Category Archives: employment law

Workers’ Compensation:  The Man-made Quagmire (Part 2 of 3)

Today’s post comes from guest author Paul J. McAndrew, Jr., from Paul McAndrew Law Firm.

This is the second part of a three-part series in which I explain why workers should claim their rights under workers’ compensation laws. The first installment explains how employers commonly and purposefully make it difficult for workers to claim comp. This second part explains ways in which workers’ compensation insurance companies (from here on our we’ll call them “insurers”) also throw up barriers to workers getting comp benefits.

It is worth noting that many employers – mostly large corporate employers – file for and obtain a certificate from the Iowa Division of Insurance to “self-insure” for purposes of workers’ compensation. These self-insured employers have offices filled with staff that carry out the same work and serve the same purposes as out-dwelling work comp insurers. They do the same things as out-dwelling insurers to bar coverage, also.  Thus, I will treat them as one entity – “the insurer.”

Our third segment will explain why other benefits and programs don’t come even close to providing what the worker receives in workers’ compensation. It’s unfortunate, but the best thing a worker can do is slog through this quagmire and make good on his or her rights in comp.


Again, researchers determined years ago that many barriers are erected by insurers. The insurers’ barriers don’t stop after the worker applies for comp. In fact, in my experience the insurers deter workers by making obtaining comp benefits so unpleasant and frustrating, that the workers with future injuries will opt to not claim comp, but rather try to make do with other benefits, if possible. The biggest reasons workers give up on their rights in workers’ compensation are due to the insurers’ conscious effort to frustrate, confuse and delay every aspect of the claims process. That, however, is exactly what should not happen in comp. Why do I say that? Because the Iowa Supreme Court has repeatedly said that for decades. According to the Court it’s a basic fact of Iowa worker’s compensation law “that the injured claimant is compensated swiftly, fairly and with the least possible ‘red tape.’” DeShaw v. Energy Mfg. Co., 192 N.W.2d 777, 784 (Iowa 1971)(citing Cross v. Hermanson Bros., 235 Iowa 739, 16 N.W.2d 616, 618 (1944)). Besides being fast in result, the process is supposed to incline in favor of the worker. Again, as stated by the Iowa Supreme Court, “we keep in mind that the primary purpose of chapter 85 [ed. the work comp code chapter] is to benefit the worker and so we interpret this law liberally in favor of the employee. Stone Container Corp. v. Castle, 657 N.W.2d 485, 489 (Iowa 2003).

So what should you do to protect your workers’ compensation rights when the insurer is ignoring them?

Part I: Dealing with the Insurer’s Persuasion Tactics

  1. The Adjuster – The Insurers’ First Fortress in the way of Every WC Claim

    People used to ask why I do not like adjusters. The reason is that very few of them (something less than 5% by my best estimate) have any goal but cutting costs for the insurer, no matter what means are used to do so. In light of that I most commonly file the claim early on so as to deal with the insurers’ lawyers rather than the adjuster. How does the adjuster form a barrier – a tough fort – standing in the way of a legitimate work comp claim?

