8-6-2018; Shawn R. Biery's IL WC Rate Sheet Available!!!; Gene Keefe on Alderman Burke and Chicago WC Morass and more

Synopsis: AUGUST IN IL—ARE WE SWEATING DUE TO HUMIDITY OR NEW IL WC RATES BEING  POSTED???—UPDATED RATE SHEETS AVAILABLE SOON FOR ILLINOIS WC RATE INCREASE!!! 

Editor’s comment: Illinois WC Rates Have Updated Again So Please Be Aware Of The New Rates or Your Claims Handling Will Suffer and Penalties May Ensue.

Email Shawn at sbiery@keefe-law.com AND Marissa at mpatel@keefe-law.com to Get a Free and Complimentary Email or Hard Copy of Shawn R. Biery’s Updated IL WC Rate-Sheet!

We like to continually hope it’s a sign of a growing state economy and influx of business however that doesn’t appear to be the case—even though rates continue to increase almost every cycle as we continue to watch the growth of IL WC rates. As we have mentioned in the past, since in the 1980’s, the IL WC Act provides a formula which effectively insures no matter how poor the IL economy is doing WC rates continue to climb.

We caution our readers to pay attention to the fact the IL WC statutory maximum PPD rate is $790.64. However, this rate is only through June 30, 2018 and the new max PPD will be published in January 2019. When it will be published in January 2019, this rate will change retroactively from July 1, 2018 forward.  At that time, if you don’t make the change, your reserves will be incorrect--if this isn’t clear, send a reply.

The current TTD weekly maximum has risen to $1,480.12. A worker has to make over $2,220.18 per week or $115,449.36 per year to hit the new IL WC maximum TTD rate.

The new IL WC minimum is creeping closer to the $725k floor. That amount is now 25 years of compensation or $555.05 per week x 52 weeks in a year x 25 years or $721,565.00! The new maximum IL WC death benefit is $1,480.12 times 52 weeks times 25 years or a lofty $1,924,156.00 plus burial benefits of $8K. IL WC death benefits also come with annual COLA increases which we feel can potentially makes Illinois the highest in the U.S. for WC death claims.

The best way to make sense of all of this is to get Shawn Biery’s colorful, updated and easy-to-understand IL WC Rate Sheet. AGAIN—If you want just one or a dozen or more, simply reply to Shawn at sbiery@keefe-law.com AND Marissa at mpatel@keefe-law.com  They will get a copy routed to you once we get laminated copies back from the printer—hopefully before they raise the rates again! Please confirm your mailing address if you would like laminated copies sent to your home or office!

Synopsis: Gene Keefe on City of Chicago WC Defense Program Morass Under Alderman Ed Burke.

Editors’ comment: The news sources in Chicago were a’rocking when a federal lawsuit was recently filed to seek to force the City of Chicago to stop letting Alderman Ed Burke run the morass that is Chicago’s WC defense program. Jay Stone, who I consider a complete and well-intentioned gadfly was behind the legal action that I feel is going to rapidly be dismissed. It has opened some debate I consider important for you, as a reader.

After that litigation got filed, the Better Gov’t Association joined in the fray and they want Chicago’s WC Program to also be taken out of control of Alderman Ed Burke. This government corruption watchdog group voiced its support for efforts to move Chicago's workers' compensation program out from under the control, or perhaps the comical lack of control, of a powerful city alderman. I don’t see any true value in moving

the WC claims from Alderman Burke to Mayor Rahm Emanuel—the City needs an outside source to be responsible for properly managing these benefits.

Here are my thoughts in order of importance:

1. Alderman Burke is the husband of IL Supreme Court Justice Anne Burke. I would think if you or I were married to an IL Supreme Court justice, you would have the highest ethical standards of any politician in this crooked state. Please keep reading to weigh your thoughts on the ethics involved. I am happy to meet with Justice Burke to discuss my opinions on this topic at her convenience.

1. Alderman Burke is near or close to being a billionaire, yep, a billionaire, because he wants all of his supporters and political donators to give him the corporate contact or decision-maker at their company for Chicago’s comically “fake” real estate tax appeals. Alderman Burke uses those contacts to legally make the billions he has made over the years. The reason I feel Chicago’s real estate tax appeals are “fake” or phony is the unquestioned fact there is no legal work going on. No IL law school teaches “real estate tax appeals.” The IL Bar exam asks no questions about this area of “law.” Alderman Burke doesn’t appear, file briefs or argue before any judge to obtain the hundreds of millions in legal fees earned by his firm in the nutty process every year and the entire process is ethically flawed. Basically, one politician—the Cook County Assessor—first screws up our real estate taxes. In response, someone files what is comically called an “appeal” so the “appeal panel” considers other properties around the subject property to “re-set” the taxes to what is arguably the accurate amount and the politicians, as lawyers, make zillions on the process. If the County Assessor just got our real estate taxes correct in the first place, the whole thing would disappear. I feel there is enough computing capability in your cell phone to get any assessment correct or very close to correct—instead, the Assessor still uses pen and paper and calculators and other silly computational devices to insure they are repeatedly wrong in setting assessments. Why would they want to be wrong? So the other politicians make zillions on the process…

