Category Archives: Workers Compensation

Fee Schedules: A defense of bureaucracy in workers compensation

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Former New Jersey Governor Chris Christie

Lawyers on “both sides of the v.” in Nebraska like to grumble about rules and regulations imposed by the workers’ compensation court.

But ideally rules make the workers’ compensation claims process easier. A good example of the benefit of some bureaucracy in workers’ compensation would be the fee schedule for medical bills required by statute and developed by the court on an annual basis. In simple terms, the fee schedule determines what an employer/insurer is required to pay for medical services in a workers’ compensation claim. The fee schedule eliminates disputes over what constitutes a  fair and reasonable charges in a Nebraska workers compensation case and in many  other states.

Contrast this with New Jersey, a state that doesn’t have a fee schedule in workers’ compensation. In New Jersey courts must determine fair and reasonable charge on a case by case basis. In fact, thanks to a reform put in place by former Governor New Jersey Governor Chris Christie, nearly 20 percent of workers’ compensation cases filed in New Jersey involve disputes between medical providers and insurers/claims administrators over medical charges.

One leading New Jersey workers’ compensation defense firm predicted, almost gleefully, that soon 1/3rd of workers’ compensation cases in the Garden State will involve cases between medical providers and insurers/claims administrators over medical charge. I hate to sound cynical, but as work injuries continue to decline, workers’ compensation defense lawyers can grind billable hours in what amount to commercial disputes between doctors and insurance companies .

Putting aside jibes at the defense bar, a lack of a fee schedule means more time and expense proving up what is a fair and reasonable charge versus spending that time and expense on proving compensability and nature and extent of disability. Plaintiffs who aren’t being paid benefits or receiving medical care have to wait for a court date while doctors and insurers spend court time arguing whether an insurer has to pay $.73 on the dollar for a procedure or $.87 on the dollar for a procedure. (By the way the decision in that case was 21 pages single space in a small font.)

Uncertainty over reimbursement for workers’ compensation services would also discourage medical providers for treating workers’ compensation patients. In my experience a mutually agreed upon fee schedule for medical charges for workers’ compensation claims greatly simplifies workers’ compensation cases. An administrative solution on medical costs in workers’ compensation is much better than litigating the issue on a case by case basis.

The offices of Rehm, Bennett & Moore, 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.

This entry was posted in fee schedule, Nebraska, Workers Compensation and tagged , , .

Lincoln skywalks promote safety in all seasons

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Lincoln’s Skywalk system helps prevent slip and fall injuries in the winter.

As snow and ice return to Lincoln, discussions between downtown Lincoln businesses and city officials about the future of the Skywalk system become even more important to workplace safety.

The skywalks once served as an indoor mall in downtown Lincoln connecting stores, parking garages and hotels. (My mom worked at Miller and Paine in the 1970s and 1980s in a building that now houses Nelnet) The skywalks and buildings served by them mainly serve office workers in downtown Lincoln. I frequent the skywalks when I have work obligations downtown. Many major downtown employers, such as Nelnet, subsidize employee parking in various downtown garages. Employees can access those garages through the skywalks.

Downtown parking garages can also be accessed from the street. But with winter comes ice and the risks of slips and falls. The question becomes who would be responsible for a slip and fall when an employee is walking to and from a company assigned and subsidized parking spot off-site. Arguably a slip and fall in this situation would be covered under workers’ compensation under the “parking lot” rule articulated in Nebraska in Zoucha v. Touch of Class Lounge. It’s also possible that an employee injured while walking to and from employer subsidized public transportation, could have a workers’ compensation claim as well.

In theory, indoor walkways like the skywalk system would reduce the chances of slip and fall accidents. But from a recent observation, maintenance is lacking some parts of the Skywalk. I observed a leaky roof that lead to wet carpet on an internal walkway in the US Bank building in August.

I recently represented a downtown office worker who feared being assaulted walking to her parking spot late at night. Skywalks can help reduce the risk of employees being assaulted on the way to their cars.

My view is that downtown business owners and the city need to work together to maintain the skywalk system in the interest of worker safety.

