Category Archives: Workers’ Compensation

Summer Means Safety Reminders for Teen Workers

Today’s post comes from guest author Kit Case, from Causey Law Firm.

L&I urges workplace safety for teens as summer hiring season nears

Teens are gearing up to search for summer jobs and the Washington State Department of Labor & Industries (L&I) is urging employers, parents and others to support safety during “Safe Jobs for Youth Month” in May.

A total of 477 youth ages 12-17 were injured in the workplace in 2013, making this year’s observance more important than ever, said Mary E. Miller, occupational nurse consultant with L&I and a youth employment expert. Of the total, 156 were in the food and hospitality industries. The next largest total, 66, occurred in the retail trades. There were no fatalities.

“Teens are eager to work and may not question a workplace situation that doesn’t seem right,” Miller said. “We’re trying to ensure youth perform safe and appropriate work and employers, parents and teachers can all help.”

Gov. Jay Inslee signed a proclamation making May “Safe Jobs for Youth Month” across the state. More information is available at www.TeenWorkers.Lni.wa.gov. The agency also offers presentations from injured young workers for students. Miller can provide a separate talk for employers and teachers.

In recent years, the number of injuries has increased despite an overall decrease the past decade. Injuries in 2003 totaled 1,135. In 2011, injuries reached a low of 425 before increasing the next two years. Injuries range from lacerations, strains and sprains to more serious fractures and concussions, Miller said.

“Employers are eager to give young workers a start in the world of work” Miller noted. “The result is we need to continue to help employers provide teens with tasks appropriate to their age.”

In general, 14- and 15-year-olds may perform lighter tasks, such as office work, cashiering and stocking shelves. Work assignments for 16- and 17-year-olds can be less restrictive and can include cooking, landscaping, and some use of powered equipment and machinery. The limits on the hours of work for all minors vary by age.

Generally, if safety equipment other than a hard hat, eye protection or gloves is required, then it’s not an appropriate job for minors. All minors are prohibited from working with powered equipment such as meat slicers and forklifts, Miller noted.

In agriculture jobs, restricted job duties differ for youth. The agency has specific information on its website at its Agricultural Jobs for Teens page.

 

Photo credit: The Library of Congress / Foter / No known copyright restrictions

Prior results do not guarantee outcomes.
Attorney Advertising.

Occupational Disease: New Cancer Study and Firefighters

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

Worker’s compensation has provided benefits or coverage for occupational diseases for generations.  In Wisconsin an occupational disease is one acquired as a result of working in an industry over an extended period of time. An occupational disease cannot result from a single incident, but rather it is the result of a disease process. Wisconsin has not excluded any occupational diseases from its worker’s compensation benefit provisions. One of those disease processes is cancer. 

Studies are done regularly to determine the cause of disease 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. A presumption of employment connected cancer exists for firefighters in Wisconsin. The statute applies to any State, County, or municipal firefighter who has worked for ten years with at least two-thirds of the working hours as a firefighter who has cancer of the skin, breast, central nervous system, or lymphatic, digestive, hematological, urinary, skeletal, oral, or reproductive symptoms. For that firefighter whose disability or death is caused by cancer, the finding is presumptive evidence that the cancer was caused by employment. Note, however, no presumption exists for firefighters who smoke cigarettes or use tobacco products for claims after January 1, 2001. Benefits for firefighters include Temporary Total Disability, Permanent Partial Disability, and if the disease (either heart or lung) precludes a return to work, duty disability payable at 75% of the firefighter’s salary, may also apply. 

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.

Prior results do not guarantee outcomes.
Attorney Advertising.

“No Trauma” Does Not Mean No Injury

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

I’ve been investigating Wisconsin and national fraud statistics in worker’s compensation to prepare for a national presentation I am making in Cape Cod in July. One fascinating and recurring basis for denial of worker’s comp claims (and potential claims against employees for fraud) stems from an insurance carrier’s review of the initial medical report.

