Author Archives: Jon Rehm

The problems posed by mandatory workplace stretching and exercise

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Many white-collar employees exercise at the beginning of the day before going to work. But many blue-collar workers are required by their employers to exercise or stretch at the beginning of their shifts.

In my view, required workplace stretching or exercises creates many issues in workers’ compensation and employment law.

Hurt while stretching at work

If a worker is injured while doing employer-mandated exercises, that injury would be covered by workers compensation. The deeper issue about employer-mandated stretching and exercise is why employers mandate it in the first place. Stretching is thought to reduce the risk of musculoskeletal injuries which would be covered by workers’ compensation. But research is not entirely clear as to whether stretching  reduces the risk of injury in the workplace.



Workplace stretching, ergonomics and wellness programs

Advocates of workplace stretching state that stretching is just one part of injury prevention. Employers also need to focus on ergonomics and other preventative measures in order to prevent injury. But, ICYMI, employers are not required by law to implement ergonomics programs. In fact, OSHA is prohibited by law from even considering mandatory ergonomics thanks to the Congressional Review Act.

Workplace stretching supporters also support employers using early intervention to address musculoskeletal injuries. But many employers don’t follow the advice offered on workplace wellness blogs. I have many clients, particularly in the livestock and meatpacking industries, that complain about soreness from overuse injuries. The response is often less than supportive from management. They are told that pain is just part of the job.

Workplace exercise and stretching and the ADA

Workplace exercise programs raise an immediate concern for workers with physical disabilities. Sometimes disabled workers are unable to complete stretches or exercises because of their disability. A refusal of to do these stretches could be construed as a refusal of work duties, so employees may feel pressured to complete the exercises and risk injury.

In my opinion, the best practice for an employee faced with this situation would be to get a medical note excusing them from exercises or stretches or allowing a modification. In other words, an employee needs to attempt to seek a reasonable accommodation for their disability under the Americans with Disabilities Act. (ADA)

Sometimes employees can’t afford to go the doctor or can’t easily access medical care. I think an employee can still ask for an accommodation based off old restrictions or even on their own.  But to be blunt, employers don’t always take self-reported restrictions seriously. That is often the case with courts as well if those self-reported restrictions lack basis in the medical records.

In short, it may be difficult for an employee to avoid being fired for refusing to perform mandatory exercises or stretching. But if push comes to proverbial shove in litigation, an employer may be in a tough spot if they fire an employee for refusing to do exercises. Disability discrimination laws protect qualified employees who can perform the essential function of their job with or without accommodation. Arguably stretches or exercises would not be an essential function of a job.  This could be particularly true of an employee is able to do their job and or if the stretches have little to do with an employee’s job duties.

But litigation is time consuming and expensive. So an employee who is forced to do stretches that aggravate an old injury or health condition should try to work with a doctor and employer, if possible, to either get excused from the exercises or to get the exercises modified.

The ADA and wellness programs

The legal issues posed by mandatory stretching for injured and disabled employees reflects a more generalized concern about wellness programs under the ADA. Federal courts partially struck down an EEOC regulation about wellness programs as they discriminated against older and disabled workers. And like mandatory exercise and stretching, studies are inconclusive as to whether wellness programs benefit employees.

The presidential election and confirmation hearings for Amy Coney Barrett have focused attention on potential changes to federal regulatory agencies and the federal courts. Narratives about regulatory agencies and courts often pose Democrats as pro-worker and Republicans as anti-worker. But the EEOC enacted the wellness program regulation during the Obama administration as part of the Affordable Care Act. Conservatives often argue against deferring to regulations issued by executive agencies based on separation of powers arguments. But in this case, workers used a separation of powers argument to strike down an anti-worker policy.

The offices of Rehm, Bennett, Moore & Rehm, which also sponsors the Trucker Lawyers website, are located in Lincoln and Omaha, Nebraska. Five attorneys represent plaintiffs in workers’ compensation, personal injury, employment and Social Security disability claims. The firm’s lawyers have combined experience of more than 95 years of practice representing injured workers and truck drivers in Nebraska, Iowa and other states with Nebraska and Iowa jurisdiction. The lawyers regularly represent hurt truck drivers and often sue Crete Carrier Corporation, K&B Trucking, Werner Enterprises, UPS, and FedEx. Lawyers in the firm hold licenses in Nebraska and Iowa and are active in groups such as the College of Workers’ Compensation Lawyers, Workers' Injury Law & Advocacy Group (WILG), American Association for Justice (AAJ), the Nebraska Association of Trial Attorneys (NATA), and the American Board of Trial Advocates (ABOTA). We have the knowledge, experience and toughness to win rightful compensation for people who have been injured or mistreated.

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Maximum benefits rates, the Governor and Nebraska workers’ compensation

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Under Nebraska law, the Governor doesn’t need to sign anything to have maximum benefits increase on an annual basis.

The role of the Governor in deciding maximum rates is a good way to talk about the role played by the Executive Branch in Nebraska workers compensation law.