The offices of Rehm, Bennett & Moore, 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.

This entry was posted in Lincoln, Nebraska, Workers Compensation and tagged , , , , , .

Be thankful for poultry workers, give them a safer workplace

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Most people were fortunate to sit down for the traditional Thanksgiving meal with turkey and all the trimmings this weekend. Stopping to reflect about what people are thankful for is a part of Thanksgiving.

People should be thankful for the people who make their meals possible.

Bloomberg reported before the holiday that turkey processors have been cited for safety violations 61 times by OSHA since 2011 and that poultry workers are 60 percent more likely to be injured on the job than the average workers. Debbie Berkowitz with the National Employment Law Project also pointed out that turkey processing can be more hazardous than chicken processing because turkeys tend to be larger than chickens.

Our firm has blogged quite a bit about the dangers of meat processing whether about poultry  or beef and pork which is more common in Nebraska and Iowa. OSHA and other government agencies like the USDA have recently announced plans that could increase the risk of injury to meat processing workers.  But even when  federal regulatory agencies were aggressive in protecting worker safety, many of an injured workers’ legal remedies – whether through workers’ compensation or anti-retaliation laws – stem from state law.

Much was made of the “blue wave” in November’s elections. Democrats picked up governorships and won control of state legislatures. Hopefully newly empowered Democrats will protect and expand worker safety and workers rights bills on a state level.

The offices of Rehm, Bennett & Moore, 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.

This entry was posted in Nebraska, OSHA, Workers Compensation and tagged , , .

Between a rock and a hard place: Hurt on the job with a non-compete agreement

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Jimmy John’s franchises in Illinois dropped non-compete clauses for their workers as part of a settlement with the Illinois attorney general

The Washington Post reported that janitors are being subject to non-compete agreements. Janitors join some Jimmy John’s franchise employees  as low wage employees who are or who have been subjected to non-compete agreements.

Non-compete agreements can be particularly daunting for injured workers. Oftentimes injured workers will quit the job where they were hurt and move to another job that is physically less demanding.  But a non-compete agreement can add more fear and uncertainty to the life of an injured worker who is already dealing with a work injury.

In Nebraska, non-compete agreements are somewhat difficult to enforce.  Nebraska outlaws restraints of trade by statute  and by case law. But non-compete agreements can be enforceable if they are reasonable in scope – for a limited time and geographic area – and ancillary to a contract of employment.

The general test of whether a non-compete is enforceable in Nebraska is that 1) not harmful to the public 2) not greater than necessary to protect employer’s legitimate interest and 3) not unduly harsh or oppressive to employee.

Courts in Nebraska tend to focus on whether the compete is too broad to protect the employer’s legitimate interest. A non-compete would likely to be held to be unenforceable under this clause if the employee had no personal or business contact with customers or prospective customers, didn’t know or have access to confidential information, has no skills or knowledge different than what they would have acquired in another business and the employer had no trade secrets regarding their industry.

The issue of whether a non-compete is unduly harsh to an employee is a separate issue. My feeling is that a good argument could be made that changing jobs as a way of essentially self-accommodating a work injury would fall into that category. I believe the Zweiner v. Becton-Dickinson East  case would bolster such an argument, but litigation is almost always uncertain and it can be costly. An injured worker looking at the prospect of a workers’ compensation claim may not be willing to take on a non-compete fight as well.

Even a low wage worker who isn’t hurt may not want to fight a non-compete on their own. Jimmy John’s franchises in Illinois only relented on their non-compete for their employees in the face of litigation from Illinois Attorney General Lisa Madigan. While I believe individual workers can fight non-compete clauses, I believe the issue of non-compete clauses and low wage workers would best be addressed in the legislative process. That means voting in legislators who have the best interests of employees in mind and at heart. Pay attention to who those candidates are and vote from them on November 6th.

The offices of Rehm, Bennett & Moore, 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.

This entry was posted in Nebraska, non-compete agreements, Workers Compensation and tagged , , .

Injured workers served poorly with AMA “cookbook” on causation

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DON”T GET ON THE AMA CAUSATION GUIDES SHIP!!!

