Category Archives: Workers’ Compensation

“Mental-Mental” Worker’s Comp Claims Following Connecticut School Shooting Injuries

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

Following the Connecticut school shootings, unions representing police and firefighters and school employees have held discussions about laws to expand situations under which worker’s comp benefits would be available for mental health issues. Connecticut worker’s compensation law does not provide for “Mental-Mental” claims, which are claims for psychological disabilities that do not stem from an original physical injury. Police officers, firefighters, and school officials do not meet the requirements of Connecticut’s Statute for psychological counseling or time lost benefits in the event they are unable to work because of psychological disability in the wake of the shootings.

Since the mid-1970s Wisconsin has recognized non-traumatic mental injury (“Mental-Mental”) in worker’s compensation. Before 1974, compensable mental injuries were limited to post-traumatic injuries, mental disorders occurring after and due to a physical accident. The statute then defined injury as “mental or physical harm to an employee caused by accident.”

The Wisconsin Supreme Court set a new “Extraordinary Stress” standard for compensability, indicating if the mental injury resulted from situation of greater dimensions than the day to day stress, which all employees must experience, benefits and medical expenses could be paid. Continue reading →

Prior results do not guarantee outcomes.
Attorney Advertising.

9/11 Rescue Workers At Increased Risk for Cancer

Today’s post comes to us from our colleague Jon Gelman of New Jersey. If you think you have a Zadroga Bill or other 9/11-related claim, please contact our office for a free consultation.

Rescue and recovery workers at the 9/11 World Trade Center terrorist attack site have been reported to be at greater risk of certain cancers. The study followed a group of workers who have been exposed to toxic dust and fumes following the attack in New York City.

The study published in The Journal of the American Medical Association reported an increased incidence of prostate and thyroid cancers, plus multiple myeloma.

Benefits are available under The Zadroga 9/11 Victims Compensation Fund Benefit Program.  The law was enacted by the US Congress and signed into law by President Barack Obama about 3 years ago.

 

Prior results do not guarantee outcomes.
Attorney Advertising.

$97 Million In Fraud: 2012’s Top 10 Workers’ Compensation Fraud Cases

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

Over the past few years, many states have aggressively gone after workers’ compensation fraud (whether it’s the employee or the employer) and the amount of employer fraud being discovered continues to be staggering, notwithstanding these efforts. Legitimate business owners that pay for workers’ compensation, as required by law, are at a competitive disadvantage with those who cheat the system, and when people suffer a workplace disability and have no insurance local businesses that provide goods and services feel the pain along with health care providers who cannot get properly paid for their services. The cost of medical care and disability ends up being shifted to the taxpayer through Social Security, Medicare and Medicaid, and in states where compliance is not vigorously enforced a culture of cheating continues. The top ten cases for 2012 are listed below.

2012 TOP TEN WORKERS’ COMPENSATION FRAUD CASES Total Fraud: $97,466,500.00

1. ‘Operation Dirty Money,’ Stings Workers’ Comp Fraud Check Cashing Scheme

Florida: July 27, 2012

Multiple arrests were announced in Florida’s joint task force’s ‘Operation Dirty Money,’ which led to the arrest of alleged ringleader Hugo Rodriguez, owner of the Oto Group, Inc., and seven other individuals. Mr. Rodriguez was the facilitator of 10 known shell companies that funneled in excess of $70 million in undeclared and undetected payroll through different money service businesses. By using shell companies, Rodriguez was able to run a large construction operation and avoid paying the cost of workers’ compensation coverage, leaving employees at risk and scamming legitimate businesses.

 

2. Firms Face Charges for Skipping Workers’ Comp Payments

Ohio: May 13, 2012 Thousands of Ohio companies violated state law by not paying their most recent workers’ compensation premium, which can drive up insurance costs for businesses that follow the rules, a Dayton Daily News analysis found. The bureau identified about 41,247 private employers in the state that failed to report their payroll data and submit premium payments by the deadline. As of May, more than 12,200 accounts remain outstanding, and those companies owe an estimated $5.6 million in premiums.

3. Case Proves Employee Leasing too Good to be True

Texas: July 10, 2012

$4,466,500.00 was awarded in a Texas court against a staffing agency and its workers’ compensation insurance company. Jackson Brothers Hot Oil Service hired Business Staffing, Inc., (BSI) in 1999 and required BSI to have workers’ compensation insurance for its leased employees. BSI had 150 client companies with 2,000 employees. BSI bought a policy from Transglobal Indemnity for a total premium of $4,100.00 to cover all its employees. After failing to pay the medical bills of a 27-year-old oil field worker who was in an explosion and had 18 surgeries, the employee and Jackson Brothers sued BSI and Transglobal for fraud. Neither Transglobal (who had its corporate headquarters in the Turks and Caicos Islands) nor BSI had a license to conduct insurance business in Texas.

