State News

NWCDN is a network of law firms dedicated to protecting employers in workers’ compensation claims.


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.


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In Arneson v. GR Mgmt., LLC, 2024 S.D. 61, 13 N.W.3d 206, the claimant, Mr. Michael Arneson (“Arneson”), worked as a maintenance manager at a hotel and casino in Deadwood, South Dakota. On July 18, 2018, Arneson was working on a commercial exhaust fan for his employer (Employer”) when the fan shorted and sent 440 volts of electricity through Arneson’s hand, which exited through his foot (“the Work Injury”).

Arneson when to the emergency room for treatment. Within the next few days, he began suffering from mild heart palpitations. Almost two weeks later, Arneson went to the hospital for his heart palpitations and was diagnosed with hyperthyroidism and Atrial Fibrillation (“AFib”).

Arneson then brought a petition for workers’ compensation benefits arguing that the Work Injury caused his AFib and that he was permanently and totally disabled.

Arneson’s treating doctor, Dr. Holloway, provided an expert opinion that Arneson’s AFib was likely caused by his hyperthyroidism and the Work Injury.  Dr. Holloway acknowledged that Arneson’s hyperthyroidism could cause AFib itself. However, he also opined that electrical shocks like the Work Injury can cause heart arrythmias, such as AFib. Dr. Holloway did not provide an opinion on how commonly hyperthyroidism causes AFib or how commonly electrical injuries, like the Work Injury, cause AFib. He simply stated he believed both hyperthyroidism and the Work Injury causally contributed to Arneson’s AFib.

Employer countered by providing testimony from two non-treating experts. First, Employer presented the testimony of a cardiologist, Dr. Brody. Dr. Brody stated that he has rarely treated electrical injuries and that electric shock-induced AFib is extremely rare, occurring in less than 1% of cases based on his review of medical literature. In contrast, Dr. Brody testified that “the association” between hyperthyroidism and AFib “is a lot stronger” and more well accepted in the medical community. Dr. Brody then opined that the Work Injury was unlikely to have caused Arneson’s AFib, and the more likely cause was Arneson’s hyperthyroidism.  Employer also provided the testimony of Dr. Elkins. Dr. Elkins, like Dr. Brody, stated that it was statistically far more likely that hyperthyroidism caused Arneson’s AFib than an electrical shock like the Work Injury.

The Department of Labor (“Department”) found that the Work Injury was a major contributing cause of Arneson’s AFib and that he was permanently and totally disabled. Employer appealed arguing it was error for the Department to accept Dr. Holloway’s testimony that the Work Injury caused Arneson’s AFib when Employer presented unrebutted evidence that the Work Injury was statistically highly unlikely to have caused Arneson’s AFib.

The South Dakota Supreme Court (“Court”) rejected Employer’s argument and relied on a Minnesota case in support, stating “[a]n opinion based solely on statistical improbability ignores the fact that, by definition, improbable events do occur.” Arneson v. GR Mgmt., LLC, 2024 S.D. 61, ¶ 35, 13 N.W.3d 206, 217 (citing Ingram v. Syverson, 674 N.W.2d 233, 237 (Minn. Ct. App. 2004) (noting “medicine is an imperfect science and a plaintiff's symptoms may not always be proven by tests and statistics.”). The Court then found Dr. Holloway’s opinion was sufficient to show the Work Injury was a major contributing cause of Arneson’s AFib and affirmed the Department.

While the Court has still not defined “major contributing cause.” The Arneson opinion provides additional information on what “major contributing cause” is not. In this case, the Court was offered an opportunity to define major contributing cause in terms of probability and soundly rejected it. Employers should be aware of cases like this that continue to define the casual standard for compensable injuries.  

The NH Department of Labor has issued the following guide to assist parties when corresponding with them:

DOLHEARINGS@dol.nh.gov    -    Continuances/Withdrawal Requests, 1st level CD/Transcript Requests, Attorney Fee                                 Requests, Reconsideration/Clarification Requests, Add Issue/Time Requests, Video/Telephonic Requests

DOLSCHEDULING@dol.nh.gov    -    Hearing Requests, LSS Hearing Requests, Attorney Availability/Unavailability,                     Notification/Withdrawal of Representation, Hearing Submissions (medical and non-medical), Witness Disclosure

FirstReport@dol.nh.gov    - First Reports of Injury, Memos of Denial

MOPSUBMISSION@DOL.NH.GOV    -    Memos of Payment, Notices of Accidental Injury/Occ Disease, General WC                                                                        questions

