9-1-2020; WC Central Misses the 800lb City of Chicago Pink Gorilla; HITECH Enters WC Claims and Litigation Practice and more

Synopsis: Missing the 800lb. Gorilla—WorkCompCentral Reports City of Chicago WC Committee Saved $1 Million After Ald. Burke Stepped Down—What About the $100M WC Claims Spend?

Editor’s comment: All Chicago media outlets are reporting Mayor Lori Lightfoot’s City of Chicago budget is expected to have a $2 billion deficit in the next 24 months. We are fairly sure it is going to be virtually impossible to make up that deficit and keep the “Second City” running in the fashion that has driven it into this whirlpool of skyrocketing debt. Municipal Bankruptcy and unpaid bills loom—hello Detroit.

In the past, I have reported one reason for this hilarious and scary financial situation is the City of Chicago was arguably a vastly “dangerous” place to work because hundreds and hundreds of City workers filed questionable WC claims over and over and over again. Along with high numbers of claims, City WC managers would allow workers to remain on TTD for years/decades to then provide giant settlements. I have warned over and over this can’t continue, as they are now completely running out of money.

You might not be surprised to learn the alderman who formerly ran the City’s WC program would not allow for light duty--causing high reserves, lost time and overtreatment. He also would not allow for surveillance of City workers, claiming it wouldn’t help—this meant City workers would quietly open businesses or make cash on the side while also getting TTD. If you research it, once this alderman was forced out due to a federal indictment, numerous workers who had been on TTD suddenly reported for work or retired.

WorkComp Central, a great national WC news outlet today reported an annual audit and financial report found the Council's Finance Committee, which ran the comp program for City employees, has saved almost $1 million in the year since the prior WC alderman managing the committee stepped down as chairman, according to the audit and a Chicago news report.

In 2018, the report indicates the committee spent $2 million, more than any other City of Chicago council committee. After the indictment was served, the managing alderman stepped down in January 2019 after he was charged with extortion. Since then, committee staff was cut to just three and the committee spent $1.1 million in 2019. Mayor Lori Lightfoot also brought in a new program administrator, and national TPA Gallagher Bassett was hired—this was a giant step for the City which hadn’t had an outside administrator, ever.

My issue is simple—the City of Chicago is broke, past broke. When I last looked they were spending over $100M annually in WC costs—please note this is for City of Chicago employees who aren’t police officers and firefighters. Police and firefighters in Chicago aren’t covered by WC. That doesn’t mean that hundreds of millions aren’t spent on such workers. The combined spend for all City workers on WC or police/fire disability is well over $200M per year in my opinion. I am not hearing any significant savings is occurring from my secret squirrels.

In short, I am not concerned about “committee costs.” I am concerned about government dysfunction and waste, waste, waste in managing WC and police/fire claims. I am hoping someone can tell us what the City is wasting, I mean, spending annually or monthly on combined WC and police/fire costs. Trust me, someone is going to have to make progress on ending phony claims and eternal disability for City of Chicago workers and police/fire folks.

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

Synopsis: Trying to Get The Low Down on HITECH In WC and Other Medical Records.

Editor’s comment: HITECH Act was implemented in 2010. It is a federal law. There has been widespread uncertainty about how to it works. The U.S. Department for Health and Human Services (DHHS) has worked several times to clear up the law, but unfortunately this has sometimes led to more confusion, not less.

Should Claimant Attorneys Use HITECH?

YES!!! Get the records needed to support your claims. Don’t mess with stupid State subpoenas that some caregivers ignore or over-charge for. File complaints with DHHS when treaters routinely ignore requests from patients for records.

When Claimant attorneys get the records and bills needed, share, share and share with the other side to support reserves, negotiations and your position in WC litigation.

Here are a few key principles:

• HITECH only applies to records requests from a patient, when the request comes from the patient directly and is in writing;

• HITECH does apply when the patient requests their medical records be sent to a designated representative, including the patient’s attorney;

• HITECH does not apply when an attorney directly requests the patient’s medical records;

• When the request is in writing from the patient, the healthcare professional must comply with HITECH and its rules

• When the request is from any other source, HITECH does not apply, and the healthcare professional can charge under state law and its rules, including the previously standard handling fee and per-page charge.