Nebraska’s maximum rate for workers’ compensation benefits will increase for 2021. The court has not announced by how much the amount will increase, but the fact that neither the State of Nebraska or the Nebraska Workers’ Compensation Court have announced there will be a hearing on the matter, means the rate will increase.

The process in which the maximum rate increases is a good way to discuss how the Executive Branch, can affect workers’ compensation in Nebraska. For now, that influence is limited, but as discussed below the influence may increase with a looming United State Supreme Court decision.

But to start, let’s talk about how the Governor can impact workers’ compensation in Nebraska and what the decision to increase Nebraska maximum benefit might mean in the near term.

The Governor and maximum benefit increases.

Most years, the maximum benefit increases for injured workers in Nebraska. Here is how the process works. Under Neb. Rev. Stat. 48-121.02 the Nebraska Department of Labor calculates the state average weekly wage which calculates the number of employees covered by the Nebraska Employment Security Act (unemployment) divided by their total wages. The Department of Labor then gives the number to Nebraska Workers’ Compensation Court. By law, this happens on October 1st.

The workers compensation court then gives this data to the Governor who has until November 15th to hold a hearing as to whether he or she will suspend maximum benefit rate increase. But by October 16th, the Governor must announce a public hearing. So unless the Governor notices a hearing by October 16, the maximum rate will increase by the amount calculated by the Nebraska Department of Labor. There are no hearings announced as of October 18, 2020, so it’s safe to assume the maximum rate will increase in 2021.

What does the maximum benefit increase mean in the big picture?

By law, the Governor needs to consider overall economic conditions and workers’ compensation costs in as factors in deciding not to increase maximum workers’ compensation benefits. This year I thought maybe the COVID-19 induced recession may have forced the business community to ask for some relief from workers’ compensation costs. Employers have been asking for overall liability shields related to COVID. However, for this year at least, it doesn’t seem like the Governor thinks workers’ compensation costs are enough of a concern to forestall an increase in maximum benefits.

The state executive branch and Nebraska workers’ compensation

Nebraska adjudicates workers’ compensation cases within our judicial branch unlike Iowa and other states who adjudicate workers’ compensation cases in the executive branch. 48-121.01 and 48-121.02 are one of the few direct mentions of the Executive branch agencies in the Nebraska Workers’ Compensation Act. The attorney general’s office has the ability to prosecute some fraud and employer misconduct and also is involved in vocational rehabilitation benefits.

Arguably the biggest influence the executive branch has over the Nebraska Workers Compensation Court is that the Governor appoints judges. But the ability of the Governor to appoint judges is reined in by a bi-partisan Judicial Nominating Commission. The Commission forwards the names of applicants for judgeships to Governor. The Commission serves as the equivalent of a judicial human resources department that screens qualified applicants for the Governor.

And unlike the federal judiciary, state court judges in Nebraska are subject to judicial retention elections. This system of judicial nominating committees and judicial retention elections is known as the Missouri Plan. However an upcoming United States Supreme Court case could change how state’s like Nebraska select judges.

Trouble on the horizon for Judicial nominating commissions?

Earlier this month, the Supreme Court heard a case from Delaware where a judicial applicant challenged a Delaware requirement that judges to their state courts retain a partisan balance on 1st Amendment grounds. Arguments in favor of the Delaware law pointed out that striking down this law could invalidate laws implementing judicial commissions in other states such as Nebraska.

A related challenge to judicial nominating committees could be the non-delegation doctrine which holds that Legislative branches can’t delegate their powers to other branches of the government or even private agencies. Non-delegation challenges have largely failed in Nebraska, but the addition of Brett Kavanaugh and likely addition of Amy Coney Barrett could mean the United State Supreme Court revives this doctrine. Nebraska law gives the Nebraska State Bar Association a role in selecting lawyer members of the Judicial Nominating Commissions.

If appellate courts held Nebraska’s methods of selecting judges is unconstitutional it would likely set off a legislative and political scramble.

The offices of Rehm, Bennett, Moore & Rehm, which also sponsors the Trucker Lawyers website, are located in Lincoln and Omaha, Nebraska. Five attorneys represent plaintiffs in workers’ compensation, personal injury, employment and Social Security disability claims. The firm’s lawyers have combined experience of more than 95 years of practice representing injured workers and truck drivers in Nebraska, Iowa and other states with Nebraska and Iowa jurisdiction. The lawyers regularly represent hurt truck drivers and often sue Crete Carrier Corporation, K&B Trucking, Werner Enterprises, UPS, and FedEx. Lawyers in the firm hold licenses in Nebraska and Iowa and are active in groups such as the College of Workers’ Compensation Lawyers, Workers' Injury Law & Advocacy Group (WILG), American Association for Justice (AAJ), the Nebraska Association of Trial Attorneys (NATA), and the American Board of Trial Advocates (ABOTA). We have the knowledge, experience and toughness to win rightful compensation for people who have been injured or mistreated.