    1. The Various Types of Obstructive Adjusters
      Adjusters commonly do several things that occur so frequently that I believe that these things are learned and practiced forms of conduct, which are designed to frustrate any injured worker. What things?
      1. The Absent Adjuster – most commonly the adjuster may never answer the phone, instead letting all of your calls go to voice-mail. Then, the adjuster will not return your calls.
      2. The Rude Adjuster – nearly as common is the adjuster who denies a claim without explanation and will be demeaning and condescending in refusing to be willing to explain anything. In a system in which the worker is usually without any way to know things, being put down and denied without explanation is a very effective method of driving the worker out.
      3. The 100% Purposely-Ineffective Adjuster – the adjuster many times will promise action on a benefit and may even set personal deadline to do so. Then, the adjuster fails to get the action and merely extends the time for the deadline, again and again. Again, this is a very effective means to drive a worker from the system because the benefits (both medical and money) are usually promptly needed.
  2. The Adjuster’s Wingman – The “Nurse Case Manager” Commonly the adjuster/insurer will assign a “nurse case manager” (hereinafter “NCM”) to your claim. The NCM is a “confidence person.” She (the NCM is always a female in my experience) will tell the worker and family that she is there to get better and more prompt care. In fact, the NCM almost invariably seeks to interfere with the minimal care that even a company doctor renders. In most cases the NCM will also do anything to persuade that the worker should be returned to work, whether safe or not. The only effective remedy I’ve found for the NCM who acts unreasonably in denying my clients care is to file a complaint with the Iowa Board of Nursing.
  3. Employer’s Choice of Medical – “Paul McAndrew’s best friend” Why is it my best friend? Because if the law allowed Iowa workers the right to choose their own medical care, more than half of the workers who come in and need me would no longer need me. Why say that? Because about 75% of the workers who come to my office do so only because they’ve been delayed, denied, and frustrated in getting timely and proper care, so much by the company doctor (usually in conjunction with the adjuster and NCM) that they can’t get back to work as they must and they come to me to merely get medical care. They don’t even want the benefits much. They want only to get healthy so they can get back to work and earn a living to support their family. How does the adjuster/NCM/company doctor bar proper and timely care? By these means:
    1. The Company “Hack” (General-Practice Doctor)
      There are many company doctors who are well known to the practicing work comp bar as being dedicated to one thing: Maintaining that doctor’s share of the insurers’ referral of injured workers by almost any means. This leads the doctor to be little more than a mouthpiece for the insurer. This takes the form of:
      1. Stating some uncouth reason why the injury did not arise out of and in course of (commonly called “cause” but very different than) work (e. g., the court reporter, Smith).
      2. Minimizing or even ignoring the worker’s injury condition until the worker is discharged to her/his own doctor, or just leaves due to frustration.
      3. Carrying the worker along over months of periodic clinic visits without any real effort to determine a diagnosis and treat that diagnosis.
    2. The Company “Sweetheart” (Specialist Doctor)
      This specialist—-commonly an orthopedic surgeon or neurosurgeon—becomes the insurer’s favorite by always giving a favorable-to-the-insurer opinion. Again, the Sweethearts are well known to lawyers, but not to the worker.

Part II: The Insurers’ Tricks for Wrongfully Manipulating Care

  • Prompt Care/Unreasonable Delay in Providing Care
    This speaks for itself. It’s far and away the most common method of denying care—just delay it long enough and the worker’s life demands will cause the worker to turn elsewhere for care. This is easily overcome with the Alternate Care Procedure, briefly described here.
  • When the Authorized Doctor Recommends Care that the Insurance Company Denies
  • When the Authorized Doctor Refers to another Doctor and the Insurance Company Denies or tries to Refer, instead, to its “Sweetheart”
  • When the Authorized Doctor orders care and, Instead, the Insurance Company tries to “Transfer Care” to a Sweetheart Who Will Likely say what the Insurance Company Wants to Hear
  • When the only Care Offered is not Convenient Care. This is now standardized: if the care offered is more than 50 miles from the worker’s home and the same type of care is offered closer, then the 50+ – care is “inconvenient.” Remember the “convenience” requirement applies only to “care.” Unfortunately, it does not apply to the company’s right to send the worker for a medico-legal, one-time “independent medical examination.”

 


Alternate Care Process

The Iowa Legislature enacted in 1913 the comp’s system’s healthcare provision method. Iowa Code 85.27. 85.27 provides that the employer has the right to make the initial selection of care. In this regard, Iowa is only one of ten out of the fifty states and the United States (under FECA (Federal Employee Comp Act) and the Long Shore Act) that provide the employer with such unfettered power. For years, a worker had to wait months or more than a year to get to the final hearing to challenge the insurance company’s denial of care.

In 1992, however, Commissioner Byron Orton drafted a provision that was accepted by consensus of all interest groups and enacted into law, which create the “alternate care process.” This process allows the worker to obtain prompt relief for the denial of proper care. The process is relatively simple and designed to be carried out by a worker or union representative.

