Tag: Workers Comp

Liberty Mutual Insurance Co. announced Thursday it has named Douglas Anderson leader of Global Risk Solutions North America, Workers Compensation Claims.

Based in Hoffman Estates, Illinois, Mr. Anderson replaces Virna Alexander, who was recently named Liberty Mutual’s chief claims officer of Global Risk Solutions North America.

Mr. Anderson, who has worked for Liberty Mutual for more than 36 years, most recently was head of Global Risk Solutions North America, Central Region, Workers Compensation.

 

 

 

Gov. Ned Lamont on Wednesday announced that businesses in Connecticut will pay on average 9.8% less in workers compensation insurance beginning on Jan. 1, 2024.

This is the 10th consecutive year that the department has approved rate decreases for the voluntary market, according to a statement.

The downward trend “reflects a noticeable decline in workplace injuries and filed claims, resulting in cumulative savings of more than $300 million in reduced premium expenses for businesses,” the governor’s office said.

 

 

 

The U.S. Occupational Safety and Health Administration said Tuesday it cited a Texas manufacturing company for willfully exposing workers to the risks of amputation and permanent hearing loss.

OSHA cited El Paso-based Dynamic Tool Co. Inc. for two willful safety violations, one willful health violation and 58 other serious violations, and proposed $596,221 in penalties, following an inspection done under the agency’s National Emphasis Program on amputations in the manufacturing industry.

The company failed to have proper machine guards in place to protect workers against amputations and other injuries and it failed to establish and maintain an audiometric testing program designed to protect workers who are exposed to excessive noise, OSHA said.

The company, which OSHA said is one of the country’s leading producers of cylindrical and elliptical cans for the automotive, military and medical industries, has 15 business days to contest the citation and proposed penalties.

 

 

 

The Occupational Safety and Health Administration faces “significant challenges in completing their mandates to ensure the protection of American workers’ safety and health,” says a report issued Wednesday by the Department of Labor’s Office of the Inspector General that names OSHA among the top performance challenges for the department.

The report said that the lapses are particularly noticeable in “high-risk industries such as health care, meat packing, agriculture, construction, fishing, forestry, manufacturing, and underground and surface mining.”

The OIG said it found OSHA had challenges “verifying hazards were abated timely,” adding that other problems exist in “completing inspections, employer reporting, reaching a sufficient number of worksites, standards on infectious diseases, workplace violence, and protecting workers from respirable crystalline silica.”

On verifying hazard abatement of safety concerns in both general industry and construction worksites, OSHA “closed many construction worksite citations for safety violations, not because the employers corrected the hazards, but because the construction projects had ended,” the report states.

“As a result, OSHA received no assurances employers would improve safety and health practices at future construction worksites,” it said.

OSHA has also “limited procedures for encouraging compliance with the injury and illness reporting requirement and for penalizing employers for noncompliance.” A recent OIG audit identified, on average, between 2016 and 2020, that 59% of establishments in all industries failed to submit their mandatory annual injury and illness reports to OSHA.

Acknowledging improvements, the OIG pointed to OSHA finalizing a new injury and illness reporting rule that will go into effect Jan. 1, 2024, revising the injury and illness reporting requirements for employers by adding a new category of workplaces — establishments with 100 or more employees in industries designated as very high-risk. 

 

A workers compensation attorney acting as a claimant in a case against his law firm was entitled to recoup costs to purchase cannabidiol, or CBD, oil to treat his workplace injury, a Pennsylvania appellate court ruled Tuesday.

The Commonwealth Court said the Workers’ Compensation Appeal Board erred in overturning a comp judge’s decision permitting reimbursement.  

Mark Schmidt injured his back in April 2017 while loading files into his trial bag. He was approved for medical expenses and later sought reimbursement for costs for his doctor-prescribed CBD oil.

His law firm – Schmidt, Kirifides and Rassias PC – refused reimbursement because the CBD oil was not a pharmaceutical drug.

Mr. Schmidt filed a penalty petition alleging his firm violated the comp act in denying reimbursement.

A comp judge granted the penalty petition and ordered the firm to reimburse Mr. Schmidt because the CBD oil was a “medical supply under the (comp) Act and part of Claimant’s reasonable and necessary medical treatment.”

The comp board reversed the decision, ruling employers and insurers cannot be forced to pay for CBD oil because it isn’t approved by the U.S. Food and Drug Administration and is derived from federally illegal cannabis.

The Commonwealth Court ruled the appeal board didn’t have the authority to reweigh the evidence used in the comp judge’s decision and that the employer violated the comp act in denying reimbursement.

The court also said FDA approval of treatment isn’t a requirement under the state’s comp act and that hemp-derived CBD oil is federally legal.  

 

 

CARLSBAD, California — Increasingly common in California are workers compensation claims involving cumulative trauma in which causation is questionable, the claim may have been filed after the injured worker is terminated or quits, and the claimant’s doctor later adds additional diagnoses.