WorkersComp@dol.nh.gov    -    Permanent Impairment Awards, Reimbursement for Job Modification, COLA, Death                                                             Allocation, Administrative Suspension/Termination, Third Party Settlement Approval, Pro Se                                                             Dispute Resolution

WorkersCompRecordsRequests@dol.nh.gov    -    Copy Requests, Employment Verifications

DOL.CABAppeals@dol.nh.gov        -    Appeal Requests, Appeal Submissions     

 SIFMC@dol.nh.gov     -    Second Injury Fund, Managed Care, Third Party Administrator Licensing    

NHCoverage@dol.nh.gov    -    General Coverage Requirements Questions, Verification of Coverage in Place,                                                     Questionnaires/Exclusions  

DOL.WCCarrier@dol.nh.gov    -    Certificates of Insurance, Coverage from Carriers, Requests for Penalty Waivers

NHLeasing@dol.nh.gov    -    Leasing Applications, Client Add/Term Forms, Quarterly Audits

DOL.WCSelfInsurance@dol.nh.gov    -    Self-Insurance

        




On July 16, 2024, the New Hampshire Supreme Court  issued a decision in Petition of City of Manchester & a., Docket No. 2022-0696.  This case was accepted by the full court from Bernard & Merrill’s Writ of Mandamus requesting that the Court address whether employers and their insurance carriers have a right to a department level hearing when the Second Injury Fund denies claims pursuant to RSA 281-A:43, I(a).

 

This Writ of Mandamus (an order directing a government official to properly fulfill their official duty or correct an abuse of discretion) was filed on behalf of eight employers who had filed claims against the New Hampshire Second Injury Fund (Fund) seeking reimbursement for indemnity and medical benefits paid out on behalf of claimants who sustained a prior permanent condition.  In all eight cases, the Fund denied the reimbursement claims, and the Department of Labor (DOL) refused to grant the employers a first level hearing to address the merits of the claims.  The question presented for review was whether the DOL was statutorily required to grant a request to hold a department level hearing when an employer’s request for reimbursement from the Fund is denied.

 

The Court agreed with the petitioner’s that RSA 281-A:43, I(a) grants employers a department level hearing before an authorized representative of the commissioner when they have been denied reimbursement from the Fund.  The Court disagreed with the DOL that hearings under this section of the statute are only allowed when the issue to be addressed is whether a claimant is entitled to benefits and that petitioner’s rights instead fall under the Administrative Procedures Act. The Court stated that it did not read the statute so narrowly and that at issue is “who is ultimately responsible for the payment of compensation to the employee-the employer or the Fund.”  The Court interpreted RSA 281-A:43,I(a) to provide for review of a denial of reimbursement and held, “to construe the statute otherwise – to provide no right to a contested hearing -a as the DOL would have us do, would subvert the purpose of the statute.” 

The Court observed that their interpretation of the statute “serves the purpose sought to be advanced by the statutory scheme” noting that the purpose of the Fund was “created to encourage employers to hire or retain employees with permanent physical or mental impairments of any origin by reducing the employer’s liability for workers’ compensation claims.”  Finally, it noted that  the legislature is free to amend the statute if it disagreed with their construction.

The Second Injury reimburses carriers and self-insured employers upwards of 16 million dollars annually.  The right to a first level hearing provides employers and their carriers the opportunity to flush out the basis of a denial and has resulted in a number of decisions awarding Second Injury Fund reimbursement.  

 

 

Michelle A. Broadhurst, Esquire

Bernard & Merrill PLLC

814 Elm Street, Suite 407

Manchester, NH 03101

Tel: 603-622-8454

Fax: 603-626-8490

E-mail: michelle@bernard-merrill.com

 

 

 

Ohio Bureau of Workers’ Compensation Update 

BWC Actions

The Board of the Ohio Bureau of Workers’ Compensation (“BWC”) met in January 2025to discuss another potential rate reduction for Ohio’s private employers. The proposed rate reduction would be 6% which would amount to almost $60 million less in premiums paid by Ohio private employers. It would apply to the next fiscal year effective July 1, 2025. If approved at the Board’s next meeting on February 28, 2025, this reduction would be the sixth straight reduction since Governor DeWine took office and the 16th rate decrease in the last 17 years going back to 2008.  Overall, the average rate levels for the 257,000 private and public Ohio employers are at their lowest in over 60 years.


The proposed 6% rate cut represents an average statewide premium change, including administrative costs. The actual premium paid by individual private employers depends on several factors, including the expected future claims costs in their industry, their company’s recent claims history, and their participation in various BWC programs.

