Category Archives: Workers’ Compensation

Death on the Job Annual Report from AFL-CIO Informative, Useful

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

The AFL-CIO’s annual report about “the state of safety and health protections for America’s workers” has been written about in a previous year on this blog. The recently released 2015 version focuses in an in-depth manner on data from 2013 and includes around 200 pages of text, tables, details and information, along with a bit of jargon.

The report is extremely informative, and Nebraska and Iowa’s numbers will be examined in more detail in future blog posts, as these are states where the firm’s attorneys are licensed.

The report can also feel overwhelming once a person processes through the fact the each numeral on each chart represents the death of one person due to the workplace. There is also a ripple effect, as each person represented here had loved ones who both cared about and relied on that person. And for many involved, their lives changed drastically when their loved one died.

I appreciate the work, funding, thoughtfulness and effort put into compiling and analyzing the data, which includes a methodology section at the end of the report.

Here’s some sobering information from the summary.

“In 2013, 4,585 workers were killed on the job in the United States, and an estimated 50,000 died from occupational diseases, resulting in a loss of 150 workers each day from hazardous working conditions.

“Nearly 3.8 million work-related injuries and illnesses were reported, but many injuries are not reported. The true toll is likely two to three times greater, or 7.6 million to 11.4 million injuries each year.”

States with the highest fatality rate in the nation include a couple of relative neighbors: North Dakota and Wyoming. West Virginia, Alaska and New Mexico round out the top five. Lowest state fatality rates in 2013 were Hawaii, Washington, Connecticut and Massachusetts (tied) and New York and Rhode Island (tied).

Please contact an experienced workers’ compensation lawyer if you or a loved one is hurt on the job or has questions about job safety.

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.

Stop Work Orders In Massachusetts Created $1.4 Million In Fines And Obtained Coverage For Over 5,000 Workers

The Massachusetts Workers’ Compensation Advisory Council has released its Fiscal Year 2014 Annual Report (PDF link). This report contains some eyebrow-raising statistics. Between 2008 and 2014, Massachusetts was able to help over 50,000 workers receive coverage due to Stop Work Orders (SWOs). In 2014 alone the Agency was able to obtain insurance for over 5,000 workers who previously had no workers’ compensation coverage.

Stop Work Orders are issued to employers who are operating without workers’ compensation insurance. An investigator is sent to the worksite and if an order is issued, the employer must cease business operations immediately. Fines will then be given starting at $100 per day until penalties are paid and the company secures insurance.

In Fiscal Year 2014, there were 5,785 Field Investigations resulting in 2,150 SWOs issued and $1,430,599 in fines collected. While SWOs are in effect, employees are still paid for the first ten days out-of-work due to the order and the days missed are considered “days worked.” In addition to the fines that the employer receives, they will be added to a debarment list preventing them from bidding or participating in any state or municipal contracts for three years.

 

Original post on www.mass.gov/lwd/workers-compensation in April 2015.

 

Workers’ Comp Programs Further Injure Injured Workers

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

Those of us who represent injured workers have known for a long time that workers’ compensation does not restore an injured worker to his pre-injury wage or status.  Two reports released in March show how workplace injuries have failed injured workers and leave them deeper in debt.  OSHA released a report indicating the changes in workers’ compensation programs have made it much more difficult for injured workers to receive benefits or medical expenses.  Although employers pay insurance premiums to workers’ compensation insurance companies who are supposed to pay benefits for medical expenses, employers provide just 20% of the overall financial cost of workplace injuries through workers’ compensation according to the OSHA report. 

This “cost shifting” is borne by the taxpayer.  As a result of this cost shifting, taxpayers are subsidizing the vast majority of the income and medical care costs of injured workers.  After a work injury, injured workers’ incomes average more than $30,000 lower over a decade than if they had not been injured.  Additionally, very low wage workers are injured at a disproportionate rate. 

Another report by ProPublica and National Public Radio found that 33 states have workers’ compensation laws that reduced benefits or made it more difficult for those with certain injuries and diseases to qualify for benefits.  Those hurdles, combined with employers and insurers increasing control of medical decisions (such as whether an injured worker needs surgery) reduced the worker’s likelihood of obtaining the medical care needed.

