OR - Worker Can Request Examination if Carrier Supports Claim Denial With IME Report
04/22/2024 | 0
The Oregon Court of Appeals ruled that when an insurer submits an independent medical examination report as evidence to support its denial of a worker’s claim, the denial is “based” on an IME, and the worker is eligible for a worker-requested medical examination.
Thomas Cardoza allegedly injured his back while working for Werner Gourmet Meat Snacks Inc. Werner had workers’ compensation insurance coverage with SAIF Corp., which contested Cardoza’s claim.
SAIF requested that Cardoza submit to an IME by a physician of its choosing. That doctor’s report s...
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A divided Arkansas Court of Appeals upheld a finding that a worker was not entitled to additional temporary total disability benefits after his treating surgeon placed him at maximum medical improvement.
Case: Reed v. M.A. Mortenson Cos. No. CV-22-817, 04/17/2024, published.
Facts: Leonard Reed worked for M.A. Mortenson Cos. as a truck driver. While he was at work in October 2017, a 4-pound piece of metal struck his right leg. Dr. David Wassell performed surgery to repair a fracture to Reed’s tibia, and he began collecting temporary total disability benefits.
In March 2018, Wassell op...
A New York appellate court ruled that the forum selection clause in an illegal insurance policy is not enforceable as a matter of public policy.
Case: Air-Sea Packing Group Inc. v. Applied Underwriters Inc., No. 711035/19, 04/17/2024, published.
Facts: Applied Underwriters Inc. and Applied Underwriters Captive Risk Assurance Co. are affiliates of Berkshire Hathaway Inc. and headquartered in Nebraska. They sold a workers' compensation insurance program in New York known as EquityComp.
Air-Sea Packing Group Inc. purchased the EquityComp program and participated in it from April 2014 ...
A New York appellate court ruled that an insurance carrier was entitled to summary judgment dismissing a claim for coverage for a construction worker’s Labor Law action.
Case: Rock Group NY Corp. v. Certain Underwriters at Lloyd's, London, No. 653310/21, 04/16/2024, published.
Facts: Rock Group NY Corp. purchased a commercial general liability policy from Certain Underwriters at Lloyd's, London.
Rock sought coverage under the policy after it became a defendant in a Labor Law action by a worker who was injured while unloading an iron beam from a truck.
As the worker was handin...
We’ll say it as often as we have to: Preferred provider organization discounts do not apply to bills for medical-legal services.
It’s a lesson that Sedgwick Claims Management Inc. has yet to learn. The third-party administrator recently applied a PPO discount to charges for medical diagnostic tests rendered as part of a medical-legal evaluation.
California regulations instruct that diagnostic testing is reimbursed according to the rates established by the Physician Fee Schedule. However, using Physician Fee Schedule rates does not make testing pe...
The California Division of Occupational Safety and Health fined a construction company $371,100 for a September 2023 fatal trench collapse in San Francisco.
A 24-year-old employee of D’Arcy & Harty Construction Inc. was replacing sewer parts inside an 8-foot-deep trench when the excavation collapsed and he was killed.
The agency commonly known as Cal/OSHA said the company failed to provide a protective system for employees working in the trench and failed to provide a means of escape such as a ladder. Cal/OSHA said it warned the company about the hazards about a week befo...
CA - Zurich Ordered to Pay $80.3 Million in Suit Over Employee Incentives
Three former managers in a workers’ compensation department in Zurich North America’s Rancho Cordova, California, branch have been awarded $80.3 million in compensatory and punitive damages by a jury that found the carrier had wrongfully terminated them for taking unofficial paid time off, according to the firm that represented them.
According to a statement issued Thursday by The Bohm Law Group Inc., which represented Melinda Brantley, Nicholas Lardie and Daniel Koos, the three were fired over accusations that they stole from their employer for taking “off the rec...
The California Assembly Appropriations Committee scheduled a Wednesday hearing for a bill that would allow electronic signatures in proceedings before the Workers’ Compensation Appeals Board.
AB 2337, by Assemblymember Diane Dixon, R-Newport Beach, would define “signature” to include electronic records and electronic signatures for WCAB hearings. The bill would also allow signature requirements in the Labor Code to be satisfied by an electronic signature.
