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Appellate court rules: employer must pay medical expenses in workers’ compensation case

The Appellate Court of Illinois recently decided an important workers’ compensation case. The court denied an employer’s request for a rehearing in a case concerning the issue of whether the company’s intent was to stipulate to payment of certain rates for the medical treatment expenses of an employee. 

The court upheld the award of benefits to the worker and ordered the Workers’ Compensation Commission to reconsider the worker’s reimbursement request for his home modifications.

The claimant, Jeffrey Berman, was employed as a food-service manager by Compass Group. He injured his back on March 19, 2009 while picking up a 40-pound box of bottled soda. A subsequent fall led to extensive complications that required hospitalization. The claimant was awarded benefits, and the employer stipulated to a fee schedule for payments for medical expenses.

In legal settings, “stipulation” refers to an agreement between the attorneys on either side of the case about certain facts and issues. The agreements are voluntary, and they are usually intended to save time in courtroom disputes. In this case, the two sides stipulated to issues concerning the company’s obligations to its employee.

On appeal, Compass Group argued that the medical expenses should have been based on a negotiated rate rather than a fee schedule. However, the court ruled that the fee schedule must stand, because the company had entered into a stipulation agreeing to it.

The claimant also cross-appealed, arguing that it was improper for the Commission to reject his claim for reimbursement for home modifications that he undertook himself based on the recommendation of a physical therapist. The Commission rejected his claim because the modifications were not recommended by a doctor. The court ruled, though, that the recommendation of a doctor is not always required, and remanded the case for further proceedings on that issue.

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Illinois workers’ compensation medical fee schedule under scrutiny

In 2011, an across-the-board 30 percent cut was implemented in medical fee schedules for the Illinois workers’ compensation system. Some observers say that medical fees in the workers’ compensation system are now so low that doctors and other medical professionals may be reluctant to treat injured workers.

Doctors report that workers’ compensation payments are now lower than Medicare rates, which has an impact on access to medical care.

A study by the Workers Compensation Research Institute, a think tank funded by the insurance industry, found that prices for surgeries in the workers’ comp system remain high, while the cost of office visits may be too low.

The report claimed that if workers’ compensation prices are set below prices paid by group health insurers or Medicare, then injured workers may not have access to care. However, if prices are set higher than for other payors, then they could be lowered without affecting access to care.

The report also compared prices paid for nonhospital professional medical services and for group health prices and Medicare rates after the 2011 fee reduction. A significant difference between surgery costs and office visits was found.

The average workers’ compensation office visit cost for a condition of low or moderate severity was $62, $14 less than the estimated group health care plan price and $11 below the Medicare rate. Researchers said that policymakers should consider whether the lowered fee schedule may impair access to care.

IWCC rules a close call insufficient for a mental disability claim

The Illinois Workers’ Compensation Commission recently ruled against a train operator who claimed a mental disability based on the trauma of believing that the train he was operating had struck and killed a pedestrian.

The worker was operating a train exiting a tunnel when he observed two young men running across the tracks. The operator was not able to stop the train, and he heard a thumping noise that caused him to believe that the train had run over and killed one of the men. However, upon exiting the train, the operator observed the two men running away.

The train operator sought psychological counseling for sleep disturbance, anxiety, flashbacks, fatigue and headaches. He also sought workers’ compensation benefits for a psychiatric disability.

The arbitrator in the case denied the worker benefits, finding that he was not exposed to a severe and sudden emotional shock. The arbitrator’s decision was confirmed by the commission.

The commission held that the operator had testified credibly as to the events. However, because the injured man was able to stand up under his own power, jump a fence and run away, the operator did not face the emotional shock of witnessing the aftermath of what he believed had happened.

In addition, the commission agreed with the arbitrator’s finding that the alleged mental disorder did not arise from a situation beyond the usual emotional tension and strain that workers must experience, particularly those who operate motorized vehicles.

Illinois Appellate Court Rules on Disability of Paramedic Trainee

The Illinois Appellate Court has issued a judgment ruling that affirms part of and reverses part of a trial court’s decision regarding a workers’ compensation claims. The worker in question had been training with the city of Chicago to become a paramedic.

