Tag Archives: Benefits

Why Your Vote Matters to Workers

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I frequently write about the intersection of workers’ compensation benefits for workers and politics. The bottom line on my comments is that workers, and citizens who care about workers, need to vote for candidates who will protect workers’ rights. These comments arise from a now quarter-century attack on workers’ compensation benefits by big business and insurance interests. Their power is almost incomprehensible in terms of the money they will spend to take away or limit benefits.

Recently, a Florida court found that the limiting of workers’ benefits in Florida has destroyed the “social bargain” that led to the creation of workers’ compensation. Workers’ compensation laws are slightly more than 100 years old. The notion of a bargain is workers got fast and fair benefits in exchange for giving up their right to full compensation. There have been a lot of discussions since the big business/insurance attack on worker benefits that the bargain is no longer fair.

The Florida court also found the exclusive-remedy rule unconstitutional. The exclusive-remedy rule deprives injured workers and their families of benefits for pain, suffering and non-occupational disability. I have also represented a client in Nebraska where the exclusive-remedy rule was limited by a court.

Big business and big insurance will not back down. They won’t let up. As I write this blog, billions of dollars are being poured into political campaigns by the Koch Industries, TD Ameritrade and scores of others to support candidates who want to reduce and eliminate workers’ benefits.

Workers, their families, and everyone else who cares about ordinary human beings must not let these wealthy interests buy elections. We must stand up and vote. We must inform ordinary human citizens that the corporate citizens are taking away our rights as fast as they can. This is a crucial election, and every election will be crucial until people stand up and convince the mega wealthy that they can’t buy elections any longer.

When Did My Workers’ Compensation ‘Accident’ Occur?

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Nebraska workers’ compensation law states that an accident is “an unexpected or unforeseen injury happening suddenly and violently, with or without human fault, and producing at the time objective symptoms of an injury.” Neb. Rev. Stat. §48-151(2). In our practice, we are often faced with a situation where an injured worker is unable to answer the question: “When did the accident occur?” Often, this is because they don’t even realize they have experienced what Nebraska workers’ compensation law considers to be an “accident.” The plain, ordinary and popular understanding of what “suddenly and violently” means in the English language doesn’t seem to fit with this situation. This is because the injury resulted from repetitive trauma – i.e. an overuse injury – and the worker is unable to point to a particular point in time when an “accident” occurred. They didn’t slip and fall, nothing fell on their foot, they weren’t in a car accident, etc. It just started hurting and affecting how well they could do their job then finally got so bad that they had to seek medical treatment.  The Nebraska Supreme Court recently addressed this issue, and, in the process, reaffirmed and explained Nebraska’s rule for determining when a repetitive trauma injury happened. 

In Nebraska, the phrase “suddenly and violently” means only that the injury manifested at an identifiable point in time. The rule for the last 15 years or so has been that the “identifiable point in time” is essentially when an employee discontinues employment and seeks medical attention. What this means in simpler terms is that the date of accident is whenever an injury got so bad an injured worker had to take off work to go to the doctor. The Supreme Court reaffirmed this rule for a number of reasons, including how simple it is to determine the date of accident, based on this objective criteria. The Court also found that it just makes sense to say that an employee has really experienced a decrease in their employability or earning capacity, and therefore experienced a disability, when they have to take time off work to go to the doctor.   

Why is it important to know the date of accident in a repetitive-trauma case? It is important for a number of reasons, and you should seek the advice of an experienced workers’ compensation attorney for more information and/or assistance with your case. Particularly for injured workers, it is important because it is relevant to when the statute of limitations on the case begins to run. These injuries often start developing years before they get so bad that the worker must take time off to go to the doctor. This fact may discourage injured workers from reporting or pursuing workers’ compensation claims because they think it is too late. It is always important to understand whether your claim is barred by the statute of limitations or not, but knowing when the accident occurred is the first step in that determination. It is also important because the maximum benefit rates available to injured workers for temporary and permanent indemnity benefits are based on what year the accident occurred and change from year to year. Finally, it is important because people change jobs, and companies change ownership. Regardless of how long an injury took to develop, and how many different employers an injured worker performed work for, Nebraska law states that the employer who employed that worker on the date of accident, and their insurance company, is liable to that worker.