1. Alderman Burke accepts/seeks legal but ethically challenged donations from three Claimant firms who have “favored nation” status and get most of the City of Chicago WC claimant work. In my opinion, one defense firm also gets favored nation status to defend City of Chicago “emergency” petitions. It is my understanding and opinion, if a defense firm gets such work, they can bill and bill and bill and bill to their heart’s content to potentially make up for their donations to Alderman Burke. No one audits such legal billing that I am aware of. To get the defense work, the firm has to donate quarterly along with making with one large annual payment, I mean donation each year.

1. It is my opinion, the City of Chicago may spend between $120M-200M each year in WC payouts. It is my further feeling Alderman Burke “hides” all WC payments/reserves and budgets either in the numerous City of Chicago departments or wherever he feels best. If you send an FOIA request for how much the City of Chicago spends on WC every year, it was my experience they will tell you they don’t know and have no way to find out. It is my feeling the “hiding” of WC payouts is unethical and inappropriate in an open government.

1. If you check online for City of Chicago job titles, there is no one identified as a claims handler manager for WC. There is no member of the City of Chicago Corporation Counsel’s office designated or specifically trained as a workers’ comp defense lawyer.

1. To my understanding, the City of Chicago has as many as 3,000 pending WC claims at any time. They have one claims manager and one defense lawyer handling about thirty times the work level of most private claims or defense firms. The lack of management or legal defense insures payouts will be huge to injured City workers.

1. I am not aware of the City of Chicago ever doing a pro se settlement under the guidance of Alderman Burke—every claim goes “legal” and one or more of his favored lawyers makes the money to handle.

1. To my further recollection, Alderman Burke does not feel the City of Chicago can and should bring any injured worker back to light work—he dismisses the concept as worthless despite the fact every company on the planet tries to implement it. Because of this “no-light-work” focus by this powerful politician, injured City workers are allowed to stay off work for years and years on TTD. When they settle, the money is well into the six-figures.

1. To my further recollection, Alderman Burke does not allow for surveillance of injured City workers on TTD. It is my opinion, he doesn’t want his private eyes to catch loyal precinct workers who have side jobs and second jobs or operate businesses while on TTD.

In short, I feel the City of Chicago is nutty when it comes to running their own WC defense program. I don’t feel the Mayor’s Office has any chance to improve on their dismal results. I feel there is a strong need for an outside company or force to handle it and try to bring the concept in line before this version of the Titanic hits the iceberg, bringing the City of Chicago down with it.

7-30-2018; Illinois Policy Institute Chronicles WC Corruption in IL Municipalities and Local Governments; IL WC IME Questions for You! and more

Synopsis: Illinois Policy Institute Chronicles WC Corruption in IL Municipalities.

Editor’s comment: We just saw a great article from Victor Caruso of the IL Policy Institute outlining their research on failed WC defense in at least one Illinois municipality. Mr. Caruso found The City of Belleville, IL offers a shocking example of what I feel is outright corruption in workers’ comp for local governments. Since 2013, Belleville has spent more than $2.5 million on workers’ comp settlements, according to city records of Illinois Workers’ Compensation Commission contracts. In 2018 alone, tiny Belleville, IL with a population of about 42,000 has so far spent $420,000 settling workers’ comp claims. Between 2013 and 2018, Belleville’s costliest year for workers’ comp payouts was 2016, during which the city spent $662,000 in just that year on workers’ comp settlements.

Mr. Caruso’s research indicates the WC claims vary widely in severity and cost. One claim settled in 2013 involving a worker “hit by a car while collecting signs” resulted in a payout of $26,100. Meanwhile, a comparatively less serious claim filed that year resulting from “lifting a heavy garbage can” earned one worker a $125,000 settlement.

Shocking WC Settlements for Almost-No-Lost-Time Claims

Many cases in which workers reported sustaining only mild injuries, and returned to work the next day, nonetheless resulted in large workers’ comp settlements, records show. One worker who reported an injury sustained while landing awkwardly exiting a firetruck collected $39,750. Another worker who reported an injury after pulling a hose collected $24,000. Both returned to work the day after their respective incidents. In fact, more than 35 percent of City of Belleville workers who received a workers’ comp payout between 2013 and 2018 returned to work the day after the reported accident date – amounting to nearly $360,000 in settlements. Huh? Who is watching the taxpayers’ money?