Ohio Judicial Decisions

Temporary Total Compensation 


State ex rel. Ohio State Univ. v. Pratt, 169 Ohio St.3d 527, 2022-Ohio-4111, 206 N.E.3d 708

On June 20, 2017, the claimant, a food and beverage manager for OSU at the Blackwell Inn, submitted her two-week notice, to resign on July 5, 2017. She had an offer of employment from a different employer. Four days later, on June 24, 2017, the claimant sustained a trip and fall injury. The claimant’s claim was allowed, and she underwent surgeries on June 27, 2017, and May 29, 2018, and was paid TTD compensation. The employer moved to terminate TTD. The commission’s SHO determined TTD was payable because the claimant did not voluntarily abandon the workforce as she was leaving her position at OSU for another position. The commission voted not to exercise continuing jurisdiction, but, in the dissent, one commissioner asserted the majority misinterpreted and misapplied State ex rel. Klein v. Precision Excavating & Grading Co., 155 Ohio St.3d 1446, 2018-Ohio-3890, 119 N.E.3d 386, by evaluating whether the claimant intended to abandon the workforce instead of whether the claimant intended to abandon her former position of employment.

The Court of Appeals granted the employer’s requested writ of mandamus and ordered the commission to vacate the award of TTD after July 5, 2017. The commission’s order was issued after the decision in Klein but before the effective date of the amendment to R.C. 4123.56(F). The Court found that, under Klein, the commission is to consider only whether the claimant has voluntarily abandoned her former position of employment and not whether she has removed herself from the workforce generally.

The Ohio Supreme Court reversed the decision of the Court of Appeals and found that the commission did not abuse its discretion by determining that, but for the injury, the claimant would have remained in the workforce. The Supreme Court explained that while Klein referenced whether the claimant “voluntarily removes himself from his former position of employment,” the analysis was specific to the facts of the case and that “Klein’s abandonment of his former position was therefore equivalent to abandonment of the workforce during the period for which he sought TTD compensation.” Thus, the Supreme Court concluded, “The question is whether those circumstances demonstrate a voluntary abandonment of the workforce – permanent or temporary – such that the injured worker’s wage loss is not the result of the work injury. In other words, do the circumstances indicate that the injured worker would be working – somewhere – but for the injury?”


 Permanent Partial Disability


State ex rel. Hobbs v. Indus. Comm., 10th Dist. Franklin No. 22AP-308, 2023-Ohio-1759

Tenth District Court of Appeals found the commission did not abuse its discretion in denying the claimant’s application for another increase in his percentage of permanent partial disability under R.C. 4123.57(A). The commission found the request was not supported with “substantial evidence of new and changed circumstances developing since the time of the hearing on the original or last determination,” as required by R.C. 4123.57(A). The record did not show the clamant underwent any medical treatment since 2002, that his condition became disabling following his last treatment, or that the claim was amended to include an additional medical condition, nor does the record support employee's contention that he testified that his medical condition was worsening since no such testimony appears in the record. The Tenth District Court of Appeals found the claimant failed to meet the burden in mandamus to demonstrate a clear right to relief, and denied the claimant’s requested writ of mandamus. Following this decision, the claimant filed a Notice of Appeal to the Ohio Supreme Court, which is currently pending.


Scheduled Loss


State ex rel. Harris v. Indus. Comm., Supreme Court of Ohio, Slip Opinion No. 2023-Ohio-3081. The claimant sustained a head injury that impacted his vision. The commission denied his motion for scheduled loss of vision compensation pursuant to R.C. 4123.57(B), relying on a physician’s medical opinion that the claimant’s vision impairment was not due to an actual injury to the eyes. The Tenth District Court of Appeals found the commission did not abuse its discretion and denied the requested writ, finding there was some evidence in the record that established the claimant’s loss of vision was not attributable to damage to the structure or function of the claimant’s eye, but was due to the loss of brain function. R.C. 4123.57(B) did not authorize loss of use compensation when the loss of brain function was the cause of the vision loss rather than actual damage to the eye structure itself. The Supreme Court affirmed the Court of Appeals’ decision and denied the writ of mandamus, albeit on different grounds. The Supreme Court determined the commission’s order, which was based upon “the absence of a credible assessment” of loss of vision, was based upon some evidence. The Supreme Court declined to address the Smith case, finding the commission’s order did not deny compensation in reliance upon that case.