Often the physician or emergency room nurse, physicians assistant or First Responder will ask an injured worker “Did you have any trauma?” If the answer to the question is “no”, the medical records will routinely indicate “no trauma”. This information is translated by the insurance carrier as a denial that an injury occurred. The level of medical sophistication for an injured worker is routinely limited. Most of my clients (and based on inquiries with other workers’ attorneys, their clients as well) believe a trauma is something akin to getting hit by a bus. They do not equate the notion of trauma with lifting a heavy object such as a table or a box. The criteria for traumatic injuries in most states, including Wisconsin, is that a single incident or episode caused the injury or aggravated a pre-existing condition beyond a normal progression. In many cases a lack of “traumatic injury” at the initial medical presentation is not an accurate indication of whether a traumatic injury actually occurred.

Prior results do not guarantee outcomes.
Attorney Advertising.

Medical Care Politics in Worker’s Compensation

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

The mythology surrounding employee fraud in worker’s compensation is pervasive. Many of my clients begin their conversations with me indicating the following: “I’m not one of those folks faking their worker’s compensation claim.”  The exaggerated media publicity concerning employee fraud has also resulted in outright worker intimidation regarding filing a claim. I had this conversation today with a prospective client.

Attorney: Why didn’t you report the incident?
Client: I didn’t want to have that on my record.  Nobody will hire me if I have a worker’s comp injury.
Attorney: Why didn’t you seek medical treatment?
Client: I do not have insurance.
Attorney: Can you obtain insurance under the Affordable Care Act?
Client: You mean Obamacare?  No way!

Fear of being stigmatized as a complainer, whiner, or simply a recipient of worker’s compensation benefits has prompted many legitimately injured workers from filing a worker’s compensation claim.

The adverse publicity concerning the Affordable Care Act (and its pejorative popular name “Obamacare”) results in many otherwise qualified workers from obtaining the health care they need, especially when denied by a worker’s compensation insurance carrier. 

The politics of medical care intrudes in the worker’s compensation arena daily.

Prior results do not guarantee outcomes.
Attorney Advertising.

Is Worker’s Comp Profitable Because Disabled Workers Don’t Get Benefits?

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

I recently wrote an article in the national magazine for the Worker’s Injury Law Advocacy Group (WILG), the Worker’s First Watch, Fall 2013 reviewing the worker’s compensation resources research report indicating that the worker’s compensation industry is extremely profitable.  I began representing injured workers in 1976.  It seems every year since then worker’s compensation insurance carriers have complained they are not making profits and the culprit responsible is increased benefits paid to workers.  In fact, over the last 20 years the insurance industry has been profitable in 16 of 19 years and broke even in one year.  Several factors account for this profitability, including worker’s compensation insurance carriers successfully pursuing deregulation and “reform” measures to restrict eligibility. 

The net result of increasingly restrictive rules for compensability in many State worker’s compensation systems as a result of “reform” resulted in many workers with disabilities caused by work who did not receive worker’s compensation benefits.

The general trend since the early 1990s has been to restrict coverage through State statutory and administrative “reform”.  Many workers face lengthy litigation and frustration.  More restrictive regulations may preclude claims where the worker lacks “objective” medical evidence for his injury, or is unable to medically document persistent pain, or has a disease resulting from multiple causation that cannot be distinguished from workplace disease, or has job stress related disorders.  One significant problem is that many injured workers fail to file for benefits.  (For those of us in the trenches daily, these pose obstacles to compensability.)  Among the many reasons for failure to file are:

  • Ignorance of worker’s compensation and eligibility.
  • Ignorance of the work-relatedness of the condition.  (Many workers know they suffer an impairment but do not know the health condition is caused by work.)
  • Reimbursement for medical care or Short Term Disability benefits available.  (Many workers use Short Term Disability or group medical insurance rather than worker’s comp.)
  • Belief that the injury is lacking in sufficient severity.
  • Many workers fear job loss or other forms of retaliation, who do not want to report a condition as work-related.
  • Workers do not want to be perceived as complainers or careless.
  • Deciding not to file based on the negative experience of co-workers.
  • Fear of the stigma associated with being a worker’s compensation claimant.  (Much of this stems from the intense focus on fraud perpetrated by the insurance industry, resulting in increased levels of stigmatization, decreasing the likelihood injured workers will file for benefits.)
  • Pressure from co-workers on safety incentive programs.  (These programs, sometimes called “Safety Bingo” create incentives not to report.)