4. Business Owner Faces Insurance-fraud Charges

California: May 2, 2012

Construction business owner George Osumi of Irvine, California was indicted on numerous felony counts of misrepresenting facts to the State Compensation Insurance Fund, among other charges. From December 2001 to March of 2006, Mr. Osumi committed workers’ compensation premium fraud by reporting his payroll to SCIF at just over $1 million, under-reporting over $3.5 million in payroll. This fraud resulted in a loss of over $814,000.00 in premium owed to the insurance fund.

5. Watertown Roofing Company and its Owners Plead Guilty and are Sentenced for Labor Violations

Massachusetts: January 11, 2012

The Massachusetts Insurance Fraud Bureau discovered that the company, Newton Contracting Company, Inc., owned by Shaun Bryan and Antoinette Capurso-Bryan, misclassified half of its workforce as subcontractors, as well as failing to disclose to auditors more than $3.4 million of their company’s misclassified subcontractor payroll during its annual workers’ compensation audits.

6. 7-Year Sentence in $3.1 Million Fraud Case

California: November 30, 2012

Steven Morales, 65, of Wildomar, CA was convicted and sentenced to seven years in prison for his part in a $3.1 million workers’ compensation scheme. His son Brian was also convicted and sentenced to 4 years in prison. Morales and his son had set up a sophisticated system of shell companies to hide payroll and avoid paying workers’ compensation premiums.

7. Construction Company President Accused of Payroll Fraud

Florida: March 29, 2012

Randall Seltzer, president of Navarre Industries, Inc., was charged with multiple felony counts, including workers’ compensation fraud. An investigation by Florida’s Department of Financial Services’ Division of Insurance Fraud revealed that Seltzer systematically and intentionally under-reported his corporation’s true payroll to his insurance carrier. The department’s Division of Workers’ Compensation issued the company two stop-work orders within a five-year period. Seltzer allegedly established a shell corporation in 2011 to intentionally violate the stop-work orders and continue operating his construction business illegally. If convicted, Seltzer could face up to 30 years in prison and pay over $2.8 million in restitution.

8. CFO Jeff Atwater Announces Arrest of Owner of Fake Company for Creating Fraudulent Insurance Certificates and Avoiding Millions in Premiums

Florida: April 13, 2012

Yucet Batista was arrested for allegedly creating more than 250 fraudulent certificates of insurance to help uninsured contractors avoid $2.1 million in workers compensation premiums. Batista created the company and obtained the workers’ compensation insurance policy for the purpose of “renting” it, or making it available to dozens of uninsured subcontractors for a fee.

9. Audits Uncover Almost $1.2 million in Workers’ Compensation Violations at Boston Marriott Project

Massachusetts: September 4, 2012

In 12 audits conducted by the Joint Enforcement Task Force on the Underground Economy and Employee Misclassification and the Executive Office of Labor and Workforce Development, it was discovered that there were $584,249.00 in misclassified 1099 wages and $584,287 in unreported W-2 earnings, for a total of $1,171,536.00 in unreported wages by subcontractors on the Marriot renovation project. Six companies misclassified workers as contractors rather than employees, and seven companies failed to report wages. Among the worst of the offenders were one company that misclassified 28 workers and failed to report over $410,000.00 in wages; another failed to report $462,081 in W-2 wages.

10. Inn Owners Facing Workers’ Compensation and Insurance Fraud Charges

California: June 13, 2012

Owners of the historic Brookdale Inn and Spa are facing trial on charges of falsifying wage information to obtain lower insurance premiums.

The owners of historic Brookdale Inn and Spa, Sanjiv and Neelam Kakkar, are facing trial on charges that they falsified wage information to obtain lower insurance premiums. According to records, the couple paid approximately $800,000 less in insurance premiums than they should have over a period of several years.

Prior results do not guarantee outcomes.
Attorney Advertising.

Can Cell Phones Cause Cancer (On The Job)?

Today’s post comes to us from Thomas Domer of Wisconsin.  New York’s standard for an occupational disease claim is very similar to Wisconsin’s in that an occupational disease must be caused by a recognizable link to the employee’s occupation. The harmful condition (cancer here) must have been caused by some aspect of the employment to be compensable.

