6-18-2018; NASI Report Indicates IL WC Dropped Compared to Rest of U.S.; Kevin Boyle on IN WC Settlement Change and more

Synopsis: Illinois Work Comp Benefits Paid Dropped Compared to Rest of U.S. Per NASI Report and Analysis.

Editor’s comment: In Illinois, workers’ compensation benefits dropped in recent years compared to the rest of the U.S., according to a recent report from the National Academy of Social Insurance or NASI. We attribute this measured decrease in IL WC costs to the impact of

  • More conservative and business-focused Arbitrators and Commissioners appointed by Republican Governor Bruce Rauner;
  • The recent change by our IL Appellate Court, WC Division to leave IWCC denials alone and not reverse denials to award benefits under the “manifest weight of the evidence” standard, as I feel they were sometimes doing. The panel has also issued what I feel are common sense rulings like Dorsey v. IWCC that provided employers statutory credit for prior loss of use of the arm/shoulder awards-settlements despite the fact such awards are now rendered on the “body as a whole.”
  • The continued exodus of jobs and humans from Illinois continues as the out-migration continues to move folks and businesses away from Illinois with the highest combined sales, property and income taxes in the U.S. Fewer jobs mean lower WC benefits being paid.

Please remember Governor Rauner appears to be trailing in the coming November election. Thousands of retired IL government workers are aligned against him—they will be voting on one issue—protecting their impossible-to-fund fake government pensions. To avoid upsetting that voting bloc, neither gubernatorial candidate is discussing or trying to “reform” this massive government catastrophe. Please also remember the IL minimum wage will skyrocket to $15 an hour if the Democrat wins the November election. That increase should end more jobs but also make WC claim costs higher for lower-paid workers who remain in this State.

Finally, and with respect to NASI, I feel the best metric on IL WC claim costs is the every-other-year ranking of U.S. WC premium costs by the State of Oregon—sadly, their next report isn’t due until after that gubernatorial election but oddly may be released in the same month—November 2018.

Either way, the NASI report In 2015, workers’ compensation benefits paid in Illinois were $2.4 billion. I am sure the annual IL benefit outlay exceeded $3B in years past. The National Academy’s stat rats confirmed between 2011-2015, Illinois experienced a 19.3 percent decrease in benefits paid, the second largest decrease across the country. Total benefits in the rest of the U.S. increased by 2 percent over the same period (Table 1). According to the report, Workers’ Compensation: Benefits, Coverage, and Costs, the large decrease in total WC benefits in Illinois is most likely attributable to a number of legislative changes implemented in 2011 that regulated the medical delivery system.

In Illinois, both medical and cash WC benefits decreased between 2011 and 2015, but the percentage decrease in medical benefits was 50 percent greater than the decrease in cash benefits (-23.3 percent vs. -15.6 percent). As a result, medical benefits as a share of total benefits paid in the state fell from 47.7 percent in 2011 to 45.3 percent in 2015. Among all states, Illinois had the seventh lowest percentage share of medical benefits relative to total benefits paid in 2015. Illinois also experienced slower growth in employer costs for workers’ compensation relative to other states. Between 2011 and 2015, costs in Illinois increased 3.8 percent, well below the 21.6 percent increase in costs that occurred in the rest of the U.S.

Table 1. Workers' Compensation Benefits, Coverage, and Costs:
Illinois and the Rest of the U.S.

 

2015

Percent Change 2011 to 2015

 

IL

Rest of U.S.
(non-federal)

IL

Rest of U.S.
(non-federal)

Aggregate Benefits, Coverage, and Costs

Total Benefits (billions)

$2.4

$55.7

-19.3%

2.0%

Medical Benefits

$1.1

$28.8

-23.3%

1.9%

Cash Benefits

$1.3

$26.9

-15.6%

2.0%

Covered Workers (thousands)

5,754

127,083

5.2%

8.1%

Covered Payroll (billions)

$320

$6,652

16.0%

19.4%

Employer Costs (billions)

$3.9

$86.0

3.8%

21.6%

Other findings on workers’ compensation in Illinois from the Academy’s report include:

  • Increases in employment and payroll covered by workers’ compensation were slightly below the growth in the rest of the nation. In 2015, covered employment reached 5.8 million in Illinois, up 5.2 percent from 2011 (compared to an 8.1 percent increase for all other states), and covered payroll was $320 billion, up 16 percent from 2011 (compared to a 19.4 percent increase for all other states).
  • Workers’ compensation benefits paid in Illinois declined as a share of payroll to $0.75 per $100 of covered payroll in 2015, down from $1.08 in 2011 (Figure 1). Illinois experienced the third largest decline in benefits as a share of payroll among all states during that period. Benefits as a share of payroll declined in the rest of the U.S., but at a much more gradual pace.