NOTE: While Section 85.27 gives the employer the right to select care, that right is qualified. The care provided must be (1) prompt, (2) reasonably suited to treat the injury and (3) without undue inconvenience to the claimant. Westside Transport v. Cordell, 601 N.W. 2d619, 694 (Iowa 1999). The failure of the employer to provide care meeting any of these three requirements gives the worker the right to bring an alternate-care procedure and have the Division of Workers’ Comp. order proper care be provided.

The Steps for Filing and Prosecuting ON YOUR OWN an Alternate Care Claim

  1. Before filing, the worker must communicate the basis of her/his dissatisfaction with the care (or lack of care) offered by the employer. If you don’t, the filing will be dismissed. Communicate dissatisfaction in writing or the employer will likely deny that there was communication.
  2. File on the form provided by the Commissioner. This form can easily be obtained at http://www.iowaworkforce.org/wc/publications.htm. There is no cost/filing fee. Make sure you send a copy of the form to your employer, also, as explained on the form.
  3. When filling out the form, ensure you state: (A) The specific medical treatment sought; (B) the grounds why what’s offered (if anything) is not proper (for example, “not prompt,” “not convenient,” or “not proper care for the injury condition,” etc.); and (C) that you ask for hearing by telephone.
  4. Alternative medical care proceedings are only prospective in nature. Bills for prior care will need to be adjudicated about a year later in the primary hearing.
  5. The grand majority of alternate care hearings are heard by phone.
  6. Alternate Care Procedures Yield Prompt Results. Why? Because by law the commissioner must both hear the alternate care matter by phone and issue the decision on the matter within ten (10) days of the filing of the alternate care petition.

Please join us next week for Part 3: Why it’s Important to Receive Comp.

Workers’ Compensation: The Man-made Quagmire (Part 1 of 3)

Today’s post comes from guest author Paul J. McAndrew, Jr., from Paul McAndrew Law Firm.

I’m starting here a three-part series explaining why workers should claim their rights under workers’ compensation laws.  The three parts are, in summary: 

  1. How the employer makes it tough to claim work comp;
  2. How the insurer makes it tough to claim work comp; and
  3. Summary:  Why it’s Important to You and your Family that you Claim Work Comp when You are Hurt on the Job. 

Below is the first installment.

 


Workers’ compensation [“work comp”] is every workers’ right. Yet, researchers years ago determined that many employers and most work comp insurers try their best to persuade workers to not make claims. That “persuasion” takes many forms. It’s important that workers know that this “persuasion” is calculated and how to deal with it. Why? Because workers’ compensation benefits are your right and those benefits are important to you, your family and the overall safety of your workplace.

Part 1: Dealing with the Employer’s Persuasion Tactics 

  1. Suppressing Reporting of Work Injuries: Pizza-Bingo Party!! — Nancy Lessin (the MA AFL-CIO Health & Safety Coordinator) taught me years ago that giving workers some type of prize for so many hours without a reported injury is NOT based on generosity. No, it’s based on cost cutting. It’s also completely contrary to public policy!

    Work comp is required by law. One of work comp’s basic purposes is to make workplaces safer. How? By making employers pay higher work comp premiums in circumstances in which there are high rates of injuries, thus giving the employer financial incentives to implement safety measures to keep injury rates low, leading to lower premium costs. Some sly employer offer such things as pizza parties, small bonuses, gift-drawings and the like knowing full well that doing so puts pressure on the workers to not report work injuries.

    Why? Because the more a worker cares about her/his brothers and sisters, the more likely the worker will — when hurt at work — do the wrong thing.  What’s the wrong thing? It’s preserving your friends’ pizza party or “prize” by putting the accident as “personal,” and putting the costs on health insurance, LTD and lost sick/vacation time. The problem with this is often not discovered until too late. What do I mean “too late?” I mean when the health insurance company investigates and finds the injury was caused by work and thus denies coverage under the standard health insurance exclusion for work injuries. And when the time missed due to the work injury outstrips the amount of sick and vacation you’ve banked for the last 13 years. Even that does not account for what happens years later.

