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.
VIRGINIA WORKERS’ COMPENSATION UPDATE
New compensation rates as of July 1, 2012:
As of July 1, 2012, the new maximum compensation rate is $935.00 and the new minimum compensation rate is $233.75. The mileage reimbursement rate remains $.555 per mile. On October 1, 2012, the COLA rate was set at 3.1%.
Commission Update:
New Member of the Full Commission
Effective March 1, 2013, R. Ferrell Newman, Esq. became the “neutral” representative on the Full Commission. The Virginia Workers’ Compensation Commission is comprised of one employers’ representative, one claimants’ representative and one “neutral” member. Before his appointment, Commissioner Newman was a longtime workers’ compensation attorney who has represented both claimants and employers.
Commission announces Alternative Dispute Resolution Pilot Program
The Commission has announced an Alternative Dispute Resolution (“ADR”) pilot program. This program will, initially, only apply to change in condition applications where both parties are represented by counsel. If a claim meets this criteria, Commission staff may contact the parties in order to determine whether the dispute, if any, can be promptly resolved. As part of this process, the parties can agree to a joint telephone conference call where they outline their respective positions or have a Commission staff member act as a “go-between” and the parties will not speak directly to one another. If this avenue is not successful, the next step is an “Issue Mediation.” At mediation, Deputy Commissioner Blevins will, similarly, attempt to find common ground and broker an agreement. This mediation can be done either telephonically or in-person. If successful, this program is likely to be expanded to cover initial Claim for Benefits applications and other contested issues in order to reduce the time and expense of proceeding to hearing.
Expedited Review Pilot Program
Starting with Requests for Review filed on or after January 2, 2013, the Commission will ascertain whether the parties agree to participate in the Expedited Review Pilot Program, provided the parties are represented by counsel. If the parties agree, a Notice of Written Statements and Oral Argument will be promptly issued and the appealing party will have twenty days to file its position statement with the Commission. The responding party will, then, have ten additional days to file its responsive pleading. Briefs submitted by either party are limited to ten pages. After position statements are filed, the Commission will set oral argument for no later than twenty days after the deadline for the last written statement and will aim to issue a decision within twenty days following argument.
Recent Case Law Developments
Prince William County School Board v. Rahim, 284 Va. 316, 733 S.E.2d 235 (2012), is a
case that has generated much interest throughout the workers’ compensation community and concerns the statute of limitations for change in condition applications. InRahim, the claimant filed a Claim for Benefits on November 15, 2007 asserting that she suffered a workplace accident on January 17, 2007, but did not seek any specific benefits with that filing. On September 8, 2008, she filed an Amended Claim for Benefits in which she sought both wage loss benefits and an award for lifetime medical benefits. On June 18, 2009, the parties entered into a Stipulated Order which agreed to the compensability of the workplace accident and a lifetime medical award, but which stated that the claimant suffered no wage loss since she had been provided light duty work by the employer at a wage rate equal to or greater than her pre-injury weekly wage. Accordingly, a “Medical Only Award” was entered.
Subsequently, on October 7, 2009, the claimant filed a change-in-condition application in which she sought temporary total disability benefits from August 11, 2009 to the present and continuing. The defense defended the application on the grounds that since there had not been a previous award of compensation by the Commission, the claimant’s wage loss claim was time-barred as it was filed more than twenty-four months after the workplace accident. The Supreme Court of Virginia unanimously affirmed the Court of Appeals’ 5-4 decision and found that the change-in-condition application was timely filed. In its decision, the Court held that, starting from the date of the medical award, the claimant had two years from the date compensation was last paid to file a change-in condition application. In this case, since the medical award was entered on June 18, 2009, the claimant had until at least June 17, 2011 to file her application. More specifically, the Court found that the language in Va. Code Sec. 65.2-708(a), which governs change in condition applications, encompasses medical only awards because the section states that “any award” can be reviewed, not just those awards which order payment of wage loss benefits. Importantly, the Court also noted that under Va. Code Sec. 65.2-708(c), the payment of light duty wages by the employer after the June 18, 2009 medical award would constitute payment of compensation and could act to toll the statute of limitations until compensation ceased.
2012 Legislative Changes
HB 137- Revises the language contained in § 65.2-105 regarding the statutory presumption that certain injuries arose out of and in the course of the claimant’s employment. The legislative enactment applies to situations where the injured worker is physically or mentally unable to testify and there is un-rebutted prima facie evidence that the injury arose out of and in the course of the claimant’s employment. In these instances, there is now a presumption that the injury “arose out of and was in the course of employment,” even though the claimant is not able to testify as to causation, unless there is a preponderance of the evidence to the contrary. The revised language strikes the previous statutory provision which presumed that the injury was “work related.”