A City of Belleville human resources official confirmed payouts for workers’ comp settlements are paid directly by the city, unless a settlement surpasses $250,000, in which case insurance coverage kicks in.

Mr. Caruso also notes workers sustaining the most extreme injuries – “dealing with a combative juvenile” or “trying to remove a door at a fire” – were more likely to receive six-figure settlements. However, comparably ambiguous and modest claims – “testing heavy equipment” or “hauling hose line” – also delivered at least $100,000. Five workers who reported “repetitive trauma” received between $19,300 and $33,000.

Workers’ comp insurance as well as provisional income injured workers receive while off the job collectively cost state and local governments $1 billion each year in Illinois, a 2017 Illinois Policy Institute report found. And local governments bear the brunt of this mandate, shouldering $727 million of that nine-figure annual bill.

Corruption in IL WC For State and Local Gov’ts Has Been Present for Decades

I am sure our IL State WC defense program is a shambles—they blindly pay hundreds of millions each year to wily workers. The City of Chicago WC defense program is run by Alderman Ed Burke who happily accepts campaign donations from WC defense lawyers and WC plaintiff lawyers and anyone else who wants to benefit via workers’ comp at the expense of Chicago taxpayers. Chicago also pays zillions in WC and other disability benefits.

The IL Policy Institute confirms Illinois’ costly workers’ comp system can’t be blamed directly on individual workers. I do feel lots of municipalities and other small IL governments corruptly use the WC system as a way to reward co-workers and give them time off with pay. It is easy to blame the system when you are doing nothing to defend your government from abusers and charlatans.

A 2015 report by Illinois’ Local Government Consolidation and Unfunded Mandates Task Force found workers’ comp to be the third-most burdensome unfunded mandate for Illinois municipalities. This runs parallel to the effect the state’s workers’ comp law has on the private sector, driving businesses across state lines toward more practical regulatory environments.

While I agree it is necessary to have a system in place through which workers are made somewhat whole for workplace accidents, Illinois’ workers’ comp law has failed to evolve with the changing landscape of modern workplace environments. Originating after the Cherry Mine Disaster in 1909, an era in which workplace danger was commonplace, Illinois’ workers’ comp law was established to guarantee rapid medical coverage and replacement wages to workers in the event of a work-related injury. The system requires good government and solid claims handling principles—if your city isn’t doing so, taxes are certain to spiral.

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

Synopsis: Questions on an IL IME for You!

Editor’s comment: We are asking our readers for your thoughts and guidance.

We have a claim where our client wants Claimant to attend an IME.

An IME was set with mileage included in the notice.

Petitioner did not attend without explanation given.

Here are some IL IME questions:

• Does the defense have to reset such an IME? What happens if they don’t?
• Can Petitioner have a doctor present in the examining room at their own expense?
• Can Petitioner have a lay-person (not a doctor) in the examining room at their own expense?
• Can the examinee demand the IME be videotaped?
• Can the examinee secretly audio-record the IME?
• Can the examinee require a specific time for the IME?

What do you think?

7-23-2018; Illinois Docs Go After WC Insurance Carriers Over 12% Annual Interest on Unpaid Medical Bills; Amended Illinois Supreme Court Rule Requires Additional Phrase for All Civil Summons and more

Synopsis: Illinois Docs Go After WC Insurance Carriers Over 12% Annual Interest on Unpaid Medical Bills. Gene’s Vote is Rotsa Ruck With This Litigation—Go Back to the Legislature.

Editor’s comment: Every doctor I know gets irate/mad/sad to see the 2011 Amendments to the IL WC Act

• Cut their reimbursements for the second time under the 2011 Amendments to the IL WC Medical Fee Schedule;
• Expanded on the areas being cut and
• Supposedly provided them with 1% per month interest on unpaid medical bills.

The fighting/litigation over the 1% per month interest on unpaid medical bills erupted into the Circuit Court of Cook County where our judiciary noted the remedy had no provision to allow it to be enforced by the doctors, hospital and other caregivers. Ooops.

Last week, a federal judge refused to dismiss a class-action lawsuit that alleges IL workers' compensation carriers engaged in a conspiracy to avoid the 1% monthly interest on late medical bills payments. This class-action lawsuit was brought against more than 80 insurance carriers, including some of the largest U.S. and international work comp carriers and claims-management firms. As the claim survived, it will now proceed to discovery. As part of the discovery process, Plaintiffs' attorneys hope to shed light on the practices of ignoring the statutory fiat that appears to require payment of such interest..