Figure 1. Workers' Compensation Benefits per $100 of Covered Payroll, 2011-2015: Illinois and the Rest of the U.S. (non-federal)

 

 

  • Costs as a share of payroll in Illinois decreased from $1.37 in 2011 to $1.23 in 2015 (Figure 2).While costs as a share of payroll in Illinois were higher than the rest of the country in 2011 ($1.37 vs. $1.27), they fell below the rest of the country in 2015 ($1.23 vs. $1.29).Illinois experienced the eleventh largest decline in costs as a share of payroll between 2011 and 2015.

Figure 2. Workers' Compensation Costs per $100 of Covered Payroll, 2011-2015: Illinois and the Rest of the U.S. (non-federal)

 

 

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Synopsis: Have you heard the news? There are brand new Indiana Section 15 (full and final settlement agreement) requirements and submission procedures, too. Article and analysis by our IN WC Defense Team Leader, Kevin Boyle, J.D.

 

Editor’s comment: The Indiana Worker’s Compensation Board just released the eagerly awaited new protocol for submitting Section 15s that will go into effect in the next 30 – 45 days. A full and final settlement agreement in Indiana is commonly known as a “Section 15.” We call them “Section 15s” because the last number of the Indiana WC statute that provides for these agreements ends in section 15. Most Indiana WC claims that are settled use Section 15s because there are tremendous benefits to closing your WC claims with them.

 

The below list isn’t all inclusive, but contains the main changes. If you’d like a complete list, please email me at kboyle@keefe-law.com. Also, although the changes don’t go into effect right away, the IWCB requests that we include the information as soon as possible.  

 

Here’s a partial list of key new elements to include in future Section 15s:

 

  • The number of weeks of TTD paid.
  • Estimated total medical expenses paid.
  • If there are outstanding medical bills, indicate the party that has responsibility to pay them with specificity if necessary.
  • Future medical care and financial responsibility obligations.
  • PPI calculations. If no PPI was assessed, explain why.
  • Permanent restrictions, if issued.
  • If Perm Total Disability is an issue, including language that the 15 does not bind Second Injury Fund, and that a determination of eligibility will be made at the time of application.
  • Injured worker’s email address and phone number if known.
  • Include the date of birth of the injured worker.

 

Extra supporting documentation to attach to the Section 15, too:

 

  • Final medical report of treating physician.
  • IME report, if any
  • PPI report and accompanying hand or foot chart, if relevant.
  • Employee waiver, if any.
  • FCE report, if any and if relevant.

 

Additionally, and probably the most significant news, are the following two changes. 

 

First, the submission procedures are changing decades of “how we used to do it.” The IWCB finally is going to start accepting electronically filed Section 15s through emails. They will be emailed instead of sent/delivered to the IWCB in paper form through the mail. These new email procedures haven’t been finalized yet so, we can’t email them in just yet. It should be implemented in the next 30 – 45 days.

 

Second, the individual hearing members will now sign the Approvals, instead of submitting the Section 15s to the IWCB administrative office as we’ve done for years, too. That’s another huge change. We are not sure yet how that could affect how quickly Approvals are signed, but we’ll find out more in the coming months, and I’ll let you know.

 

Again, if any questions on these changes, and other settlement agreement issues that could affect your claims, please email me, kboyle@keefe-law.com. Even if I’ve not been on your claim as it was handled, if you reach a settlement on your case and need a quick Section 15, contact me.

6-11-2018; RUMC Increases Its PTSD Treatment Capabilities With Grant--Will WC Treatment Follow?; How to Become Self-Insured for Work Comp in Indiana, by Kevin Boyle, J.D. and more

Synopsis: RUMC Taking the Point on PTSD Treatment in the Midwest U.S. Will Treatment for Your WC Claimants Follow?

Editor’s comment: After a recent shooting in Florida, lots of WC claimants are seeking WC benefits for PTSD or Post-Traumatic Stress Disorder due to the stress of everyday work. The problem with this concept is authentication—the fine line between true psych injuries and folks that want to game the system to bank WC benefits for life.

