Category Archives: Workers’ Compensation

Workers’ Compensation May Cover Weight Loss Treatment, Surgery

Gastric bypass is one type of weight loss surgery

Today’s post comes from guest author Rod Rehm, from Rehm, Bennett & Moore.

Obesity is a disease that affects Americans in many ways.

Workers’ compensation is affected by obesity as well. A work injury or disease, coupled with chronic obesity, frequently becomes much more difficult to deal with. The usual methods of treatment may not be possible for an injured worker living with chronic obesity. 

Thomas A. Robinson, a noted expert on workers’ compensation, recently posted a great discussion on obesity treatment. The well-written article discusses how various state workers’ compensation systems deal with these problems. The short answer is some states award benefits for treating obesity as part of the work injury, and some don’t. Nebraska and Iowa have cases denying gastric bypass surgery based on factual findings that it was not necessary to treat the work injury, but leaving to door open with more proof of medical necessity. 

Our firm has had at least one case where gastric bypass surgery was paid voluntarily when it was apparent the surgery was necessary to enable proper treatment of a serious work injury. A workers’ compensation trial award was entered in early January awarding gastric bypass surgery as necessary to reduce weight so a back surgery could be performed safely. This award reinforces that with proof of medical necessity to treat a work injury, weight loss treatment and surgery may be covered by workers’ compensation in Nebraska.

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Mileage Reimbursement Set at 56 Cents per Mile for 2014

Today’s post comes from guest author Brody Ockander, from Rehm, Bennett & Moore.

Getting reimbursed for mileage and travel expenses is often part of the medical process in a workers’ compensation claim. However, it’s essential to keep detailed receipts and have a plan for submitting those expenses in a timely manner.

The federal government has set the 2014 mileage reimbursement rate to 56 cents per mile. This rate was effective Jan. 1, 2014. This is a decrease from 56.5 cents per mile last year, but the price of gasoline is also slightly cheaper.

Generally speaking, the federal rate changes annually. However, when gas prices went soaring in 2008, a mid-year increase went into effect.

As a reminder from a blog post that firm partner Todd Bennett wrote in 2011, injured workers can be reimbursed for activities such as “travel to seek medical treatment, pick up medications, or while participating in a vocational rehabilitation plan.”

The best way to do this is to work with your attorney and legal assistant to keep track of all mileage. This can include appointments for Independent Medical Exams (IME), too. Then your attorney can help you get reimbursed. 

It is often essential to save receipts and keep a record for yourself of your doctor’s visits and other reimbursable trips, including physical therapy and trips to pick up medication. Providing that log to your attorney and saving receipts incurred from specific doctor visits and other reimbursable trips creates a “narrative” that makes it easier to justify those expenses.

Because money is always tight for injured workers, contact an experienced workers’ compensation attorney if you have questions about a specific situation.

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College Athletes Unionized? They Must Be Employees First

Northwestern University Quarterback Kain Colter

Today’s post comes from guest author Charlie Domer, from The Domer Law Firm.

Northwestern University quarterback Kain Colter announced plans to form the first labor union for college athletes. The College Athletes Players Association, in concert with the Steel Workers (who have agreed to pay the legal bills for the effort) will try to unionize college athletes. The big question: whether college athletes can be considered employees.  If certified by the National Labor Relations Board, the union will be called the College Athletes Players Association. In order for the association to be recognized as a union, the players have to prove they are employees and that the NCAA or each school is its employer. Most experts indicate this is an uphill legal fight.

Worker’s compensation lawyers see everything through the prism of worker’s compensation law. Most State statutory schemes presume that a worker is an employee, except where the employee may be considered a volunteer or an independent contractor. Where the top five power conferences ACC, SEC, Pac-12, Big Ten, Big Twelve generate nearly $10 billion annually, it is hard to claim players are “volunteers” in this system.

Some college athletes who have been seriously injured have filed worker’s compensation claims. Those claims have all been dismissed on the notion that the injured player was not a “employee” and thus not entitled to benefits. (see our prior blog posts on this issue) 

Athletes who successfully use their college careers as a platform for a later career in professional sports are not the norm. In many situations, college players are injured, precluding any further athletic career for pay. There is no compensation awarded for this lost potential career. Furthermore, if an athlete is injured while on campus, once they leave school or graduate, the school generally does not covered future medical costs for that injury.  

Worker’s compensation lawyers will be monitoring the case with interest.

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Are Firefighter Cancer Deaths an Occupational Disease?

Today’s post comes from guest author Rod Rehm, from Rehm, Bennett & Moore.

Workers’ compensation has provided benefits or coverage for occupational diseases for generations. Occupational disease is defined by Nebraska law as: “a disease which is due to causes and conditions which are characteristic of and peculiar to a particular trade, occupation, process, or employment and excludes all ordinary diseases of life to which the general public is exposed.” This is a typical definition of an occupational disease. Some examples of recognized occupational diseases are black lung disease for miners, mesothelioma for asbestos workers, lung disease for rubber workers, and leukemia for workers exposed to benzene.  