“Electronic signatures were used effectively in workers’ compensation proceedings for three years durin...
A California Senate Committee last week passed a bill that would extend full-pay salary continuation benefits to injured county park rangers and housing authority officers outside of Los Angeles.
The Senate Committee on Labor, Public Employment and Retirement on Wednesday voted 5-0 to pass SB 1058, by Sen. Angelique Ashby, D-Sacramento.
Typically, a person who misses three or more days from work due to a compensable injury is eligible for temporary disability benefits calculated at two-thirds of pre-injury earnings and capped at the state’s average weekly wage. Currently, the maximum t...
A committee in the California Assembly unanimously passed a bill that would direct schools to continue paying those who are excluded from the workplace due to COVID-19.
The Assembly Committee on Labor and Employment on Wednesday voted 6-0 to pass AB 3106, by Assemblymember Pilar Schiavo, D-Chatsworth.
Mitch Steiger, a lobbyist for the California Federation of Teachers, said that during the pandemic, the state had exclusion pay and supplemental sick leave for those who were kept out of the workplace because they tested positive for or had symptoms of COVID-19. Employers are still re...
The Minnesota Supreme Court upheld an award of benefits to a social worker for post-traumatic stress disorder and clarified that comp judges may review the Diagnostic and Statistical Manual of Mental Disorders criteria when considering the persuasiveness of expert reports, but they can't make their own diagnosis of a claimant’s condition.
Janine Tea was a social worker for Ramsey County, and her clients were those with a history of mental illness who had trouble functioning in society.
In February 2020, one of Tea’s clients killed his girlfriend in an act of extreme brut...
An Ohio appellate court upheld an order of the Industrial Commission correcting an error of law and awarding a worker temporary total disability benefits.
Case: State ex rel. Jack Thistledown Racino LLC v. Person, No. 23AP-20, 04/16/2024, published.
Facts and procedural history: Chanel Person worked for Jack Thistledown Racino LLC. She fell while at work in July 2019 and established her entitlement to benefits for muscle strains in her back. In 2021, Person’s claim was expanded to include the substantial aggravation of preexisting spondylolisthesis.
Dr. Louis J. DeMicco reported that ...
The North Carolina Court of Appeals ruled that an employer could not be made a third-party defendant in a civil action filed by its employees arising from a fatal retaining wall accident.
Case: Hernandez v. Hajoca Corp., No. COA23-1001, 04/16/2024, published.
Facts: W.D. Building Rentals LLC leased property in Hendersonville to Hajoca Corp. Tina Ward Foster owns the adjacent property, which is situated at a higher elevation than the one Hajoca leased. A concrete and cinderblock retaining wall marked the property line.
A storm damaged part of the retaining wall in 2020, and it was not immedi...
A New York appellate court ruled that a worker should not have been denied summary judgment on his Labor Law claim for injuries from falling through an unguarded opening.
Case: Blacio v. Related Construction LLC, No. 157518/22, 04/16/2024, published.
Facts: Jimmy Blacio allegedly suffered injuries while moving large wooden panels from the basement to the 12th floor of a construction project. Blacio and a co-worker had to walk past a stairway on the 12th floor. As he was passing the stairway, he fell through an unguarded opening.
Procedural history: Blacio filed suit against Related Construc...
A California legislative committee passed a bill that would require notifying workers of their right to consult an attorney.
The Assembly Appropriations Committee on Wednesday voted 15-0 to pass AB 1870, by Assemblymember Liz Ortega, D-San Leandro, which would update what is to be included on notices that employers must post to include the right of injured workers to consult an attorney.
The bill also would require that workplace posters explain that injured workers’ attorney fees are paid out of any benefits they receive.
The Assembly Insurance Committee voted 12-...
The Oklahoma Legislature passed a bill that would allow insurance carriers to send cancellation notices electronically.
The state House of Representatives on Wednesday voted 90-0 to pass SB 1627, by Sen. Ally Seifried, R-Claremore.
The bill would declare that electronic notice that an insurance policy is being canceled has the same effect as sending the notice by mail.
Cancellation notices can be sent electronically only if the recipient consents and the carrier complies with the Uniform Electronic Transactions Act.
The measure has not been amended since the Senate voted 44-3 to pass ...