We just learned Rush University Medical Center is getting its biggest gift ever—$45 million from the Wounded Warrior Project to fund mental health care specifically for military veterans. As one of our top defense lawyers, Shawn R. Biery is a former U.S. Marine (and the son of a former Marine), we are sensitive to the stresses of the battlefield and the need to provide care to post-combat military veterans. If someone has a real psych injury and real PTSD issues, they need real treatment.

When we move to the private sector, we worry about your municipality and mine when every police officer and fire fighter seems to be lining up for work comp or duty disability benefits for the normal stresses of the work they applied for and accepted when hired. Every day work of police officers and firefighters can’t result in numerous folks going on the dole. If the work stress is real and intense, the workers need to be treated and brought back to less stressful settings. We feel the experts on PTSD at RUMC are going to draw the line on what is real and what is fantasy.

Either way, two years ago the same charity gave $15 million to the Rush University Medical Center to start outpatient treatment for post-traumatic stress disorder. This new money will expand those efforts.

We note, of the 262 veterans who underwent a three-week Intensive Outpatient Program, more than 60 percent no longer "meet criteria for PTSD," said Dr. Mark Pollack, chair of Rush's psychiatry department. To me, that indicates the program is designed to maximize authentication of who needs care and lost time from work and who has to fight the good fight to stick it out and get back to the work force with the rest of us.

Michael Linnington, CEO of the Jacksonville, Fla.-based Wounded Warrior Project, said Rush's "phenomenal results" paved the way for additional funding, expected to cover 1,500 more veterans over five years.

Rush is one of four hospitals participating in the Wounded Warrior Network and the first in line for renewed support, he said. The other members are Emory Healthcare in Atlanta, Massachusetts General Hospital in Boston and UCLA Health in Los Angeles.

Between 90 percent and 95 percent of PTSD participants complete Rush's program, compared with a third who finish behavioral health therapies "strung out months" by the VA, Linnington said. "The beauty of this program, it is an intensive outpatient program. The only thing that separates it from inpatient, they don't sleep at night in the hospital."

The Intensive Outpatient Program is part of Rush's Road Home Program, begun in 2014 with funding from the McCormick Foundation and other donors; it has treated nearly 1,300 veterans and expects to provide therapy and counseling for another 3,500, including family members, over the next five years.

My suggestion/recommendation for my readers is to try out the program at RUMC and report back on the efficacy of what they are offering. Please let me know how they do, moving forward and I will continue to monitor and report.

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Synopsis: How to Become Self-Insured for Work Comp in Indiana, by Kevin Boyle, J.D., KCB&A’s Indiana WC Defense Chair.

Editor’s comment: If you are a risk/safety/HR manager for a company that may qualify to be self-insured for your Indiana operations, Kevin Boyle is your go-to guy to assist in that process.

Kevin confirms the Indiana WC Board’s  2018 Self-Insurance Application and Guidelines are now available.

The IWCB just released their 2018 Self-Insurance application and guidelines. They are easy to complete and, if you can become self-insured, the savings may be dramatic.

 

Completed applications should be returned to the IWCB no later than July 31, 2018, and late or incomplete applications are subject to late fees.

Safe web links to the seven IN WC self-insurance forms are available on line here: https://www.in.gov/wcb/2367.htm.

Pursuant to I.C. 22-3-5-1(b), renewal applications must be accompanied by a payment of $250.00.

 

The IN WC Board does not accept cash payments. Checks or money orders must be payable to "Worker’s Compensation Supplemental Administrative Fund."

 

Incomplete applications and renewal applications received after July 31, 2018, will be charged an additional $250.00 late fee.

 

Deadline extensions shall be granted only under extraordinary circumstances and at the Board’s discretion. 

 

If you have further questions/concerns, email Kevin Boyle at kboyle@keefe-law.com.

 

 

Synopsis: E-Notice Announcement from IWCC.

 

Editor’s comment: IWCC Chairman Joann Fratianni announced another important step forward in the IWCC's modernization and technological upgrade of operations. Pursuant to the IWCC's Rules, as found in Section 50 of the Illinois Administrative Code, parties will receive case activity notices electronically beginning in about a month on July 2, 2018.  

 

The IWCC will no longer send most case notices via U.S. Mail as of this date.*  All parties (law firms on behalf of clients and pro se litigants) will be required to maintain a designated electronic mail ("e-mail") address for receiving case notices, just as they are now required to maintain a physical address to receive them by U.S. Mail. You only need to fill out the "E-Mail Registration Form" once (just like providing us your physical address), so they can update their system.  