More studies are done to determine the cause of diseases as medical science advances. A recent study concludes that smoke and chemical exposure by firefighters may cause higher rates of cancer among firefighters. Firefighters, while usually healthier than the general population, have a higher incidence of cancer. More studies need to be done to determine if the peculiar exposure to smoke causes or aggravates cancer.

As medicine and science evolve, there may be more recognized “occupational diseases” and more workers and their families compensated for harm caused by the workplace.

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Construction Site Falls – Leading Cause of Fatalities in the Construction Industry

Today’s post comes from guest author Kristina Brown Thompson, from The Jernigan Law Firm.

On January 23, 2014, a young man, only 30 years old, fell to his death while working on a Raleigh construction site. According to news reports, the deceased was working on scaffolding on an apartment complex and fell approximately five stories. The North Carolina Department of Labor is investigating the accident. It’s unclear exactly what went wrong.

Unfortunately, this was the second construction accident within one week in Raleigh. On January 22, 2014, a platform collapsed at North Carolina State University and three workers were injured. Fortunately, none of the injuries appear to be life-threatening. However, one of the injuries involved a trauma to the head which is always cause for serious concern.

Falls are the leading cause of fatalities in the construction industry. According to OSHA, the four main causes for workplace falls are (1) unprotected sides, wall openings, and floor holes, (2) improper scaffold construction, (3) unguarded protruding steel rebars, and (4) the misuse of portable ladders.

In North Carolina, we follow the “unexplained-fall rule” which holds that “if an employee sustains a fall and there is no evidence that it arose from a cause independent of the employment, compensation [i.e. disability and medical benefits] should be allowed.” North Carolina Workers’ Compensation: Law and Practice, with Forms, 4th Edition, Leonard T. Jernigan, Jr.

While workers’ compensation benefits should be provided in these type of cases, in some situations the injured worker may also have a personal injury claim against one of the building contractors. 

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Facebook Pictures’ Use Evolving in Workers’ Compensation Cases

Today’s post comes from guest author Brody Ockander, from Rehm, Bennett & Moore.

In the past, I have warned about the possible pitfalls of social media on a workers’ compensation claim.

However, the Nebraska Workers’ Compensation Court has never really ruled on Facebook in the context of discovery matters in a work comp claim, meaning how much access can your employer have to your Facebook account if you file a workers’ compensation claim? 

Recently, however, the Nebraska Workers’ Compensation Court (at least one judge) has taken the position that in order for your employer to gain access to photographs from your Facebook profile, it must “make a showing of the necessary factual predicate underlying [the] broad request for access.” In other words, your employer must have a decent reason to suspect that a certain photograph or something from your Facebook account has the potential to be relevant to the work comp case before the court will simply grant full access to your Facebook account to your employer.

Therefore, depending on your situation, your Facebook may be safe from your employer to some degree. However, this is a cautionary tale to remind you that even though your employer cannot simply have blanket access to all of your Facebook photos – at least according to one Nebraska judge – it does not mean that your Facebook photos or posts are necessarily safe from your employer gaining access to them at some point during your work comp case. I think the judge in this case takes a step in right direction, but you still must be aware that anything you put on Facebook may be subject to discovery (i.e., your employer may still possibly get access to it) at some point in the future.

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$46 Million Stolen: 2013’s Top Ten Workers’ Compensation Fraud Cases

Professor Leonard T. Jernigan Jr. has compiled a list of 2013’s Top 10 Workers’ Compensation Fraud Cases

Today’s post comes from guest author Leonard Jernigan, from The Jernigan Law Firm.

Employer Fraud Cases (9):$44,064,492.00
Employee Fraud Cases (1): $1,500,000.00
Total: $45,564,492.00

Every year we hear about fraud in Workers’ Compensation cases and the public believes the fraud is employee driven. However, in 2009 I began tracking the Top Ten Fraud Cases and 100% of the Top Ten between 2009-2012 involved employers or shady characters posing as legitimate businesses. The amount of employer fraud is staggering. In 2013 one employee fraud case did crack the Top Ten, so the record is now 49-1 (employer fraud v. employee fraud) over the past five years.

  1. Florida: Owners of Diaz Supermarkets in Miami-Dade are Accused of $35 Million Fraud (4/16/13)

    John Diaz and his wife Mercedes Avila-Diaz owned and operated four supermarkets in the Miami-Dade area. They have been arrested and accused of workers’ compensation fraud and other fraudulent transactions totaling $35 million. One business they operated had no coverage for employees for ten years. They allegedly engaged in a scam to help subcontractors obtain false certificates of insurance that allowed the subs to work for general contractors who required the certificates.

  2. California: Hanford Farm Labor Contractor Convicted of Fraud in the Amount of $4,195,900 (12/6/2013)

    Richard Escamilla, Jr.

    Richard Escamilla, Jr. (47), owner of ROC Harvesting, misrepresented information to workers’ compensation insurance carriers by using new business names to obtain insurance and avoid providing a claim history. Escamilla pleaded guilty on October 29th and was sentenced to pay restitution of $4.1 million and serve six years in prison.

