petitioner's records from her treating physicians have demonstrated evidence of disability. Petitioner underwent surgery to her left shoulder which included a subacromial decompression, rotator cuff repair (for an 80% tear), a proximal biceps tenodesis, and intra-articular evaluation, debridement, and removal of loose bodies. While surgery improved Petitioner's condition and she was released with no restrictions, she has continued to notice limitations in her left arm and shoulder.

Petitioner's testimony concerning her injury and her ongoing symptoms and complaints was found credible. In light of Section 8(b)1 of the Act and after considering the foregoing factors, the Arbitrator concluded Petitioner has suffered a loss of 17.5% of a person as a whole as a result of her work accident. This case illustrates the thinking process of an Arbitrator as they go through each factor of a case.

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