An Italian court ruled that excessive mobile phone use can cause cancer. Italy’s Supreme Court upheld a ruling linking a business executive’s brain tumor and excessive mobile phone use. While much of the scientific opinion generally suggests there is not enough evidence to declare such a link, those studies were co-financed by the same companies that produce mobile telephones. The evidence in the Italian case was based on studies conducted between 2005 and 2009 by a group led by Dr. Lennart Hardell, cancer specialist at the University Hospital in Orebro in Sweden. The Italian court, relying on this research, noted this was independent research unlike other research financed by mobile telephone companies. The business executive Innocenzo Marcolini developed a tumor in the left side of his head after using his mobile telephone for 5 to 6 hours a day for a dozen years. He usually held the phone in his left hand while taking notes with his right hand.  He developed a “neurinoma” which affected his cranial nerve, and sought worker’s compensation from the Italian Worker’s Compensation Authority. The initial application was rejected because of a lack of proof but a court in Brescia later ruled there was a causal link between the use of mobile and cordless telephones and tumors.

Wisconsin provides benefits for an employee’s death or disability due to a cancerous condition if causally related to work exposure to carcinogens. There are numerous potential cancer causing agents in the workplace, but none so far have been linked to cell phone use. The causation standard is straightforward in Wisconsin. If the patient suffers from a condition caused by an “appreciable period of workplace exposure” the physicians are asked whether that exposure was either the sole cause of the condition or at least a material, contributory, causative factor in the condition’s onset or progression. This Italian court case suggests a further inquiry into the subject may be appropriate.

Prior results do not guarantee outcomes.
Attorney Advertising.

The Costs and Complications of The Other Disease on Workers’ Compensation Claims

Today’s guest post comes to us from Jon Gelman of New Jersey.

Employers and their insurance companies are responsible for the treatment of all medical conditions that arise from an industrial accident or exposure. A recent study published by NCCI concludes that costs are soaring as medical conditions become more complicated by other conditions known as comorbidity diagnoses. These conditions are frequently: obesity, hypertension, drug abuse, chronic pulmonary conditions and diabetes.

“While the average medical cost for a workers compensation claim is approximately $6,000, the medical cost of an individual claim can be a few hundred dollars or millions of dollars. In 2010, an NCCI study found that claims with an obesity comorbidity diagnosis incurred significantly higher medical costs than comparable claims without such a comorbidity diagnosis. Relative to that study, this study expands the number of comorbidities examined and provides additional information on both the types of claimants receiving comorbidity diagnoses and the types of providers submitting comorbidity diagnoses.”

KEY FINDINGS

  • The share of workers compensation claims with a comorbidity diagnosis nearly tripled from Accident Year1 2000 to Accident Year 2009, growing from a share of 2.4% to 6.6%Claims with a comorbidity diagnosis have about twice the medical costs of otherwise comparable claims
  • Comorbidity diagnoses for hypertension are the most prevalent of those investigated
  • The initial comorbidity diagnosis tends to occur early in the life of a claim
  • Hospital and physician visits account for a majority of visits resulting in a recorded comorbidity diagnosis
  • Only a small portion of visits result in the recording of a comorbidity diagnosis

View complete report: Comorbidities in Workers Compensation

 

 

Prior results do not guarantee outcomes.
Attorney Advertising.

What Is An Occupational Disease?

 

The Workers Compensation Law protects workers who sustain injuries in the course of their employment. There are different types of injuries that are covered under the law. An accidental injury is the most common and familiar to the working person. An accidental injury is easy to identify it is usually a traumatic event. However, most workers are not informed as to the existence of another form of an injury that is covered under the law. That is the occupational disease. An occupational disease does not arise from a specific traumatic event. It is a condition or disability that develops over time usually based upon a repetitive aspect of an occupation.

An occupational disease does not arise from a specific traumatic event. It is a condition or disability that develops over time usually based upon a repetitive aspect of an occupation.

To be considered an occupational disease there must be a distinctive feature to the claimant’s employment that caused the condition to develop. For instance a construction worker who lifts heavy bags of cement for 10 years and is diagnosed with tear in the knee without any incident may have a claim for an occupational disease. Another typical case is a data-entry worker who develops carpal tunnel syndrome from heavy computer work. Workers who are exposed to a noisy work environment can file a claim for an occupational loss of when they retire or are removed from the noisy work area.

A claimant can file a claim for benefits under the occupational disease statute even if the diagnosis comes long after the claimant has left the harmful work environment. This is a common feature of the slow starting job related diseases, like silicosis and chronic obstructive pulmonary disease. The claim must be filed within Continue reading →

Prior results do not guarantee outcomes.
Attorney Advertising.