Joseph Locasto was employed by the city of Chicago as a trainee at the Chicago Fire and Paramedic Academy,where he was training to become a paramedic for the Chicago Fire Department. In May 2008, after two days of intense training that Locasto claims included military-style hazing and long periods of continuous physical exercise with limited water breaks, he experienced leg cramping and discolored urine. 

Locasto went to the emergency room, where he was diagnosed with acute kidney failure, rhabdomyolysis and compartment syndrome. Rhabdomyolysis is a condition that causes the kidneys to stop functioning, and it can be caused by overexertion and dehydration. The condition affected Locasto’s ability to work, and he claimed disability benefits. A retirement board found that the claimant had made a full recovery by August 3, 2009.

The trial court awarded temporary total disability for time periods prior to August 3, 2009. That judgment was affirmed by the appellate court. However, the trial court confirmed a ruling by the Illinois Workers’ Compensation Commission that awarded benefits for temporary partial disability and temporary total disability after August 3, 2009, but the appellate court reversed that judgment.

Illinois Appellate Court Affirms Police Officer’s Workers’ Comp Claim

The Illinois Appellate Court has affirmed the decision of the Illinois Workers’ Compensation Commission — and therefore, upheld an award of benefits to a community service officer who was injured when he fell down a flight of stairs at a police station. The appellate court agreed with the original decision that the officer’s employment put him at a greater risk of injury.

In Village of Villa Park v. Illinois Workers’ Compensation Comm’n, the Village of Villa Park appealed an order from the circuit court, which confirmed the Commission’s award of benefits to community service officer John Simons. The circuit court found that his injury arose out of and in the course of his employment.

Simons was injured on April 5, 2007 while he was on duty at a Village police station. As a community service officer, he performed duties that included parking enforcement, police officer backup and accident reports. Simons’ knee gave out as he descended a staircase, and he sustained injuries to his lower back and right knee. He was treated at the Elmhurst Hospital emergency room.

Simons had injured his knee in a prior fall unrelated to his employment, and another officer observed that Simons was walking with a limp prior to the fall at work. However, a different officer testified that he had not noticed Simons limping before the accident.

Usually, risks personal to an employee are not compensable unless the employment places the worker at a greater risk. Simons’ case revolved around whether an exception applied to the general rule of noncompensability for injuries caused by personal risk. The appellate court agreed with the original ruling and held that the officer’s employment put him at a greater risk of injury than the general public and that his injury arose out of and in the course of his employment.

USPS facility in Illinois cited for safety violations

The Occupational Safety and Health Administration of the U.S. Department of Labor cited a U.S. Postal Service facility in Champaign, Illinois for eight safety violations. The administration proposed fines of $144,000. During a June 2013 complaint inspection, inspectors found a lack of fall protection and energy control procedures that exposed employees to increased risk of work injuries.

The inspection found safety violations in the training provided for stopping equipment before clearing jams. Inspectors found that workers were exposed to amputation and laceration hazards due to the potential for unintentional operation of the conveyor while jams were being cleared.

The citations included four repeat violations, including failure to ensure that each device had a tagout or lockout device affixed by authorized employees and failure to conduct inspections of energy control procedures. Other violations included failure to ensure the uniform height of stairway risers and inadequate fall protection for workers clearing jams on a conveyor.

Three violations were cited as “serious,” meaning that there is a substantial probability that serious physical harm or death could occur as the result of a hazard of which the employer was aware or should have been aware.

The Champaign facility employs 294 workers. About 434,000 people work for the Postal Service nationwide.

Family of Junior Seau objects to NFL concussion settlement, says wrongful death claims should be treated differently

The family of Junior Seau, an NFL player who committed suicide in 2012, has objected to the league’s $760 million proposal to settle a lawsuit by thousands of former players over the risk of concussion injuries. Seau’s family said that wrongful death claims should be treated differently from injury claims.

The deal has already been rejected by a federal judge, who felt it did not allocate enough money for such a large group of plaintiffs. Under the terms of the proposed settlement, $5 million would be allocated for each former player with a diagnosis of a brain condition caused by repeated blows to the head during NFL practice and play. However, attorneys for Seau’s family said that only a minimal payment of a few thousand dollars would be available for family members of retired or deceased players.

Seau died in 2012 from a self-inflicted gunshot to the chest. Later studies of his brain confirmed that he suffered from chronic traumatic encephalopathy, or CTE, a brain disease that results from repeated head trauma and that can cause dementia and aggressive behavior.

