Tag: Workers Comp

Findings of a large-scale study published Thursday in the Journal of the American Medical Association have narrowed down to 12 the most common symptoms of long COVID.

Experts in the workers compensation industry have pegged the mystery behind long COVID as an issue to watch, as insurers and employers covering COVID-19 comp claims have been grappling with how to define long COVID and how to provide medical care. At least one study found that up to one-third of COVID-19 comp claimants have long COVID.

Thursday’s study, which included nearly 10,000 Americans, identified the most-common symptoms and a symptom-based scoring system, all with the aim of improving future diagnostics and treatment, according to a statement by the Researching COVID to Enhance Recovery initiative, known as RECOVER.

The 12 symptoms included post-exertional malaise, fatigue, brain fog, dizziness, gastrointestinal symptoms, heart palpitations, issues with sexual desire or capacity, loss of smell or taste, thirst, chronic cough, chest pain, and abnormal movements. The research team also found that long COVID was more common and severe in study participants infected before the 2021 Omicron variant.

 

 

 

A New York appeals court denied a workers compensation claim denial appeal from an airline pilot who says he developed brain damage as a result of toxic fume inhalation.

The Appellate Division of the Supreme Court of New York on Thursday denied an appeal by pilot David Dunlap, who filed a comp claim against his employer, JetBlue Airways Corp., after developing neurological disorders.

The appeals court ruled on technical grounds, finding Mr. Dunlap failed to offer a complete response to a question on his application for review to the Workers’ Compensation Board.

After Mr. Dunlap filed his comp claim in October 2019, a comp judge found he failed to establish work-related injury causation. Mr. Dunlap appealed to the board in August 2021, but the board denied his application for review, finding that Mr. Dunlap didn’t identify a written report of a toxicologist who reviewed his medical records for the airline.

Mr. Dunlap appealed. The appellate court found the board committed no error since it was permitted to adopt “reasonable rules consistent with and supplemental to” the state’s comp law.

The court ruled the board properly denied the comp claim because Mr. Dunlap failed to identify – by date, name and other information – the employer’s toxicologist’s report despite challenging the report’s admissibility and findings.  

In a footnote, the court said legislators recently changed the law to prevent technical omissions from being grounds for claims and review denials, but that the law went into effect after Mr. Dunlap’s case and was not retroactive.  

 

A report released Tuesday by New York Inspector General Lucy Lang details patterns of “egregious workers compensation abuse” by unions representing state correctional officers.

The office concluded that a lost wage benefit of six months at full pay for claims afforded to Security Services Unit members provides a “monetary incentive” for statewide corrections officers to abuse the comp system, something Ms. Lang says is buoyed by existing employment contract terms.

According to the report, employees with the Security Services Unit, which includes corrections officers, are entitled to up to six months of full pay if they become ill or injured on the job without having to choose between using accrued leave time or receiving less than their full pay through the New York State Insurance Fund, the state’s comp insurer.

After the first six months of a claim, a worker can charge their accrued leave credits to continue receiving full pay, after which the worker can receive lost wage benefits paid by the state fund.

The inspector general says that since the enactment of a 2015 collective bargaining agreement, the office received complaints about corrections officers abusing the lost wage benefits, and that the comp abuse led to workplace safety concerns and “significant workers’ compensation-driven staffing shortages” in prisons.

The inspector general recommended revising the lost wage benefit in any future labor agreements.

Ms. Lang said unlike in this situation, the lost wage benefits for other state employees are typically financially capped or otherwise limited. 

 

 

An injured worker was entitled to additional attorneys fees for which she sought reimbursement that were incurred while litigating over an underlying petition for legal fees in her workers compensation claim, an Oregon appeals court has ruled.

In a Wednesday decision, the Court of Appeals of Oregon sided with claimant Karista Peabody, who filed an occupational disease claim against SAIF Corp.

Ms. Peabody’s claim was initially denied, but she fought the denial, and then filed a petition seeking $31,000 in attorneys fees if she prevailed in her case.

The Workers Compensation Board overturned an administrative law judge’s claim denial, and found Ms. Peabody was entitled to a reasonable attorneys fee of $12,500, but later reconsidered and found that $21,280 was more appropriate.