Substantial Aggravation of a Preexisting Condition


Dunn v. Devco Holdings, Inc., 3d Dist. Union No. 14-22-18, 2023-Ohio-680


The claimant suffered a workplace injury to her hip, and she later filed for additional psychological conditions in her workers’ compensation claim. The commission additionally allowed the claim for “substantial aggravation of persistent depressive disorder, with anxious distress, late onset, with persistent major depressive disorder, moderate.” The employer appealed to common pleas court under R.C. 4123.512. The trial court found in favor of the claimant, finding the testimony of Dr. Black to be persuasive in that her diagnosis is based upon objective diagnostic findings, objective clinical findings, or objective test results as required by R.C. 4123.01(C), and that the psychiatric condition arose from the injury.


The employer appealed, arguing the claimant did not present evidence of objective diagnostic findings, objective clinical findings, or objective test results that demonstrated a substantial aggravation of her psychological condition. Specifically, the employer argued the MMPI-2 test that Dr. Black had administered to the claimant is not an objective test and did not show substantial aggravation. The Third District Court of Appeals found Dr. Black testified at trial that the MMPI-2 is a standardized objective test. It gives you the idea of the person’s personality characteristics and helps with your diagnosis formulation. It has 567 true and false questions and the responses are combined together and scored to give you kind of a concrete and quantifiable results. She added that the MMPI-2 was developed out of standardized testing and provides a concrete and quantifiable result. She explained that although the person’s answers are subjective, the actual results and scoring of it makes it objective. The appellate court affirmed the trial court’s decision, finding the Dr. Black’s testimony showed that the MMPI-2 test provided objective results, and her testimony that the claimant’s injury substantially aggravated a pre-existing condition was based on objective findings, as required by R.C. 4123.01(C).


© Copyright 2025 by Christopher Ward and Raymond Tarasuck Calfee, Halter & Griswold, LLP. All rights reserved. Reprinted with permission.

On December 6, 2024, Governor Hochul signed Senate Bill S6635 into law, which amends §10(3)(b) of the Workers’ Compensation Law. The legislation, effective January 1, 2025, aims to expand coverage for mental stress claims to all workers. 
 
The bill’s justification explains that it seeks to ensure that work-related post-traumatic stress disorder (PTSD) is properly identified, treated, and compensated under the workers’ compensation system. Prior to 2017, any claim for work-related stress could be defended on the grounds that the stress experienced by the claimant was not greater than that which usually occurred in the claimant’s normal work environment. That defense was eliminated in 2017 for claimants classified as first responders, such as police officers and firefighters, who were making a claim for stress that occurred during a work-related emergency. In such cases, the first responder claimant only had to show that they experienced extraordinary stress. Nevertheless, certain first responders who claimed stress-related injuries were still denied coverage due to court rulings that deemed their stress as a normal part of their occupation. 
 
The amendment to WCL §10(3)(b) eliminates the specific reference to first responders. Instead, it uses the term “worker” to encompass all types of workers. This change eliminates the defense that the stress was not greater than that which normally occurs in the work environment from all classes of claimants. Additionally, it removes the reference to extraordinary work-related stress incurred in a work-related emergency” and replaces it with “at work.” This change means that with respect to first responders, the stress claim need not be predicated on a work-related emergency. As of January 1, 2025, all workers in New York making a claim for mental stress need only show that the stress was “extraordinary.” The employer may not defend the claim on the basis that the claimant’s alleged stress was not greater than that which usually occurs in the normal work environment. 
  
Following this change in the law, much will depend on the Board’s interpretation of the word “extraordinary,” which is defined as meaning “going beyond what is usual, regular, or customary” or “exceptional to a very marked extent.” (“extraordinary.” Merriam-Webster.com. 2024. https://www.merriam-webster.com/dictionary/extraordinary (26 December 2024)). The use of this word in the statute suggests that run-of-the-mill stressors to which all workers are occasionally subjected are insufficient to support a claim for mental stress. Board Panel decisions following the 2017 amendment to WCL §10(3) which eliminated the “not greater than that which usually occurs in the normal work environment” defense for first responders suggests that the Board will require claimants to demonstrate exposure to extraordinary stress.  
 
For example, in Town of New Castle, 2018 WL 6132752 (WCB Case No. G1404105, decided 11/16/18), the claimant made a stress claim based on increased anxiety related to several incidents in which he saw blood at work. The Board found that the claimant’s exposure to blood over the course of his career as a police officer was not “extraordinary” and thus not compensable. The Board cited to an Appellate Division case, Cook v. East Greenbush Police Dep’t, 113 A.D.3d 1005 (3d Dep’t 2014) to explain its reasoning. In Cook, the claimant, a police officer, responded to an active shooter incident. Through binoculars, he saw the shooter firing an automatic rifle at officers. He directed a fellow officer to return fire, resulting in the shooter being killed. Following department procedures, the claimant approached the vehicle with other officers, handcuffed the suspect, and removed the firearm. In doing so, the claimant noted the suspect’s severe injuries, which included blood and visible brain matter. 
 
