October 18, 2016

10-17-2016; State of Oregon Nat'l WC Premium Ratings are Released With Surprising Results; IL WC Legislative Update from the IL State Chamber; Bob Kosin RIP and much more

October 18, 2016/ Eugene Keefe

Synopsis: State of Oregon Rankings Released--Illinois WC Gets One Spot Better for Business.

Editor's comment: One of the more statistically significant methods to track WC costs across the U.S. is the every-other-year ranking from the State of Oregon.

Here are some key links for the Oregon study of state by state workers' compensation costs:

• To read a summary of the study, go to http://www.cbs.state.or.us/external/dir/wc_cost/fi...

• Prior years' summaries and full reports with details of study methods can be found at http://www.oregon.gov/DCBS/reports/Pages/general-w...

• Information on workers' compensation costs in Oregon, including a map with these state rate rankings, is at http://www.cbs.state.or.us/external/dir/wc_cost/ma...

You will note Illinois WC dropped to eighth from seventh nationally in workers’ compensation premiums.

For the other states KCB&A handles and defends our great clients:

Indiana remains 49th,

Michigan is 34th,

Wisconsin is 12th (their ranking two years ago was 23d); and

Iowa is 24th.

We predicted and had high hopes for better progress on IL WC premium costs but to no avail. This minimal change will probably keep Illinois WC system at the forefront of Governor Rauner’s goal of bringing down WC costs to bring in more businesses. The State of Illinois continues to lose manufacturing jobs to our neighboring states because of our workers’ compensation premium rate and some of the highest property and overall taxes in the nation, per the Illinois Policy Institute and the American Insurance Association.

The Illinois WC premium rate is $2.23 per $100 of payroll. The national median WC premium cost was $1.85 so IL is getting slowly closer to the median.

Chris Hurley, president of the Trial Lawyers Association, was quoted as claiming the 2011 IL WC reforms lowered benefits but did not reduce WC insurance premiums. Those IL WC reforms included reducing all WC medical fee schedules by 30% for all treatment performed after Sept. 1, 2011. We continue to tire of ITLA telling everyone the WC problem in Illinois is those “evil” insurance carriers that aren’t passing along their savings to customers.

AIA advocates an IL WC Medical Fee Schedule based on 175% of Medicare rates and the need for a close examination of its indemnity benefits.

Illinois government faces a growing budgetary crisis: nearly $10 billion in a backlog of unpaid and badly aging bills and a years-old estimate of $111 billion in government pension liability the Illinois Policy Institute says is actually double that amount because investments are not growing at the 7% rate projected by Illinois policymakers. Two weeks ago, Standard & Poor’s dropped Illinois’ credit rating to BBB, citing its history of deficits and failure to reduce spending or address future pension needs.

IL WC System Isn’t Happy About Always Being Compared to Indiana! We Assure our Readers Indiana Isn’t the Garden of Eden for Work Comp.

Take a look at this article:

http://www.workcompwriter.com/has-the-other-shoe-dropped-new-report-signals-feds-are-losing-patience-with-state-workers-compensation-programs/

We are certain Indiana workers' comp program provides truly minimal WC benefits in many settings. They do pay for medical care and their medical costs were some of the highest in the U.S. They just brought in a hospital medical fee schedule to rein in rising WC medical costs.

IN WC T&P Awards are, in my view, comically low and push Claimants to other gov’t benefit streams, making Indiana WC appear "cheaper" but not really. A total and permanent disability award in IN WC provides benefits for only 10 years or 120 months. After 10 years, that's it. The employer/insurance carrier is done. A 25 year old Indiana worker with serious injuries/brain damage and an unquestioned inability to work again only gets benefits until age 35. That means he or she is going to be going on SSDI or welfare to eat and feed a family. Those expected costs aren’t characterized as workers comp costs but someone has to pay for a seriously injured worker and their family for a long time.

Moving away from T&P values, IN WC PPI or impairment ratings are so low as to barely be worth it. A worker with a badly broken arm or leg in IN with pins and plates in the extremity who goes back to regular work might get $1,000 to $5,000.