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Why does your doctor want you to sign a “work restriction agreement”?

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I saw something new in the world of workers’ compensation last month; a “work restriction agreement” between an employee and a doctor. The agreement raised my eyebrows when I first saw it and it raised my eyebrows again when I dug it up to write this post.

The more I thought about this agreement, the more I saw the handiwork of a nurse case manager. Nurse case managers have all sorts of advantages over injured in workers in a workers’ compensation claim. In my mind, this agreement really seemed like running up the proverbial score.

So why did this agreement rub me the wrong way?

Trust and stigma in workers’ compensation

When I saw the agreement, I thought about the agreements that doctors often make patients sign in order to receive opioid pain medication. To some extent those agreements are well-intentioned because they can inform patients about how to take medication properly.  But the agreements have been criticized for undermining the doctor-patient relationship and stigmatizing users of prescription drugs as potential addicts. Injured workers are equated with drug addicts.

Like drug addiction, issues about doctor-patient trust and stigma are major issues for injured workers. Many injured workers refuse to claim workers compensation benefits out of fear as being stigmatized as freeloaders looking to “milk the system”. But even if workers overcome that stigma and claim benefits, most workers are surprised to find how little privacy they have regarding their health history once they claim benefits.

The role of the nurse case manager

One of the most visible examples of the relative lack of privacy in workers’ compensation claims is the nurse case manager. A nurse case manager is usually a nurse hired on behalf of the workers compensation insurer, but it can be someone employed directly by your employer. This nurse case manager will suddenly pop up in the examination room when you visit your doctor or a doctor about a work injury.

We tell our clients to tell that nurse case manager to scram (politely of course). That might be less of an option if the nurse case manager works at your company and is more or less in management. An employee may feel pressured to allow a company nurse case manager in an exam room out of fear of losing their job or being disciplined. Nebraska law makes it illegal for employers to retaliate against employees for claiming workers’ compensation. I’ve never seen a case related to an employee telling an in-house nurse case manager to leave an examination room, but it could be an interesting case.

But even if you can get the nurse case manager out of the exam room, you can’t stop a nurse case manager from talking with your doctor privately. So, what is it that the doctor and the nurse case manager talk about? Oftentimes it’s whether an employee can return to work. That’s where these “work restriction agreements” come into play.

How the work restriction agreement works and can work

I think nurse case managers are driving the bus on “work restriction agreements.” Some doctors like nurse case managers. I think part of reason some doctors like nurse case managers is oftentimes a nurse case manager will have access to written job descriptions that help doctors to tailor work restrictions.

The work restriction agreement I saw incorporated a written job description. The agreement contained a provision that the workers work restrictions were just exactly as described by the doctors note. This would limit the employee’s ability to testify to the extent of their own restrictions at trial.

In addition, the agreement contained a provision that the employee would refuse work that exceeded her restrictions. Interestingly enough, the agreement created no requirement that the employer not ask or force the employee to exceed their stated work restrictions.  Overall the document created obligations for the employee, but none for the employer. (If this sounds like collusion, it is and you can read more about why this collusion is usually permitted here.)

Given the one-sided and legalistic nature of the “work restriction agreement”, I am not surprised it showed up in cross-examination like questioning from an employer’s lawyer in a workers’ compensation deposition. The nurse case manager was essentially helping to create what amounts to attorney work-product to be used in a workers’ compensation case. (It could also be used in an employment law claim as well.) But while a “work restriction agreement” is a fairly blatant effort to create evidence, nurse case managers have more subtle tactics.

In Nebraska, medical dictation or charting can be admitted into evidence in a workers’ compensation case without worries about hearsay or foundation objections. A good nurse case manager can influence doctors to create medical evidence that is helpful for an employer.

Why nurse case managers have clout

Of course, insurers have more blunt tactics to influence medical evidence – they pay the bill. I remember sending a questionnaire out to a doctor in a case because their dictation wasn’t enough to help prove my client’s case. I was bluntly told by clinic staff that since “workers compensation already paid the bill” that they saw no reason why they needed to fill out additional paperwork. Paying the bills gives insurers a lot of influence and make their nurse case managers seem a lot more persuasive than they would be otherwise.

Many nurse case managers also have long-standing relationships with doctors which leads doctors to trust nurse case managers. It seems nurse case managers aren’t happy with their advantages and are seeking to further their advantage over injured workers through the use of forms like “work restriction agreements” that further stigmatize injured workers.