HB 153- Any employee who suffers an injury on or after July 1, 2012 is excluded from coverage under the Virginia Workers’ Compensation Act if there is jurisdiction under the Longshore and Harbor Workers’ Compensation Act or the Merchant Marine Act of 1920.
HB 453- Excuses the Commonwealth of Virginia from penalties associated with failure to pay wage loss benefits pursuant to an Award if the Commonwealth has made a payroll payment to the injured worker in lieu of compensation for at-issue disability period.
HB 1169- The Virginia Workers’ Compensation Commission will retain jurisdiction over claims in connection with disputes over partially paid medical bills even in instances where partial payment has been made by an entity other than the employer, insurer, guaranty fund or uninsured employer’s fund.
SB 576- Until July 1, 2015, the maximum .5 percent tax rate may be assessed against uninsured employers or self-insured employers. The revenue generated by said tax funds benefits that are awarded against employers from the uninsured employer’s fund.
SB 577- States that a majority of Commissioners constitutes a quorum enabling the Virginia Workers’ Compensation Commission to take judicial and legislative action when there is a vacancy on the Full Commission. The Chairman of the Full Commission has the discretion to appoint a deputy commissioner to hear a review request when all Commissioners are unable to hear a review request.
For more information, please contact Lynn Fitzpatrick at 703-793-1800 or lfitzpatrick@fandpnet.com
STONE LOUGHLIN & SWANSON, LLP
TEXAS LAW ADVISORY
jstone@slsaustin.com jloughlin@slsaustin.com dswanson@slsaustin.com eshanley@slsaustin.com
eholmes@slsaustin.com dprice@slsaustin.com sgatlin@slsaustin.com
512-343-1300
April 2013 Workers’ Compensation Law Update
More Bills Related to Workers’ Compensation
Last month, we provided you with a summary of the more important bills the Legislature is considering which make substantive changes to comp. And keep your eye on the following additional bills—
• SB 1550/HB 2787 - Allows claimants to recover attorneys’ fees if they prevail on judicialreview of a medical necessity dispute, irrespective of whether the appeal was filed by the claimant or the carrier.
• HB 1762 - Provides that a certificate of insurance showing a temporary employment service maintains comp insurance constitutes proof of workers’ compensation coveragefor both the service and all employees of the service assigned to a client company.
• HB 287 - Requires an IRO or URA, on written request by a party to a reviewed medical dispute, toprovide the name and qualifications of the healthcare providerwho performed the review.
In Addition, Bill Would Make Use of Name or Symbols Related to "Texas" and "Workers’ Compensation" Illegal Only When Used in Deceptive Manner
Currently, the Texas Labor Code makes it illegal to use the terms "Texas" and "Workers’ Compensation" in a business name or document when related to a product or service concerning workers’ compensation coverage or benefits. SB 381 would amend Texas Labor Code §§419.001 and 419.002 and only make the use of the terms illegal if they are used in a "deceptive manner." The amendment explains that "deceptive manner" means a person knows the use of the terms would or could convey the "false impression" that someone, something, or some speech is endorsed or authorized by the DWC.
OIEC Budget on the Chopping Block?
In a recent floor amendment, freshman State Rep. Craig Goldman sought to eliminate $8.2 million of yearly funding to the Office of Injured Employee Counsel. While the signs indicate the amendment will not pass, it is interesting to see that OIEC is again the target of budget cuts.
Tip on Filling Out Form DWC 32: Multiple Certifications
A recent article by Erika Copeland at DWC reminded system participants that multiple certifications taking into account different outcomes for an extent of injury determination will only be provided by a designated doctor when the doctor is ordered to address MMI, IR, and extent of injury. If only MMI and IR is requested, multiple certifications will not be provided. This means adjusters should request the DD address extent of injury, in addition to MMI and IR, if multiple certifications are desired. It is not clear whether the opinion on extent and the opinion on MMI/IR have to be by the same doctor, or can be different doctors, or if the reviews have to be at the same time.
Workers’ Compensation? Worker’s Compensation? Or Workers Compensation?
There is an ongoing debate among pedantic system participants like us about the proper use of an apostrophe in the term, "worker[’]s[’] compensation." We invite you to join the debate. Stone Loughlin & Swanson will provide a $25 Starbucks gift card to the first person to e-mail Jane Stone at
jstone@slsaustin.com with the correct punctuation. Twitter-speak not allowed.
