NWCDN Members regularly post articles and summary judgements in workers’ compensations law in your state.
Select a state from the dropdown menu below to scroll through the state specific archives for updates and opinions on various workers’ compensation laws in your state.
Contact information for NWCDN members is also located on the state specific links in the event you have additional questions or your company is seeking a workers’ compensation lawyer in your state.
Sanctions against an employer in workers’ compensation are rather rare, and the case ofPschunder-Haaf v. Synergy Home Care of South Jersey, A-3138-13T3, (App. Div. May 12, 2015) provides some guidance on conduct that may lead to such sanctions.
The petitioner, Pschunder-Haaf, a home health aide, injured her low back when a patient fell on her. She filed a workers’ compensation claim, and the Judge of Compensation entered an order requiring Synergy to provide medical and temporary disability benefits to her. The Judge also required an evaluation byDr. Luis Cervantes, a neurosurgeon. An order dated September 7, 2010 ordered treatment with Dr. Cervantes and continuing temporary disability benefits until either Dr. Cervantes cleared petitioner to return to work or until the company offered light duty authorized by Dr. Cervantes.
Synergy did not pay certain medical bills and terminated temporary wage benefits. There is no indication in the decision to suggest thatDr. Cervantes cleared petitioner to return to work or that petitioner returned to light duty work. Petitioner therefore filed a motion to enforce the prior court order. That led to a second order awarding petitioner temporary disability benefits, medical care, and counsel fees assessed against Synergy.
Fusion surgery followed, and petitioner alleged that she injured her left shoulder during the fusion surgery. Synergy did not accept the left shoulder injury alleged to derive from surgery, leading to another motion for medical benefits. Once again the Judge of Compensation ordered the company to provide treatment for the shoulder.
The petitioner amended the original claim petition to include injuries to her left shoulder and left knee. When Synergy failed to provide additional medical treatment, petitioner filed yet another motion. Her expert,Dr. Rosen, argued that her right leg gave way as a result of instability caused by radicular pain from her spine, and that in turn caused left knee problems.
The Judge of Compensation accepted the testimony of Dr. Rosen, petitioner’s expert, over that ofDr. Maslow, respondent’s expert, on the question of causation of the left knee condition. She ordered that Synergy provide treatment for the petitioner’s primary and derivative injuries. She denied Synergy’s motion for reconsideration and assessed sanctions of $5,000 and $10,000 against Synergy. She awarded petitioner $7,500 in counsel fees and $5,654.14 in reimbursement for expenses, including the cost ofDr. Rosen’s testimony, which was $4,500.
Synergy appealed both the order in respect to the derivative shoulder and knee claims and the sanctions. First, the Appellate Division found that there was credible evidence to support the judge’s decision that the derivative claims arose from work.
Second the court noted that there was substantial evidence in the record to support the judge’s conclusion that the shoulder was injured during the fusion procedure, and the left leg was injured because the right leg kept giving out due to radicular pain from petitioner’s work-related back condition.
On the sanctions issue, however, the Appellate Division took issue with some of the court orders. First, it noted that the Administrative Rules of the Division of Workers’ Compensation allow fines and penalties in an amount not to exceed $5,000 for unreasonable delay or continued noncompliance. The Court vacated the $10,000 sanction because it exceeded the amount contained inN.J.A.C. 12:235-3.16(h)2. Next, the Court focused on the award for costs of $800 and $4,500, the latter being the expense ofDr. Rosen’s testimony. It cited N.J.S.A. 34:15-64(a), which limits the fee to an evaluating physician likeDr. Rosen to $400 for the report and another $400 for testimony. It found that the order for costs was in excess of the amounts allowed by the statute.
The Court did affirm the $5,000 sanction against Synergy and the assessment of counsel fees of $7,500.
The case is important for practitioners because it is one of a very few appellate decisions that focuses on sanctions and costs as well as the statutes and rules that apply. Employers run the risk of sanctions if they choose to disregard a court order as opposed to filing a motion to be relieved form the court order.
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John H. Geaney, Esq., is an Executive Committee Member and a Shareholder in Capehart Scatchard's Workers’ Compensation Group. Mr. Geaney concentrates his practice in the representation of employers, self-insured companies, third-party administrators, and insurance carriers in workers’ compensation, the Americans with Disabilities Act and Family and Medical Leave Act. Should you have any questions or would like more information, please contact Mr. Geaney at 856.914.2063 or by e‑mail at jgeaney@capehart.com.