 

PLEASE NOTE that it does not matter if you already have an e-mail on file or in use with the IWCC – they are populating the system with new and updated information.  So, please submit a law firm/pro se e-mail address to the IL Commission again.

 

* The only exception to electronic notices is Respondent parties at the time a case is initially filed will be notified that a case has been filed against them by U.S. Mail at the address provided by Petitioner. This is the current practice and won’t change.

 

Attorneys – Their system links cases before the IWCC to the law firm, not the individual practitioner.  So, please provide the IWCC your firm's e-mail address for receipt of electronic notices. If one of your attorneys "updates" your firm e-mail address with their own, all firm notices will go to the most updated address.

 

If you have questions on this process, send me an email.

6-4-2018; IL WC Appellate Court Denies Fall-Down--I can't figure out the rules; Circuit Court Commends Arb. Andros on Causal Relation Claim; IL WC E-Notices to Start July 2 and more

Synopsis: IL WC Appellate Court Denies Stair Fall Down Claim. I remain baffled about the rules in IL WC slip-fall claims.

 

Editor’s comment: In Lampert v. The Illinois Workers’ Compensation Commission, et al. (Ferrell Hospital, Appellee) facts of the event are simple. Petitioner was a registered nurse for Ferrell Hospital. On November 26, 2012, after working a full shift at the hospital, she clocked out at approximately 8:00pm and headed to the parking lot where she usually parked her personal car. She exited the hospital to a set of carpeted stairs. As she descended the stairs, she reported she held on to the handrail because the stairwell was dark.

 

Without any apparent reason, she slipped off the top step and fell all the way down the flight of stairs, causing a serious injury to her left ankle. She was x-rayed and then diagnosed with a left ankle fracture. She underwent not one but two separate ankle/leg surgeries.

 

At the time of the event, she had a personal bag over her shoulder but her hands were free; she wasn’t holding anything. She described the outside weather at the time of the fall to be “misting and kind of sleety.” She also testified it was dark at 8pm on a November night. She admitted the stairs and parking lot were both open to the general public, patients as well as employees, but noted most non-employees used Ferrell Hospital’s front entrance or its emergency room door to enter and exit the hospital.

At arbitration before Arbitrator Lindsay, Petitioner’s claim was denied as she failed to establish her injury “arose out of” employment. Petitioner appealed the decision to the IL WC Commission panel headed by then-Commissioner Mario Basurto. The IWCC panel affirmed the denial. The matter went to the Circuit Court and then the Appellate Court, WC Division. In a unanimous but “non-published” Rule 23 opinion, the five-justice Appellate Court affirmed the decisions of the Circuit Court, Commission panel and Arbitrator.

The basis of the appeal was three-fold—Petitioner claimed she was exposed to a “neutral risk” on the staircase to a greater degree than the general public because

(1)   It was dark outside (doesn’t it get dark outside most nights?)

(2)   The “rained-on” stairs were wet and slippery, creating a dangerous condition (rain has a tendency to do that)

(3)   She traversed the stairs more often than the general public. (Twice a day isn’t a lot more than the “public”)

The Appellate Court dispensed with the initial arguments confirming Petitioner had the burden of proof and she never attributed darkness or weather conditions to the reasons that she fell. The ruling notes she simply testified she slipped on the top step of the staircase. I wonder if she needed a surface analysis/expert on this subject.

The appellate ruling uniquely dealt with her argument she was exposed to an increased risk of injury, compared to the general public because she traversed these stairs more “often.” The decision ruled there was no evidence presented to distinguish the outdoor stairs Claimant was traversing, even if those stairs were potentially wet from rainfall, similar to any other typical outdoor stairway, across the globe.

The Court felt it did not have any evidence suggesting Petitioner was more likely to slip and fall on her employer’s premises than she or any other member of the public would be likely to fall on any other outdoor stairway that was exposed to rainfall (citing Dukich v. Illinois Workers’ Compensation Comm’n, 86 N.E.3d 1161.)

This ruling demonstrates the willingness of some Arbitrators/Commissioners and our reviewing courts to reign in compensability and the cost of workers’ comp in our State. I am sure our state WC costs are going down for this reason and that should be reflected in the 2018 State of Oregon WC Premium survey due this November or thereabouts. I have seen fall-down claims like this one ruled compensable and consider all fall-down rulings in Illinois to be unpredictable.