The Board Panel noted that even for a police officer, this was an “extraordinarily stressful event, which was unlikely to be repeated during claimant's career.” Although in Cook the Appellate Division affirmed the Board’s disallowance of the claim under the previously available defense that the claimant’s stress was not greater than that which usually occurs in the normal work environment (as a police officer), the Board Panel in Town of New Castle cited to the case to show an example of “extraordinary” work-related stress in the context of police work.  
 
In City of Schenectady, 2022 WL 5621898 (WCB Case No. G2914532, decided 10/03/22), the claimant, a police officer, made a stress claim predicated on an incident where he attempted to arrest a suspect. The Board Panel denied the claim, noting that the arrest in question did not meet the "extraordinary" standard as it involved a relatively routine incident in which the claimant was never threatened with imminent harm. 
 
In Village of Maybrook Police Dep’t., 2023 WL 1487253 (WCB Case No. G1837604, decided 1/31/23), another police officer claimant alleged work-related stress following an attempt to arrest a combative suspect without assistance or back up. The Board Panel denied the claim noting that the events of the case did not meet the “extraordinary” work-related stress standard because the incident involved a relatively routine arrest in which the claimant was never threatened with imminent harm. This echoed the language used by the Board Panel in City of Schenectady 
 
These cases suggest that the Board will require a demonstration of “extraordinary” stress for all workers, as was required of first responder claimants making stress claims between 2017 and 2025. Ultimately, the rule outlined by the Appellate Division in Loh Lin v. Burroughs Corp., 75 A.D.2d 702 (3d Dep’t 1980), remains in place. That is, the stress alleged by a claimant must exceed the aggravation normally experienced in the usual give and take of employment.  
 
The amendment to WCL §10(3)(b) expands mental stress claim eligibility to all workers while removing defenses tied to normal work environment stress. However, as demonstrated by past Board Panel decisions, the term “extraordinary” remains a threshold that claimants must meet. Claimants will need to prove stressors that go beyond the ordinary pressures of employment, as mere dissatisfaction or routine challenges are insufficient to support a claim. The Board Panel cases cited above illustrate the Board’s application of this standard, emphasizing the need for evidence of exceptional stress. 
 
Ultimately, successful defense of mental stress claims following this legislative change will depend on the consistency with which the Board and its Law Judges interpret the word “extraordinary.” While the amendment appears to broaden access to mental stress claims, the use of the word “extraordinary” maintains an objective standard to prevent overreach. Moving forward, careful attention to Board and court decisions will be necessary to fully understand the practical implications of this expanded coverage for mental stress claims. 
 
This legislative change opens the door to more claims for mental stress than seen in the past. However, it does not necessarily mean that a significant number more will be established as compensable.  Claimants will need to prove ‘extraordinary’ stress through testimony, and hopefully, Law Judges will limit compensable claims to those involving truly extraordinary stress, especially considering that most workers feel stress at some point during their careers that has some relationship to work. 

Is injured worker failing to report to offered light duty work, or failing to keep medical appointments or schedule medical procedures recommended by the authorized treating physician for work injury care?  A valuable tool in Indiana to control uncooperative employees is the ability of the adjustor or defense attorney to suspend benefits under Indiana Code 22-3-3-11 for not reporting to light duty work, and 22-3-3-4(c) for refusing medical treatment or services.

Often simply noticing the injured employee, in writing, of the plan to suspend TTD and/or medical treatment is enough to convince the employee that compliance is mandatory.  The Indiana Board Form, 54217, is available on the Indiana Board website, www.wcb.in.gov, and must be submitted in completed form to the Board through 1) the adjustor portal or 2) by the defense attorney, with copy to the injured worker or its attorney, and benefits may be suspended.   Only when the injured employee begins complying, benefits are reinstated.

The Commonwealth Court recently addressed the use of CBD oil in Schmidt v. Schmidt, Kirifides & Rassias, P.C., _ A.2d _ (Pa. Cmwlth. 2023).  There the claimant’s treatment for a back injury treatment was mostly pain management, for which he was prescribed various medications, and CBD oil.  The CBD oil was prescribed to avoid the use of increased narcotics.  The employer refused payment on the basis that CBD oil is not a pharmaceutical drug.  Consequently, the claimant filed a Penalty Petition.  The Workers’ Compensation Judge granted the Penalty Petition, concluding that the CBD oil was a medical supply under the Act, and was reasonable and necessary.  While the Judge ordered payment, she did not assess a penalty.