    First, you work injury may be “the gift that keeps on giving.” It may require 2 or even 3 surgeries, leading to even more medical expenses and time off work. Only work comp pays this.  No LTD or health insurance comes close. Bottom line: Don’t be misled by the “gifts” for no reported work injuries. The only entity getting that “gift” is your employer.

  2. Termination—Yes, we all know the employer who makes up an excuse — ANY excuse — and fires the injured worker within days of the injury.  This is illegal under all public policy, Iowa law (Springer v. Weeks) and U.S. law (the Americans with Disabilities Act).
  3. Return to work at a job that is not within even the company doctor’s work restrictions. Remember — not trying a tendered job — any job — sets up the argument that the worker is “insubordinate,” “refusing work” or “no-call/no-show.” One must try any job, whether the job’s tasks are within restrictions or not. One need not, however, continue to do any tasks that cause worsening of the work-injury condition. If asked to do something outside restrictions set by the doctor:
    1. report that the job’s outside your restrictions;
    2. when told to do the job anyway (which will likely happen), perform the job the best you can and hope for the best; and
    3. if the job does what is feared — worsens your injury condition — go to the company workers’ compensation officer and demand a return to the company doctor immediately, before your injury is permanently worsened.

Stay tuned next week for Part 2: Dealing with the Insurance Company’s Persuasion Tactics.

Are You Misclassifying Your Workers and Committing A Fraud?

To avoid misclassifying your workers follow these tips:

  • Don’t make assumptions. If you are a business owner you should consult a tax professional and an attorney to ensure you are complying with IRS and labor laws when hiring staff or contractors.
  • If contracting with staffing companies or labor brokers, make sure those agencies are properly classifying its workers as employees. Companies can be held responsible for labor violations of their contractors.
  • Consider filing a SS-8 Form (Determination of Worker Status) with the IRS and ask that agency to determine whether the worker is an employee or independent contractor.
  • Be aware that contractors set their own schedules and pricing, and perform the work as they see fit. If you want control over these areas, make sure you hire an employee.
  • Check the workers’ compensation policies of any subcontractor you hire. (Look out for “ghost policies,” which aren’t designed to cover known employees.)
  • Don’t rely on excuses such as “He only works a few days a week.” “She agreed to be an independent contractor.” “They use their own tools.” “He’s done this for so long he doesn’t need my supervision.”

Thanks to McClatchy DC!

 

Health Care Testing: A New Frontier for Worker’s Comp

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

As a worker’s compensation lawyer, I see many news stories through the prism of how the news event or trend will affect injured workers in the worker’s compensation system. A federal judge in Minnesota has ruled that Honeywell, Inc. can begin penalizing workers who refuse to take medical or biometric tests. 

The EEOC had claimed Honeywell’s policy violated the Americans With Disabilities Act and the Genetic Information Nondiscrimination Act. They filed a lawsuit in Minneapolis on behalf of two Minnesota employees of Honeywell.

The tests Honeywell required their employees to take measured blood pressure, cholesterol, and glucose, as well as signs that employee had been smoking. Employees who declined to take the test could be fined up to $4,000 in surcharges and increased health costs. Honeywell said the program is designed to “encourage employees to live healthier lifestyles and to lower health care costs.” Honeywell says the testing promotes employee well-being. Management also indicated “We don’t believe it’s fair to the employees who do work to lead healthier lifestyles to subsidize the healthcare premiums for those who do not.”

The ramifications of such testing for worker’s compensation immediately come to mind. In any kind of an occupational exposure claim, such tests could be used to help deny worker’s compensation claims for employees who smoke, are overweight, have diabetic condition, claims involving occupational back conditions, carpal tunnel claims, and any kind of respiratory complaints. Another “slippery slope” may be the use of these kinds of testing to actually screen prospective employees, since the employer rationale would be that hiring folks with those pre-existing conditions would cost the employer more money.

Can I Get Fired For Filing Bankruptcy?

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

Low and middle income people are the last people to benefit from any economic recovery. For many economic recovery means a return to work the opportunity to put their household finances in order with steady income provided by a job. Unfortunately unpaid debts often mean that employees get garnished  or even having to file bankruptcy.