Alphonso Myers worked as a security guard and was injured in that position. He applied for and received social security disability benefits. In his application, he advised the Social Security Administration that he was in pain all the time during the period of his application, he could only stand for twenty minutes and could only walk for 10 to 15 minutes. He said sometimes his pain was so severe that he needed to remain at home and lie down. Since 2005 he was unable to lift more than 10 pounds.
While Myers was applying for social security disability benefits, he was also applying or a job withKnight Protective Service for a position as an armed security guard. As part of the post-offer process, Myers indicated he had no relevant disabilities. A supervisor noticed that Myers seemed to be in pain on the job. Myers admitted that he had undergone neck and back surgeries and had recurrent pain. The supervisor became concerned that Myers was not fit for the job of a security guard because someone might grab his weapon or even take him hostage. Myers was told that the company wanted him to pass a fitness examination.
For reasons that are unclear, the company never set up the fitness examination, and Myers felt that he was effectively terminated by the company. He sued under theADA and claimed that he was discriminated against based on disability. The trial court rejected his suit, and Myers appealed. The U.S. Court of Appeals, 10th Circuit, affirmed the dismissal of the law suit.
First, the court said Myers was not able to show that he was qualified for the position that he sought atKnight Protective Service. “As he acknowledged in his written application with Knight, the essential functions of his job as an armed security guard required him to engage in frequent and prolonged walking, standing, and sitting; to react quickly to dangerous situations; to subdue violent individuals; and to lift heavy weights.”
The court emphasized that Myers represented to the Social Security Administration that he was in pain frequently and could often only stand for 20 minutes. “When a plaintiff makes seemingly inconsistent statements like those before us he must offer a ‘sufficient explanation’ for the apparent contradiction.” The court made clear that every plaintiff should have an opportunity to explain apparently contradictory statements on a social security application under the case ofCleveland v. Policy Mgmt. Sys. Corp., 526U.S. 795, 805 (AD Cases 941) (1999). But in this case Myers was unable to reconcile his statements to the Social Security Administration with his assertions in court that he could do his job. In fact, there was no dispute that since 2005 Myers had been unable to lift more than 10 pounds.
The lessons from this case are worth remembering. First, there is great value in post-offer medical examinations. Fitness-for-duty examinations are also invaluable, but the mistake the company made in this case was not setting up the examination. Secondly, employers who face workers’ compensation or disability discrimination suits should always pursue the records of any social security application. In the workers’ compensation context, employers who may be confronted with fitness issues should always read the claimant’s statements to the various IME physicians as well as the statements that the claimant makes in court regarding limitations in work or non-work activities. Sometimes claimants make statements in workers’ compensation court or to IME physicians that suggest that the job is continuing to injure them or that they cannot perform the duties of the job safely. All too often this information does not get to the insured.
This case can be found at Myers v. Knight Protective Serv., Inc., U.S. Court of Appeals, Tenth Circuit, No 12-6056 (December 22, 2014).
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John H. Geaney, Esq., is an Executive Committee Member and a Shareholder in Capehart Scatchard's Workers’ Compensation Group. Mr. Geaney concentrates his practice in the representation of employers, self-insured companies, third-party administrators, and insurance carriers in workers’ compensation, the Americans with Disabilities Act and Family and Medical Leave Act. Should you have any questions or would like more information, please contact Mr. Geaney at 856.914.2063 or by e‑mail at jgeaney@capehart.com.
I reported last year on the cases summarized below and all three in one way or another have involved an attack on the constitutionality of all or portions of Florida’s workers’ compensation laws. Since the last report these cases have made their way through the appellate process and we now await the decisions of the Florida Supreme Court for all three. The current status is summarized below.
Florida State Circuit Court Judge Determines the Exclusive
Remedy Provision of the Workers Compensation Act Is Unconstitutional
On August 13, 2014, a circuit civil court judge in Miami-Dade County entered an Order on Amended Motion for Summary Final Judgment in the case ofFlorida Workers’ Advocates & Elsa Padgett v. State of Florida. Procedural issues resulted in what was essentially an unopposed lawsuit filed by the injured worker’s attorney. The order declared Florida’s workers’ compensation law in its entirety (Chapter 440, Florida Statutes) to be unconstitutional so long as §440.11 remains a constituent part of the law as a whole.