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Bobby Anglin, a South Carolina resident, suffered a compensable automobile accident while working for his North Carolina employer, Dunbar Armored, Inc. Anglin received benefits pursuant to the North Carolina Workers’ Compensation Act from Defendants and later settled his third-party claim against the other driver in the South Carolina accident for $92,712.55. After this settlement, Defendants agreed to resolve their workers’ compensation lien against the liability settlement for one third of the lien value or $10,613.16. Anglin also reached a settlement with his under insured motorist (UIM) carrier; however, Defendants were not aware of the UIM settlement when the workers’ compensation lien was settled.
Subsequently, Anglin filed suit in Superior Court seeking a declaration eliminating Defendants’ workers’ compensation lien pursuant to N.C.G.S. § 97-10.2. He contended that South Carolina law applied to the determination of Defendants’ subrogation interests in the UIM settlement because it was paid pursuant to a South Carolina policy. He also contended that since South Carolina law does not allow subrogation of UIM funds, Defendants’ lien should be eliminated. Finally, Anglin argued that Defendants lien was already satisfied by their previous agreement to accept one third of the lien value. The trial court disagreed, applied North Carolina law, held there was no accord and satisfaction of the lien with the previous settlement as Defendants were not aware of Anglin’s UIM settlement at the time of the previous lien settlement, and awarded Defendants the remaining $21,206.31 of their workers’ compensation lien. Anglin appealed.
On April 2, 2013, in Anglin v. Dunbar Armored, Inc., the North Carolina Court of Appeals affirmed the decision of the trial court, upholding the award to Defendants in satisfaction of their workers’ compensation lien. The court noted that where a party seeks a determination of a workers’ compensation lien pursuant to N.C.G.S. § 97-10.2 it is seeking "remedial" or "procedural" relief and, as such, the law of North Carolina, as the forum state, applies. Since North Carolina law does not prohibit subrogation of UIM funds, the trial court did not improperly award Defendants a portion of Anglin’s UIM settlement in satisfaction of the remainder of their workers’ compensation lien.
Risk Handling Hint: Where Defendants have a particular interest in recovering from an injured workers’ third-party settlement to satisfy their subrogation lien, special consideration should be given to bringing an action in North Carolina’s courts, pursuant to N.C.G.S. § 97-10.2, to avoid the potential application of unfavorable subrogation laws in other states.
Rayford H. Taylor
Of Counsel
Casey Gilson P.C.
Six Concourse Parkway, Suite 2200
Atlanta, Georgia 30328
770-512-0300 -Ext. 529
770-512-0070 -Fax
rtaylor@caseygilson.com
www.caseygilson.com
SunTrust Bank v. Travelers Prop. Cas. Co. of Am., (03/28/2013)
The worker was injured in the course of his employment following a motor vehicle collision. He received workers' compensation benefits before filing suit against two third-party tortfeasors. Although the insurer timely intervened in the suit to protect its workers' compensation subrogation lien, the worker and the tortfeasors settled the case for a confidential lump sum without the insurer's knowledge, participation or consent. Among other terms, the settlement agreement included a conclusory statement that the proceeds of the settlement did not fully and completely compensate the worker for his injuries. The insurer filed its motion to enforce its subrogation lien, which the trial court granted.
On appeal, the estate administrator contended the trial court erred in finding the terms of the settlement agreement did not extinguish the insurer's right to enforce its subrogation lien. The court disagreed and held the insurer had the right to intervene and the trial court was required to conduct a hearing on whether the worker was fully compensated, so that the insurer could attempt to enforce its subrogation lien.
720428-1
Rayford H. Taylor
Of Counsel
Casey Gilson P.C.
Six Concourse Parkway, Suite 2200
Atlanta, Georgia 30328
770-512-0300 -Ext. 529
770-512-0070 -Fax
rtaylor@caseygilson.com
www.caseygilson.com
Zheng v. New Grand Buffet, Inc., (03/20/2013)
Zheng sustained a compensable injury on May 27, 2010, and began receiving medical care and income benefits. Her employer suspended Zheng's income benefits on October 1, 2010, asserting that Zheng underwent a change in condition for the better based on a regular duty work release from her authorized treating physician ("ATP"). Zheng disputed that she had undergone a change in condition for the better and sought reinstatement of her income benefits, payment of certain medical expenses, permission to change her ATP, a late penalty, and an assessment of attorney fees.
The administrative law judge ("ALJ") found the employer's suspension of benefits "was not improper" in view of an August 24, 2010, statement from the ATP that he anticipated she would be able to return to work on August 31, 2010. The work release was prospective, however, depending on test results and an evaluation, and Zheng did not return to the doctor on August 31, 2010, as scheduled. Instead, Zheng elected to see another physician of her own choosing. After reviewing evidence from the physicians who saw Zheng before and after, the ALJ reinstated Zheng's income benefits as of October 1, 2010, concluding that the employer did not establish by a preponderance of the evidence that she had a change in condition for the better that allowed her to return to work without restrictions.