This sets up the odd scenario where a worker can be walking into the workplace with a friend who doesn't work there. They both fall down on a slippery substance negligently left by the owner/employer and badly break their arms. They both get over $100,000 in medical care to fix their arms.

The friend sues and wins a jury verdict for $500,000 for the badly broken arm due to the negligence of the property owner.

The worker has the same medical care and same recovery and gets $3,000 for PPI. The worker can't sue in civil court for the negligence of the employer; WC coverage blocks any third party claim against the employer.

Most people feel this wildly disparate outcome is unfair. Folks in the federal government are starting to notice per the link at the top above. If and when the leading Presidential candidate on the Democrat side wins, I feel you can expect the pressure on the low-ball states to get hotter. IL WC may be a little bit too much but there needs to be a fair middle-ground.

On the Other Side, Illinois WC Total and Permanent Disability Awards Are Becoming Comically/Shockingly Expensive.

The maximum total and permanent disability rate in Illinois is now $1,428.74. Consider as an example a 25 year old construction worker who is adjudicated to be T&P, they will receive $74,294.48 a year on a tax-free basis to start. The silly IL WC Rate Adjustment Fund will boost that income to double in about 23 years so this worker at age 48 will be getting about $150,000 a year, every year. The amount will continue to rise and the same worker will be getting quadruple that amount or about $300,000 in the 46th year or when they reach 71. Yes, you are correct, they will be receiving about a million dollars every three years! And the WC payout will continue to spiral until they pass.

If you do the math, you will note such a claim has a lifetime cost well into the tens of millions of dollars. When some rocket scientist created the IL WC RAF or Rate Adjustment Fund, no one apparently did the math.

You may also note a worker in IL doesn’t have to be seriously injured or brain-damaged to get T&P benefits in this crazy state. Our “odd-lot” total and permanent disability concept provides multi-million benefits to lots of IL State and City of Chicago workers who get “permanent restrictions” and the hapless government claims people don’t bring them back to sedentary jobs when they open up. To our understanding such government workers not only get zillions in T&P benefits, they can simultaneously receive IL government pensions. Both systems have built-in COLA increases!

We vote the secret-powers-that-be that run the IL WC Commission come up with a middle ground to make sure injured workers are taken care of without making them wildly rich.

We also vote all IL state and local governments should be required to bring all injured workers on restrictions back to sedentary jobs when such work opens up. Anyone who tells you our governments don’t have sedentary jobs is not telling you the truth.

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

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Synopsis: Illinois WC Legislative Update from the Folks at the IL State Chamber.

Editor’s comment: At last week’s IL State Chamber Annual WC presentation, Jay Dee Shattuck, one of the top WC Gurus at the IL State Chamber of Commerce provided a legislative update for Illinois workers’ comp participants.

As we indicate above, Governor Rauner feels IL workers’ compensation reform is important to maintain a competitive business environment in Illinois. Unfortunately, the Governor’s efforts have been blocked by the Illinois General Assembly. The House and Senate both pushed their own workers’ compensation bills, but both their bills did not become law.

There are currently negotiations with a state-wide working group trying to come up with an “agreed bill” This might be bipartisan workers’ compensation reform that can be supported by employers, labor, and the medical community. A goal is to tie these reforms to a budget bill to help address Illinois state finances.

There are several key issues in these reform negotiations:

Causation – The IL WC causation standard is challenging for Illinois employers as Illinois allows a workers’ compensation claim for even a minor aggravation of a preexisting condition. The Governor is pushing for a causation standards in line with some other states where they require the work exposure to be the “prevailing factor” in order for a claim to be viable.
Traveling Employees – The IL WC Act does not define what a “traveling employee” is and efforts to codify the concept continue. Our concern is coming up with language that reins in the concept. What we saw being proposed as legislation would clearly expand the idea.
Self-insurance regulation – The state is pushing for a higher level of reporting claims data from self-insured employers so that more analysis can be done.
WC Premium regulation – Some are saying there is no issue from the claims side and the problems with Illinois workers’ compensation is excessive insurance carrier premiums. They are calling for greater regulation of rates because of this. There are significant concerns insurance premium regulation could reduce the number of carriers willing to write coverage in Illinois which would ultimately drive up costs further and drive more employers into the assigned risk pool.
Reining in the IL Reviewing Courts - There is concern around the appeals process as the IL Appellate Court, WC Division has consistently expanded the application of work comp concepts beyond the simple “plain English” version of the IL WC Act.. The Appellate and Supreme Courts also require the employer post an appeals bond for litigation that is appealing which creates an undue burden on employers. Finally, cases cannot be appealed to the Supreme Court without certification from two of the justices of the “middle” court. If the Appellate Court decisions are unanimous, there is no avenue for further appeal. And it always appears to us the certification of many claims for Supreme Court appeal seems to be political, as in the Interstate Scaffolding ruling that was a fight over $5,000!
PPD awards – Illinois has some of the highest indemnity benefits in the nation. The proposed reform legislation is not looking to reduce these rates, but they are looking at reforms that would allow credit for prior PPD awards on a body as a whole injury. Under current case law, an employee can receive cumulative PPD awards that far exceed what the body as a whole is valued at. This lack of credit for prior injuries to the whole body significantly increases employer exposures for PPD awards. Another concern around this area is that the courts have started oddly ruling injuries to the shoulder or hip are whole body injuries and not arm or leg which would allow for credit.
AMA guidelines are also causing a challenge as the Commission and courts do not like just basing PPD awarded on the AMA guides alone because they feel the benefits are somehow inadequate. Prior to adopting the AMA guidelines PPD in Illinois was determined by the whims of the Arbitrators and Commission panels..
Professional sports teams are looking for caps on wage loss benefits for professional athletes.
The IL WC Medical Fee Schedule is one of the highest in the nation as it is based on billed charges. Some employers and local governments are pushing to use a Medicare-based fee schedule which is used in most other states.
Drug compounding – This is a loophole in the fee schedule which some observers feel is being abused. Many states have passed legislation to address this issue. We agree with the attack on this concept.
Durable Medical Equipment – This is another area where loopholes in the fee schedule are being exploited and providers are billing rental charges that far exceed the full value of the equipment. We agree a DME provider should be allowed to bill two or three times the value of the equipment.
Electronic medical billing – IL WC Payers are required to accept electronic billing and to in turn make electronic payments. Medical providers are complaining this is not happening consistently.
Physician dispensing – This is a continued cost driver that requires additional legislation to fix. Many feel this is greatly abused. However, there is recognition physician dispensing may make sense in some areas (first fill for example) so it is important to have fee regulation in place so the charges are not excessive. Our favorite example was a single tube of “pain cream” being dispensed by a physician for $4,000!!
Interest on delayed payment of WC medical bills – The medical community is pushing for some path to actual enforcement of a 1% interest charge for delayed payment of medical bills. Issues arise due to needed documentation and whether there is a legitimate dispute over the charges.
Penalties on delayed payments – Medical providers are pushing for increased penalties on delayed payments.
Limits on Physical Therapy visits – There has been discussion about limits on physical therapy visits. Many feel this is better addressed with utilization review.

We strongly support Mr. Shattuck and State Chamber President Todd Maisch and all their staff who do the hard work to seek to rein in IL WC costs. For more information, please reach out to the Chamber at their great website at www.ilchamber.org.

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Synopsis: Bob Kosin, Rest in Peace.

Editor’s comment: Wereceived news Attorney Bob Kosin passed away about ten days ago. Bob was a stalwart Claimant attorney, first licensed in 1956. He leaves two great attorneys as part of his legacy, son David Kosin and daughter-in-law Marilyn Kosin who learned well at the foot of this master advocate. Their carry on his legacy at www.kosinlaw.com.

Bob had a gruff exterior but a heart of gold. He will truly be missed.