Plaintiffs’ argument in Padgett is neatly distilled by their own words: “Your movant's main complaint is that if an injured worker, after reaching maximum medical improvement has a loss of wage earning capacity that is not total in character it will go uncompensated under the 2003 Florida Act. The injured worker would have had to wait until he reached maximum medical improvement and tested the labor market before he knew that he not only had the right to be compensated for his disability but that he would not get any benefit for his loss in the workers' compensation scheme. Padgett, FWA and WILG pray for a judgment holding the exclusive remedy provision ins. 440.11 Fla. Stat. 2003 invalid and unconstitutional so that all injured workers in Florida may have the option of either a tort or a workers' compensation recovery at the outset.”
Unimpeded by the absence of a defense, the Padgett trial court concluded that the legislative changes to Chapter 440 that began a shortly after Florida’s 1968 Constitution was enacted and continued sporadically through the 2009 legislative session have removed rights without offering equivalent alternatives thereby violating the mandate of Florida’s 1968 state Constitution. This resulted in the court’s declaration that:
“As a matter of law, Chapter 440, effective October 1, 2003 is facially unconstitutional as long as it contains §440.11 as an exclusive replacement remedy. I find that the Florida Workers’ Compensation Act, as amended effective October 1, 2003, does not provide a reasonable alternative remedy to the tort remedy it supplanted. It therefore cannot be the exclusive remedy. §440.11 is constitutionally infirm and invalid. IT IS ORDERED AND ADJUDGED, that Declaratory Relief is GRANTED. Judgment is entered for Petitioners/Intervenors. §440.11 Fla. Stat. 2003 is unlawful, invalid and unconstitutional.”
With no defense to better inform the trial court judge, the outcome was probably inevitable.
Normally an appeal of a case involving workers’ compensation benefits would go to Florida’s First District Court of Appeal as it is the intermediate appellate court to which all appeals from decisions of a judge of compensation claims must go for review. However, because this case was not specifically about particular workers’ compensation benefits but rather an effort to wage an attack on the constitutionality of legislative changes to Chapter 440 (including attorney’s fees payable to claimant lawyers in workers’ compensation claims), the appeal from the trial court was to Florida’s Third District Court of Appeal instead. The case number is 3D14-2062. The appeal has been fully briefed as of March 13, 2015 and oral argument was held on March 30, 2015. Participation in the appeal was, as would be expected, considerably more populated than in the trial court with numerous amicus appearing on behalf of one side or the other. We anticipate a decision within the next six months.
Rob Grace, however, has twice prevailed in trial court on similar claims, including one brought by the same plaintiff attorney in the same jurisdiction asPadgett was brought. Rob secured a dismissal of the claims both times and his victory inDigrius v. Anchorage Resort & Yacht Club (16th Judicial Circuit Case No. CAP13998 / 442013CA000998A001PK) is now on appeal with the very same Third District Court of Appeal that has thePadgett case. The appeal was filed March 31, 2015 and thus remains in infancy stages. We expect that various amici will appear for both sides and that resolution will be later this year or early next year.
Employers Be Careful About Denials Based on
Course and Scope, Employment Relationship or Inconsistent Positions
The attacks on Florida’s workers’ compensation exclusive remedy provision are not limited to cases likePadgett where the objective is a wholesale destruction of Chapter 440. As with most if not all workers’ compensation systems, Florida law requires that the accident and resulting injury(ies) arise out of the course and scope of employment for Chapter 440 to apply. When the employer/carrier responds to a claim with the assertion that the accident and/or injury is not connected to the course and scope or they assert denials that are inherently at odds (i.e. no course and scope coupled with defenses based on employment), they can be relatively certain that a civil suit will follow and that an estoppel analysis will be undertaken by the trial, and most likely later the appellate, court.
Picon v. Gallagher Bassett Services, Inc., 548 Fed.Apps. 561 (11th Cir. 2013) does an excellent job of reviewing eight Florida appellate court cases in which the exclusive remedy was involved. Of the eight cases, six were decided favorably to the injured employee and two favorably to the employer/carrier. The six cases that favored the injured employees involved assertions by the employer/carriers that no accident happened in the “course and scope of employment” either standing alone or combined with other defenses inconsistent with the course and scope of employment denial. See, e.g.,Elliott v. Dugger, 542 So.2d 392 (Fla. 1st DCA 1989); Byerly v. Citrus Publishing, Inc., 725 So.2d 1230 (Fla. 5th DCA 1999);Schroeder v. Peoplease Corp., 18 So.3d 1165 (Fla. 1st DCA 2009); Coastal Masonry v. Gutierrez, 30 So.3d 545 (Fla. 3d DCA 2010);Mena v. J.I.L. Construction Group Corp., 79 So.3d 219 (Fla. 4th DCA 2012);Ocean Reef Club, Inc. v. Wilczewski, 99 So.3d 1 (Fla. 3d DCA 2012)(for case distinguishingOcean Reef see VMS, Inc. v. Alfonso, 147 So.3d 1071 (Fla. 3d DCA 2014)).