Ms. Peabody sought reconsideration, arguing she was now entitled to additional attorneys fees she incurred while litigating the underlying petition for attorneys fees.

The board rejected the request, finding additional fees are not awardable when the sole issue in the underlying case is the reasonableness of a separate attorneys fee award.

The appeals court disagreed, ruling that the comp board was “authorized to award, and claimant was entitled to receive, reasonable fees incurred in determining the amount of the fee award to which claimant was entitled for prevailing against SAIF’s denial of her claim on board review.”

The court remanded the case back to the comp board.

 

An Ohio children’s hospital has been cited by the U.S. Occupational Safety and Health Administration after inspectors said the facility failed to adequately protect employees against workplace violence perpetuated by patients.

OSHA on Thursday said it cited Columbus-based Nationwide Children’s Hospital for one serious violation and one other-than-serious violation and proposed $18,000 in fines after an investigation sparked by worker complaints found the facility failed to take steps to protect employees from patients whose bites, kicks, punches and other assaults caused serious injuries.

Nurses and mental health staff suffered concussions, lacerations, contusions and sprains after the assaults, which occurred in the facility’s Big Lots Behavioral Health Pavilion in November 2022. The hospital unit provides acute behavioral health services with intensive outpatient programs.

OSHA also found that the facility failed to keep required records detailing employee injuries.

The hospital has 15 business days to contest the citation and proposed penalties.

Nationwide Children’s Hospital is the second largest pediatric hospital in the country, according to OSHA.

 

An analysis by S&P Global Market Intelligence shows that 36 states saw reduced workers compensation insurance rates in the first quarter of the year.

The most significant rate reduction was the 79 rate cuts across nine states representing an aggregate calculated premium change of $22.3 million.

AmTrust Financial Services Inc. came in second for largest rate reduction after it received approval for 39 rate decreases in the first quarter for a premium change of $20.3 million, according to the analysis, which was released Tuesday.

Missouri Employers Mutual Insurance Co. was singled out for having the largest single rate decrease, a 5% cut that went into effect on Jan. 1 and is expected to lower comp insurance premiums by $9.7 million for about 13,500 new and renewal business policyholders.

According to the analysis, Georgia and South Carolina approved of hundreds of rate cuts in the first quarter, with Georgia regulators approving 206 rate decreases and neighboring South Carolina allowing 314 rate reductions to go into effect.   

The analysis also showed that there were fewer rate increases nationwide than during the prior quarter, with the most significant rate hike in California, where SiriusPoint Ltd. increased comp insurance rates 8.3% beginning Feb. 24 for new and renewal business. 

 

 

 

 

Discount retailer Dollar General Corp. is facing $3.4 million in new proposed penalties after the Occupational Safety and Health Administration said inspectors found workplace safety hazards at nine store locations across four states.

OSHA on Tuesday announced the hefty fines against the nationwide company after inspections of Dollar General locations in Maine, North Dakota, Ohio and Wisconsin in late 2022.

Safety violations discovered by inspectors include blocked aisles, emergency exits, fire extinguishers and electrical panels, many of which were obscured by store merchandise and other materials.

“Dollar General continues to expose its employees to unsafe conditions at its stores across the nation,” OSHA Assistant Secretary Doug Parker said in a statement.

The latest investigations took place at Dollar General stores in Enfield, Maine; Casselton, Garrison, Hillsboro, Killdeer, Minot and Tioga, North Dakota; Kettering, Ohio; and Kewaunee, Wisconsin.

In the North Dakota investigation, inspectors also learned that at least six employees suffered exposure to toxic vapors after several chemical containers ruptured.

The inspections across the four states took place between October and December of last year.

Dollar General was already facing more than $21 million in proposed fines since 2017 after OSHA inspectors visited 240 stores nationwide.  

 

 

As health care system mergers become more commonplace, workers compensation experts are monitoring how physician consolidations might affect issues such as medical costs, patient access and quality of care.

“From my perspective, we’ve seen this trend for a while,” said Jason Beans, CEO and founder of Chicago-based Rising Medical Solutions, which provides medical cost containment services to comp insurers and employers. “The independent practices and independent doctors have been getting gobbled up, oftentimes by either larger groups or by the hospital systems.”

Mr. Beans said his company analyzes annual medical inflation trends and the effect on comp. The recent takeaway: where there has been an increase in medical costs there is often a related merger or acquisition of a health care system.