Does HITECH Apply to WC IME Reports?

The five bullet points above create something of a legal anomaly—IME docs are very careful to tell examinees they aren’t “patients” and no doctor-patient relationship is created. Very few IME docs make direct recommendations to patients for care. IME docs tell someone other than the examinee of their opinions and best thoughts.

In my view, HITECH requests should not apply to WC IME’s due to the lack of a doctor-patient relationship. Watch this space for news on this issue, if I hear of it.

1.     A physician or healthcare giver has a request from a patient asking for a copy of their records in electronic format. Can the doctor or healthcare giver charge the patient a handling fee and per-page copy fee?

From what I can tell, the HITECH Act is a federal law, and federal law preempts state law. The HITECH Act states a doctor/healthcare giver can charge a flat fee of $6.50. Alternatively, a provider can charge a “reasonable, cost-based fee” for producing electronic records when requested directly from the patient. That means the labor cost to the healthcare giver of producing records, is the demonstrable labor cost to put the records onto a CD, plus postage.

2.     The patient requested electronic records, so the doctor/hospital/caregiver scanned the paper records and put them on a CD. What can be charged under HITECH?

Whether the doc has to scan paper records into an electronic version, or drag and drop already-electronic records onto a disc, they may only charge the patient a flat fee of $6.50.  HITECH does give them a second option, which is to charge a “reasonable, cost-based fee” instead of the $6.50, for the actual labor cost to produce the electronic records. This would involve the labor-related cost to the healthcare giver’s business in scanning the paper record, uploading the record to a cloud-based system, or time spent creating and sending out a CD.  For example, if they pay someone on your staff $20.00 an hour to process records requests and they spend 10 minutes on the request, the labor cost is $3.33. They can add on the cost of the CD, which is about .20 cents and postage.

However, if they intend to charge something other than the flat fee, they must disclose those charges to the patient before sending the records. That is why most providers are choosing to charge the flat $6.50 fee for all requests, as it is simpler and more cost-effective to have one unified procedure for all requests.

3.     The patient letter also asked for a verification/certification that a caregiver has produced all the records. Can they charge the State administrative fee for preparing that?

No. The HITECH Act does not allow a provider to charge for the verification of the patient’s electronic record. DHHS has expressly stated that a provider cannot charge an administrative fee to verify the patient record.

4.     The caregiver doesn’t keep records in electronic form, so can they charge the old state per-page and handling fees?

The short answer is no.  The HITECH Act requires they comply with a request for records in electronic format if it is readily producible electronically. That means they must scan the paper records (typically into .pdf form) and transfer them onto a CD or flash drive.

If you have absolutely no ability to produce the records in any kind of electronic format, then (and only then) can you provide the patient with a hard copy of the record. Even in that case, they still must comply with HITECH in how they charge the patient. They cannot charge the handling and per-page fee allowed under state law. Under HITECH, they may only charge for actual labor costs and the cost of supplies.

6.     What does the doc do I do about x-ray films? They can’t scan those.

In this situation, it would be acceptable to charge the client the cost to you of reproducing the films and putting them onto a CD because the Act states that the records be “readily producible” in the manner requested.

7.     The patient (and not the patient’s attorney) sent a letter asking for their records in electronic format, but there was no HIPAA form. What is to be done?

When a provider receives a letter signed by the patient asking for medical records, the patient’s signature serves as the authorization.  A separate HIPAA release is not required.

8.     If a provider outsources all of records requests to a records provider, can they charge the patient for the cost of the third party vendor to copy the records?

No. HITECH does not allow the provider to pass the costs of a third party vendor to copy/scan records.

11.What is the deadline to respond to a request for electronic records?

The provider has 30 days to comply with the request. If you cannot comply within this time period, the provider must notify the patient of the reason for the delay within the initial 30 days and then the records are due in 30 more days.

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

Synopsis: The “Nuts and Bolts” of Investigating OccDisease Claims with a Specific Focus on this Pandemic—Consider Asking Shawn R. Biery, J.D. for His OccDisease Investigation Protocol.