The two cases that favored the employer/carriers did not have such an assertion. SeeTractor Supply Co. v. Kent, 966 So.2d 978 (Fla. 5th DCA 2007); Coca-Cola Enterprises, Inc. v. Montiel, 985 So.2d 19 (Fla. 2d DCA 2008).
Thus, it is fair to say that if/when an employer/carrier chooses to assert that the alleged accident was not connected to the “course and scope” of the employee’s employment there will likely be a tort suit following and the employer/carrier is equally likely to find themselves losing any motion for summary judgment based on the workers’ compensation exclusive remedy principle. Instead, a judge or jury will make the decision after completion of a full blown trial because, as thePicon court noted, “[w]hen the record reveals multiple possible explanations for the denial, or the language in the denial document is ambiguous and gives rise to more than one interpretation, issues of material fact exist over whether the employer’s position is inconsistent so as to indicate possible estoppel.”
Landmark Attorney Fee Case Makes its way to Florida Supreme Court
Marvin Castellanos vs. Next Door Company, Et Al.
Florida Supreme Court Case No. SC13-2082
Lower Tribunal Case Citation 124 So. 3d 392 (Fla. 1st DCA 2013)
This is the case which the Florida Supreme Court has for review on discretionary jurisdiction in which the 2009 attorney’s fee statute (Florida Statute §440.34) was declared constitutional by Florida’s First District Court of Appeal but certified to involve a question of great public importance. The appeal was filed in October, 2013, briefed by the parties and various amicus, and oral argument conducted on November 5, 2014. Since that time, notices of supplemental authority have been filed with the Florida Supreme Court, mostly providing additional one paragraph decisions from Florida’s First District Court of Appeal passing along similar cases with essentially identical opinions. The approach in this case, as in others like it, is a broad deployment of various theories such as violations of constitutional rights of separation of powers, right to be rewarded for industry, free speech, free association, due process, and equal protection. It also makes the argument akin to what was deployed in theFlorida Workers’ Advocates case summarized above, i.e. the cumulative effect of changes has stripped Chapter 440 of benefits in a way that no longer provides a reasonable alternative to common law negligence remedies. Our firm handled the appeal on behalf of the Employer/Carrier in a similar case which has been stayed by the Florida Supreme Court, pending resolution ofCastellanos, after being affirmed per curiam by the First District Court of Appeal.
With the appellate process having ended six months ago, other than the supplemental authority filings, we expect something to happen relatively soon. There has been some discussion of convening a special legislative session aimed at trying to get the various parties to agree to a solution that would avoid the possibility of a constitutional ruling on §440.34. As of this update, this possible effort remains ill-defined and uncertain. If there is no legislative intervention, then the Court will ultimately issue its decision. What that decision will be and what, if anything, the Court might do to cure any perceived constitutional infirmity is anyone’s guess. It is most unlikely that the entire statute would be scrapped, and more likely that the Court might roll back to the latest version of the statute that the Court finds to not be problematic, to simply engraft Florida’s seminal case on reasonable attorney’s fees on to the current statute (Lee Engineering & Const. Co. v. Fellows, 209 So. 2d 454 (Fla. 1968)), or to fashion another remedy which does not visit chaos upon the system. I represented the E/C/SA one of the many companion cases toCastellanos.
First District First Strikes, Then On Reconsideration Upholds, Florida’s
104 Week Limit On Temporary Benefits – Now Before Florida Supreme Court
Bradley Westphal v. City of St. Petersburg, Etc., Et Al.