Workers’ Compensation May Cover Weight Loss Treatment, Surgery

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Gastric bypass is one type of weight loss surgery

Obesity is a disease that affects Americans in many ways.

Workers’ compensation is affected by obesity as well. A work injury or disease, coupled with chronic obesity, frequently becomes much more difficult to deal with. The usual methods of treatment may not be possible for an injured worker living with chronic obesity. 

Thomas A. Robinson, a noted expert on workers’ compensation, recently posted a great discussion on obesity treatment. The well-written article discusses how various state workers’ compensation systems deal with these problems. The short answer is some states award benefits for treating obesity as part of the work injury, and some don’t. Nebraska and Iowa have cases denying gastric bypass surgery based on factual findings that it was not necessary to treat the work injury, but leaving to door open with more proof of medical necessity. 

Our firm has had at least one case where gastric bypass surgery was paid voluntarily when it was apparent the surgery was necessary to enable proper treatment of a serious work injury. A workers’ compensation trial award was entered in early January awarding gastric bypass surgery as necessary to reduce weight so a back surgery could be performed safely. This award reinforces that with proof of medical necessity to treat a work injury, weight loss treatment and surgery may be covered by workers’ compensation in Nebraska.

Is Worker’s Comp Profitable Because Disabled Workers Don’t Get Benefits?

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My friend Tom Domer of The Domer Law Firm in Milwaukee, who happens to be one of the most knowledgeable workers’ compensation lawyers I know, wrote a great blog post explaining why workers’ compensation insurance companies profit mightily and injured workers struggle. Workers need to avoid the kind of thinking that leaves them with empty pockets and insurance companies with growing bank accounts. Injured workers should speak with qualified experienced lawyers before deciding whether to pursue workers’ compensation benefits or to abandon a claim if they are being denied.

I recently wrote an article in the national magazine for the Worker’s Injury Law Advocacy Group (WILG), the Worker’s First Watch, Fall 2013 reviewing the worker’s compensation resources research report indicating that the worker’s compensation industry is extremely profitable.  I began representing injured workers in 1976.  It seems every year since then worker’s compensation insurance carriers have complained they are not making profits and the culprit responsible is increased benefits paid to workers.  In fact, over the last 20 years the insurance industry has been profitable in 16 of 19 years and broke even in one year.  Several factors account for this profitability, including worker’s compensation insurance carriers successfully pursuing deregulation and “reform” measures to restrict eligibility. 

The net result of increasingly restrictive rules for compensability in many State worker’s compensation systems as a result of “reform” resulted in many workers with disabilities caused by work who did not receive worker’s compensation benefits.

The general trend since the early 1990s has been to restrict coverage through State statutory and administrative “reform”.  Many workers face lengthy litigation and frustration.  More restrictive regulations may preclude claims where the worker lacks “objective” medical evidence for his injury, or is unable to medically document persistent pain, or has a disease resulting from multiple causation that cannot be distinguished from workplace disease, or has job stress related disorders.  One significant problem is that many injured workers fail to file for benefits.  (For those of us in the trenches daily, these pose obstacles to compensability.)  Among the many reasons for failure to file are:

  • Ignorance of worker’s compensation and eligibility.
  • Ignorance of the work-relatedness of the condition.  (Many workers know they suffer an impairment but do not know the health condition is caused by work.)
  • Reimbursement for medical care or Short Term Disability benefits available.  (Many workers use Short Term Disability or group medical insurance rather than worker’s comp.)
  • Belief that the injury is lacking in sufficient severity.
  • Many workers fear job loss or other forms of retaliation, who do not want to report a condition as work-related.
  • Workers do not want to be perceived as complainers or careless.
  • Deciding not to file based on the negative experience of co-workers.
  • Fear of the stigma associated with being a worker’s compensation claimant.  (Much of this stems from the intense focus on fraud perpetrated by the insurance industry, resulting in increased levels of stigmatization, decreasing the likelihood injured workers will file for benefits.)
  • Pressure from co-workers on safety incentive programs.  (These programs, sometimes called “Safety Bingo” create incentives not to report.)