According to panelists at several sessions during last week’s annual Workers Compensation and Risk Conference, the question for employers is whether to settle or fight. There’s a growing consensus that settling can be the best option for such so-called runaway claims, but there are red flags that may signal plausible defense, the experts said.

“As we know, these claims don’t get better; they get worse,” said Anthony Culpepper, partner at Michael Sullivan & Associates LLP in El Segundo, California.

Michael Sullivan, general managing partner of the firm, said, settling can often be the best approach, as the cost to fight claims in California has increased exponentially due to new regulations related to expenses for reviewing medical records. Some cases are challenging to win without an extensive review of records that document pre-existing conditions or earlier injuries, he said.

Legal experts have long complained about costs to review medical files in California: $3 a page in excess of the flat rate of $2,015 for the first 200 pages of medical documents. Many cases can involve thousands of pages.

“A lot of times the problem is you didn’t settle,” Mr. Sullivan said.

Miscalculating the value of a claim is also a pitfall, as employers often put a cap on a proposed settlement when increasing the amount might save in the long run, Mr. Culpepper said.

In one older case, a plaintiff’s attorney asked for $50,000 on a cumulative trauma injury, and Mr. Culpepper was given a $35,000 maximum to settle. Years later the claim — still open — was nearing $3 million in costs, he said.

“Somebody didn’t value that claim properly and it was a big, big miscalculation,” he said. “We’re all trying to get rid of these things early before they get expensive.”

Injuries can start small and snowball so there needs to be a focus on a claimant’s medical history, Mr. Culpepper.

“If they’re taking (non-steroidal anti-inflammatory) medications, which sometimes you don’t always know at the beginning, probably their kidney is going to get worse. Now, you have bought a kidney disease claim,” he said of NSAID drugs commonly prescribed long term to those with musculoskeletal injuries and pain, which can complicate claims that continue without closure.

Creating a team to adequately evaluate claims and a claimant’s history is a best practice for ensuring effective communication, said Karen Saturday, Trabuco Canyon, California-based associate vice president and program claims director at Falls Lake Insurance Cos.

“The longer (the claim) stays open, the worse it’s going to get,” she said. “You want to ensure that you have built the best team possible so you are getting the information as quickly as you can, and you are communicating back and forth with your staff as expediently as possible.”

Indicators that a claim can be fought are increasingly easy to spot, said Steven Cox, partner and president, Cox and Associates P.C., which represents employers in defending comp claims.

Mr. Cox said the No. 1 goal should be to spot problematic claims early. He outlined red flags, including that the mechanism for the injury is “questionable,” as when body mechanics and the injury described do not align; where there’s an early review for surgery, indicating a possible earlier problem with the allegedly injured body part; an unusual diagnosis that is not familiar in comp settings, such as strokes that don’t fall into the 99% of comp injuries that are orthopedic in nature; and changes in diagnoses and body parts added to the claim.

Often, the issues can be spotted early, he said.

“My biggest takeaway is when everything has gone crazy, when my little carpal tunnel case has turned into a failed back and a knee replacement or a hip replacement, before all that happens, let’s put on the brakes. Look at the first medical reports,” he said.

A former Colorado contractor was sentenced Thursday in connection with the death of a worker who was caught in a trench collapse as he and others installed a sewer line at a residential construction site in November 2021 in Breckenridge.

Peter Dillon, former owner of Avon-based A4S Construction LLC, was sentenced to 90 days in jail, four years of probation and 300 hours of community service following his August guilty plea to a manslaughter charge related to the death of employee Marlon Alfredo Diaz.

Prosecutors had taken the case on referral from the U.S. Occupational Safety and Health Administration, which said Mr. Dillon failed to implement a written safety and health program at the company and never conducted safety audits or inspections at his work sites.

The sentencing was announced by Heidi McCollum, the district attorney for 5th Judicial District.

 

 

 

Businesses in Florida will pay an average of 15.1% less in workers compensation insurance rates starting Jan. 1, 2024, Florida Insurance Commissioner Michael Yaworsky announced on Monday.

Based on a rate filing by the National Council on Compensation Insurance, this is the seventh consecutive year of reduced rates for businesses, according to a statement issued by Mr. Yaworsky.

According to written testimony by NCCI officials, much of the decrease — 13.6% — is the result of loss experience, trends and benefits paid to injured workers in 2020 and 2021.

 

 

The average duration of temporary disability benefits in workers compensation lost-time claims increases with the age of the injured worker, but after age 40 the increase becomes less significant, the National Council on Compensation Insurance says in a report published Thursday.  

The report, Workers Compensation Temporary Disability Benefit Duration – A First Look, which is the first installment in a new series, also shows that shoulder injury claims in comp have the longest average duration of temporary disability benefits, with an average of 123 days.  

The construction and utilities sector has the longest average and median duration of temporary disability benefits out of all economic sectors at 116 days and 74 days respectively, the report states.

The report’s authors said average duration varied by state, age, body system and medical condition.

The data used in the report was based on a total of 272,968 claims filed during a 12-month period. The 2023 data updates previous reporting on temporary disability benefit duration that was published between 2010 and 2013, according to the NCCI.