The offices of Rehm, Bennett, Moore & Rehm, which also sponsors the Trucker Lawyers website, are located in Lincoln and Omaha, Nebraska. Five attorneys represent plaintiffs in workers’ compensation, personal injury, employment and Social Security disability claims. The firm’s lawyers have combined experience of more than 95 years of practice representing injured workers and truck drivers in Nebraska, Iowa and other states with Nebraska and Iowa jurisdiction. The lawyers regularly represent hurt truck drivers and often sue Crete Carrier Corporation, K&B Trucking, Werner Enterprises, UPS, and FedEx. Lawyers in the firm hold licenses in Nebraska and Iowa and are active in groups such as the College of Workers’ Compensation Lawyers, Workers' Injury Law & Advocacy Group (WILG), American Association for Justice (AAJ), the Nebraska Association of Trial Attorneys (NATA), and the American Board of Trial Advocates (ABOTA). We have the knowledge, experience and toughness to win rightful compensation for people who have been injured or mistreated.

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Unless you have Marine One, Air Ambulances are a pricey proposition

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Last Friday President Trump travelled to Walter Reed Hospital in the Presidential helicopter, Marine One, to seek treatment for COVID-19. The President has use of a helicopter, most of us don’t. Sometimes air ambulances are necessary, particularly in remote rural areas, to transport individuals with severe injuries or illnesses.

But if you read this blog, you know that air ambulance bills are often  incredibly expensive — and even worse not covered by insurance.

So why are air ambulance charges often not covered by insurance?

Preemption: Federal rock breaks state scissors

Air ambulances are regulated by the Federal Aviation Administration. The authority for this regulation is the so-called interstate commerce clause. Insurance, whether health insurance or workers compensation, is governed by state law because Congress ruled that insurance regulation is the purview of state law. Workers’ compensation laws are state laws that are constitutionally valid due to a state’s general police powers under the 10th Amendment.

So when accident victims try to pay for an air ambulance charge with health insurance or through workers’ compensation insurance, air ambulance providers argue they aren’t bound by state laws regulating insurance since they are regulated by the federal government.

This argument is called preemption. Preemption means that if state and federal laws conflict on a subject that federal law governs. In other words, the federal rock crushes the state scissors. A majority of courts side with  the air ambulance companies in holding that federal law regulating air ambulances pre-empts states from using their laws on insurance to regulate air ambulance charges.

In practical terms, injury cases involving air ambulances are more difficult to resolve. Fortunately, air ambulances aren’t covered by Nebraska’s lien statute which gives doctors and other providers a right to recover unpaid bills out of a personal injury settlement. This can give attorneys some leverage over these providers

What would the Founding Fathers think about air ambulances?

Before he went to the hospital, the President nominated 7th Circuit Court of Appeals Judge Amy Coney Barrett to replace Ruth Bader Ginsburg on the Supreme Court. Barrett’s views on abortion and other hot button social issues have drawn attention. But the bulk of cases decided by federal courts tend to be esoteric and obscure issues like air ambulance charges that stem from tensions within the United States Constitution.

I don’t know if Barrett has ruled on an air ambulance case. Barrett is known as an “originalist” or someone who looks at the intentions of the Founding Fathers in interpreting the Constitution.

But in my mind air ambulance cases are one example of the limits of the originalist approach. Passenger air travel post-dates the Constitution by about 130 years. What would the Founding Fathers know about air ambulances? Anyone who brings an originalist approach to deciding an issue like air ambulance charges is just dressing up their policy preferences in late 18th century garb.

The offices of Rehm, Bennett, Moore & Rehm, which also sponsors the Trucker Lawyers website, are located in Lincoln and Omaha, Nebraska. Five attorneys represent plaintiffs in workers’ compensation, personal injury, employment and Social Security disability claims. The firm’s lawyers have combined experience of more than 95 years of practice representing injured workers and truck drivers in Nebraska, Iowa and other states with Nebraska and Iowa jurisdiction. The lawyers regularly represent hurt truck drivers and often sue Crete Carrier Corporation, K&B Trucking, Werner Enterprises, UPS, and FedEx. Lawyers in the firm hold licenses in Nebraska and Iowa and are active in groups such as the College of Workers’ Compensation Lawyers, Workers' Injury Law & Advocacy Group (WILG), American Association for Justice (AAJ), the Nebraska Association of Trial Attorneys (NATA), and the American Board of Trial Advocates (ABOTA). We have the knowledge, experience and toughness to win rightful compensation for people who have been injured or mistreated.

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Anti-trust and workers’ compensation

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Anti-trust law wasn’t created just to address monopolies, it was also designed to address unfair business practices. That’s why a different type of anti-trust law could benefit injured workers

A federal judge in New York sustained a challenge mounted by a group of Democratic attorney generals to a narrow interpretation of the joint-employer rule proposed by Labor Secretary Gene Scalia.

The joint-employer rule seeks to make businesses liable for violations Fair Labor Standards Act by their franchisees. The federal judge held the Department of Labor’s interpretation of the rule was “Arbitrary and capricious.” You can read more about how federal courts view workplace regulations here.

But the reason, I am writing about this decision is to start discussing the role anti-trust law plays or could play in workers’ compensation and employment law. Put another way, this post seeks to introduce my fellow solo and small firm workers’ compensation plaintiff’s lawyers to the scholarship of Sanjukta Paul, Marshall Steinbaum, Veena Dubal and others.  While discussions of anti-trust center on the rise of the gig economy and worker classification, I think a new way of thinking about anti-trust law goes to the core issues of workers’ compensation.