  3. Michigan: Insurance Executive Embezzled $2.6 Million from Workers’ Comp TPA (06/06/2013)

    Jerry Stage

    Jerry Stage (67), the former CEO of a non-profit workers’ compensation insurance company, and George Bauer (55), the bookkeeper, both pleaded guilty to embezzling from the Compensation Advisory Organization of Michigan (CAOM) for more than a decade. Mr. Stage embezzled $2.6 million from the company and conspired with Mr. Bauer to cover up the embezzlement.

  4. California: Employee Wasn’t Wheelchair Bound After All – Fraudulently Took $1.5 Million in Benefits (8/9/13)

    Yolandi Kohrumel

    Yolandi Kohrumel, 35, claimed for nine years that she was wheelchair bound after complications from toe surgery, but after she had collected $1.5 million in benefits it was revealed her claim was false. Her father, a South African native, was also engaged in the scam. Both pleaded guilty to insurance fraud, grand theft and perjury. Ms Kohrumel was sentenced to one year in jail, plus restitution.

  5. California: Father and Son Landscapers Accused of $1.45 Million in Insurance Fraud (5/7/13)

    Sunshine Landscaping

    Jesse Garcia Contreras (57) and Carlos Contreras (33), who operate a Thousand Palms landscaping business, are accused of committing $1.45 million in insurance fraud. They are accused of defrauding the California State Compensation Insurance Fund by misclassifying employees from January 2008 to March 2012. Mr. Jesse Contreras is the president and CEO of Sunshine Landscaping and his son is Director of Accounting. If convicted, they each face up to 19 years and 8 months in prison.

  6. Florida: Workers’ Compensation Check Cashing Operation Charged with $1 Million in Fraud (2/27/13)

    As a result of its investigation of I&T Financial Services, LLC, a company that was allegedly set up to execute a large scale check cashing scheme for the purpose of evading the cost of workers’ compensation coverage. Domenick Pucillo, the ringleader of the fraud scheme, was arrested and charged with filing a false and fraudulent document, forgery, uttering a forged instrument, and operating an unlicensed money service business. If convicted on all charges, he faces up to 45 years in prison. $1 million was seized during this investigation.

  7. West Virginia: Coal Company Contractor in Mingo County Caught in $405,000 Scam to Avoid Workers’ Comp Premiums (11/6/13)

    Bank of Mingo

    Jerame Russell (50), an executive with Aracoma Contracting, LLC, a company that provided labor to coal companies on a contract basis, entered a guilty plea to a scam that involved funneling over $2 million through a local bank to pay employees in cash, thus avoiding payroll taxes and $405,000 in workers’ compensation premiums. Aracoma also bribed an insurance auditor to cover up its true payroll.

  8. Ohio: Roofing Business Owners Guilty of $283,592 in Workers’ Comp Fraud (7/30/2013)

    Frederick Diebert

    The owners of Triple Star Roofing were found guilty of fraud on July 15 for failing to report payroll to the Ohio Bureau or Workers’ Compensation(BWC). The company failed to report to the BWC from 2004 to 2008, resulting in under-reported premiums of $283,592.

  9. Florida: Owner of Staffing Company arrested for $130,000 in Workers’ Comp Fraud

    Preferred Staffing of America, Inc.

    The owner of Preferred Staffing of America, Inc., a temporary staffing agency in Tampa, has been arrested for allegedly running an organized workers’ compensation fraud scheme. Preferred Staffing’s owner misled clients into believing that his company was a licensed professional employer organization (PEO) and could provide workers’ compensation insurance coverage. Employers were reportedly charged more than $130,000 for workers’ compensation insurance and other services that were never provided.

For more information, contact: Leonard T. Jernigan, Jr. Adjunct Professor of Workers’ Compensation N.C. Central School of Law The Jernigan Law Firm 2626 Glenwood Avenue, Suite 330 Raleigh, North Carolina 27608 (919) 833-0299 ltj@jernlaw.com www.jernlaw.com @jernlaw

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Legally Speaking – Volunteer Firefighters and Ambulance Workers

Catherine M. Stanton

Catherine M. Stanton

Catherine M. Stanton

Hello friends!  Today’s editorial is going to discuss Volunteer Firefighters and Ambulance Workers and their rights under New York State Workers’ Compensation Law.

While paid New York City firefighters are covered by special contract, and not covered under New York State Workers’ Compensation Law, all New York State active volunteer firefighters in a county, city, town, village or fire district are entitled to benefits under the law if they are injured in the line of duty.  Most New York State active volunteer ambulance workers are entitled to benefits as well.

To be entitled to benefits, a firefighter must be engaged in activities pursuant to orders or authorization that include, but are not limited to, participation in fire drills, parades and funerals; travel to and from fire calls or authorized activities; firehouse duties; property inspections; and maintenance and repair of equipment.

Volunteer ambulance workers must be engaged in duties at the ambulance facility or elsewhere, including but not limited to, public exhibitions and drills; attendance at training school; travel to and from calls directly related to the prevention of accidents or other disasters; delivery of emergency health care; instruction in ambulance duties; or maintaining equipment.  The benefits depend on the seriousness of the injury and the length of disability.

 A determination of the benefits will be made…

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