October 11, 2016

10-10-2016; Arthur O. Kane RIP; Dealing with Closure of Medical Rights in IL WC; IWCC Budget Disappears (?) and more

October 11, 2016/ Eugene Keefe

Synopsis: May God Bless and Keep the Memory of Arthur O. Kane, J.D.

Editor’s comment: Art Kane was licensed as an IL attorney on December 14, 1939. He was an amazing businessperson, legal advocate, philanthropist and mentor. To our understanding, Arthur Kane joined with Irving Greenfield and other top Illinois attorneys in the 1950’s and 60’s to create the Illinois workers’ comp model that we have today.

His lifelong friend was Martin Boyer who formed a claims company that was initially the Martin Boyer Company, later Cambridge Integrated Services. Many of the top execs from those companies are still in the Illinois claims industry today. Art Kane’s firm was named Kane, Doy & Harrington and was considered one of top defense firms in the central U.S. He once said his law firm handled 10% of all workers' compensation claims across Illinois, His former law partner Sam Doy, now deceased, fought on the beaches in Normandy and was wounded in Europe and awarded a Purple Heart. Current IWCC Commissioner Michael Brennan worked at the Kane, Doy, Harrington firm for almost two decades.

The story told about Martin Boyer and Art Kane is they sold the claims company/TPA they owned for a solid value to watch the purchaser do less than well. Martin Boyer and Art Kane bought the company back at a discount to again rebuild the business and sell it again. They again bought it back, rebuilt the business and again sold it and made a lot of money doing so.

Art Kane became famous for handling claims on both sides of the matrix, when there was no conflict of interest. I still remember him appearing at oral arguments before a Commission panel. He argued the first case for the defense side of a claim. Later in the oral docket, he handled another complex case for the Petitioner-side. By the end of the docket, he argued another case for the defense side, each time making it clear to the panel whether he was “wearing a black hat or a white one.”

Art Kane also pioneered the somewhat ethically challenging concept of “appearance-only” handling of defense files. What he would tell the Martin Boyer Co. adjuster to do was send him the Application only and his firm would file just an appearance without having a complete defense file. The adjuster would continue to seek to work out details with Claimant attorney and if they could resolve the claim, Art Kane’s would simply close the file. If not, the file contents would be sent over for “full defense.” The concept highlighted how powerful Art Kane became because no one ever fought about such handling and members of the Claimant bar would always provide some opportunity for his attorneys to get the file and get prepared for hearing. We assure our readers the concept of “appearance only” handling wouldn’t work in the Circuit Courts where the attorneys are less genteel and way more aggressive.

As a philanthropist Arthur O. Kane gave millions to support the University of Chicago: He and his beloved wife, Esther donated $3 million in 1996 for a 10,000-square-foot expansion that became the Arthur Kane Center for Clinical Legal Education, according to a press release by the University of Chicago. In 2015, Kane and his wife made a bequest to support two Law School positions for faculty members who have demonstrated expertise in constitutional law and/or administrative law. He and his wife also donated a significant amount of money to the Rehabilitation Institute of Chicago where they were board members.

Kane was a past president of the Illinois Workers’ Compensation Lawyers Association and Chairman of the Chicago Bar Association’s committee on workers’ compensation. Arthur Kane died on Oct. 1 "peacefully in his sleep," according to an obituary in the Chicago Tribune. He was 98.

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Synopsis: Dealing with Unpaid Medical Bills When Settling IL WC Claims.

Editor’s comment: We had a fairly sincere Claimant attorney complain:

We don’t know if work-related medical bills remain outstanding. Bills pop up months and sometimes years after the date of service. This is because bills sometimes sit in limbo with insurance carriers and as long as the treatment provider marks the bill as pending, they often don’t send additional bills. The bill could sit as pending because the WC claims handler wants more info or the WC adjuster doesn’t want to pay but hasn’t denied payment, or WC has denied and the treatment provider resubmit.