My friends and colleagues on the WILG listserv were discussing the AMA Guides to the Evaluation of Disease and Injury Causation, 2nd edition. The consensus was that the new guidebook treats injured workers, to quote the President, very unfairly.

Lawyers in Illinois and Montana have encountered the AMA Causation Guide. I encountered the causation guide in Nebraska this spring/summer in Tapee v. Nestle (available on NWCC Decision and Order Search by clicking here). My experience was that the trial judge was not impressed by the opinions of an examining expert who relied generalizations from studies rather than looking at the particulars of my client’s injury.

A colleague in Montana seemed to have a similar experience.  Another weakness of the AMA Causation Guides is that doesn’t address the fact that states have different standards for medical causation. For example, even if it’s true that occupational causes aren’t a prevailing factor in causing carpal tunnel syndrome, that doesn’t matter in Nebraska because a worker only needs to show that occupational factors were a contributing factor to the injury.

Even among WILG members, the AMA Guide to Causation is still confused with the better known AMA Guides to Permanent Impairment that have been subject to numerous court challenges. The so-called AMA 6th has long been a target of plaintiff’s lawyers because of how it reduces compensation for many types of permanent injuries. When the AMA 6th came out about 10 years ago, plaintiff’s lawyers were good about educating courts about the problems with the AMA 6th.

Nebraska isn’t bound by the AMA Guides to Impairment, but courts often follow them in determining permanent disability for scheduled member impairment. In 2010, one trial judge criticized the AMA 6th in Endorf v. Chief Industries (click here for NWCC Decisions and Orders Search) But the insurance defense bar was relentless in pushing the AMA 6th and it is often used as a basis to pay permanent impairment in Nebraska despite early misgivings by some workers’ compensation judges.

I suspect the insurance defense bar will be as relentless in pushing the AMA Causation Guides. From discussion on the WILG listserv, it appears as if there is a nationwide push to use the AMA Causation Guides. The AMA Impairment Guides are sometimes referred to as a “cookbook”. (Hence the headline and artwork for this post) But at least in Nebraska where the AMA Guides to Impairment are generally just applied to so-called “scheduled members” that are paid on a loss of use basis, I can see why a judge may rely on those guides. (The distinction between scheduled member disability being paid on a loss of use basis and non-scheduled injuries being paid on a loss of earning power basis in Nebraska seems to be largely a judge-made distinction)

But causation would seem to be a different story. Causation would seem to be an issue that Judge’s would still want to decide on an individualized basis rather than deferring to a book. But prolonged use of the AMA Causation Guides may eventually lead to an informal heightening for medical causation standards by workers’ compensation judges. 

Maybe this is burying the lead, but the more acute danger is that stae legislatures will adopt the AMA Guides to Causation like they did with the AMA Guides to Permanent Impairment.

Plaintiff’s lawyers have some studies they can use to the counter the AMA Guides to Causation. The American Academy of Orthopedic Surgeons have compiled studies about carpal tunnel syndrome that would contradict the studies that form the basis of the AMA Causation Guide. Plaintiff’s lawyers may also want to bone up on rules regarding expert testimony. At least in Nebraska, those rules don’t govern admissibility of medical evidence, in workers’ compensation but they can certainly be helpful to a court in weighing medical evidence.  NWCC Rule 10 narrowly defines who can testify by written report in our workers’ compensation court. In my experience, “non-Rule 10 experts” can make good witnesses for the plaintiff on cross-examination.

Lawyers for injured workers need to see recognize the threat posed by the AMA Guides to Causation and make every available factual and legal argument against its application at every opportunity –whether in a courtroom, a legislative committe hearing, at a legal confernece and/or on social media.

 

The offices of Rehm, Bennett & Moore, 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.

This entry was posted in AMA Guides to Causation, AMA Guides to Impairment, Nebraska, Workers Compensation and tagged , , , .

Why are mental-mental benefits generally limited to first responders?

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Convenience store clerks are often exposed to violence. But in order for them to be compensated for work -related mental trauma, they generally need to have a physical injury.