U.S. Federal District Judge Nancy Rosenstengel denied a defense motion to dismiss. She ordered Plaintiffs to restate the complaint's fraudulent concealment allegations with more specificity. The amended complaint is due by Aug. 2. If you want her order, send a reply.

The problem I feel is present is our nutty IL legislators who repeatedly create laws that seem effective but without any penalty or path to enforce them. Please note in Indiana it is possible for a caregiver or hospital to start a work comp claim in their own right—they don’t need or want the help of the patient. The IN WC Board can and will get involved to require the insurance company to properly pay a medical bill. The IL WC system has no such concept or remedy—all benefits flow through Claimant and Claimant’s attorney. If Claimant and their attorney isn’t concerned about an unpaid medical/hospital bill, the caregiver can and does routinely get stuck negotiating for less money and losing the statutory interest ostensibly due.

Of very recent vintage, the Illinois Appellate Court in Marque Medicos v. Liberty Mutual Insurance rebuked Liberty Mutual Insurance for their alleged failure to pay medical bills for treatment of a number of injured workers. The Appellate Court confirmed IL doctors were provided no recourse to force reimbursement or interest payments, because the IL WC Act does not provide standing to seek payment to medical providers.

In a move to close that loophole in the law, the Illinois legislature this year passed Senate Bill 904, which would allow doctors to bill employers directly, require insurers to pay interest at 2% monthly on overdue medical bills and authorize providers to sue in court to collect payment. You will note that bill isn’t law just yet. The bill is awaiting action by Republican Gov. Bruce Rauner, who has not indicated he plans to sign it into law. The Illinois State Medical Society, long outraged by insurers' alleged stalling tactics, lobbied for the bill and has aggressively urged Rauner to sign.

Plaintiffs in the Beatty claim are taking a different tack than in previous suits. Instead of relying solely on the provisions of the IL WC Act, the lead Claimant Beatty argues the IL WC insurance companies engaged in a pattern of “fraud” prohibited by the Illinois Consumer Fraud and Deceptive Business Practices Act.

The complaint alleges insurance WC carriers fraudulently concealed their failure to pay the statutory interest due Plaintiff and the proposed class by employing a number  of tactics, including:

• ◾Providing false information on the name of the insurance company, which prevents doctors from pursuing payment from the correct carrier.
• ◾Transmitting false information in explanations of benefits (EOBs). "Such false information is transmitted for the purpose making it appear on the face of the EOB that payment was timely, and concealing that the payment was outside the time limits proscribed" by law.
• ◾Failing to provide EOBs at all in settlements or rulings by the Workers' Compensation Commission, which makes it impossible to determine if payments were made in a timely fashion.
• ◾Sending payments without including interest.
• ◾Giving false information to the worker on when the request for payment was received.

The federal complaint also charges IL WC insurers did not act in isolation, but were part of what is claimed to be an industry-wide effort to thwart payments of reimbursements and statutory interest to doctors. Yawn. The IL WC carriers are alleged to have participated in trade associations that developed such practices and purchased software that magically does not calculate interest payments due to physicians.

Please note the practice of “balance billing” is similarly illegal under the IL WC Act. No penalty or proscription is assigned; in my view, balance billing continues by medical providers on occasion. Hard to imagine a class action about a “conspiracy” in by doctors’ balance-billing would go anywhere.

I don’t agree with this litigation and I predict it will be eventually dismissed; that may happen in the Seventh Circuit Court of Appeals or U.S. Supreme Court in several years. Enjoy the interminable wait. We will continue to report progress and see where it goes.

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

Synopsis: Amended Illinois Supreme Court Rule Requires Additional Phrase for All Civil Summons. Analysis by our GL team leader, Brad Smith.

Editor’s comment: A recently-amended Illinois Supreme Court Rule requires the following language to be added to all civil summons:

E-filing is now mandatory for documents in civil cases with limited exemptions.

To e-file, you must first create an account with an e-filing service provider. Visit https://efile.illinoiscourts.gov/service-providers.htm to learn more and to select a service provider. If you need additional help or have trouble e-filing, visit http://www.illinoiscourts.gov/FAQ/gethelp.asp or talk with your local circuit clerk's office.

The language, "or talk with your local circuit clerk's office" was added to the Rule on July 19. The amended Rule takes effect immediately.

The new requirement also applies to the following rules:

•          Rule 108 Notice to Heirs and Legatees

•          Rule 110 Rights of Interested Persons During Independent Administration

•          Rule 113 Notice of Entry of Default and Judgment of Foreclosure; Special Notice of Surplus Funds

•          Rule 291 Proceedings Under the Administrative Review Law

•          Rule 292 Form of Summons in Proceedings to Review Orders of the Illinois Workers' Compensation Commission

For further information contact Brad Smith at bsmith@keefe-law.com.