The ALJ also found the employer had a panel of physicians and that the employer's manager had explained the panel's function to Zheng when she had been rehired two months before she was injured. Zheng had received treatment from the three physicians on the panel: Dr. Chang, Dr. Wu, and Dr. Armstrong. However, instead of returning to Dr. Armstrong, she changed physicians on her own without Board approval. Because the employer had been providing appropriate medical treatment, it did not lose control of her treatment and was not responsible for paying the new physicians' expenses. The ALJ denied Zheng's request that one of her new physicians be designated as her ATP, finding that the employer should first have the opportunity to offer treatment by another physician of the employer's choice. Finally, finding that the case was closely contested on reasonable grounds, the ALJ denied the employee's request for attorney fees and penalties.
Both sides appealed the ALJ's decision to the Appellate Division of the State Board of Workers Compensation, which adopted the ALJ's findings of fact and conclusions of law. Both parties appealed this decision to the superior court, which conducted a hearing. The superior court did not issue an opinion within 20 days of the hearing, and thus the Board decision was affirmed by operation of law.
On appeal, the appellate court affirmed the ALJ's rulings because there was evidence of a valid panel, the panel had been explained to the employee, and she went to an unauthorized physician without permission of the employer/carrier. The employee's remedy was to petition the State Board for a change, rather than seeking treatment on her own.
720425-1
Rayford H. Taylor
Of Counsel
Casey Gilson P.C.
Six Concourse Parkway, Suite 2200
Atlanta, Georgia 30328
770-512-0300 -Ext. 529
770-512-0070 -Fax
rtaylor@caseygilson.com
www.caseygilson.com
Garcia v. Shaw Indus., Inc., (03/29/2013)
Employer found not liable for intentional infliction of emotional distress and defamation for reporting employee's possible fraud to State Board of Workers' Compensation
The employee was not a citizen of the United States, but entered the country legally with a border-crossing card. The employee was not authorized to work in the United States, but obtained employment using the name, Social Security number, and personal information of another person, whose identity the employee paid to use.
The employee fell and injured her back at work. After treatment, she returned to light duty work and filed a claim for benefits. During that period, the employer became aware of the employee's situation and immigration status. The employer terminated the employee, but continued to provide medical treatment and TPD benefits.
The employer filed a complaint with the State Board's fraud and compliance unit. The employee was later arrested on warrants for forgery and possession of fraudulent documents after her deposition in the workers' compensation case was completed. The employer cooperated with the State Board, and arranged for the State Board to arrest her after the deposition. The employee filed her IIED suit, which was dismissed.
On appeal, the employee contended the trial court erred in granting summary judgment to the employer on her IIED claim, because there was evidence the employer set her up for arrest causing her severe emotional distress. The appellate court concluded the employer's conduct did not rise to the level of extreme and outrageous conduct necessary for an IIED claim. Even if the employer knew the employee was operating under an alias, it was not malice for the employer to want to bring the illegal behavior to an end. In addition, when the employer filed an administrative fraud complaint with the Georgia State Board of Workers' Compensation, it truthfully and accurately related the facts.
720424-1
David Gray was working as a truck driver for UPS when he suffered a fatal heart attack. The claim was denied and, after a hearing, the Deputy Commissioner found the death compensable. The Full Commission affirmed. InGray v. UPS, 713 S.E.2d 126 (2011), the Court of Appeals affirmed in part and remanded the case to the Full Commission to enter findings on whether Defendants had successfully rebutted thePickrell presumption. Decedent’s widow filed a Petition for Discretionary Review and Petition for Writ of Certiorari to the North Carolina Supreme Court, both of which were denied. The Full Commission then entered an Opinion and Award denying the Mrs. Gray’s claim for death benefits and she appealed.
On March 19, 2013, in Gray v. United Parcel Service, Inc.,the Court first considered whether the Full Commission erred in concluding that decedent’s death was not compensable. In rejecting this argument, the Court found that the decedent’s autopsy listed the cause of death as coronary atherosclerosis, and Defendants’ expert witness opined that decedent’s fall from his work truck did not cause or contribute to his heart attack. The Court also noted that no evidence was presented that a fall was an accepted cause of a heart attack and as such, the evidence supported the Commission’s finding and conclusion that Mrs. Gray failed to carry her burden of proof to show that her husband’s death was the result of an accident arising out of the course and scope of his employment.