Those of us who have hearings daily that involve the non-reporting of an injury, or significant time delay between the occurrence of an injury and the reporting of an injury, can refer to the above list for some ammunition on the “non-filing” or “late filing” issues.

What is Workers’ Compensation Law in Nebraska?

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Before workers’ compensation was an option in Nebraska, injured workers could only sue their employers under tort law for damages. While providing complete compensation – i.e., damages such as those for pain and suffering were available – it also required proof of negligence, and claims were often barred by affirmative defenses such as assumption of the risk and contributory negligence. For more than 100 years now, injured workers have had the protection of workers’ compensation laws that provide for no-fault benefits that are received quickly, and employers can avoid more expensive court challenges.

The Nebraska workers’ compensation system includes a dedicated court, and Nebraska is one of the only states to have this avenue for injured workers.

There are several different types of benefits that an injured worker is entitled to:

1.      Benefits to manage or cure the injury: includes hospital, doctor, chiropractic and physical therapy costs. This also includes the costs of diagnostic testing, doctor-prescribed medicine (even if it’s over-the-counter) and items like braces.

2.      Compensation while temporarily disabled: These payments of two-thirds of an injured worker’s average weekly wage may start after an injured worker has been off work for seven days, and usually an injured worker continues to collect payments – either for total or partial disability – while he or she is convalescing until a doctor signs off on a full return to work and/or places an injured worker at maximum medical improvement.

3.      Compensation for permanent injuries: These benefits are two-thirds of an injured workers’ average weekly wage (or wages earned in a 40-hour work week for part-time workers) and are available after an injured worker has reached maximum medical improvement. These benefits may be for permanent impairment to a specific body part or may be to compensate for an injured worker’s loss of earning ability. This distinction depends on the type of injury. Benefits may also be partial or total, depending on the type and degree of injury.

4.      Vocational rehabilitation: These are services provided under Nebraska workers’ compensation law to injured workers when, as a result of a compensable injury, the injured worker is unable to perform suitable work for which he or she has previous training or experience. This may include job placement and retraining. 

5.      Death benefits: If a worker dies as a result of his or her injury, that worker is entitled to medical expenses as well as burial expenses up to $10,000.  The deceased worker’s dependents are also entitled to benefits, which vary depending on the circumstances.

If the system worked the way it was supposed to, employers (or their insurance companies) would pay injured workers, pay the medical bills, and focus on getting the worker either back to work or moving on with the best quality of life possible. The reality is that employers (and their insurance companies) don’t always see eye-to-eye with doctors’ opinions or treatment recommendations, or follow work restrictions. Speaking with an experienced attorney when navigating the workers’ compensation system can reassureinjured workers and their loved ones and make a very stressful time a little less difficult.

Different states have workers’ compensation systems that vary, but all, to some extent, are intended to protect injured workers. If there are questions, please contact the firm and provide the details to an attorney who can advise on the best steps to take for each specific situation.

How Do Iowa Workers’ Compensation Permanent Benefits Work?

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Iowa’s workers’ compensation laws classifies permanent injuries to the neck, back, shoulders or hips are as unscheduled, or body as a whole, disabilities. Most other injuries are treated as scheduled member injuries, for which an injured worker can still recover permanent partial disability (PPD) benefits.

A permanent partial disability is a permanent injury that does not totally keep the injured person from eventually returning to work.

How is my percentage of disability determined in Iowa scheduled member cases? 

