Category Archives: Workers’ Compensation

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.

What is Workers’ Compensation Law in Nebraska?

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

Before workers’ compensation was an option in Nebraska, injured workers could only sue their employers under tort law for damages. While providing complete compensation – i.e., damages such as those for pain and suffering were available – it also required proof of negligence, and claims were often barred by affirmative defenses such as assumption of the risk and contributory negligence. For more than 100 years now, injured workers have had the protection of workers’ compensation laws that provide for no-fault benefits that are received quickly, and employers can avoid more expensive court challenges.

The Nebraska workers’ compensation system includes a dedicated court, and Nebraska is one of the only states to have this avenue for injured workers.

There are several different types of benefits that an injured worker is entitled to:

1.      Benefits to manage or cure the injury: includes hospital, doctor, chiropractic and physical therapy costs. This also includes the costs of diagnostic testing, doctor-prescribed medicine (even if it’s over-the-counter) and items like braces.

2.      Compensation while temporarily disabled: These payments of two-thirds of an injured worker’s average weekly wage may start after an injured worker has been off work for seven days, and usually an injured worker continues to collect payments – either for total or partial disability – while he or she is convalescing until a doctor signs off on a full return to work and/or places an injured worker at maximum medical improvement.

3.      Compensation for permanent injuries: These benefits are two-thirds of an injured workers’ average weekly wage (or wages earned in a 40-hour work week for part-time workers) and are available after an injured worker has reached maximum medical improvement. These benefits may be for permanent impairment to a specific body part or may be to compensate for an injured worker’s loss of earning ability. This distinction depends on the type of injury. Benefits may also be partial or total, depending on the type and degree of injury.

4.      Vocational rehabilitation: These are services provided under Nebraska workers’ compensation law to injured workers when, as a result of a compensable injury, the injured worker is unable to perform suitable work for which he or she has previous training or experience. This may include job placement and retraining. 

5.      Death benefits: If a worker dies as a result of his or her injury, that worker is entitled to medical expenses as well as burial expenses up to $10,000.  The deceased worker’s dependents are also entitled to benefits, which vary depending on the circumstances.

If the system worked the way it was supposed to, employers (or their insurance companies) would pay injured workers, pay the medical bills, and focus on getting the worker either back to work or moving on with the best quality of life possible. The reality is that employers (and their insurance companies) don’t always see eye-to-eye with doctors’ opinions or treatment recommendations, or follow work restrictions. Speaking with an experienced attorney when navigating the workers’ compensation system can reassureinjured workers and their loved ones and make a very stressful time a little less difficult.

Different states have workers’ compensation systems that vary, but all, to some extent, are intended to protect injured workers. If there are questions, please contact the firm and provide the details to an attorney who can advise on the best steps to take for each specific situation.

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

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. 

$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

Employer Fraud Cases (9):$44,962,492.00
Employee Fraud Cases (1): $1,500,000.00
Total: $46,462,492.00

 

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

    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. California & North Carolina: Cleaning Company Owner Convicted of Underreporting Payroll and Ordered to Pay $898,000 (8/3/2013)

    L. D. Hardas, President of Awesome Products Inc., said support from the community and the state was key to bringing his company to Mount Airy.

    The president of Awesome Products, a cleaning company in California, was convicted and sentenced for underreporting his payroll by over $8 million, resulting in a premium loss of $898,000. Loksarang Dinkar Hardas (53) was sentenced to five years in state prison, stayed pending successful completion of 10 years of formal probation, a $250,000 fine, and restitution payment of $898,000. Notwithstanding his conviction, the town of Mount Airy, N.C was standing by Mr. Hardas and willing to give his company taxpayer money in hopes that Awesome Products would build a manufacturing facility and create jobs in Surry County, N.C.

  8. 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.

  9. 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.

  10. 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

Worker Privacy Concerns : Employers’ Access to Employees’ Prior Worker’s Compensation Claims

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

Republican legislators are feeling their oats these days. Throughout the Midwest, legislators are depriving workers of collective bargaining rights and trying to restrict workers’ rights in workers’ compensation claims.

In Missouri, workers’ compensation legislation was recently proposed that would have permitted an employer to provide a potential hire’s name and Social Security number so an employer could identify the potential employee’s prior workers’ compensation claims and the status of those claims. The Missouri Division of Workers’ Compensation estimated an online data base that would include over a half million claim records with over 10,000 records added each year.

To his credit, Democratic governor Jay Nixon vetoed this proposed online data base which would allow businesses to check a prospective employee’s workers’ compensation claims. He said it was “an affront to the privacy of our citizens and does not receive my approval.” As expected, supporters of the workers’ compensation data base (employers primarily) said the legislation would speed the hiring process and help bosses and workers. Regularly, information about workers’ compensation claims is available by written request and takes about two weeks to arrive.  Supporters of the legislation indicated the law was “preventing workers’ compensation abuses.”