 

On appeal, the Workers’ Compensation Appeal Board reversed the decision and order of the WCJ.  The Board concluded that CBD oil could not be a reasonable and necessary medical treatment when the FDA has issued several warning letters to firms marketing CBD products for violating federal law.  The WCAB also reasoned that the claimant did not submit the required medical reports and forms to trigger the employer’s reimbursement obligations.  The claimant appealed to the Commonwealth Court.

 

As was the case in the medical marijuana decisions of Fegley and Appel, dealing with the issue of whether medical marijuana is payable as treatment for a work injury, the Commonwealth Court reversed the decision of the Board.  This decision, as did the medical marijuana reimbursement cases, reflected a lack of understanding by the Court regarding application of the Medical Cost Containment Regulations in Pennsyvlania.  If there is no submission of medical bills with reports, the time frame to issue payment under the Medical Cost Containment Regulations never starts to run.  In fact, in this matter, the claimant’s medical provider appears to have “prescribed” topical treatment and the Claimant, on his own volition, elected to change what was “prescribed” or recommended to be ingestible CBD oil.  Thus, the treatment that was subject to reimbursement may not have actually had been “prescribed” by the medical provider.

 

If all that is required is a “recommendation” by the medical provider for medical marijuana or a CBD product or any other potential treatment modality, do we no longer need to have specific prescription provided for this to be treatment for which a insurer/employer/carrier is required to issue payment for reimbursement?  Why are reimbursements to be treated differently than payment of a medical bill under the Act and Regulations?  A medical provider does not simply indicate in a note that he is prescribing or recommending “narcotics” or pain medication and the Claimant is then allowed to determine the type, dosage, and frequency of what pain medication they feel works best.  The narcotic medication is actually being prescribed by a physician in terms of type, amount, dosage and frequency. 

 

This may now not necessarily be the case in Pennsylvania with recent reimbursement cases being handed down by the Commonwealth Court.  The Court either did not consider this issue or lost sight of what actually happens when there is a prescription provided by a medical provider.  The Claimant now apparently simply gets “prescribed” medical marijuana or a CBD product and then has carte blanche to determine what he or she wants so as to obtain this “treatment” without any actual further guidance from his or her medical provider.

 

With narcotics or any other actual prescription, a Utilization Review can find it to be reasonable and necessary but at a lower dosage or frequency than what was actually prescribed by the treating physician if the matter is referred to utilization review.  With reimbursement cases, there will not be ongoing bills submitted along with office notes from the prescribing physician so as to trigger the time period to file for utilization review.   If the submission of the invoice by the Claimant is what triggers the need to file Utilization Review, it is the Claimant who is picking the strain and amount of medical marijuana or the type and amount of CBD product such that the Claimant may potentially be the “provider” subject to review since they are actually determining what is being purchased and used as “medical treatment” based upon a recommendation as opposed to an actual prescription.  If so, there is no reviewer of the same specialty, as is required to be the peer conducing Utilization Review, given the Claimant is not an actual medical provider such that a proper Utilization Review may not be able to be properly performed.  A Utilization Review of the “prescribing” doctor would not be able to comment on what is actually being prescribed if there is no actual prescription in terms of type, amount, dosage, frequency, which is what is present on a normal prescription should it be subject to utilization review.

 

Regardless of how one feels about the benefits of medical marijuana and CBD oil, there is an established body of law and procedures to deal with these very issues of prescription medication and recommended medical treatment. However, years established procedures are now being short-circuited by the Court in allowing for unregulated “prescriptions” and treatment in the form of medical marijuana and CBD products for which the employer is responsible.  This same issue could later be applied to other “treatment” modalities for which reimbursement is sought.  This could be recommendations for a “firm bed”, “soaking tub” or “transportation device” or other such “treatment” where the Claimant has carte blanch to interpret as they see fit and then seek reimbursement for what is “prescribed.”

 

Do any and all recommendations of a medical provider that result in the Claimant purchasing a something arguably related to treatment of a work injury now need to be reimbursed in Pennsylvania given the recent Court holdings concerning reimbursement or should payment for all medical treatment still be subject to the terms and provisions of the Act and corresponding Regulations before payment need be made for such “treatment”? The recent holdings are problematic as they allow for circumvention of the Act and Regulations and if they continue to be followed by the Court, can allow for potential abuses and deny Employers and Carriers the rights afforded under the Act and Regulations before payment is required to be remitted for treatment of a work-related injury.  The Pennsylvania Supreme Court has granted allowance of appeal in the Schmidt matter such that hopefully these issues can be further reviewed and properly addressed by the Court. 