Florida Supreme Court Case No. SC13-1930 & 1976
Lower Tribunal Case Citation 122 So. 3d 440 (Fla. 1st DCA 2013)
Florida’s workers’ compensation law provides for wage loss benefits comprised of (1) temporary partial disability benefits (TPD) payable when the employee cannot work regular duty but can work modified duty; (2) temporary total disability benefits (TTD) when the employee cannot work at all but is expected to be able to return to work; (3) permanent impairment benefits which were intended to provide monetary compensation for a permanent impairment of working skills; and (4) permanent total disability benefits (PTD) payable when an employee is unable to work at least sedentary duty within a 50 mile radius of his or her home. See Florida Statute §440.15. Benefits #1 and #2 are available onlybefore a claimant is at overall MMI and the claimant cannot get more than 104 weeks of these benefits combined. Benefits #3 and #4 are available onlyafter a claimant is at overall MMI.
The same judge of compensation claims assigned to Mr. Westphal’s claim had previously been assigned a very similar claim and in the previous claim had concluded that “that the Legislature did not intend to leave a claimant such as Mr. Hadley out in the cold with no basis for indemnity benefits when that worker is totally disabled for more than 104 weeks.” He therefore declared that claimant to be entitled to permanent total disability benefits even though the claimant was not at MMI. This resulted in an appeal and ultimately an opinion from the First District Court of Appeal en banc reversing the judge of compensation claims and ruling that the benefits gap was not an infirmity. SeeMatrix Employee Leasing, Inc. v. Hadley, 78 So. 3d 621 (Fla. 1st DCA 2011).
Faced with the same issue in Mr. Westphal’s case the judge of compensation claims followed the mandate ofMatrix Leasing and denied PTD benefits to Mr. Westphal. From this decision Mr. Westphal’s case moved to the First District Court of Appeal. The First District initially issued an opinion that was consistent withMatrix Leasing. The Court then reconvened en banc, withdrew the previous opinion, receded fromMatrix Leasing, and ruled that “a worker who is totally disabled as a result of a workplace accident and remains totally disabled by the end of his or her eligibility for temporary total disability benefits is deemed to be at maximum medical improvement by operation of law and is therefore eligible to assert a claim for permanent and total disability benefits.” In so doing, theWestphal court said it was “unnecessary to consider the claimant’s argument that the statute, as we previously construed it inHadley, is unconstitutional as a denial of the right of access to the courts.”
The case is now with the Florida Supreme Court. It was fully briefed as of March 26, 2014 and oral argument was held June 5, 2014. Given the time the case has been pending before the Court post-oral argument, it would seem reasonable to expect a decision sooner rather than later.
David A. Lamont, Esquire
Workers’ Compensation Partner, The Bleakley Bavol Law Firm
Cousineau McGuire Shareholder Jennifer Fitzgerald, OfficerNatalie Lund, and AssociateElizabeth Cox will be presenting at the 2015 Minnesota Department of Labor and Industry (DOLI) Workers' Compensation Summit at Cragun's Conference Center in Brainerd, MN on Wednesday, June 17, 2015.
Their presentation is titled "Litigating and Settling Claims", and takes place at 2:30pm on June 17th. For more information and to register, please visit the DOLI website:
Natalie K. Lund, Workers’ Compensation, andMichael D. Sharkey, Civil Litigation, have both been promoted to Officers at Cousineau McGuire effective June 1, 2015.
Ms. Lund began working at the firm in June of 2012 and focuses her practice on workers’ compensation litigation. She has successfully assisted and represented clients in all phases of claim management and subsequent legal proceedings, from formulating language in response to a reported injury, to obtaining favorable results at administrative hearings, in settlement and motion practice, and at hearings. She has also defended clients through the appeal process, including review by the Minnesota Supreme Court.
Mr. Sharkey has been with the firm since August of 2013 and represents both individuals and businesses in a wide variety of civil disputes, focusing primarily on product liability, premises liability, dram shop, and construction defect. He is also one of the few mortuary law attorneys in the country, with a growing practice representing funeral homes, crematories, and cemeteries.
Ms. Lund can be reached at nkl@cousineaulaw.com or (952) 525-6951 and Mr. Sharkey can be reached atmds@cousineaulaw.com or (952) 525-6990.
Cousineau McGuire Shareholder Tom Coleman and AssociateMichael Johnson both authored articles published in theWilliam Mitchell Law Review, Volume 41, Issue 4. This edition of the Law Review featured an entire segment on Workers’ Compensation Law.
Coleman’s piece was titled “Fundamentals of Workers’ Compensation in Minnesota,” and provided a primer for the basics of workers’ compensation. It included a discussion and analysis of the Employer-Employee relationship, the definitions of injury and disability, Arising Out Of and In The Course Of, benefits available, benefit calculations, defenses, and the distinction between occupational disease and injury claims.