Wisconsin’s workers’ compensation records are subject to Wisconsin public records law, except for records identifying an employee’s name, injury, medical condition, disability, or benefits – which are confidential.  Authorized requestors are limited to parties of the claim (the employee, the employer, and the insurance carrier), an authorized attorney or agent, a spouse or adult child of a deceased employee. Workers’ Compensation Division staff may provide limited confidential information regarding the status of claims to a legislator or government official on behalf of a party. In addition, workers’ compensation staff are not permitted by law to conduct a random search to determine if other injuries have been reported.

If the requestor is the same employer or insurance carrier involved in a prior injury, then access will be allowed. If the requestor is a different employer or insurance carrier but they make a reasonable argument that the prior injury and the current injury are related, access may be allowed. For example, the Department considers injuries “reasonably related” if the two injuries involve the same body areas. 

Simply put, in Wisconsin, at least for the present, claimant information is confidential and not open to the public, other than to the parties to a current claim.

Worker’s Compensation Advocacy: Playing Fair in the Same Sandbox

Workers’ Compensation hearings tend to be relatively cordial

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

I just completed another semester teaching the worker’s compensation course at Marquette University. Part of my responsibility includes instructing students on the ethical practice of worker’s compensation law. I also recently read an article in the American Bar Association Journal in which a lawyer was chastised by the Judge for inappropriate behavior in a class action lawsuit. 

The lawyer held depositions in a Dunkin Donuts, wore a T-shirt and shorts to the deposition, drew penis cartoons during the deposition, and played Angry Birds on his computer throughout. He also disrespected the opposing counsel, indicating in the presence of the opposing party that the counsel was inadequately trained to handle the case. 

While worker’s compensation claims can be bitterly fought, worker’s compensation attorneys on both sides, in general, remain highly professional and relatively cordial.

While worker’s compensation claims can be bitterly fought, worker’s compensation attorneys on both sides, in general, remain highly professional and relatively cordial. Part of the explanation is the absence of actual “discovery” in worker’s compensation – no depositions, requests for production of documents, etc. that lead to the kind of results discussed above. Injured workers waive physician-patient privilege and worker’s compensation carriers can obtain any and all relevant medical records to defend the claim. Experts’ reports are required to be exchanged by Statute, and depositions are held only in rare circumstances (when parties are unavailable at a hearing). Although this “trial by surprise” can sometimes produce surprising results depending on the testimony, the absence of substantial pre-hearing discovery also means, in general, the absence of gamesmanship present in some other more contentious areas of the law.

9/11 Fund Starts Making Payments To Victims

Official White House Photo by Chuck Kennedy

Today’s post comes from guest author Jon Gelman from Jon Gelman, LLC – Attorney at Law.

The Zadroga 9/11 Victims Claim Fund has started to make payments to victims of the World Trade Center attack. First Responders andthose who lived or worked in the immediate geographical site near “ground zero” may be entitled to the payment of benenfits for illness and injuries that they suffer as a result of the terrorist attack.

Those eligible include, individuals present at  a 9/11 crash site at the time of or in the immediate aftermath, who suffer physical harm as a result of the crashes or debris removal. Also the personal representatives of individuals who were present at a 9/11 crash site, who died as a result of the crashes or debris removal, are eligible to file claims.

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All This Tragedy Should Be A Catalyst For Change

Today’s post comes from guest author Edgar Romano from Pasternack Tilker Ziegler Walsh Stanton & Romano.

This has been a tragic week in our country. Monday’s Boston Marathon attack was followed by Wednesday’s massive blast at the West Fertilizer Company in Texas. As I write, the final death toll from the West Fertilizer Co. fire has yet to be determined. It is currently unknown what caused the blast and it is unknown whether the casualties included employees, first responders or citizens. However as we look at this tragedy we should be reminded that this spring marks the 102nd anniversary of the Triangle Shirtwaist Fire. That terrible event which took place on March 26, 1911 was followed by a swift and aggressive response by workers and labor activists. Their response led to the establishment of many of the protective organizations American workers now rely on, including the workers’ compensation system, the American Society of Safety Engineers, and the U.S. Department of Labor.

As with the Triangle fire, this should be a time for action as well as reflection. April 28th is Workers’ Memorial Day, a great opportunity to talk about how to establish better workplace safety so that no tragedies like the Triangle factory or West Fertilizer explosion – if caused by unsafe work conditions – occur again. Whatever the cause, let this tragic week be a wake up call to us to prevent more people from dying needlessly in the future,