These things take months. Treatment providers also change billing companies quite frequently and bills get held hostage. Additionally, treatment providers often sell or turn over the accounts, which can happen multiple times and by the time it gets to a company that works the account, it has been many, many months, and the whole time the bill would show up as 0 with the treatment provider because they do a write off in their accounts. These are just a few scenarios.

Basically, her message was medical liability has to remain open and infinite in settling a WC claim in this state.

And then you have a very difficult and troubled attorney in central IL He and his defense opponent had “open-ended” medical liability language in the lump-sum contracts following the model above. Then Petitioner’s counsel got the claim settled and waited about ninety days. After all the dust settled and everyone thought the IL WC claim was closed, for the first time, Counsel presented about $40,000 in medical bills for treatment no one on the employer/insurance carrier was aware of. Claimant’s counsel asserted the settlement contract wording was “all medical bills are paid.”

In my view, this was classic sandbagging—I feel he knew he was going to get a fight over the unpaid medical bills and hid them until he cashed the settlement check and disbursed the proceeds. Once that was complete, he then started the second fight.

We don’t mean the worker treated at ABC Hospital starting in the emergency room and then being admitted for surgery. We understand many times, some but not all of the bills get paid and fell through the cracks. In our view, that isn’t an issue when we know the worker treated at ABC Hospital.

Our problem starts when the worker treated at ABC Hospital and the surgical and follow-up medical care was with four different medical providers our side knows of. In our view, the defense side has to pay for such care whenever the bills are presented for treaters we are aware of.

We get mad when work-related medical care occurs that no one on the defense side knows about with a cost of $40K and there was literally no presentation, defense or denial of those bills. What if the bills were $140K or $440K? Under the theme presented by counsel in the quote above, the exposure for unpaid medical bills is infinite.

Our rule is we pay for medical bills for work-related medical care of which the defense is aware. Our lump sum settlement contracts say that. If there is a beef, we assert Petitioner or their attorney have to plead and prove we were aware of the care and/or the bills. We don’t ever use language in lump sum settlement contracts that says “all medical bills are paid” as that creates unlimited and infinite medical liability.

We don’t have to settle but if we do, we can’t have infinite post-settlement liability. If we try the claim, medical rights remain open but we have the ability to dispute bills and care.

We ask our readers—if you have a better approach to reasonably cutting off medical liability when settling/closing an IL WC claim—send it along, on or off the record.

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

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Synopsis: IWCC Budget and Fund-Spending Disappears?? JCAR to Examine WCC Rules on FOIA, Filing, Judicial Review

Editor’s comment: We recently learned two things of interest to WC readers in Illinois.

First, one of our readers noticed the IL WC Annual reports for years have reported the IWCC’s budget along with how much of Illinois’ business’ money is wasted, we mean spent on the various funds run by the IWCC. For the first time anyone can remember, the last or 2015 IWCC Annual Report dropped/skipped/deleted the budget and the levies and expenditures on the funds. No reason for the deletion is outlined.

In our view, the goal of doing so is to hide the budget from everyone and not allow simple but important analysis or monitoring. We are sure the information is contained somewhere in the IL State Budget that might be about twenty volumes of other stuff. No, we don’t want to go through all of that to find out what this one state agency is doing with our tax dollars and levies.

We find it particularly galling to see this is happening under Republican leadership. The math is there, why not let us know? Maybe we should send an FOIA request for them—see below.

Second, a bipartisan legislative oversight committee will review several Illinois Workers' Compensation Commission rules during its coming meeting.

JCAR or the Joint Committee on Administrative Rules will look at regulations concerning access to records, electronic filing, pre-arbitration, arbitration, review, oral arguments, judicial review, settlement contracts and lump sum petitions, the discipline of attorneys and insurance regulations. The proposed rule on access to records would bring the IL workers' compensation system into compliance with Illinois' updated Freedom of Information Act. It would require the Workers' Compensation Commission to respond to records requests within five business days from receiving a FOIA request. It would also make public all records dealing with payrolls, public funds, and settlement and severance agreements, unless exempted by statute.