Johnson co-authored an article with Thomas M. Domer titled “A Comparison of Wisconsin and Minnesota Workers’ Compensation Claims.” Their piece covered the differences in liability/causation between the states, with a look at “In the Course of Employment” issues, involvement of alcohol, “Arising out of Employment” issues, as well as benefits.
Both articles can be accessed on the William Mitchell Law Review website here:
Cousineau McGuire Chartered proudly announces the hiring of a new associate, Joseph D. Klemann. Klemann, a 2014 graduate of William Mitchell College of Law, is practicing in the Workers’ Compensation group.
Prior to joining Cousineau McGuire, he was a Certified Student Attorney for the William Mitchell Law Clinic, where he worked with clients on mortgage and predatory lending issues. During law school, Joseph was a legal extern for the Honorable Kermit E. Bye, United States Court of Appeals for the Eighth Circuit.
Cousineau McGuire is pleased to announce that Whitney L. Teel has been elected to shareholder effective January 1, 2015. Whitney concentrates her practice in the areas of Workers’ Compensation and Medicare Secondary Payer Act compliance. She represents employers and insurers in all aspects of workers’ compensation disputes, from initial liability consultations, all the way through trial and appeal.
Additionally, Whitney is a contributor to LexisNexis’ The Complete Guide to Medicare Secondary Payer Compliance, a national publication regarding Medicare compliance in workers’ compensation claims. She also speaks nationally to clients and other attorneys on the Medicare Secondary Payer Act.
“I am honored to be elected shareholder,” says Teel. “As my practice continues to grow, it has been very rewarding to serve more clients and further develop my expertise.”
Whitney earned her J.D. from Hamline University School of Law, cum laude, where she served as Managing Editor for theHamline Law Review.
Citing procedural difficulty in hearings involving simultaneous issues of MMI/IR and extent of injury (EOI), Deputy Commissioner of Hearings Kerry Sullivan has implemented a limited and voluntary pilot project assessing a two-step (“bifurcated”) approach to resolve these disputes. If the parties agree during the BRC that: (1) the EOI determination will likely lead to an agreement on MMI/IR, or (2) the EOI dispute has so many variables that deciding it first will lead to a better outcome and a more efficient hearing, they will sign an “Election” to bifurcate the hearing, and the EOI issue will be tried first, followed by a hearing on the MMI/IR issue (if necessary). After the EOI hearing, the Hearing Officer will issue an Interlocutory Order including findings of fact on the EOI issue, after which the parties will have a reasonable period of time to reach an agreement. If no agreement is reached, a second hearing will be held on the issues of MMI and IR based on the Hearing Officer’s EOI determination. The Hearing Officer will then issue a Decision and Order incorporating the earlier interlocutory EOI findings, also making determinations on MMI and IR.
Sullivan cites that potential benefits of this approach include: (1) more agreements; (2) establishing correct medical benefits sooner based on the interlocutory order; (3) more control by parties over developing their evidence on MMI and IR; and (4) better, more accurate decisions, as the Hearing Officer will have a better range of adoptable options matching the EOI determination from which to choose.
The Division anticipates that most cases in the pilot project will be ready for the CCH on EOI after only one BRC. This is because in cases included in the pilot project, the parties will not be asked at the BRC to obtain alternate certifications or RME reports prior to the resolution of the EOI issue, as this evidence can be more efficiently obtained after that determination.
The determination of whether the bifurcated approach will be used will be made at the BRC, only at the request of the parties, and will not be imposed over the objection of any party. At this time, the pilot project is limited to proceedings conducted in the Division’s Weslaco field office. The Division plans to closely track the success of the project and make adjustments to improve it and correct any problems prior to expanding the program. Sullivan invites feedback, ideas, and suggestions by email: Kerry.Sullivan@tdi.texas.gov
The Commissioner fined James David Key, Sr., MD and Thomas Dunn, PT and ordered them to remove themselves as practitioners in the Texas Workers’ Compensation system. Key was cited for submitting bills for hand or limb muscle testing that he did not perform, and for submitting a charge for health care that was not furnished. Dunn was cited for improperly listing his NPI number on billing when he was not the rendering provider, for not including the correct billing codes when submitting medical bills, and for improperly appending modifier “GP” to CPT Codes, which are limited to services provided by a physical therapist or a non-therapist pursuant to an outpatient physical therapy plan of care.
