Tag: Workers Comp

A New York contractor has been indicted for allegedly defrauding the New York State Insurance Fund of nearly $3 million by underreporting employee payrolls in order to reduce his amount of required state insurance premium payments.

Manhattan District Attorney Alvin L. Bragg Jr. announced Thursday the charges against Juan Escobar and his drywall and carpentry companies – Infinity Drywall Corp., Infinity Quality Services Inc., JMC Drywall Corp. and JJM Buildings Inc.

The defendants were indicted on felony counts of conspiracy, insurance fraud and falsifying business records.

According to authorities, Mr. Escobar issued cashier’s checks to shell companies in the names of family members that were made to appear as legitimate payments to subcontractors for construction work, and the proceeds were funneled to an off-the-books payroll, often to the tune of $50,000 per week.

Prosecutors said Mr. Escobar ordered injured workers to falsely claim that their injuries did not occur at jobsites, and he instructed workers to avoid safety inspectors or gave them cash if they agreed to not file workers compensation claims.

Mr. Escobar is also accused of failing to report work injuries to the New York State Insurance Fund and he would misrepresent a worker’s employment status if a comp claim did ultimately get filed.

Prosecutors said the actions left workers on large construction projects underinsured and unprotected.

The state’s insurance fund provides workers comp and disability benefits to New York employers.

The D.A.’s Office said Mr. Escobar cashed more than $26 million in checks at locations in Manhattan and Queens during the alleged scheme, which is said to have taken place between November 2013 and October 2021.

The money was allegedly used to fund the companies’ unreported payrolls. 

 

 

Florida lawmakers will consider adding crime scene investigators and 911 dispatchers to the list of professionals who qualify for the state’s presumption for post-traumatic stress disorder.

H.B. 337, filed Monday, sets provisions that such a professional would need to witness or respond to qualifying events, such as mass killings or “directly witnessing” death or verbally assisting someone in an emergency that includes death.

The bill also states that a claim must be filed within 52 weeks after the qualifying event or the diagnosis of the disorder, whichever is later. 

 

A divided West Virginia Supreme Court on Thursday upheld a denial of benefits to a health care worker for her back conditions, finding they had not arisen out of a workplace accident but instead aggravated a preexisting condition.

Donna J. Carter was working for Davis Health System when she injured her back in December 2019 while moving patients. A “consistent” medical history of sciatica with an increased level of back pain dating back to 2017 was part of her medical records, according to Carter v. Davis Health System.

Her physician stated that she injured her back due to a muscle strain from pulling and lifting and that her condition was a direct result of an occupational injury, noting that it aggravated a prior injury. Another doctor reported that Ms. Carter’s most recent symptoms began after moving patients in the operating room while at work and that she needed surgery.

A claims administrator for the health system’s insurance carrier denied Ms. Carter’s claim, stating that medical records pointed. to a preexisting condition.

The Office of Judges upheld the rejection of Ms. Carter’s claim, and the Board of Review affirmed.

The West Virginia Supreme Court agreed with the lower rulings, stating that under state law, a non-compensable, preexisting injury may not be added as a compensable component of a claim for workers compensation medical benefits merely because it may have been aggravated by a compensable injury.

A dissenting justice wrote the case “presents us with an opportunity to correct a structural fault in our workers’ compensation review procedures: an age-related bias against workers such as the petitioner, who are far more likely to have degenerative musculoskeletal conditions after a lifetime of physical labor.”

WorkCompCentral is a sister publication of Business Insurance. More stories here.

Under a bill filed in Mississippi, injured workers or surviving family members of those killed while at work would be able to sue the employers if certain criteria are met.

S.B. 2863 would add an exception to the state’s exclusive remedy provision in workers compensation law “(w)hen an injured employee, or his legal representative in case death results from the injury, can demonstrate that the employee’s injury or death on the job was caused by the employer’s gross negligence where injury was substantially certain to occur.”

The bill, filed on Jan. 16, was referred to a judiciary committee.   

 

Washington state lawmakers will soon introduce legislation that would allow state regulators to better address workplace musculoskeletal injuries, a common driver of workers compensation claims.  

Senate Bill 5217, which will be formally filed on Jan. 24, would repeal a current prohibition that prevents the state Department of Labor and Industries from enacting rules designed to thwart workplace musculoskeletal injuries and disorders.

The legislation is aimed at restoring the state’s “ability to more strategically address important workplace safety issues and reduce costs for all employers and workers,” the bill reads.