NFL Players Suing For Workers’ Compensation – Head Injuries At All Levels Are Cause For Concern

In light of the lasting damage caused by head injuries, NFL players are catching on that they can get workers’ comp benefits. We hope the NFL takes all necessary steps to protect its players, and we are glad that the workers’ comp system protects all injured workers.

A recent ESPN article highlighted this recent phenomenon:

“Playing professional football is inherently dangerous, but the known risks do not prevent players — and former players — from filing workers’ compensation claims against teams, courts have ruled. And while an individual compensation award might cost a team just $20,000, the changing types of claims being filed could end up costing teams millions of dollars a year.”

The article also points out that teams might be liable for millions in yearly claim payments and that at least one insurance broker who has worked with an NFL team thinks that workers’ compensation costs could force significant changes to how the game is played on the field. It saddens us that cost, not player safety, could be the cause of this much-needed change, but we welcome anything that will keep our workers — and players — safe.

We recommend that you read the whole article to get a better understanding of how football injuries can have serious and long-lasting effects. This is important, not just from a fan’s pespective, but also because young children and adolescents have suffered irreperable harm from injuries incurred while playing amateur football.

For this recent ESPN report highlights a case where a young player was paralyzed after an on-the-field play went wrong:

 

Check out this video for an entertaining debate between Malcolm Gladwell, Buzz Bissinger, TIm Green and Jason Whitlock about the place of football in America’s colleges:

BAN COLLEGE FOOTBALL – On WNET from Intelligence Squared U.S. on Vimeo.

Prior results do not guarantee outcomes.
Attorney Advertising.

10 Things To Do If You Get Hurt At Work

When you’re injured at work in New York, people often ask what they should do immediately following the accident. There are several basic things you should do to protect your rights under New York State Workers’ Compensation Law.
  1. Report the accident to your supervisor/employer as soon as is possible. Under NYS law you have 30 days to give your employer notice of the accident. Report the injury to your supervisor and be clear about how it happened and that it happened at work.
  2. Follow up with your employer to ensure they have prepared an accident report. If a report is not being prepared, you should write a letter stating the circumstance of the accident for your Supervisor. If you can, send your letter by email or have your supervisor sign a note that acknowledges receipt. A paper trail is always helpful.
  3. When you receive a copy of the accident report, or any paperwork from your employer or its insurance carrier, be sure to make copies for yourself. Keeping your own file is always helpful in the long run. You should bring that file with you to hearings to show your attorney and the judge, if needed.
  4. If you are a member of a union, you should tell your shop steward of the injury as well. Be sure that you report to the shop steward who you gave notice to, when you gave it, and ask what your union policy is on Workers’ Compensation injuries.
  5. Keep a log of<!–more–> all significant contacts you make along the way. Note your doctor visits, conversations in adjusters, and any documents received.
  6. If you are out of work because of your injury, you need to see your doctor every 45-90 days (depending on your injury). The reports that your doctor submits to the NYS Workers’ Compensation Board is the evidence required to support your continuing disability. Without those reports your treatment may be obstructed and any indemnity payments you’re receiving may be stopped.
  7. When you visit the doctor remember to be clear and discuss in detail the circumstances of your injury. Everything from what job you do, to where you were hurt, to the mechanics of the injury (For example: Did you fall backwards? Sideways? Land on your knees? Your back? Some other way?)
  8. If your doctor says you can return to work in a lighter capacity, be sure to get a letter that lays out what physical restrictions you have. You should keep a copy for yourself and provide copies to your employer.
  9. Do not be afraid to follow up with your doctors to get copies of the medical reports they are submitting to the Board. Up to date medical evidence is an essential component of a workers’ compensation claim. You do not want to leave your fate to the efficiency and prowess of others to prepare, scan, and upload documents to State computer programs.
  10. If your doctor tells you that treatment has been denied, discuss the need for treatment with your doctor and ask if he/she needs you to sign a “variance” request to affirm you would like to bring the issue to the Board.

Sometimes the “smell test” is most applicable. If something doesn’t smell right don’t be afraid to consult your attorney (or retain one if you haven’t already). There are a number of moving parts in these cases — doctors, adjusters, independent medical consultants, physical therapists, judges, your lawyers, insurance company lawyers — that asking questions and doing your best to get a firm grasps on the status of your claim is only going to help you as you recover from your injury.

Prior results do not guarantee outcomes.
Attorney Advertising.