Those of us who have hearings daily that involve the non-reporting of an injury, or significant time delay between the occurrence of an injury and the reporting of an injury, can refer to the above list for some ammunition on the “non-filing” or “late filing” issues.

Prior results do not guarantee outcomes.
Attorney Advertising.

How To Prepare For Your Workers’ Compensation Hearing

If you have a serious injury on the job and file a claim for workers’ compensation benefits you will most likely at some point in time have to attend a hearing before the Workers’ Compensation Board. The hearing process can be daunting to many first time attendees. They don’t know what to expect; what to bring or in many cases even what to wear. Those who have attended hearings are upset about the fact that they have to wait for a long period of time in a huge waiting room only to be rushed in and out of the hearing courtroom or “part” in a matter of minutes. They complain that while sitting inside a hearing “part”, the parties all seem to be speaking in codes and abbreviations and they don’t seem to really understand what has occurred. 

I am hoping that by providing information to you the hearing process does will not be as overwhelming and as confusing as it seems. When I first started in the practice, the board regularly scheduled hearings for any and all outstanding issues including need for treatment and or surgery. Most injured workers had numerous hearings before the workers’ compensation board with the same judge presiding and in many times the same insurance representative. Hearings were scheduled every 3-4 months untill the case was resolved which could take about 2 years.  

Today however things are radically different. Most times medical requests are dealt with in-house. The medical treatment guidelines lay out specifically what is pre authorized if certain medical conditions apply. If the treating doctor wishes to pursue treatment outside the scope of the treatment guidelines he must request it and this may be authorized or denied. These requests and denials are all done through paperwork and the injured worker unfortunately has very little to say in the matter.

The amount of hearings has declined tremendously so if you are not represented by an attorney you need to be prepared. 

  • Put together a file. 
  • Make sure any administrative decisions have established all sites of injury you are claiming. If not, you need to tell the judge that you have a claim for other sites and you will be directed to produce medical where appropriate. 
  • While your treating physician should be submitting regular medical reports to the workers’ compensation board and insurance carrier, you should always have your own copies of your medical records including diagnostic studies. 
  • You are entitled to reimbursement for mileage and prescriptions related to your claim. Bring copies of bills and mileage requests if the carrier has failed to reimburse you for these expenses. 
  • You should bring copies of all pertinent paperwork with you to proceed with your claim. 
  • Do not ever come late to a hearing but bring reading material as many cases rarely start at the time indicated. However if you are late the judge will probably not recall your case and now you must wait for a rehearing. 
  • You should be dressed appropriately and while a suit is not required, be mindful of the fact that you are appearing in a court room. 

The key to being your own successful advocate is to be prepared, be polite and be patient. 

Prior results do not guarantee outcomes.
Attorney Advertising.

Understanding Your Claim: Workers’ Comp Terms Explained In Plain Language

Today we continue discussing workers’ compensation injuries and procedures.  While no one plans to get hurt on the job, there are some things you need to know if you find yourself dealing with the workers’ compensation system. If you are unfortunate enough to find yourself injured on the job you may be scheduled for a hearing or more likely receive an administrative decision regarding your claim. Many people who find themselves attending a hearing or in receipt of a decision are often times confused by the terminology. As a practitioner of workers’ compensation I can tell you that there are a lot of terms of art, abbreviations and the like that we use on a regular basis during the course of a claim.

One of the most common abbreviations we use is ANCR or ODNCR. For example, if you have an injury to your back you might receive a decision indicating ANCR back. Without ANCR or ODNCR, you cannot have a successful claim for workers’ compensation benefits. But what does it mean?  ANCR stands for accident, notice and causal relationship. ODNCR stands for occupational disease, notice and causal relationship. Here I will discuss each of the components.