The Illinois General Assembly delegates the power to oversee the rule-making process to the Joint Committee on Administrative Rules. The committee ensures that each agency's rules meet the requirements of the Illinois Administrative Procedure Act and that they do not exceed the agency's authority.

The committee requires people who wish to speak about a rule to mail their written comment to: Joint Committee on Administrative Rules, 700 Stratton Office Building, Springfield, Illinois 62706. View the agenda for the meeting, which links to each proposed WCC rule, on the third and fourth page, here.

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

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Synopsis: You Can Vote Today!!!

Editor’s comment: Voting is one of our most fundamental rights as Americans. It is the cornerstone of our democracy and our civic duty. Early voting is officially underway in Illinois. You can vote early using a mail-in ballot or at a local polling place.

Some people think their vote doesn’t matter. That’s just not true. Elections - especially those at the state and local levels - are often decided by just a few hundred votes. Your vote matters.

Get out there and VOTE!!!

October 03, 2016

10-3-2016; Use Caution Using Credit Checks in Hiring by Lilia Picazo; Answers from Last Week's IL WC Article; Consider Pittsburg Biomechanics in Your Next Claim; Vote NOW! and much more

October 03, 2016/ Eugene Keefe

Synopsis: If You Run Employee Background/Credit Checks, Read This! Illinois Appellate Court in Ohle v. Neiman Marcus Group ruled IL employers cannot use credit checks to deny employment to sales associates job applicants. Analysis by Lilia Picazo, J.D.

Editor’s Comment: We are not fans of courts telling businesses how to operate and protect themselves from scammers. On September 27, 2016, the Illinois First District Appellate Court reversed the Circuit Court's ruling in favor of Defendant Neiman Marcus. The Court found Neiman Marcus violated Illinois’ Employee Credit Privacy Act when it denied Plaintiff Ohle a job in 2012 after running a credit check, which revealed several civil judgments against her and accounts in collection.

In 2012, Catherine Ohle applied for and was denied a “Dress Collections Sales Associate” position at Neiman Marcus after failing a credit check. Ohle filed suit arguing the use of credit checks violated the Illinois Employee Credit Privacy Act. This Act “prohibits an employer from inquiring into a potential employee’s credit history and prohibits an employer from refusing to hire an applicant or discriminating against the applicant because of his or her credit history.” 820 ILCS 70/10(a) (West 2012).

Neiman Marcus admitted Ohle applied for, was interviewed, and offered the sales associate position contingent upon completing a successful credit and background check. Neiman Marcus admitted the failed credit check was the reason it did not hire Ohle or other potential sales associates. Plaintiff sued them for this decision. Neiman Marcus moved for summary judgment arguing there were no genuine disputes of any material facts. Neiman Marcus claimed the “access” exemption to the Act allowed their action and they denied they engaged in unlawful practices alleging a satisfactory credit check was a “bona fide occupational requirement” for a sales associate position who handled money. It argued the sales associate position had “access” to personal or confidential customer information by accepting credit application and entering the information into a POS register.

Cook County Circuit Court Judge Kathleen Kennedy agreed the sales associate position fell within the “access” exemption and granted summary judgment in favor of Defendant Neiman Marcus. The IL Appellate Court disagreed noting the “access” exemption was too broadly interpreted. A ruling in favor of Neiman Marcus would exempt all retail sales employees from the protections of the Act intended by the legislatures. The Court reasoned sales associates were “neither managers nor select few employees” entrusted by Neiman Marcus to handle credit card applications. The court found sales associates were instructed to place credit card applications in a locked drawer for handling at a later time by a cash credit office.

The Appellate Court panel wrote “… most stores, including retail stores like defendant’s would be exempt and employers would be allowed to deny employment to citizens who face ‘financial hardships that are often unpreventable’ due to the ‘harshest economic we’ve seen in decades’ and who are not able to obtain employment despite ‘bad credit’” in situations such as Ohle’s.