What is anti-trust law

To the extent that plaintiff’s lawyers think at all about anti-trust, anti-trust is thought about as a way to maintain competitive markets. But, as scholars point out, when anti-trust law was created in the late 19th century, anti-trust was thought of a way to fight economic concentration and support fairer business practices.

The innovation of anti-trust law was that it regulates what Sanjukta Paul describes as “coordination rights.” Coordination rights are the ability of different individuals and enterprises to work towards common ends. Coordination can be cooperation among equals or it can involve one party controlling another.

How anti-trust applies in workplace law.

Going back to the example of the joint-employer controversy, the Trump administration sought to give franchisors more ability to command franchisees without being responsible for complying with wage and hour laws. By case law, this relationship is already codified in existing anti-trust law. This relationship, according to scholars, is what enabled the rise of gig economy companies like Uber and Lyft. Uber and Lyft can largely control drivers without defining them as employees and having to worry about violating anti-trust law.

Of course, workers who are classified as contractors are not covered by workers’ compensation. But the issue of worker classification in workers’ compensation pre-dates the gig economy. Issues about who is covered by workers’ compensation are as old as workers’ compensation statutes themselves.

Most states have a law like Nebraska’s statutory employer law (Neb. Rev. Stat. 48-116) Our statutory employer statute seeks to prevent employers from avoiding workers’ compensation by use of subcontractors. Our statute expressly mentions the use “artifice and schemes” to avoid liability. In other words, the drafters of Nebraska’s workers compensation laws were regulating the coordination rights of employers. 

Statutory employer statutes within workers’ compensation laws are anti-trust laws. Workers compensation and anti-trust laws developed at roughly the same time out of the same impulse to reform a newly industrializing society. It’s not surprising that workers’ compensation laws would include anti-trust concepts or would address coordination rights in a practical way.

Workers’ compensation and coordination rights

But the use of anti-trust law in workers’ compensation extends beyond employee classification issues. Employers often co-ordinate with insurers/claims administrators, nurse case managers and doctors to limit workers’ compensation workers compensation benefits for employees. I sometimes refer to these efforts as the workers’ compensation legal-medico complex. The workers’ compensation legal-medico complex is one example of entities exercising their coordination rights.

In practice the workers compensation medico-legal complex can exercise their coordination rights with impunity. Plaintiff’s lawyers have very limited success in using the civil RICO statutes in fighting these practices.

But a renewed and reformed anti-trust law could give injured workers another outlet to fight coordination between insurers, employers and medical providers. The Federal Trade Commission was created at about the same time as workers’ compensation laws. A re-oriented FTC or a state equivalent could crack down on employer-centered coordination of workers’ compensation claim management as an unfair trade practice.

However a re-orientation of anti-trust would require near political and intellectual revolution. The Epic Systems case decided by the Supreme Court in 2018 limits the ability of workers to coordinate through collective action litigation. The case also seeks to limit protected concerted activity under the National Labor Relations Act strictly to formal union activity rather than more informal collective action. Gig economy companies have also successfully used anti-trust arguments to fight efforts to allow gig workers to unionize.

I am not going to address how anti-trust evolved its anti-worker bent. I think Professor Paul does a good job of describing the intellectual and legal history of the (d)evolution of anti-trust law. Her work is worth reading by plaintiff’s attorneys. The more familiar plaintiff’s become with anti-trust concepts the more likely it is that, to quote Marshall Steinbaum, that we can open up a second front of anti-trust law in the fight over worker classification. I think anti-trust law would also be a way to make workers’ compensation work for injured workers rather than the employer-oriented legal-medico bureaucracy.

The offices of Rehm, Bennett, Moore & Rehm, which also sponsors the Trucker Lawyers website, are located in Lincoln and Omaha, Nebraska. Five attorneys represent plaintiffs in workers’ compensation, personal injury, employment and Social Security disability claims. The firm’s lawyers have combined experience of more than 95 years of practice representing injured workers and truck drivers in Nebraska, Iowa and other states with Nebraska and Iowa jurisdiction. The lawyers regularly represent hurt truck drivers and often sue Crete Carrier Corporation, K&B Trucking, Werner Enterprises, UPS, and FedEx. Lawyers in the firm hold licenses in Nebraska and Iowa and are active in groups such as the College of Workers’ Compensation Lawyers, Workers' Injury Law & Advocacy Group (WILG), American Association for Justice (AAJ), the Nebraska Association of Trial Attorneys (NATA), and the American Board of Trial Advocates (ABOTA). We have the knowledge, experience and toughness to win rightful compensation for people who have been injured or mistreated.