Editor’s Comment: Shawn R. Biery of Keefe, Campbell, Biery & Assoc understands the challenges this crisis has brought to you and your claims management protocols. Suddenly, we are all being asked to figure out when/where and how someone contracted a life-threatening disease which comes with possible 7-figure OD claims exposure. To understand the risks and costs, please remember Shawn regularly updates his Illinois WC Rate Sheet—if you want a copy, send an email to Shawn or his great assistant Marissa Patel at mpatel@keefe-law.com

What Shawn has begun to detail are crucial investigation materials which you might want to consider--his new OccDisease Investigation protocol to allow you to:

1. Investigate and verify OccDisease claims for emergency workers covered under the new Rules promulgated by the IWCC;

2. Investigate and verify claims for other workers possibly not covered by the Rules and

3. Insure you have a strong basis to accept or deny OccDisease benefits in settings that may come at you and your company very rapidly.

We are constantly working to update the potential investigation protocols. Please again note, as we outline above, any Covid-19 exposure may come with 7-figure risk/reserves on a per claim basis—this is possibly a business-busting concept.

Please also make note, if you don’t diligently investigate, even without a presumption, our IL WC Commission may rule any Covid-19 claim is going to be adjudicated to be compensable.

Those supervisors, managers and adjusters who are now becoming OccDisease investigators will need the following skills:

Interviewing – the ability to draw out the relevant information through effective questioning

Communication (verbal and written) – the ability to interact effectively with injured persons, witnesses and suspects, as well as other investigators, and to communicate the findings of the investigation to a wide variety of individuals and organizations

Technical competence – the awareness of safe working procedures that should be adopted, with particular relevance to the event under investigation

Hazard recognition – the ability to ensure workers and investigators are not exposed to unnecessary risk

Interaction – personal attributes that enable effective relations with other people

Deduction – the ability to scrutinize all the evidence obtained, e.g. through observation, from witnesses’ statements and from documentary evidence, and to form a coherent picture that enables the causal factors to be identified

If you want a copy or someone to consult with an OccDisease Investigations and Rules, feel free to contact Shawn at sbiery@keefe-law.com or John Campbell at jcampbell@keefe-law.com

8-17-2020; Kevin Boyle, JD on "Must Read" for Construction Liability Claims; AMA Guides for Impairment Going Online and more

Synopsis: Federal Seventh Circuit Court of Appeals rules in Indiana case that Property Owner, Contactors Not Be Held Civilly Liable for Worker’s Fall. This is a “Must Read.” Comment by Kevin Boyle of Keefe Campbell Biery & Associates, LLC.

Editor’s comment: Independent Contractor’s Employee was Unable to Pursue Negligence Claims Against Various Parties to the Construction Contracts. Jeffords v. BP Products North America Inc., Case No. 19-1533 (7th Cir. June 29, 2020).

BP has an oil refinery in Whiting, Indiana and hired Fluor Constructors to provide engineering, procurement and construction management services for a project. BP and Fluor each entered into separate contracts with MC Industrial for the construction work. BP also contracted with Central Rent-a-Crane for crane operation services. Central had no contracts with Fluor or MCI.

Mr. Jeffords worked for Central, and while on the catwalk of the crane he lost his balance, fell and suffered injuries. He filed a negligence suit against BP, Fluor and MCI. The Northern District, Hammond Division judge granted summary judgment for defendants, finding that none owed a duty of care. The Court of Appeals affirmed applying Indiana law.

The court held that plaintiffs asserting negligence claims must prove that defendant owed him a duty of care and breached it in a way that caused injury. The court said that even if it accepted the premise that BP, MCI and Fluor all could be characterized as general contractors or construction managers, that did not mean they owed a duty of care to Mr. Jeffords as the employee of an independent contractor. Whether a duty exists depends solely on the language of the contracts.

While MCI was contractually charged by Fluor with responsibility for the safety of its subcontractors' employees, Central was not MCI’s subcontractor. Therefore, MCI owed no duty of care to Mr. Jeffords under its contract with Fluor. The court also noted that none of the contracts contained language imposing on any defendant a specific legal duty toward, or expressly assigning responsibility for the safety of, Central's employees.