Overall, injured workers who should be paid under workers’ compensation are receiving less benefits and their medical care is being dodged by insurers and paid for by taxpayers through Medicaid and Medicare, or by increased insurance premiums for all of us through group health insurance rate increases.

Our general sense that injured workers are faring poorly is borne out by the research.

OSHA Reports that Cost of Work-related Injuries are Shifting to Employees

Many decades ago, OSHA created workplace safety standards to help employees avoid injuries from dangerous working conditions. Despite these standards, each year more than 3 million workers are seriously injured or killed while on the job. Because Workers’ Compensation fails to cover all the costs of injury, some low-wage workers (who have a disproportionate rate of injury and have more hazardous occupations than other workers) are slipping below the poverty line ($24,250 for a family of four), and the financial burden of work-related injuries is shifting from those who created the unsafe work environment to the families and workers who are injured. In 2012 alone work-related injuries and deaths cost $198 billion, according to the National Safety Council.

According to a recent report by OSHA, Workers’ Compensation only covers about 21% of lost wages and medical costs, so injured workers and their private insurance policies are then forced to cover on average 63% of the injured worker’s medical bills. Taxpayers are picking up the final 16% of work-related injury costs.

The solution to this inequality is for companies to create a workplace that prevents injuries and illnesses from occurring in the first place. OSHA believes that the reason for the majority of work-related injuries and fatalities is due to a combination of the misclassification of employees as independent contractors, the rising usage of temporary workers, and workers from different companies that are forced to work together at the same jobsite despite differences in training.  About 4,500 workers are killed on the job every year according to the Bureau of Labor Statistics. Three million serious occupational injuries and illnesses are reported annually and OSHA suspects that this figure is only a fraction of the unreported number of injuries and fatalities on the job.

Read more about the cost of failing to protect workers here: http://1.usa.gov/1zJOFCC

Facebook Postings Hurt Workers’ Compensation Claims

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

While Facebook is extremely popular and used by over a billion people every day, no Facebook posting has ever helped an injured worker in a workers’ compensation claim. On the contrary, use of a Facebook page poses real dangers for injured workers pursuing workers’ compensation benefits.

Since Facebook is a public site, anything posted can be used by respondent insurance companies in claims denial. Even the most benign postings (birthday parties, family gatherings, etc.) can pose problems. For example, a grandparent lifting a 30 pound grandchild when doctors have imposed a 10 pound lifting limit could damage a claim. Additionally, nothing prevents an Administrative Law Judge from looking at a Facebook page.  Even innocent posts may be subject to misinterpretation. A picture of the worker riding a motorcycle or fishing taken prior to the injury but posted afterward could place the seed of doubt in an ALJ’s mind that the worker is not as limited as he claims. The best advice is to be extremely careful about what is posted because “friends” are not the only one who can access your Facebook page.

Examining Workers’ Compensation Costs to Employers

Source: Bureau of Labor Statistics National Compensation Survey 1991 – 2014 (Credit: Sisi Wei/ProPublica)

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

Business and insurance interests are bombarding state legislatures every day of the week to take workers’ rights away by complaining how most states’ workers’ compensation systems are too expensive.

Recently, ProPublica and NPR produced a very detailed explanation of the state of workers’ compensation, focusing, rightly so, on injured workers. This article, which was the first in the series, included an interactive graphic that showed that even though business are complaining about rising premius, workers’ compensation insurance coverage is generally at its lowest rate in 25 years, “even as the costs of health care have increased dramatically,” according to the article.

As examples, using the average premium cost to the employer per $100 of workers’ wages, Nebraska employers paid $1.93 in 1988, while they actually paid $.15 less for the premium in 2014, for a total of $1.78 per $100 of workers’ wages, according to the chart. Iowa was more dramatic, with the price of workers’ compensation insurance $2.79 per $100 of workers’ wages in 1988. It went down $.91 to $1.88 per $100 of workers’ wages in 2014.

By scrolling down in the article, a person finds another graphic that shows how employer costs have risen for other categories, but have fallen for workers’ compensation. Most notably, the cost of workers’ compensation insurance coverage (per $100 of workers’ wages) went from $2.71 in 1991 to $2.00 in 2014. During the same timeframe, the cost of health insurance went from $8.55 to $12.52 and the cost of retirement benefits went from $5.50 to $7.29, all per $100 of workers’ wages, according to the chart in the article.