This is initially determined by a doctor chosen by your employer or your employer’s insurance company. The doctor typically looks at a medical text to determine what percentage is appropriate. If that physician assigns you a rating of permanent disability that you think is too low, you have the right to be examined by another doctor whom you choose. The cost of this second opinion is also paid by your employer or their insurance company. However, you must first submit an application to the Iowa Workers’ Compensation Commission to get this second opinion.

How much will I receive in permanent partial disability payments? 

The amount of money you receive as a PPD benefit payment depends on several things. First, your average weekly income before the accident or injury affects the amount of your weekly benefits. Injured workers receive 80 percent of their previous weekly pay, up to a maximum benefit amount of $1,419 each week. All workers entitled to PPD benefits will receive a minimum weekly payment of $270, even if their weekly earnings were lower than that amount.

Second, the amount of your disability also affects the amount of benefits. Scheduled members are assigned a number of total weeks by statute. You simply apply the percentage of disability assigned by the doctor to the total weeks. The result is how many weeks the worker must be paid the full weekly benefit.

How is my percentage of disability determined in Iowa body as a whole cases? 

Body as a whole injuries have a different compensation package. An injured worker with a permanent body as a whole injury receives a maximum of 500 weeks of PPD benefits. You will receive benefits according to the lost earning capacity. For example, if a back injury left you with a 15 percent earning capacity loss, you will receive benefits for 15 percent of the 500 weeks, or 75 weeks at the full weekly rate discussed above.

When determining the percentage of lost earning capacity, the Commissioner will weigh a number of factors:

  • age of the worker;
  • the employer’s ability to accommodate a return to work;
  • lack of motivation to find a job;
  • whether the earning capacity changed after the healing period;
  • psychological conditions impacting ability to work;
  • employee’s work experience, educational background, and training before the injury;
  • functional impairment or impairment rating caused by injury;
  • whether the worker can speak English or has tried to learn English;
  • inability to engage in other employment because of injury, despite making bona fide efforts to do so;
  • has the worker retired; and
  • workers’ refusal to submit to medical treatment or surgery.

None of the factors are determine the issue alone, and all factors will be considered as a whole when determining the earning capacity rate. Typically, a vocational counselor must be hired to evaluate these factors and how they impact a workers’ earning capacity. Anyone with permanent restrictions from a work injury should contact an attorney to ensure they receive all of the permanent benefits to which they are entitled.

Whole body injuries can affect the rest of your life and be incapacitating. The attorneys at Rehm, Bennett & Moore can make sure you receive all of the benefits you are owed, which includes fair compensation for your injury. Contact our office at (800) 736-5503 to set up your free initial consultation with one of the attorneys licensed to practice in Iowa. Find out more about the practice at www.rehmlaw.com.

Contact a Workers’ Compensation Lawyer, Even if Your Medical Bills Are Being Paid: Here’s Why

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Nebraska is a state that has a “prompt payment rule” for medical expenses in workers’ compensation cases. This means that so long as your employer has sufficient knowledge that your medical care is necessary because of the injury, your bills should be paid. This is a huge plus because even a minor workers’ compensation injury can cause an employee to rack up thousands of dollars in medical bills.

In Nebraska, delay of medical payment is treated as a denial of a claim. That is why a delay in paying for medical bills from a work injury gives the employee the right to pick their own doctor for a work injury.

The issue of doctor choice brings up a couple of the hidden dangers of the prompt payment rule.  Many times, employers will promptly pay medical expenses for doctors who will oftentimes release employees before they are done healing and return employees back to work before they are ready. Employees need to be able to know their doctor-choice rights before they agree to an employer/insurer-oriented clinic or doctor – especially if that doctor is not their family doctor.