Fluor and MCI had contractual obligations to take reasonable precautions related to sanitation and health for the safety of its personnel and the personnel of others, and to protect all work done and all materials furnished, but this language was designed to protect property, not people.

It  was noted that defendants additionally had contractual obligations to comply with regulations promulgated under OSHA, but the Court  held that contractual promises cannot be enforced by anyone not a party to them, in privity with a party to them, or an intended beneficiary of them. Mr. Jeffords was not a party or in privity with a party to any of defendants' contracts. Finally, the Court found that none of the defendants had assumed duties of care toward Mr. Jeffords by their conduct, and that BP could not be held vicariously liable for negligence by Fluor or MCI, since neither owed him a duty of care.

To read the federal court’s decision, click here.

This analysis was researched and drafted by Kevin Boyle, JD, KCB&A’s IN defense team leader. Kevin can be reached for thoughts, comments and defense of IN or IL WC/GL and EPLI claims.

Synopsis: Impairment Ratings Protocols To Morph from AMA Guide Books to Online Guidelines.

Editor’s comment: When the Workers' Compensation Institute's national conference convenes this week online, enormous interest will be focused on the American Medical Association's new concept for issuing valid impairment rating guidelines in the work comp arena. To the extent the IL WC Act contemplates impairment ratings as a method for choosing “permanent partial disability,” this is important to claims and risk managers and lawyers on both sides.

The AMA “Big Book” Will End In This Cyber-Era

Books are much out of style in this digital age. We expect the AMA’s prior practice of releasing a large and complex hardcover version of their AMA Guides to the Evaluation of Permanent Impairment every 10 years or so is going to forever end. Versions of these Guides were adopted by more than 30 states' workers' comp statutes, and the latest, the Sixth Edition, has been challenged by appellate court decisions in two states.

In response, the AMA will start to offer the Guides in an online fashion only, perhaps by subscription. They will revise them in “real time,” constantly updating and evaluating impairment ratings as medical evidence evolves and input from all sides of the WC matrix flow in.

Once this online capability starts, for the first time, if any party objects to the formula to create an impairment rating, they'll be able to quickly petition an AMA panel of experts to revise the AMA Guides. This process will allow for peer review and input from a range of specialists. The main focus is to create a formulary that is open to input from all sides—a more “transparent process,” in the words of one expert.

One question from worker advocates is whether the new system, in the works for more than a year, will lead to substantial changes in the current impairment ratings.

Many Veteran Observers Don’t Expect Significant Change

In our view, Claimant lawyers oppose anything that limits their ability to get high impairment values from hearing officers and maximize claimant and their recoveries. Any “science” that limits their involvement, influence and income is certain to be criticized. For that reason, we feel there will be court challenges to follow whatever the online AMA Guides might do to limit Plaintiff/Petitioner recoveries.

One proposal under consideration by the AMA panel would refine functional inventories, which include exercises and questionnaires that help measure impairment. Another would require use of the newer version of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders to help doctors assess mental and behavioral issues.

The defense team at KCB&A still recommends our clients consider getting an impairment rating on any significant WC claim, as such ratings are admissible and provide lower values than traditional IL Permanent Partial Disability levels. There is no “science” of any kind supporting how our hearing officers used to and still set PPD values in pretrials and decisions—they go by tradition and a “seat of the pants” view of what to write. We feel this is contrary to what the AMA Guides and impairment ratings are supposed to provide—reproducible and scientific values.

You Can Still Register and Participate in the WCI Virtual Conference That Starts Tomorrow—It is Free and Should Be Informative

https://event.vconferenceonline.com/microsite/html/event.aspx?id=1693

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

Synopsis: The “Nuts and Bolts” of Investigating OccDisease Claims with a Specific Focus on this Pandemic—Consider Asking Shawn R. Biery, J.D. for His OccDisease Investigation Protocol.