A recent report by the Workers Compensation Research Institute confirmed this, finding an increase in the average payment per medical procedure in comp claims involving consolidation of physician practices.

“It definitely can cause spikes,” Mr. Beans said. “The biggest impact is when a hospital system buys (a private practice) because it shifts to another fee schedule. That’s where you see kind of a jump in cost.”

Hospital systems typically tout mergers as benefitting patients, with a goal of expanding access to care and improving overall community health.

But workers comp experts worry that these physician consolidations can create monopolies, thereby decreasing competition and possibly diminishing access to care for injured workers.

“A system can just say, ‘we’re not going to take workers comp,’” said Dr. Michael Choo, chief medical officer of Walnut Creek, California-based medical management service company Paradigm Corp., during a panel discussion at the National Council on Compensation Insurance’s Annual Issues Symposium earlier this month.

Dr. Choo said previous hospital consolidations have resulted in a 40% increase in pricing, and that 74% of U.S. physicians are now considered employees of a large health system.

While cost is one potential downside of consolidation, quality and access to care for injured workers also need to be factored in, experts said during a panel discussion at the NCCI symposium.

Dr. Choo said consolidation can sometimes lead to improved quality of care for injured workers.

Kenji Saito, Augusta, Maine-based president of the American College of Occupational and Environmental Medicine, said practice consolidations can help promote shared digital platforms for virtual care.

Consolidation can also result in the sharing of “some of the wealth of knowledge around specialty care and advanced care,” he said.

Comp patients, particularly those in rural communities, can benefit from these integrations, since they can allow them to access specialty care, Dr. Saito said.

However, physician autonomy when it comes to caring for patients can be a challenge if the purchaser of the physician practice is more motivated by revenue than care, he said.

“It’s a little unfortunate that it’s happening that way, but I think we’re seeing now that it is a trend,” he said.  

 

First responders in Ohio experienced increased mental health issues during the COVID-19 pandemic, and public health researchers are now putting forth recommendations for policymakers and community members to aid front-line workers who are combatting such illnesses across the country.

Researchers with West Virginia University’s School of Public Health, Department of Health Policy Management and Leadership, published a study Monday in the Community Mental Health Journal that addresses mental health within the first responder community.

The authors looked at opportunities and challenges faced by those pushing mental health policies and programs in the first responder community, using Ohio as focal point given that state’s support for measures benefitting first responders, such as 2021 legislation expanding workers compensation eligibility for first responders suffering from post-traumatic stress disorder.

The study says that more programs and policies are needed to help first responders suffering from mental illnesses amid increased workload demands and cumulative stressors stemming from staffing constraints because of the COVID-19 pandemic.

The researchers concluded that a need exists to adopt and implement new programs and policies supporting first responder mental health on the local, state and federal levels, and that non-governmental stakeholders should play their part in supporting mental health initiatives for front-line workers.    

Recommendations included establishing centralized organizations to coordinate policy and programming activities, expand mental health policy research and evaluation efforts, and link first responders with culturally competent clinicians. 

 

 

 

An Illinois appeals court, reversing a lower-court decision, ruled that a woman injured while piloting a skydiving plane was ineligible to collect workers compensation benefits because she was flying on a volunteer basis at the time to get flight time experience.

The Appellate Court of Illinois, Fourth District, Workers’ Compensation Commission Division, on Monday overturned a Henry County Circuit Court decision allowing Hanna Larson to collect comp benefits after she was injured June 29, 2014, in a crash landing.

Ms. Larson suffered blunt-force trauma to her face and underwent two reconstructive nasal surgeries as a result of the accident.

An arbitrator determined Ms. Larson was an employee of Quad City Skydiving Center Inc., the owner of the plane, allowing her to collect comp benefits. The company appealed that decision to the Illinois Workers’ Compensation Commission, which reversed it, finding that Ms. Larson failed to prove she was an employee.

The trial judge reversed the commission’s decision, finding Ms. Larson proved she had a contract for hire with the business at the time of the accident.

In Monday’s decision, the appellate court said the trial court was wrong to conclude Ms. Larson was an employee, because she acknowledged she was volunteering to pilot the plane as it gave her the opportunity to log flight hours for free.