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Why injured workers stop going to the doctor even if they are still in pain

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Jon Rehm here. I had something come up this weekend, so I didn’ t have time to edit the post I was working on for Monday. It’s about workers’ compensation and anti-trust. It should be worth the wait. It’s fun to write about a new topic.

Anyhow, the lawyers at the firm cut a video blog a few weeks back that should be up on Facebook and will soon be on You Tube and maybe in a podcast format in the near future.

In the meantime, here is an “evergreen” post from about a year ago that is still worth reading.

Some work injuries never really resolve. Often an injured worker works through pain in order to support themselves and their family. Many workers in this situation stop seeking medical treatment for their work injury – and that often causes major problems for the injured worker.

Besides the obvious health issues, there are two legal problems that arise when an injured worker gives up on medical care. The first is that it lowers their chances of getting future medical care awarded in court. Injured workers who stop seeking medical treatment for their injuries can also undermine their credibility with a judge. The assumption is that if an injured worker isn’t seeking medical treatment they really aren’t hurt and any testimony about pain or limitations lacks credibility.

But there are many good arguments to make about why injured workers’ stop seeking medical treatment.

1.Workers’ compensation stops paying medical benefits – When workers’ compensation stops paying for medical care, many injured workers can’t afford to pay for treatment.

1a. Injured workers are told their case is “closed” by an insurer or employer – Insurance adjusters and nurse case managers often tell injured workers that their case is closed when their doctor places them at maximum medical improvement or MMI. This often accompanies a check for permanent disability that many workers believe is a settlement that closes their case.

A workers’ compensation case stays open for at least two years from the last payment of benefits.  A case is only closed if it goes to trial and gets dismissed or if the injured worker signs settlement paperwork that is filed with the Nebraska Workers’ Compensation Court.

But, it’s easy to understand why an injured worker may think their case is closed and not go to the doctor in this situation. After all they have been told by an authority figure that their case is closed and they received a check for permanent disability.

Many self-insured employers in Nebraska also discourage injured workers’ from seeking medical care after the employee is released from care by a doctor.

2. Non-existent or bad health insurance – An injured worker can continue seeking medical treatment in a denied workers’ compensation case by having their health insurance pay. Some employees do just that whether it’s under their insurance or under a spouse’s insurance. Taking that action can be  helpful. But if you don’t have health insurance because it’s not offered or because you can’t afford it, that’s not an option.

High deductible and co-pay insurance can be almost as bad as no insurance. I’ve seen two employees with supposedly “good insurance” have medical bills in disputed workers’ compensation claims sent to collections. Nebraska has enacted legislation to protect injured workers from debt collectors, but an injured worker would likely need to get an attorney to enjoy the protections of that law. Often times injured worker don’t want to or are afraid to contact attorneys. Adjusters and other company health personnel will also discourage employees from calling lawyers.

3. Unable to take time off from work to go to doctor — Medical clinics tend to be open during business hours when injured workers are working. That time crunch can also be amplified by having to commute to a job.

Insurance and management side readers may say “What about FMLA?” FMLA could allow an injured employee to take time off for medical care. But some employees may not be aware of their rights under the FMLA. Employers usually also require paperwork for FMLA which requires the cooperation of a medical doctor which can create a hurdle for some employees — particularly those without a good relationship with a doctor.

Not all employees are eligible for FMLA.  Maybe their employer has fewer than 50 employees. Maybe they haven’t been employed for more than a year.  Maybe an injured worker has exhausted their FMLA leave during their work injury.  Maybe the employee hasn’t worked enough hours because of the injury to be eligible for FMLA.

As added insult to a work injury, an employee taking time off work to see medical treatment would be taking intermittent FMLA. Employers hate intermittent FMLA and often employees who use intermittent FMLA are often suspected of fraud.

Urgent care clinics and emergency rooms are available for treatment after hours. But going to an ER complaining of pain is a good way to get tagged as a drug seeker by the insurance industry.

4. Worker is alienated from treating doctors — Some employees don’t go to the doctor if they are in pain because they don’t trust or like their doctor. I will be the first to admit that some injured workers are unreasonable people. But some doctors have a lousy bedside manner. Some doctors are overly cozy with nurse case managers who work for insurers or employers. When either of those two factors are present, even a reasonable and personable injured worker may feel that treating with that doctor is futile.

I mentioned suspicions of drug seeking behavior by injured workers earlier in this post. Concerns about drug abuse by injured workers have been heightened over concerns stemming from the opioid crisis. As a result, doctors are even more reluctant to prescribe pain medication. As I pointed out in April, concerns about opioid addiction are good pretext for insurers and claims administrators to wash their hands of medical care obligations under workers’ compensation.

But if opioids and benzos are off the table for long-term pain management, what are the alternatives? Currently, there isn’t much that is widely accepted. If injured workers hear from their doctors that they can’t do anything about their long-term pain, that message will discourage an injured worker from seeking medical treatment.