Editor’s Comment: Shawn R. Biery of Keefe, Campbell, Biery & Assoc understands the challenges this crisis has brought to you and your claims management protocols. Suddenly, we are all being asked to figure out when/where and how someone contracted a life-threatening disease which comes with possible 7-figure OD claims exposure. To understand the risks and costs, please remember Shawn regularly updates his Illinois WC Rate Sheet—if you want a copy, send an email to Shawn or his great assistant Marissa Patel at mpatel@keefe-law.com

What Shawn has begun to detail are crucial investigation materials which you might want to consider--his new OccDisease Investigation protocol to allow you to:

1. Investigate and verify OccDisease claims for emergency workers covered under the new Rules promulgated by the IWCC;

2. Investigate and verify claims for other workers possibly not covered by the Rules and

3. Insure you have a strong basis to accept or deny OccDisease benefits in settings that may come at you and your company very rapidly.

We are constantly working to update the potential investigation protocols. Please again note, as we outline above, any Covid-19 exposure may come with 7-figure risk/reserves on a per claim basis—this is possibly a business-busting concept.

Please also make note, if you don’t diligently investigate, even without a presumption, our IL WC Commission may rule any Covid-19 claim is going to be adjudicated to be compensable.

Those supervisors, managers and adjusters who are now becoming OccDisease investigators will need the following skills:

Interviewing – the ability to draw out the relevant information through effective questioning

Communication (verbal and written) – the ability to interact effectively with injured persons, witnesses and suspects, as well as other investigators, and to communicate the findings of the investigation to a wide variety of individuals and organizations

Technical competence – the awareness of safe working procedures that should be adopted, with particular relevance to the event under investigation

Hazard recognition – the ability to ensure workers and investigators are not exposed to unnecessary risk

Interaction – personal attributes that enable effective relations with other people

Deduction – the ability to scrutinize all the evidence obtained, e.g. through observation, from witnesses’ statements and from documentary evidence, and to form a coherent picture that enables the causal factors to be identified

If you want a copy or someone to consult with an OccDisease Investigations and Rules, feel free to contact Shawn at sbiery@keefe-law.com or John Campbell at jcampbell@keefe-law.com

8-7-2020; Ottawa IL Appellate Court Dramatically Changes Liability/WC Law for IL Staffing Industry; Gov. Pritzker Appoints Two New Pro-Labor Arbitrators and more

Synopsis: Must Read for All IL Staffing Companies!! Ottawa Appellate Court Dramatically Changes Liability/WC Law for IL Staffing Industry. Research and Analysis by Lindsay Vanderford, J.D.

Editor’s Comment: In a split 2-1 Decision, the 3d District Appellate Court decided an appeal from the Circuit Court’s grant of dismissal of a common law or general liability lawsuit in favor of a worker attempting to sidestep the plain meaning of the IL WC Act in Jaime Quintana v. Ferrara Candy Company, Appeal No. 3-19-0414, Circuit No. 17-L-890.

In a split decision, the Third District Illinois appeals panel comprised of Justices McDade, Wright, and Holdridge held a temporary worker, injured while working at a Ferrara Candy plant, may be able to avoid the exclusivity provision of the IL WC Act and bring a WC claim and also sue his temporary employer in Circuit Court if a finder of fact decides he is not a “borrowed employee.” Ferrara filed a Motion to Dismiss, arguing that legal relationship was clear, and the negligence suit filed by Quintana directly violated the exclusivity provision of Section 5 of the IL WC Act. Justice McDade penned the majority decision which asserts, “the existence of that relationship is not so clear to an average worker … that the question should be taken from the finder of fact and resolved by the court as a matter of law.”

Pertinent facts of the underlying suit are that Quintana was employed by Elite Staffing, the agency which assigned him to work at the Ferrara plant. On November 11, 2015, Quintana was injured when wooden pallets from a forklift operated by a Ferrara employee fell on him. On October 12, 2017, Quintana filed a complaint against Ferrara, alleging negligent training or supervision of the forklift operator.

Ferrara moved to dismiss, contending that under the Illinois Workers’ Compensation Act, Quintana was a “borrowed employee” and was barred from suing his “borrowing employer.” As we are all aware, the Act limits borrowed employees, precluding them as a matter of law from maintaining civil actions against their borrowing employers. The “exclusive” vehicle for remedy against a borrowing employer is to seek workers’ compensation for any employment-related injuries.