Bradley R. Andreen, Esq.

Rulis & Bochicchio LLC 

On June 3, 2025, Goodyear will celebrate 100 years of soaring over America’s favorite sporting events. Approximately 3.5 years after Goodyear blimps first began flying across the country, the company announced that it would build a tire manufacturing plant in the moderately sized city of Gadsden, Alabama. It would be the first such plant in the South. Gadsden had nudged out a bevy of other suitors such as Atlanta due to its central location, abundant natural resources, and a readily available workforce. The Gadsden plant opened in July of 1929, with a ceremony and dedication. Although the community was happy to cut the ribbon and start making tires, the real excitement came with the news that one of the Goodyear blimps would soon be paying a visit. In December of the following year, the Goodyear airship “Defender” traveled from Nashville to Gadsden. During the trip, the blimp became lighter due to expended fuel and sandbags that were dropped to help navigate in the face of a strong headwind. When several Gadsden plant employees attempted to secure the blimp by grabbing the ropes hanging from the blimp, a gust of wind caused Defender to unexpectedly lunge upwards. All but two employees dropped their rope. One of the two remaining rope holders let go at approximately 25 feet and sustained a back injury from the ensuing fall. Unfortunately, the other man did not drop his rope when he had the chance. As the airship climbed higher, the pilot tried to maneuver the ship over the Coosa River to offer the man a softer landing. Unfortunately, the man ran out of grip strength before the blimp was over the river. After holding on for close to 10 minutes, Iken Douglas Phillips plummeted 150 feet to his death. In one disastrous incident, the Gadsden plant had incurred two of its first Alabama workers’ compensation claims.

My Two Cents:

In the last two years, there has been a concerted effort by a few Alabama plaintiffs’ attorneys to have the entire Alabama WC Act declared unconstitutional. One of the challenges recently made it to the Alabama Supreme Court. Fortunately, the Act survived that round. Had Alabama’s high court agreed with the plaintiff’s position, it would have eradicated more than 100 years of the Grand Bargain which offers indemnity and medical benefits through no fault insurance in exchange for said benefits being the exclusive remedy against the employer.

So, what would have happened to the injured Goodyear employee and what recourse would the deceased employee’s dependents have had without the Alabama WC Act to provide no fault benefits? The answer is that they would have had to prove that Goodyear or perhaps the blimp pilot breached a duty of care and, said breach, caused the accident. Even if they were able to prove negligence or even wantonness against one or more of the defendants, the defendants would have asserted that the employees were contributorily negligent and/or assumed the risk by not letting go of the rope like their co-employees. Let’s not also forget that the stock market crash leading to the Great Depression had occurred a few months after the plant opened and Goodyear had become THE EMPLOYER of Etowah County. The reality was that no juror was going to bite the proverbial hand that was feeding the community. That means the employee and the dependents would have been on their own without any recourse, benefits, or financial assistance to help them.

A Few More Cents:

In the last 105 years, the Alabama WC Act has grown from a meager 33 pages to more than 450 pages. Despite the many statutory additions, changes, and court interpretations, the Grand Bargain remains in effect. The recent constitutional challenges have been unsuccessful to date, but they are occurring more often and with new and inventive arguments. Unless updates are made to some of the more obviously outdated provisions, we can expect the challenges to keep coming. As they say, even a blind squirrel sometimes finds a nut. This nut will send Alabama into the pre-Grand Bargain work accident dark ages.

More Info:

If you are looking for more information about the Alabama Workers’ Compensation Act or the recent constitutional challenges, check out the Alabama Workers’ Comp Blawg at https://www.alabamaworkerscompblawg.com.

About the Author:

This article was prepared by Mike Fish, an attorney with Fish Nelson amp; Holden, LLC, a law firm dedicated to representing self-insured employers, insurance carriers, and third-party administrators in all matters related to workers’ compensation. Fish Nelson & Holden is a member of the National Workers’ Compensation Defense Network. If you have any questions about this article or Alabama workers’ compensation in general, please contact Fish by e-mailing him at mfish@fishnelson.com or by calling him directly at 205-332-1448.