The Court also addressed the issue of whether the Full Commission applied the correct medical causation standard in concluding that Mrs. Gray’s medical expert’s testimony was speculative. The Court recounted that Mrs. Gray’s medical expert admitted that he did not have a medical explanation for Decedent’s fall and the Commission, therefore, reasonably concluded that her expert testimony was speculative and properly relied on medical evidence presented by Defendants.
Risk Handling Hint:
While the Court initially remanded the Gray case back to the Full Commission to consider whether Defendants had successfully rebutted thePickrell presumption, their subsequent holding inGray is yet another reminder that the Full Commission can weigh evidence and make credibility determinations that will not be disturbed on appeal so long as there is some evidence to support the Commission’s findings and conclusions.
The 28th Annual Workers’ Compensation Institute was held on April 19 & 20 at the Minnesota CLE Conference Center. This content rich event featured sessions on significant cases, legislative changes, updates from OAH and DOLI, workplace violence, aging workforce, and more subjects covered in multiple break-outs.
Cousineau McGuire’s Mark Kleinschmidt presented Landmines in Drafting Stipulations for Settlement.
Thomas Kieselbach is speaking on a panel at this year's Minnesota Workers' Compensation Symposium. He will be joined by others from SECURA Insurance and US Bank discussingRun Away Litigation Cost.
Cousineau McGuire will also be exhibiting at the event which draws hundreds of claims adjusters annually. This Symposium will take place Wednesday, May 8 at the Minneapolis Marriott Southwest. For more information on this conference, please visit the website for the Minnesota Workers' Compensation Symposium.
Risk Handling Hint - Written Notice; Reasonable Excuse; Actual Knowledge
In the course of bringing coffee and doughnuts to a morning meeting in 2006, James Yingling’s car was hit by another driver who ran a red light. Yingling called his supervisor and the branch manager, who both came to the scene of the accident, and later reported the accident to his manager in Charlotte. However, Yingling never gave Bank of America any written notice of the accident. Later that day, Yingling began feeling back pain and sought treatment, but continued to work for Bank of America. Two years later, Yingling suffered another work-related injury when he slipped and fell on a recently waxed floor. He did not return to work after that accident. Shortly thereafter, Yingling filed a written notice of a claim for both the 2008 slip-and-fall accident and the 2006 car crash. Defendants denied both claims, on the basis that Yingling failed to give written notice without reasonable excuse and that Defendants were prejudiced by the two year delay.
The case was heard by Deputy Commissioner James C. Gillen, who entered an Opinion and Award in favor of Yingling. Defendants appealed to the Full Commission, which affirmed the Deputy Commissioner’s decision. Defendants appealed.
On March 5, 2013, in Yingling v. Bank of Am., the Court of Appeals considered the case and upheld the Full Commission’s Opinion and Award. The Court first considered whether the Full Commission erred in rejecting Defendants’ lack of notice argument. Recounting the details of the case, the Court found Yingling provided actual notice to his supervisor, branch manager and manager in Charlotte, on the day of the accident. The Court further noted that although Yingling did not immediately seek medical treatment, he did soon thereafter and he notified Bank of America of his need to be absent from work to attend medical appointments. N.C.G.S. § 97-22 states the employer must have "knowledge of the accident"; but the Court found that it does not require knowledge of a "work-related injury" as argued by Defendants.
The Court then addressed the second prong of N.C.G.S. §97-22; prejudice to Defendants. In rejecting this argument, the Court held that Defendant had received sufficient notice of the accident, and so any prejudice it suffered was its own fault, so to speak. If Defendants had properly investigated the accident at the time it received actual notice and accepted the claim as compensable, it could have directed Yingling’s treatment and filed a third-party claim against the driver of the other vehicle.
The last argument addressed by the Court was whether the Full Commission erred in approving Yingling’s treating physician in light of the 2011 changes to N.C.G.S. § 97-25. The 2011 amendments only changed the word "physician" to "health care provider." The Court admonished that the change did not indicate that the Legislature intended to alter the long-standing rule that the Industrial Commission can approve a health care provider chosen by the employee. Moreover, the right to direct medical treatment is triggered only when the employer has accepted the claim as compensable. Nothing in the revised statute suggested to the Court that the Legislature intended to allow the employer to enjoy the benefits of choosing a treating physician without bearing the associated obligations, i.e., paying for medical treatment.
Risk Handling Hint:
Where the employer has some notice of a work-related injury,Yingling suggests that it is not enough to rely on an employee to report any ongoing medical issues. Risk managers must take affirmative steps to determine whether subsequent absences or medical treatment are due to the work-related incident.