Neiman Marcus argued two additional exemptions:

(1) sales associates had unsupervised access to cash and merchandise valued at over $2500, and

(2) sales associates had signatory power over business assets of $100 when issuing gift cards or refunds over $100.

The Court found sales associates did not have unsupervised access to merchandise and cash valued over $2500 because associates were supervised by managers and monitored by surveillance. The Court further found sales associates performed regular job duties when issuing gift card or refunds over $100. The Court found the duties did not arise to a signatory power over Neiman Marcus’s assets, as they did not have access to the department store’s bank accounts or authority issue checks on behalf of the store.

The Appellate Court remanded the case back to the Cook County Circuit Court for trial.

We consider this an anti-business decision and all HR managers should be aware of it. This ruling is especially important for our clients and other business entities that may use credit checks to deny employment. The Appellate Court’s ruling signifies that business entities cannot use a single credit check metric to deny employment to an applicant. While one can argue a credit check reflects an applicant’s level of trustworthiness, the Appellate Court’s ruling narrows the use of the credit check to higher level positions with access to sensitive business assets.

The research and writing of this article was performed by Lilia Picazo, JD. Lilia can be reached at lpicazo@keefe-law.com for any questions regarding workers’ compensation and employment law.

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Synopsis: Answers from Last Week’s Article on IL WC--Always Consult with Keefe, Campbell, Biery & Associates on Four Types of Claims and More!! Check out the correct answers below.

Editor’s comment: We have recently reviewed a number of claims that were previously handled by other firms, including some “house” defense counsel operations. What we saw were lots of mistakes, some potentially expensive. We did our best to correct issues and point the claims in the right direction to rapid closure, sometimes finding ways to save lots of money.

The four types of challenging WC claims are

· Death Claims;

· Amputation Claims;

· Total and Permanent Disability Claims and

· Claims that Involve MSA’s or Medicare Set-Asides.

Here are Ten Simple Questions you might want to ask your existing defense firm about these challenging claims to see if they know what they are talking about. They shouldn’t have to research these sorts of issues.

1. In an IL death claim, if the only survivor is a 15 year-old child, can the weekly death benefits be paid to the child? No, children/minors have no standing at the law; the money would have to be paid to the child’s guardian.

2. In an IL amputation claim, can you safely accept the claim and pay weekly permanency benefits? No, once you are aware of the fact of the amputation, you have to pay the full amount to the injured worker all at once. If you do anything else, there is a high risk of penalties and attorney’s fees in an amount as much as 70% of what is owed. We don’t agree the IL WC Act says this but the Appellate Court, WC Division says that is the law.

3. In a total and permanent disability claim in this state, can the employee receive benefits from a source other than the employer and its insurance carrier? Yes, the Rate Adjustment Fund. If you need more information on the RAF, send a reply.

4. How many “types” of total and permanent disability claims are there in Illinois Work Comp? There are three—does your defense attorney know what they are?

5. Can an injured worker adjudicated to be totally and permanently disabled also work and earn additional money? Yes, the IL Courts ruled a statutory total and permanent disability claimant can work and make money while also getting a significant tax-free weekly pay check for life.

6. If you are settling a claim with an MSA, can there be a reversionary clause allowing the amount “set-aside” to be returned to the employer or its carrier? Yes.

7. Under what circumstances can a weekly IL death benefit be payable to a survivor for more than 25 years? If there is a child who is physically or mentally disabled, the benefit can be due while the disability continues, even if that is more than 25 years.

8. What is the purpose of a “death prove-up” in an IL death claim? To insure the employer/insurance carrier is paying the right widow/widower, children or dependents. If you don’t do a prove-up, you might have to double-pay a later arriving claimant.

9. If someone makes $200 a week and they suffer an accident today that results in total and permanent disability, what is their minimum weekly T&P rate? $535.79!!

10. What is the minimum combined death benefit payable to a widow-widower who survives 25 years after their decedent? $535.79 times 52 weeks in a year times 25 years or $696,527.00!!