On December 6, 2024, the Alabama Supreme Court released its opinion in the case of Crenshaw v. Sonic Drive in of Greenville wherein it refused to find the Alabama Workers’ Compensation Act unconstitutional. At the trial court level, a plaintiff, as the father of a minor employee, sued the minor’s employer for negligence as the result of an injury he sustained on the job. The employer quickly asserted the Alabama Exclusivity Doctrine which serves to protect employers from such lawsuits in exchange for providing no fault workers’ compensation benefits. The trial judge dismissed the lawsuit despite the plaintiff’s claim that the Alabama Workers’ Compensation Act was unconstitutional for a number of reasons. The focus of the plaintiff’s constitutional challenge was that the WC Act does not contain a mutual elective option. The plaintiff argued that, while employers can opt out of WC coverage, employees do not have that option. Both employers and employees had the right to opt out until the 1973 amendments at which time rights to both were extinguished. Then, the employers’ right to opt out was restored in the 1992 amendments. It was undisputed that the employees’ right to opt out was never restored. However, the Court of Appeals held that the legislature properly acted within its police power when it passed legislation that resulted in the unequal opt out right.

                                        

My Two Cents: You may be asking yourself, “self, what is this police power that the court relied on to allow for a WC Act that is undisputedly not mutually elective”? Good question! The answer is that a legislature exercises its police power if it enacts legislation that is designed to eradicate or ameliorate a perceived social evil.

                          

You may now be asking yourself, “self, what the heck does that have to do with the above constitutional challenge?” Another good question! To answer that, you must go back in time over 100 years to observe the conditions presented by the industrial revolution in the late 1800s and early 1900s. Safety could not keep pace with growth and a sharp increase in workplace injuries was the unfortunate result. Injured employees who could not work had no means of support for themselves or their families. They had no means of paying for medical treatment. Their only recourse was to sue the employer and attempt to prove liability and damages. The social insurance we now know as workers’ compensation was designed to provide no fault indemnity and medical benefits. In exchange for providing these benefits, employees gave up the right to sue employers in tort. This is commonly referred to as the Grand Bargain. While there have been numerous amendments to the Alabama WC Act over the years, the Grand Bargain remains fundamentally intact.

                           

The reality is that no Alabama high court is going to find the Alabama WC Act unconstitutional as currently drafted because it would adversely affect current and future injured employees, it would terminate all benefits for previously injured employees, and it would effectively terminate the employment of countless people working in the Alabama WC industry. When you consider all of that, is there any question that Alabama’s WC Act was designed to eradicate or ameliorate a perceived social evil? You will have to answer that one for yourself.

                      

This blog submission was prepared by Mike Fish, an attorney with Fish Nelson & Holden, LLC, a law firm dedicated to representing self-insured employers, insurance carriers, and third-party administrators in all matters related to workers’ compensation. Fish Nelson & Holden is a member of the National Workers’ Compensation Defense Network. If you have any questions about this submission or Alabama workers’ compensation in general, please contact Fish by e-mailing him at mfish@fishnelson.com or by calling him directly at 205-332-1448.

On September 20, 2024, the Alabama Court of Civil Appeals released its opinion in the case Zackery v. Huntley wherein it reversed both the District Court and the Circuit Court’s judgment in favor of plaintiff that awarded workers’ compensation benefits. The appellate Court’s decision to reverse the WC judgments was due to the plaintiff initially and improperly filing the WC lawsuit in District Court. The Circuit Court was only involved because the employer appealed the final judgment to the Circuit Court for a de novo review. In Alabama, Circuit Courts have original jurisdiction in workers’ compensation cases. Since plaintiff originally filed the WC matter in District Court, the Circuit Court did not properly obtain jurisdiction since it was only involved in its capacity as an appellate court.

                  

My Two Cents: In may types of civil matters, a lawsuit can be filed in the District Court if the amount in controversy is $20k or less. Reasons for filing in District Court include a cheaper filing fee, less formality, and a quicker path to a bench trial. Any District Court judgment can be appealed to the next level which is the Circuit Court. The Circuit Court judge handles the appeal de novo which is Latin for anew or from the beginning. Basically, that means the judge is not supposed to consider the prior judgment and basically wipe the slate clean.

                  

This blog submission was prepared by Mike Fish, an attorney with Fish Nelson & Holden, LLC, a law firm dedicated to representing self-insured employers, insurance carriers, and third-party administrators in all matters related to workers’ compensation. Fish Nelson & Holden is a member of the National Workers’ Compensation Defense Network. If you have any questions about this submission or Alabama workers’ compensation in general, please contact Fish by e-mailing him at mfish@fishnelson.com or by calling him directly at 205-332-1448.