Quintana argued the borrowed employee relationship did not exist because he signed a waiver, prepared by Ferrara and given to all assigned employees, disclaiming any direct employee-employer relationship with Ferrara Candy. The waiver stated, “I agree that I am solely an employee of staffing firm and that I am eligible only for such benefits as Staffing Firm may offer to me as its employee. I further understand and agree that I am not eligible for or entitled to participate in or make any claim upon any benefit plan, policy or practice offered by Ferrara.”

Please note we do not feel that waiver language is well-drafted and consider it confusing. If you are using such a waiver, we strongly suggest you reply or contact Lindsday Vanderford or the defense team at KCB&A if you want better or more appropriate language for such a waiver.

At the lower level, Circuit Judge Raymond Rossi agreed with Ferrara that Quintana’s status as a borrowed employee was clear, dismissing the case. We thoroughly support Judge Rossi’s seasoned opinion noting his lengthy tenure in Will County’s Twelfth Judicial Circuit Court.

Quintana appealed, and Justice McDade reconsidered the borrowing employer issue noting a two-prong inquiry was required to determine whether a borrowed-employee relationship was created. The first prong,

(1)  whether the alleged borrowing employer had the right to direct and control the manner in which the employee performed the work, she found to have been established.

(2)  The second prong, whether there was an express or implied contract of hire between the employee and the alleged borrowing employer, she found muddled by the wording of the benefits waiver and Quintana’s understanding of same.

McDade noted the waiver referred to “any benefit plan, policy or practice offered by Ferrara,” with “policy or practice” potentially understood by Quintana to mean Ferrara was not offering him employment and thus not “offering” workers’ compensation. Notably, and as pointed out by the dissent, eligibility for benefits under the IL WC Act is determined by law and isn’t an option. Any right to those benefits cannot be validly waived by an employee pre-accident.

Despite that clarity of the law, Justice McDade questioned whether Claimant Quintana knew or should have known that, despite the seemingly definitive contrary language of the waiver he signed, he had nonetheless entered an employer-employee relationship with Ferrara. Though McDade admits Quintana had entered the relationship, the decision concludes, “The majority finding is that the existence of that relationship is not so clear to an average worker reading that specific waiver language that the question should be taken from the finder of fact and resolved by the court as a matter of law.” Justice Wright signed on.

Justice Holdridge who is a veteran and knowledgeable WC appellate court member, dissented arguing a plain reading of the waiver reveals it to limit Quintana’s eligibility solely for internal employee benefit plans. He disagreed with the majority’s suggestion the waiver is open to a second interpretation, that Ferrara was somehow attempting to decline Quintana workers’ compensation coverage, calling that interpretation “contrary to law” and a stretch.

In pertinent part, Holdridge noted, “Workers’ compensation is not some type of elective program that an employer may voluntarily offer at its discretion — it is statutorily required by state law. Therefore, I fail to see how workers’ compensation is encompassed within this language and was waived by Quintana.” He further commented, “the majority’s second interpretation strains to find an ambiguity where none exists, is unreasonable, and leads to an absurd result.”

Notably, this decision was filed under Supreme Court Rule 23 and may not be currently cited as precedent by any party except in very limited circumstances. We find this lack of precedent favorable and agree with Justice Holdridge’s sentiments regarding its absurdity. In the absence of any further appeal, we trust the finder of fact will consider the evidence and determine Petitioner was clearly a borrowed employee and subject to the limitations of the IL WC Act as is any other worker.

This article was researched and written by Lindsay R. Vanderford, JD. Lindsay can be reached with any questions related to workers’ compensation defense and employment law defense at lvanderford@keefe-law.com.

Synopsis: Gov. Pritzker Announces Two Plaintiff Attorneys Appointed to Arbitrator Positions at the IWCC.

Editor’s comment: Illinois has the odd spectacle of having a billionaire Governor who is wholly pro-labor. We assume his slant will continue and hope our State and its economy will survive him. That said, we are certain both of these appointments are solid attorneys, highly professional and know the IL WC Act inside and out.