On fascinating aspect of this decision is how the Appellate Court ruled regarding Petitioner’s assertion she was exposed to an increased risk because she used the stairs more often than the general public. The Court did not agree with Petitioner that just because she used the stairs at least twice a day (if not more as it was not clear from the opinion) she was somehow exposed to an increased risk of a work injury. Instead, the Appellate Court ruling analyzed the specific facts of this event. Petitioner did not present any evidence this particular set of stairs was more likely to cause a slip and fall as opposed to any other set of outdoor stairs used by the public.

You can read the ruling at Lampert v. IWCC

Synopsis: Circuit Court affirms IL WC Arbitrator and Commission award of benefits/surgery despite gap in care after first MMI.

 

Editor Comment: IL WC Defense practitioners and claim handlers are encouraged to resolve cases promptly upon claimant reaching MMI, thereby avoiding the return for care which may be deemed related to the injury.

 

We came across this ruling and felt it was report-worthy, because of the lesson to be learned for the IL WC claims handler/defense community.

 

In Berkeley School District #87 v. IWCC and Salvador Maldonado (17 L 50476) Petitioner worked long hours shoveling snow over several days after a particularly heavy snow-storm in early 2015. He treated conservatively and all medical treatment wrapped up by March of that year. However, several  months later in July, he asserted his symptoms returned and an MRI identified a tear and a concomitant need for surgery.

 

Respondent School District was understandably upset with this dramatic change in a simple back strain claim, as no new injury occurred and there had been an MMI release previously. However, a detailed assessment of the record and fact notes symptoms never fully resolved, leading to an arbitration award by Arbitrator George Andros for the requested surgery. The IWCC panel headed by Commissioner Stephen Mathis affirmed the award.

 

Upon confirming the Arbitrator and Commission award, Circuit Court Judge McGing complimented the careful and detailed analysis of Arbitrator Andros, which explained Petitioner’s lingering complaints, lack of any intervening event and expert medical support for causation and the reasonableness and necessity of surgery. It does appear from the IWCC computer this claim is moving to the Appellate Court, WC Division so watch this space for further news—please note the burden on Respondent will be demonstrating the ruling is against the “manifest weight of the evidence” or the decision of the court below is obviously wrong—that burden will be very challenging to meet.

 

It is our impression this award comes down to a temporal perspective. If the gap in care after the original MMI finding had been 14 or more months rather than 4 months, we may have seen a different conclusion. However, in the instance in which similar symptoms never fully resolve, or otherwise return within a relatively shorter time-frame, we can expect Arbitrators and other hearing officers, including the reviewing courts will find causal connection to the work-injury and the reasonableness and necessity of surgery.

 

From a defense perspective, the defense team at KCB&A recommends you institute prompt settlement negotiations upon the finding of MMI to seek avoid such complex situations.

 

 

Synopsis: E-Notice Announcement from IWCC.

 

Editor’s comment: IWCC Chairman Joann Fratianni announced another important step forward in the IWCC's modernization and technological upgrade of operations. Pursuant to the IWCC's Rules, as found in Section 50 of the Illinois Administrative Code, parties will receive case activity notices electronically beginning in about a month on July 2, 2018.  

 

The IWCC will no longer send most case notices via U.S. Mail as of this date.*  All parties (law firms on behalf of clients and pro se litigants) will be required to maintain a designated electronic mail ("e-mail") address for receiving case notices, just as they are now required to maintain a physical address to receive them by U.S. Mail. You only need to fill out the "E-Mail Registration Form" once (just like providing us your physical address), so they can update their system.  

 

PLEASE NOTE that it does not matter if you already have an e-mail on file or in use with the IWCC – they are populating the system with new and updated information.  So, please submit a law firm/pro se e-mail address to the IL Commission again.

 

* The only exception to electronic notices is Respondent parties at the time a case is initially filed will be notified that a case has been filed against them by U.S. Mail at the address provided by Petitioner. This is the current practice and won’t change.

 

Attorneys – Their system links cases before the IWCC to the law firm, not the individual practitioner.  So, please provide the IWCC your firm's e-mail address for receipt of electronic notices. If one of your attorneys "updates" your firm e-mail address with their own, all firm notices will go to the most updated address.

 

If you have questions on this process, send me an email.