Congress intended for bankruptcy to allow for people to get a fresh start so they prohibited discrimination based on bankruptcy and even let employees sue employers for such discrimination. But this law is not as strong as other laws prohibiting discrimination on factors such as race or sex for two reasons.

First of all, your status as a debtor in bankruptcy must by the sole cause of job loss. Discrimination is difficult enough to prove already under either a motivating factor or proximate cause standardsole cause is more exacting than even the difficult proximate cause standard. If your employer has any other legitimate reason to fire you besides your bankruptcy, then a court will likely find the termination was lawful. The only way for an employee to preserve any type of discrimination case is not to give the employee a reason to terminate them because of their poor performance , attendance or poor attitude. But even good employees can get fired legitimate reasons such as restructuring and economicreasons.

Secondly most courts do not believe that bankruptcy discrimination prohibits employers from failing to hire employees based on bankruptcy.

Title VII and most state anti-discrimination laws state that a failure to hire based on certain protected categories is unlawful activity.

Finally in any discrimination claim, the employer needs to be aware of your protected status. In a bankruptcy discrimination case this means that your employer had to have known about your bankruptcy status prior to firing you. Some employees get fired because  employer doesn’t want to deal with a garnishment.  Most people, me included, think that such an action is wrong or unfair. But unless your employer knows that garnishment is linked to your bankruptcy status, then firing you based on that garnishment is legal  – unless the garnishment is a cover or pre-text for another unlawful reason.

I would encourage anyone reading this post to contact their U.S. Senator or Congressperson and ask them to change the bankruptcy discrimination statute to mirror other federal anti-discrimination laws such as Title VII.

What Football Can Teach White-collar Employees About Layoffs, Severance

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

With football season upon us, I would like to use football to explain some common situations that employees face.

I get a lot of calls from white-collar professionals who have long careers with a company but then are laid off a few months after a new boss is hired. This happens a lot in football when a general manager/athletic director replaces a head coach and the head coach fires the previous coach’s assistant coaches. White-collar employees in middle-management positions are essentially the equivalents of assistant coaches in football. In the world of football, it is assumed that a new head coach can bring in his new assistants. The same assumption holds true in the business world.

Assistant coaches are oftentimes “bought out” of their employment contracts. Sometimes white-collar professionals have employment contracts, but more often than not they do not. Sometimes professionals are offered severance agreements, but unless there is an employment contract, that severance is not a buyout. Employers are also under no obligation to offer severance. If severance is offered, that doesn’t necessarily mean that an employer wrongfully terminated the employee.

Of course, no employee can be terminated because of age, disability, sex, race, nationality, or in retaliation for engaging in a protected activity like filing for workers’ compensation or filing with OSHA. But even if there is some appearance of wrongful motivation on behalf of the employer, the employer can still defeat a potential lawsuit if they have a legitimate business reason for terminating the employee. Going back to a football analogy, if the new head coach wants to switch an offensive or defensive scheme, they have the right to hire the person they choose. The fact the new hire might be less effective than the old hire is not a decision that a court will second guess in a wrongful termination. Sure, if there is something else wrongful going on, it is something a court or a jury could consider, but in a case where there is a recent change in management, employees will have difficult time overcoming the assumption that the new boss just wants to “put in their team.”

Senior Care Workers Are Victims of Wage Violations

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

I found a recent story from California very troubling. The nation’s largest assisted living company agreed to pay $2.2 million to settle claims for underpayment and mistreatment of the workers who take care of the elderly. Lack of proper overtime pay, lack of mandatory meal and rest periods, and improper payment of mandatory training are examples of the mistreatment. 

The victims were the least-paid workers who did the hardest physical labor, according to the story. These people who bathed, fed, and provided the most hands-on care for our frail, elderly loved ones were denied wages and overtime pay for 7 years, according to the terms of the settlement.