We are confident few defense lawyers know the answers to what we feel are simple and basic questions. We have several adjunct professors of workers comp law on staff to quickly answer your biggest concerns. We also have Shawn R. Biery and Matthew Ignoffo who are MSA-certified and know the law on Medicare Set-Asides backwards and forwards.

We confirm for all of our readers, if you are dealing with a complex claims, such as the ones above or any other complex WC issue in Illinois, Indiana, Wisconsin, Iowa or Michigan, send us your concerns and we will typically respond with research and the answers you need. We don’t charge for such work unless and until you assign us the file.

Give us a try! We appreciate your thoughts and comments. Please post them on our award-winning blog.

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Synopsis: What Is Pittsburgh Biomechanics and Would They Help In Your Next WC or GL Defense?

Editor’s comment: Biomechanics is the application of the principles of engineering and laws of physics to the living systems, such as the human body. The human injuries provide a basis for a biomechanical reconstruction that along with the mechanical reconstruction allows the determination of probable accident scenarios.

Biomechanists determine the mechanism of the injury and the forces involved, and relate them to the tolerance data and everyday loads to verify whether a claimed injury is consistent with a specific set of actions or exposure to a specific accident environment.

Who/What Is Pittsburgh Biomechanics?

Pittsburgh Biomechanics is a [regional/national] consulting firm that provides its clients with the knowledge and expertise they need in cases involving human injury as a result of an incident/accident. They use engineering and biomedical sciences to explore the cause, nature, and severity of injuries.

Their Role in WC and GL Claims Defense of Your Toughest Claims

They provide their clients with a biomechanical investigation, which includes the basic technical background that they need to consider when involved in accident-related cases, such as low-speed motor vehicle collisions, slip-and-falls, occupational injuries, etc. Their engineers help the clients, including attorneys practicing personal injury law, understand the role that a biomechanical analysis can play in a wide range of accident scenarios.

Top Ten Reasons to Consider/Use Pittsburgh Biomechanics?

Pittsburgh Biomechanics helped pioneer the science!
They’re equipped with tools like state of the art research equipment, proprietary software, 3D Analysis and visual communication that helps tell a powerful, potentially game changing story.
They have extraordinary experience of 77 years for all professionals combined
Pittsburgh Biomechanics includes a team of two MDs, eight PhDs, three Masters of Science and two RNs.
They produce remarkable results. For example, they are 39-1 in trials using their expert testimony, and 95% of the 1100 cases they’ve analyzed have resulted in denials or compromise settlements that changed the face of those cases.
They turn assignments as quickly as needed and can be available 24/7 for consultation.
Their rates are extremely competitive
They are growing and adding new, Fortune 500 self-insured and insurance carrier clients.
Pittsburgh Biomechanics has the strongest possible client focus – they will understand client objectives and customize their approach to meet your needs
They possess the strongest possible credibility. Their reputation is their most valuable asset.

Management by Top BioScientists

The company is run by Dr. Kevin Toosi, M.D., PhD. He is a faculty member at Department of Bioengineering at the University of Pittsburgh where he received his PhD in Biomechanics Track. He conducts clinical research to understand the mechanisms through which repetitive strain injuries of nerves and tendons occur and investigate the acute and chronic changes in the musculoskeletal systems by collecting and analyzing biomechanical data. His primary research interests include studying median nerve injuries, such as carpal tunnel syndrome, and investigating the relationship between those injuries and biomechanical factors affecting wrist structure and function.

As the Principal Scientist at Pittsburgh Biomechanics, he uses engineering and medical sciences to explore the cause, nature, and severity of accidental injuries. As a biomechanist, he determines the mechanism of the injury and the forces involved, and relate them to the tolerance data and everyday loads to verify whether a claimed injury is consistent with a specific set of actions or exposure to a specific accident environment. He has more than seventeen years of experience in the areas of clinical medicine, basic and clinical research, mechanics of soft tissues, human injury biomechanics, injury causation, and occupant kinematics in motor vehicle accidents.

To retain them as experts in your next claim, go to their website at http://www.pghbiomechanics.com/ or call 412-221-1671

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