  1. An ACCIDENT or OCCUPATIONAL DISEASE is one arising out of and in the course of the employment. Just because you get injured or sick on the job does not definitively mean you are entitled to file a claim. For example, if an employee gets assaulted on the job by a jealous spouse because of a domestic dispute, the injuries sustained would not be compensable as there is no work connection. If you are injured solely as a result of intoxication from alcohol or drugs while working, you would not be able to obtain workers’ compensation benefits. Similarly in occupational claims not only do you have to show that it occurred in the course of employment but that it must flow naturally from the work involved.
  2. The second component is NOTICE specifically notice to your employer that you were hurt on the job. The law prescribes that notice be given to the employer within 30 days of the accident and should be in writing although oral notice may be accepted. While many jobs have their own internal notice requirements, the law in New York State is 30 days. Notice is different than filing with New York State. The Statute of Limitations to file a claim with the New York State Workers’ Compensation board is 2 years. You may file within the 2 year statute but still lose your claim if you didn’t file proper notice with your employer within 30 days.    
  3. Lastly, there must be CAUSAL RELATIONSHIP, between the job and the injury sustained. Is the injury you are suffering from as a result of the accident which occurred on the job. In order to prove this you must have a medical report from a qualified medical provider. The doctor should be a licensed to practice under the workers’ compensation and familiar with the system which includes the requisites necessary in order to file a proper report. If you are able to confirm these components, your case may be accepted or established. It is imperative that these steps are followed as it is possible that a very serious injury may sustained but never established because it fails to follow what has been directed.

Prior results do not guarantee outcomes.
Attorney Advertising.

How Do Social Security Disability And Workers’ Compensation Benefits Work Together?

As a practitioner in the workers’ compensation field for almost 25 years, I have represented thousands of injured workers. A large percentage of those injured workers are also entitled to Social Security Disability (SSD) benefits which are benefits based upon disability and not age. My Partner, Barbara Tilker has practiced in the area of social security disability for over 35 years and she has provided me with important information regarding SSD. But what exactly are these benefits and who is entitled to them? In order to qualify you must have the requisite work credits. The number of work credits you need depends on your age. Generally speaking you need at least five years of work (20 credits). You will often hear people say you need to have worked five of the last ten years. You also must have substantial gainful employment – having minimum earnings of $1070 per month. The maximum SSD rates are based on individual income and FICA tax paid.  They are running around $2500 per person max and $4000+ if there is a dependent family

Filing for SSD can be a lengthy process. Every case is different, and some are processed faster than others. However, we’ve found that it takes the Social Security Administration (SSA) between four (4) to six (6) months to make an initial decision. If that decision is unfavorable (and about 70% of initial decisions are denials), it can take between eight (8) to twelve (12) months to have a hearing before an Administrative Law Judge (ALJ) scheduled. A year to a year-and-a-half wait is not uncommon.

Due to the lengthy process, you should file for SSD as soon as possible. You should file as soon as you know that you will be out of work for at least twelve (12) straight months OR if your condition is expected to result in death. You should talk to y our doctor to see how long he/she expects you to be unable to work. Your doctor’s support is incredibly important to your case so talk to him/her before making the decision to apply.

In order to make sure that you get the maximum amount of benefits you’re entitled to, your application must be filed within 17 full months from the time that you become disabled and unable to work. If you’ve already been out of work for a year or more, consider putting in an application right away to prevent any loss of benefits you would otherwise be entitled to. 

In New York, Social Security disability benefits are offset by workers’ compensation. There is an 80% ceiling on concurrent WC and SSD translates as follows:  A disabled individual (including dependent family benefits) cannot exceed 80% of highest gross income of the last five years worked, together with workers’ compensation benefit. This is computed on a monthly basis. If exceeded, social security is offset. Many of my clients have multiple concurrent medical issues – they may have a back injury as a result a work related accident but they may also have diabetes or a prior leg condition. Social Security takes all of these medical conditions into account to determine whether or not you are entitled to benefits. Your entitlement to SSD is based upon your overall medical condition and not just your workers’ compensation claim. While no one plans on getting injured or disabled, you should plan on knowing what you are entitled to before the unthinkable occurs.

Prior results do not guarantee outcomes.
Attorney Advertising.