The lawsuit, filed in federal court in Philadelphia, has 4,500 plaintiffs. Up to 20,000 former players could eventually receive payment.

After the judge’s rejection of the NFL’s settlement offer, experts said that the league would likely have to negotiate a higher settlement. Seau’s family asked the judge to take their concerns into account in deciding on future settlement proposals.

Proposed legislation would limit workers’ comp

In Illinois, legislation has been proposed that would limit employees’ ability to receive workers’ compensation for injuries sustained in accidents on the way to work.

State Sen. Kyle McCarter (R, Lebanon) introduced Senate Bill 2622, which would prevent requirements for employers to provide workers’ compensation if a worker was not traveling specifically for work purposes when he or she was injured.

The proposed law states that an injured worker may only receive compensation if the injury “arises out of and in the course of employment” and while the worker is “actively engaged in the duties” of his or her employment.

The legislation would deal with cases such as one recently decided by the Illinois Supreme Court, in which a Springfield pipefitter accepted a temporary job at a Rock Island County power plant. The worker stayed in a motel to avoid the 200 mile commute. On the way to work, the man and a coworker hit an icy patch of road and crashed. The worker was seriously injured.

The Illinois Workers’ Compensation Commission found that the worker should receive compensation, but the state high court ruled that the worker made a personal decision to take the job knowing the length of commute required, and that he was therefore not a traveling employee.

Senate Bill 2622 was introduced before the Supreme Court ruling.

Railroad companies ordered to pay back wages to injured workers after whistleblower investigation

After a whistleblower investigation by the Occupational Safety and Health Administration (OSHA), the agency ordered two railroad companies to pay back wages to five injured, suspended workers.

OSHA found that Union Pacific Railroad Co. and Grand Trunk Western Railway Co. violated federal law by disciplining and/or suspending the five employees after reports of workplace illnesses or injuries. The companies disciplined the workers and suspended them for between one and 60 days with no pay after they reported illnesses or injuries.

An OSHA spokesperson said that companies may not retaliate against workers for reporting a workplace injury, and that this type of retaliation was far too prevalent in the railroad industry.

The companies were ordered to pay the employees compensatory and punitive damages, back wages plus interest and attorney’s fees. In addition, the disciplinary information must be removed from the workers’ personnel files, and the companies must post information about whistleblowers’ rights in the workplace.

Grand Trunk Western was ordered to pay four workers, including three conductors and a carpenter, a total of $85,580. Union Pacific was ordered to pay one worker $11,289.68 along with interest and attorney’s fees.

OSHA is responsible for enforcement of the whistleblower provisions of 22 separate statutes that protect workers who report specific violations of the law in certain industries. Workers who believe they have been victims of retaliation may request an OSHA investigation.

OSHA launches probe of worker injury at snowboard park

A federal investigation has been launched into an accident at a snowboard park in which a young worker suffered a serious injury to his arm. The Occupational Safety and Health Administration (OSHA) announced the investigation.

The teenage worker’s arm became stuck in a conveyor lift at Raging Buffalo Snowboard Park and Ski Area in Algonquin. A coworker found the injured employee stuck in the conveyor lift at the top of a ski hill. First responders needed approximately one hour to free his arm by cutting through the lift. According to authorities, the injured employee was then airlifted to Advocate Lutheran General Hospital in Park Ridge.

More than 30 emergency personnel and nine emergency vehicles responded to the scene.

An OSHA spokesperson said that investigators will attempt to determine if there were any safety violations involved in the incident. The investigation is expected to last up to six months and will involve inspections of the machinery, interviews with employees and a determination of whether the worker was trained to work on the lift.

The investigation will also examine whether there was a lock-out mechanism installed with the equipment to prevent it from operating while being serviced.

The park is permitted to operate while the investigation continues.

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The law firm of Briskman Briskman & Greenberg represents injured people throughout Illinois, including Chicago, the Chicagoland area, Joliet, Waukegan, Cicero, Evanston, Arlington Heights, Wheaton, Bolingbrook, and Naperville, as well as other cities within Cook County, Will County, DuPage County, Lake County and McHenry County. Briskman Briskman & Greenberg also represents injured people throughout Wisconsin, including Kenosha, Milwaukee, and Madison.
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