Governor JB Pritzker announced the following appointments in his administration:

Jeanne AuBuchon will serve as Arbitrator on the Workers’ Compensation Commission.* AuBuchon is a Plaintiff personal injury and criminal defense attorney at AuBuchon Law, LLC. AuBuchon is a member of the American Bar Association, Illinois State Bar Association, St. Clair County Bar Association, East St. Louis Bar Association, National Association of Counsel for Children, and Land of Lincoln Legal Assistance Foundation Pro Bono Bar. She sits on the Board of Directors for the Lansdowne Community Initiative and is a Precinct Committeewoman for Sugar Loaf Township in St. Clair County. She earned her Bachelor’s in Journalism from University of Missouri-Columbia and Juris Doctorate from St. Louis University School of Law.
 
Gerald Napleton will serve as Arbitrator on the Workers’ Compensation Commission.* Napleton is Associate Attorney at Ridge & Downes, PC where he handles prosecution of worker’s compensation and personal injury matters for injured clients. Napleton is a member of the Illinois State Bar Association, where he serves as Chair of the Workers Compensation Section and served as Chairperson of the Young Lawyers Division in 2016. He is also a member of the Illinois Bar Foundation, where he served as Board Member in 2017 and Fellow from 2015 to present. Napleton is also the President of the Marist High School Law Association and Bagpiper with the Shannon Rovers Irish Pipe Band. Napleton earned a Bachelor of Business Administration (Management), Bachelor of Arts (Philosophy) from Saint Xavier University and Juris Doctorate from DePaul University College of Law. 
 
* Appointments pending confirmation by the Illinois Senate.

Synopsis: The “Nuts and Bolts” of Investigating OccDisease Claims with a Specific Focus on this Pandemic—Consider Asking Shawn R. Biery, J.D. for His OccDisease Investigation Protocol.

Editor’s Comment: Shawn R. Biery of Keefe, Campbell, Biery & Assoc understands the challenges this crisis has brought to you and your claims management protocols. Suddenly, we are all being asked to figure out when/where and how someone contracted a life-threatening disease which comes with possible 7-figure OD claims exposure. To understand the risks and costs, please remember Shawn regularly updates his Illinois WC Rate Sheet—if you want a copy, send an email to Shawn or his great assistant Marissa Patel at mpatel@keefe-law.com

What Shawn has begun to detail are crucial investigation materials which you might want to consider--his new OccDisease Investigation protocol to allow you to:

1. Investigate and verify OccDisease claims for emergency workers covered under the new Rules promulgated by the IWCC;

2. Investigate and verify claims for other workers possibly not covered by the Rules and

3. Insure you have a strong basis to accept or deny OccDisease benefits in settings that may come at you and your company very rapidly.

We are constantly working to update the potential investigation protocols. Please again note, as we outline above, any Covid-19 exposure may come with 7-figure risk/reserves on a per claim basis—this is possibly a business-busting concept.

Please also make note, if you don’t diligently investigate, even without a presumption, our IL WC Commission may rule any Covid-19 claim is going to be adjudicated to be compensable.

Those supervisors, managers and adjusters who are now becoming OccDisease investigators will need the following skills:

Interviewing – the ability to draw out the relevant information through effective questioning

Communication (verbal and written) – the ability to interact effectively with injured persons, witnesses and suspects, as well as other investigators, and to communicate the findings of the investigation to a wide variety of individuals and organizations

Technical competence – the awareness of safe working procedures that should be adopted, with particular relevance to the event under investigation

Hazard recognition – the ability to ensure workers and investigators are not exposed to unnecessary risk

Interaction – personal attributes that enable effective relations with other people

Deduction – the ability to scrutinize all the evidence obtained, e.g. through observation, from witnesses’ statements and from documentary evidence, and to form a coherent picture that enables the causal factors to be identified

If you want a copy or someone to consult with an OccDisease Investigations and Rules, feel free to contact Shawn at sbiery@keefe-law.com or John Campbell at jcampbell@keefe-law.com