Secondly, employees can get lulled into contentment when an employer pays their medical bills. Medical benefits are one aspect of workers’ compensation benefits; the other is loss of income benefits. An employer/insurer may use their leverage with a doctor to minimize loss of income benefits. Also, when employees get into litigation, they are oftentimes confused by the fact that an employer will pay for medical benefits, but not loss of income benefits, or will deny that the injury is even work related. This is related to the prompt payment rule. Just because an employer pays medical bills, that doesn’t necessarily mean that they or a workers’ compensation judge will believe those medical bills are related to the work accident.

Six Tips for Safe and Fair Holiday Employment

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This time of year, many people get holiday jobs to earn extra money. That means some people will get injured at work and run into other difficulties working holiday jobs. Here are six tips on how to deal with the workplace challenges arising from holiday jobs. These tips for safe and fair employment apply just as well to any second job, not just a holiday job.

  1. Just because you have a “holiday job” doesn’t necessarily make you a seasonal employee: In some states, including my home state of Nebraska, employees can have their benefits reduced if they are a “seasonal employee.” However, even if you have a holiday job, your job may not be seasonal. In Nebraska, “seasonal employment” is defined as a job that is dependent on weather or can only be done during certain times of the year. For example, if you hurt your back working at an electronics store at your holiday job, that employment is not seasonal because you can work at an electronics or really most any retail store at any time of the year.
  2. You can’t be paid workers’ compensation for how your holiday or second job affects your regular job: If you are off work at your regular job because of an injury at your second job or holiday job, you are only paid income-replacement benefits for the income you lost at your holiday job or second job. For example in Nebraska, if you were hurt at your holiday/second job that pays $120 per week and you are unable to do your regular job that pays $600 per week, your only income benefit would be two-thirds of your second/holiday job, which would be $80. Employees should be extra cautious in second jobs or holiday jobs for just that reason. Employees should also consider applying for private disability plans if they plan on having a second job in order to account for the possibility of losing income due to an injury at their second job. In short, employees should do a thorough cost-benefit analysis before taking a holiday job or second job.
  3. Your permanent disability benefits could be better than your temporary benefits: In full-time employment, permanent and temporary disability benefits are generally fairly close. But with part-time employment, permanent disability benefits may be much higher than temporary benefits. In my state of Nebraska, temporary benefits are paid based on a typical work week. For example, if you are a part-timer working 12 hours a week at $10 per hour, your temporary disability pay would be $80 a week. However, in Nebraska and some other states, permanent disability is based on no less than a 40-hour week. So if you are a part-timer getting paid $10 per hour, your permanent disability rate would be $266.67 per month. This is good for employees, because serious injuries will usually have permanent effects that can permanently affect an employee’s ability to earn a living.
    If you are an injured part-time worker and your insurance company is trying to force you to take a settlement based on your part-time wage rate, you should consult with an attorney in your state.
  4. Your employer/insurer may be low-balling your wage rate: Say you get paid $8 an hour as a barista but you have an agreement to share tips, or you work in retail but you get store credit, or you teach exercise classes at a health club but you have an agreement that you get a free membership. In any of those scenarios, you could possibly use those benefits to increase your loss-of-income benefits.
  5. You are still protected by most fair-employment laws: Part-timers are still covered by most fair-employment laws. The most glaring exception is likely the Family and Medical Leave Act (FMLA), which provides 12 weeks of unpaid leave and job protection for employees with a serious health condition, to care for a close family member with a serious health condition, or take care of a close family member who is affected by a military deployment. FMLA requires 1,250 hours worked in the last calendar year and 1 year of employment. That 1,250 hours a year translates to roughly 24 hours a week. Many people working second jobs don’t meet the eligibility standards for FMLA.
  6. Independent contractor, independent conschmacktor: Many holiday employees do fairly low-wage work that doesn’t require any specialized training or education. If this describes your holiday job or second job, then you are an employee, despite the fact that your company may have classified you as an independent contractor. Since you are an employee, you should be covered by workers’ compensation law. If you are misclassified as an independent contractor, you should look for other employment and consider reporting your unscrupulous employer to the United States Department of Labor or to your state’s department of labor.