The question of why coverage of so-called “mental-mental” injuries, or work injuries that do not involve a physical injury, is generally limited to first responders is a question that is increasingly vexing attorneys for injured workers and commentators on workers compensation — and workers.

The answer boils down to politics.

From a logical and moral point of view there is no reason why a convenience store clerk and a police officer shouldn’t be able to collect workers’ compensation for purely mental injuries from exposure to violent crime. 

Legally that moral and logical sentiment is often expressed as an argument that such distinctions violate equal protection under state and federal constitutions. Advocates for injured workers have had some success in striking down so-called workers compensation reforms on equal protection grounds.

But while equal protection arguments can be useful in restoring rights to workers compensation, they are less helpful in creating new rights such as compensation for mental injuries. When addressing whether a law is constitutional, appellate courts usually decide first on what level of scrutiny to apply. The less stringent the scrutiny, the more likely the court will find the law to be constitutional.

Health and safety laws like workers compensation are generally afforded rational basis scrutiny by appellate courts. That means courts will generally uphold the constitutionality of those laws. That deferential level of scrutiny emerged out of the New Deal era as a way to uphold the constitutionality of laws relating to social welfare. But in the modern era rational basis scrutiny is often used to argue that the protections of laws like workers compensation shouldn’t be expanded by courts in a way not intended by a legislature.

In Nebraska it was the legislature that created compensation for mental-mental injuries for first responders and expanded that protection to prison guards and Department of Health and Human Services employees in contact with high risk indviduals. So ultimately providing protection for purely mental injuries to all workers — not just first responders — will be a political issue.

 

The offices of Rehm, Bennett & Moore, 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.

This entry was posted in Nebraska, PTSD, Workers Compensation and tagged , , , , , , .

Nebraska Supreme Court rules on employment risk, attorney fees and third party claims

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The Nebraska Supreme Court has made three recent rulings about workers’ compensation

Three important cases have recently come down from the Nebraska Supreme Court regarding workers’ compensation claims.

Probably the case with the biggest impact is Maroulakos v. Walmart case. In that case, the Supreme Court affirmed a decision by the trial court that found that an injury was not compensable when a worker was injured because of an “idiopathic” fall. What makes this case distinct from its predecessors is that it appears as though there was possibly evidence that there was an increased risk to the injured worker, which could have made the idiopathic fall compensable. However, the trial court did not explore that option and the Supreme Court found that it could not make a determination on an issue that was not at issue during the trial court. In other words, it appears that the Maroulakos case puts an extra burden on the Plaintiff to ensure that an “increased danger” analysis is overtly pled and argued at trial for idiopathic falls. The concurrence in that opinion hints that the at the trial court level, the court probably should have conducted an analysis as to whether there was an increased-danger when there was evidence presented that could contribute to that analysis of an idiopathic fall.

Another recent case was Dragon v. Cheesecake Factory. In Dragon, the work comp case reached a settlement that was accomplished via a settlement release under Section 48-139(3). The settlement was not paid, however, within the 30-day limit proscribed in 48-139(4) and thus, the Plaintiff argued that he was entitled to a 50% penalty for the late payment. The trial court denied the penalty under a theory that it did not have authority to award a penalty after the release had already been signed. The Supreme Court overturned the finding of the trial court and awarded the penalty based on the fact that the Nebraska Legislature cleared up any ambiguity in the statute in awarding penalties for settlements that are not paid within 30 days.

The final case that recently came down worth discussing is Gimple v. Student Transp of America. In Gimple, there are two take-aways. First, if there is a third-party action, along with the work comp claim, the Work Comp Court does not authority to make a determination of future credits for the employer or work comp carrier based on any monies paid in that their-party action.

Second, if there is a stipulation and no dispute as to an injury; then, there is a permanent impairment assigned to that injury, the Defendant must pay the permanent partial disability in a timely manner, within 30 days. In other words, there is no reasonable controversy.

The offices of Rehm, Bennett & Moore, 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.

This entry was posted in attorney fees, employment risk, Nebraska, third party claims, Workers Compensation and tagged , , , , .