Care for the old, frail and disabled is big business. Nearly 750,000 people are receiving assisted living care, according to the ProPublica article. And the industry is just going to expand, as folks are sicker but have higher expectations for care, while also living longer, according to this article from NPR

Fair treatment of our elders’ caregivers is essential. The wages are low, as most difficult jobs often are. Violating employment rules and statutes for businesses to save money and make larger profits seems particularly offensive for these workers. And they are not often protected from or informed of the hazards of their jobs, many of which can have serious consequences for workers’ health and well being, according to these blog posts from respected colleague Jon Gelman, an attorney in New Jersey: Protecting Healthcare Workers is a Goal of NIOSH and NIOSH Acts To Prevent Lifting Injuries For Home Healthcare Workers.

Congratulations to the workers and their representative who stood up to this very large employer that has around 500 facilities in the United States. It takes courage and tenacity to fight battles like this.

All of us who care about workers need to be aware that these are battle worth fighting. And that these battles can be won.

I Was Offered a Severance Agreement. Now What?

If you are given a severance agreement, consult with an attorney

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

Federal law requires that many employees who are offered severance agreements be advised by their employers to consult with an attorney before signing a severance agreement. If you have a severance agreement, you should consult with a knowledgeable employment-law attorney as soon as possible. Almost all severance agreements have a short time period, usually no more than 21 days, for the employee to accept the agreement. Here are some of the factors to consider in whether to accept a severance agreement.

If you have a severance agreement, you should consult with a knowledgeable employment-law attorney as soon as possible.

A. The value of the certainty of a severance agreement versus the uncertainty of a wrongful-termination suit. This requires an attorney to evaluate the strength of any possible employment-law claims you might have against your former employer. In many cases, the value of a certain amount of guaranteed severance pay is worth more than the uncertain outcome of a wrongful-termination claim that might not resolve for at least a year. Certain types of unfair-employment practices create more fear of litigation for employers than others. Employers are often willing to pay severance in order to avoid the expense and uncertainty of litigation. This fear can give employees some leverage in negotiations, which could lead to an increase in severance pay. However, every situation is different.

If an employee decides to reject severance and pursue a wrongful-discharge claim, a knowledgeable employment-law attorney can advise you on your chances of receiving unemployment benefits. Employers, especially smaller ones, will often fight unemployment claims if there are bad feelings surrounding a termination. If an employee is found to have been fired for misconduct, they are potentially losing many thousands of dollars in unemployment benefits. Before you reject severance, you should know your chances for receiving unemployment benefits.

B. A knowledgeable employment attorney may be able to review the severance agreement and find contract provisions to offer the employer in order to increase the severance pay. The fear of litigation is a stick, but sometimes employees can offer carrots in the form of favorable contract language to increase severance benefits.

C. Severance pay is not the only consideration in a severance agreement. A standard severance agreement often includes a provision that the employee is eligible for COBRA. COBRA requires that the employee pay the entire premium for health insurance. Sometimes employers are willing to pay that COBRA premium for a period of time.

Another possible severance benefit is the guarantee of a positive reference. A severance agreement is a contract releasing any claims – usually with the exception of workers’ compensation (see below) – by the employee against the employer. However, if the employer breaches the contract in regards to a positive reference, that can give the employee a breach-of-contract claim if the severance agreement is drafted properly. Many companies are willing to check out what employers are saying about former employees for a reasonable fee, so employees can enforce contract provisions regarding positive references

D. Workers’ Compensation. The laws regarding settling a workers’ compensation claim are very precise. I have never seen a severance agreement that creates an enforceable release of a workers’ compensation claim. However a savvy employer may be able to release your workers’ compensation claim through a severance agreement under recent changes in Nebraska’s workers’ compensation law. This is why you should consult with a lawyer who is familiar with fair employment and workers’ compensation law. This is especially true if you have an ongoing workers’ compensation claim against your employer.

E. You still might be able to bring a wrongful termination suit even if you signed a severance agreement. The Equal Employment Opportunity Commission has provided guidelines about when a severance agreement is not binding on the employee. If you feel you were railroaded into signing a severance agreement, it still might be worth your time to consult with a knowledgeable employment attorney.