The offices of Rehm, Bennett & Moore and Trucker Lawyers are located in Lincoln and Omaha, Nebraska. Six attorneys represent plaintiffs in workers’ compensation, personal injury, employment and Social Security disability claims. The firm’s lawyers have combined experience of more than 90 years of practice representing injured workers and truck drivers in Nebraska and Iowa in state-specific workers’ compensation systems. The lawyers regularly represent hurt truck drivers and often sue Crete Carrier Corporation, K&B Trucking, Werner Enterprises, UPS, and FedEx. Lawyers in the firm hold licenses in Nebraska and Iowa and are active in groups such as the College of Workers’ Compensation Lawyers, Workers’ Injury Law & Advocacy Group (WILG), American Association for Justice (AAJ), and the Nebraska Association of Trial Attorneys (NATA).  We have the knowledge, experience and toughness to win rightful compensation for people who have been injured or mistreated.

“Cost-Shifting” Exposed: How Injured Worker Medical Care Decisions Are Made (And Who Pays)

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

Medical coverage is a topic on everyone’s mind. Obamacare, while controversial, has started a real dialogue in this country regarding health care. Regardless of whether you are in favor of the current law, most Americans want affordable health care for themselves and their families.

Many employers pay for a substantial amount of their workers’ premiums as a benefit to them, and take this into consideration when making salary decisions due to the high cost, thereby leaving workers to pay for all or some of their medical coverage. Sometimes insurers pay for benefits that are not their responsibility because the proper entity refuses to pay. This is known as cost shifting. As a practitioner in the field of Workers’ Compensation, this idea of cost shifting has become an all too common occurrence. 

By way of background, as a result of social reform, most states enacted some form of Workers’ Compensation legislation in the early 20th Century. In exchange for timely payment of medical and indemnity benefits, workers gave up the right to sue their employers. In 2007 in New York, there was a series of further reforms that led to compromise between labor groups, the insurance industry and the Business Counsel. There was an increase in the amount of weekly benefits to injured workers to conform with the State average weekly wage (now a maximum of approximately $800 per week) in exchange for a limit on the amount of weeks an injured worker is entitled to receive these benefits.  Additionally, medical treatment guidelines have been introduced with the premise that they would streamline costs and get injured workers faster and more effective medical care. These guidelines are based upon the principles of Evidence Based Medicine (EBM), which is the use of clinical trials and data to determine whether a specific treatment should be recommended for a specific diagnosis.  It is sometimes referred to as “cookbook” treatment. 

In New York, the Court of Appeals recently ruled by a 4-3 margin that any treatment not specifically included and pre-authorized is presumptively unnecessary. In other words, if a treatment requested is not within the medical treatment guidelines, it is denied. This takes the decision making out of the hands of the treating physician who is really in the best position to determine what treatment would be most beneficial for patients. In order to overcome this presumption, the doctor now must engage in what has been seen in most cases as an exercise in futility to request a variance to overcome this presumption.

The New York Committee for Occupational Safety and Health (NYCOSH) reported that the New York State Workers’ Compensation Board received 202,643 variance requests in the first 10 months the guidelines were implemented. A quarter of the requests were rejected by the Board immediately. The rest can lead to protracted litigation. As a result, in many instances injured workers will now shift the cost to another party, such as their own private insurance, Medicare or even worse, pay for the treatment out of pocket. It is the path of least resistance. We all pay an additional price for medical costs borne by group health insurance carriers, Medicaid, and Medicare that should in fact be paid by Worker’s Compensation insurers. This cost shifting may increase Workers’ Compensation insurance profits, but it hurts both the employers’ and the employees’ bottom line. Injured workers don’t stop needing treatment just because their medical claim is denied. Someone has to pay for the cost of lost time and medical treatment. It is time that the proper party step up and take responsibility.

 

 

Catherine M. Stanton is a senior partner in the law firm of Pasternack Tilker Ziegler Walsh Stanton & Romano, LLP. She focuses on the area of Workers’ Compensation, having helped thousands of injured workers navigate a highly complex system and obtain all the benefits to which they were entitled. Ms. Stanton has been honored as a New York Super Lawyer, is the past president of the New York Workers’ Compensation Bar Association, the immediate past president of the Workers’ Injury Law and Advocacy Group, and is an officer in several organizations dedicated to injured workers and their families. She can be reached at 800.692.3717.