Sponsors of the measure say that the absence of the state’s authority to regulate practices to help prevent musculoskeletal injuries has contributed to avoidable and excessive injury claims and costs in the workers compensation system for all employers statewide.  

According to the bill, work-related musculoskeletal injuries make up at least one-third of all comp claims, resulting in time loss and wage replacement.

Musculoskeletal disorders are also a common cause of long-term disability in the state.

The bill states that many of the state’s critical industries, such as health care, are considered high-risk for musculoskeletal injuries, and these same industries currently experience major staffing shortages, leading employers to pay higher costs for absenteeism, decreased productivity and workers comp claims.

Under the bill, the Department of Labor and Industries would not be permitted to adopt more than one set of rules designed to prevent musculoskeletal injuries within a 12-month period for industries and risk classes that did not previously have such rules.

 

 

Legislation filed in New Hampshire would make all types of cancer among firefighters a presumptive occupational disease eligible for workers compensation.

Senate Bill 71, introduced Wednesday, states that cancer diagnoses in firefighters are presumed to be occupationally caused, making active-duty, volunteer and retired fire department members eligible to collect comp benefits.

The bill would remove language from existing law that says firefighters diagnosed with cancer can only collect comp benefits if the type of cancer involved was caused by exposure to heat, radiation or a known carcinogen as defined by the International Agency for Research on Cancer.

The bill also calls for the creation of a commission to study workers comp in firefighter cancer cases.

The New Hampshire bill comes on the heels of similar legislation introduced in other states, including Connecticut and Nebraska.

Connecticut lawmakers on Friday read through two more bills that would extend the state’s workers compensation presumption for post-traumatic stress disorder to several classes of first responders.

H.B. 6366 would extend benefits to volunteer emergency medical service personnel, first responder dive teams, K9 search and rescue personnel and dispatchers. H.B. 6370 would add to the law video technicians who review and process police body camera footage.

In Mississippi, lawmakers on Monday introduced S.B. 2624, which would create a PTSD presumption for first responders and, as an alternative to workers compensation when applicable, paid mental health services and 30 days paid time off, the costs of which would be capped at $7,500 annually.

 

Back, hip, knee and neck injuries that cause disability or death in law enforcement officers would be presumptive occupational diseases eligible for workers compensation benefits under a bill filed Thursday by Virginia lawmakers.

The measure, House Bill 1905, would amend the state’s workers compensation law to state that these types of injuries would make numerous classifications of law enforcement officers eligible for comp awards including full hospital, surgical and medical treatment as well as disability indemnity and death benefits.

Not covered under the bill would be volunteer law enforcement chaplains, auxiliary and reserve deputy sheriffs and auxiliary and reserve police officers. 

 

Workers compensation medical facility payments grew across all facility types and all U.S. regions during the past decade, with facilities costs constituting the largest driver of overall comp cost changes, according to a report released Wednesday by the National Council on Compensation Insurance.  

Nationwide, facility costs made up about 40% of all comp costs and increased by about 3% per year on average during the past 10 years, Boca Raton, Florida-based NCCI said.

The report is the second in a planned four-part series examining the impact of macroeconomic factors such as inflation on overall comp medical costs.

The new research shows that costs per workers comp claim paid to medical facilities grew 3.3% annually over the past decade.

A key driver of increased facility costs throughout the past decade was Increases in the amount paid per visit, NCCI said.

“Inpatient stays have decreased considerably over the years, to the tune of 3% annually,” wrote Raji Chadarevian, NCCI executive director of actuarial research. “This has contributed to managing medical costs increases due to facility services.”

The exception was in the southeastern region of the country, where inpatient hospitalization was the largest contributor.

The most significant contributor to the facilities cost increase overall was hospital outpatient services, which the report defined as surgeries, emergency room treatments and “other,” which includes evaluation and management, radiology and physical therapy.

 

Connecticut lawmakers on Thursday introduced two bills that would amend workers compensation law that would expand post-traumatic stress disorder presumption — the third such bill this season — and require insurers to maintain death benefits that take into account consumer costs increases.

H.B. 6284 would call for the state’s existing PTSD presumption for first responders to include police technicians. Two bills introduced this month would expand that presumption to all workers who experience a qualifying event, such as death.

H.B. 6272 would amend state law to require that workers compensation death benefits “keep up with the cost-of-living and inflation rates.”

Both bills were referred to Joint Committee on Labor and Public Employees.