Some doctors are willing to perform novel pain management techniques like stem cell therapy or prolotherapy. But since these methods are relatively new, so they aren’t widely accepted. Since novel ways to treat pain aren’t widely accepted, it’s easy for insurers and claims administrators to deny those novel treatments.

The offices of Rehm, Bennett, Moore & Rehm, which also sponsors the Trucker Lawyers website, are located in Lincoln and Omaha, Nebraska. Five attorneys represent plaintiffs in workers’ compensation, personal injury, employment and Social Security disability claims. The firm’s lawyers have combined experience of more than 95 years of practice representing injured workers and truck drivers in Nebraska, Iowa and other states with Nebraska and Iowa jurisdiction. The lawyers regularly represent hurt truck drivers and often sue Crete Carrier Corporation, K&B Trucking, Werner Enterprises, UPS, and FedEx. Lawyers in the firm hold licenses in Nebraska and Iowa and are active in groups such as the College of Workers’ Compensation Lawyers, Workers' Injury Law & Advocacy Group (WILG), American Association for Justice (AAJ), the Nebraska Association of Trial Attorneys (NATA), and the American Board of Trial Advocates (ABOTA). We have the knowledge, experience and toughness to win rightful compensation for people who have been injured or mistreated.

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What COVID-19 conspiracy-mongering tells us about causation in workers’ compensation

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Some conspiracy theorists argued last month that COVID-19 only killed 9000 instead of 154,000 (at the time) Americans. This number was based on Centers for Disease Control (CDC) data stating that only 9,000 death certificates involving COVID-19 patients listed COVID-19 as the sole cause of death. In the majority of deaths, COVID-19 combined with other factors to cause death.

The argument about was counts as a COVID-19 death echoes arguments about what counts as a work injury for the purposes of workers’ compensation. Does work have to be the sole, substantial or just a contributing factor for an injury to be covered under workers’ compensation?

In Nebraska, the answer to that question is that work merely needs to be a contributing cause to an injury or medical condition in order for it be covered under our workers’ compensation laws. Nebraska’s relative permissive causation standards stand contrast with more stringent causation standards in neighboring states.

But even if work needs to be a substantial or but for cause of an injury or medical condition, work duties can combine with other factors to be covered under workers’ compensation. The Supreme Court’s decision outlawing workplace discrimination based on gender identity and sexual orientation contained a great discussion about causation. In that case the court found that even a but for factor, a stricter standard than contributing factor, could combine with other factors to create legal liability.

Social media hoaxes and workers’ compensation

The COVID-19 causation kerfuffle shows once again why workers are ill-served by social media conspiracy-mongering and misinformation. Employers often attempt to suppress claims by telling workers that aggravations of old injuries are not covered. Some workers also self-suppress workers’ compensation claims by  believing that aggravations of old injuries aren’t covered or that work needs to be the only reason for a work related-injury or medical condition. The idea that a condition needs to be the sole cause of an injury or death feeds that misguided line of thinking.

Causation is only part of the battle for aggravations of old injury

Nebraska law has fairly permissive causation standards work injuries. But the Nebraska Supreme Court recently signaled it could be harder for workers who have been previously compensated for work injuries to be compensated for new injuries. While the re-emergence of apportionment of permanent disability benefits is a disturbing development, it would appear apportionment doesn’t apply to temporary disability or medical benefits.

But, Nebraska also allows employers to get out of paying workers’ compensation benefits by arguing misrepresentation. The defense is based on employees concealing the effects of prior injuries, employers relying on that misrepresentation and the employee getting injured due to their alleged misrepresentation. The misrepresentation defense is usually used against employees with old injuries. And unlike apportionment, misrepresentation is an absolute defense to paying all types of benefits under the Nebraska Workers’ Compensation Act.

The offices of Rehm, Bennett, Moore & Rehm, which also sponsors the Trucker Lawyers website, are located in Lincoln and Omaha, Nebraska. Five attorneys represent plaintiffs in workers’ compensation, personal injury, employment and Social Security disability claims. The firm’s lawyers have combined experience of more than 95 years of practice representing injured workers and truck drivers in Nebraska, Iowa and other states with Nebraska and Iowa jurisdiction. The lawyers regularly represent hurt truck drivers and often sue Crete Carrier Corporation, K&B Trucking, Werner Enterprises, UPS, and FedEx. Lawyers in the firm hold licenses in Nebraska and Iowa and are active in groups such as the College of Workers’ Compensation Lawyers, Workers' Injury Law & Advocacy Group (WILG), American Association for Justice (AAJ), the Nebraska Association of Trial Attorneys (NATA), and the American Board of Trial Advocates (ABOTA). We have the knowledge, experience and toughness to win rightful compensation for people who have been injured or mistreated.

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Ghosted by your workers’ comp. insurance company?

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The workers’ compensation insurance industry likes to talk about patient advocacy. But after a certain point in a claim, injured workers are often left hanging by insurance companies and the nurse case managers they hire to manage employee medical care.

Workers left in a lurch by insurers are often confused or ignorant about how to proceed in a claim. And surprise, surprise, insurers use this ignorance and confusion against injured workers.

Here are some common scenarios when injured workers get ghosted by insurers or nurse case managers in workers’ compensation claims.

Medical care

Employers have an affirmative and ongoing duty to offer medical care to injured workers. But what happens when a doctor, particularly, a surgeon states an employee is done with treating a work injury and employee is still in pain? Bluntly often this means that an employee stops getting treatment. But assuming an employee has the ability to get medical care outside of workers’ compensation, an employee still faces challenges.

If an employee seeks treatment for pain and that treatment is related to the injury, sometimes employers will argue that they don’t have to pay for that treatment. Nebraska Workers’ Compensation Court Rule 50 holds an employee is stuck with the doctor they chose at the beginning of the claim unless 1) the defendant denies medical care or 2) the parties agree to a change or 3) the court orders a change.

What constitutes a denial of care is a crucial question. Employers have an affirmative and ongoing duty to offer medical care to injured workers. The safest route for an employee is to ask the insurer to approve medical care. But that isn’t always possible if employees don’t have that information or adjusters don’t respond to inquiries. Insures also tend to ignore injured workers who don’t have a lawyer.

Arguably, not offering medical care is a denial of compensability, so an employee can chose to any provider doctor and have those bills paid. An ongoing and affirmative duty to offer care should mean an employer can’t get out of paying medical bills just because the stopped communicating with you about your claim. However, getting medical bills paid in that situation will probably involve hiring a lawyer and going to court. Many employees are intimidated by that process.

Why employers should offer you medical care

Employers have good reason to offer ongoing medical care. First of all, an injured worker can lose out on disability benefits if they decline medical care Neb. Rev. Stat 48-120(2)(c). By offering medical care, an employer can also maintain control over medical care. A recent case provides a good example of the protections that employers are entitled to if they offer medical care.

The Nebraska Supreme Court held in Rogers v. Jack’s Supper Club that an employer was not responsible for paying for bills incurred for treatment in Florida for an employee who moved from Nebraska to Florida. The court held so because the employee didn’t ask to formally change doctors from the court or the employer.

I think Jack’s Supper Club is a harsh result. I believe Neb. Rev. Stat. 48-120(6) gives judges broad latitude to order changes of doctors under Rule 50.  But in that case the defendant actually offered medical care to the injured employee. Arguably, the defendant in that case, met their affirmative duty to offer medical care and did not deny compensability.

Aren’t they supposed to pay me something?

While employers have a duty to offer you medical care for a work injury, their duty is less clear when it comes to paying permanent disability benefits. Again, insurers and nurse case managers tend to disappear after surgical care ends. Usually when a surgeon releases an injured worker from care they are deemed to be at maximum medical improvement or MMI.

I’ve written quite a bit about employers/insurers short change employees by ending payment of temporary disability and delaying payment of permanent disability. But that squeeze or delay presumes an employee actually gets paid permanent disability. In order to get paid disability for an injury to a specific body part, a doctor generally needs to give an impairment rating. But usually someone needs to ask for and pay for an impairment rating.

Often times insurance types just don’t ask for the impairment rating. Once they insurer gets an impairment rating, they have 30 days to pay the value of the impairment rating to an injured worker. But they don’t have a spelled out duty under Nebraska law to ask for an impairment rating the same way they have a duty to offer medical care.

I would argue the beneficent purpose of the Nebraska workers’ compensation act would give insurers a duty to ask for an impairment rating. But it might be up to the Unicameral to impose that duty on insurers.

Do I have an impairment rating for my injury?

If you had surgery, you almost certainly have an impairment rating. That impairment rating is likely worth at least a few thousand dollars of tax free money. If you have had surgery there is a reasonable possibility you will need some medical care in the future. Impairment ratings and future medical care cost insurance companies money. One reason that insurers and employers ghost injured workers is that they are hoping they won’t make additional claims or ask for payment of benefits that they are owed.

The offices of Rehm, Bennett, Moore & Rehm, which also sponsors the Trucker Lawyers website, are located in Lincoln and Omaha, Nebraska. Five attorneys represent plaintiffs in workers’ compensation, personal injury, employment and Social Security disability claims. The firm’s lawyers have combined experience of more than 95 years of practice representing injured workers and truck drivers in Nebraska, Iowa and other states with Nebraska and Iowa jurisdiction. The lawyers regularly represent hurt truck drivers and often sue Crete Carrier Corporation, K&B Trucking, Werner Enterprises, UPS, and FedEx. Lawyers in the firm hold licenses in Nebraska and Iowa and are active in groups such as the College of Workers’ Compensation Lawyers, Workers' Injury Law & Advocacy Group (WILG), American Association for Justice (AAJ), the Nebraska Association of Trial Attorneys (NATA), and the American Board of Trial Advocates (ABOTA). We have the knowledge, experience and toughness to win rightful compensation for people who have been injured or mistreated.

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