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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George Washington, an employee of Runnells Center for Rehabilitation and Healthcare, left work on March 5, 2015 and drove his car to pick up lunch at a nearby restaurant.  Returning from lunch, his car struck a guardrail on a snow-covered access driveway owned by Runnells.  He completed an accident report at the scene, exited his vehicle, then slipped and fell, fracturing his ankle.

In April 2016, Washington sued Runnells, his employer, seeking compensatory damages.  Defendant Runnells surprisingly failed to argue that workers’ compensation was plaintiff’s exclusive remedy.  One cannot sue one’s employer in civil court except for rare exceptions.  Eventually Runnells amended its position in the case to argue that plaintiff could not sue the company in civil court, and the amendment was allowed.  That set the stage for an interesting decision.  Was Mr. Washington at work when he slipped and fell on an access road coming back from lunch?

The Superior Court held that plaintiff could not bring a civil suit against Runnells.  It did not matter that plaintiff was returning from a lunch break.  His car had reached the premises owned or controlled by his employer and he was technically in the course of employment when he was injured.  Therefore his sole remedy was workers’ compensation benefits, something Washington did not desire.

Washington relied on Acikgoz v. N.J. Tpk. Auth., 398 N.J. Super. 79 (App. Div. 2008).  He argued that his case was similar to this 2008 case.  In that case two vehicles collided on an access road owned by the New Jersey Turnpike Authority, and a civil case was allowed.  Both drivers worked for the Turnpike Authority. Acikgoz had completed his shift and was heading home.  Lowden, the other driver, was merely driving to work to pick up his paycheck.

The Court in Acikgoz allowed the civil law suit stemming because it held that Lowden was not in the course of his employment, as he was just picking up a paycheck. He was not there to work.  Further, the access road was open to the public.  The Court found that Lowden used the access road for “convenience” rather than for the benefit of his employer.

The Appellate Division concluded that Washington’s case was not the same as Acikgozat all. The Appellate Court felt that Washington’s civil case was barred because plaintiff was technically at work when he was injured on the employer’s premises.  The court noted that the road he was on was not used by the public.  The Court also held that the civil case should be dismissed without prejudice pending a decision in the Division of Workers’ Compensation on the issue of compensability.  It is noteworthy that the Appellate Division in this case deferred to the Division of Workers’ Compensation for the final say on the application of the premises rule, predicting that the Division of Workers’ Compensation would be in agreement.  That has not been the trend in recent cases where the Superior Court has been faced with workers’ compensation compensability decisions, making their own final determination.

This case can be found at Washington v. Runnells Operating, LLC, A-3996-16T2 (App. Div. July 25, 2018).  It illustrates an important point in workers’ compensation.  The premises rule is a strict rule.  When one is on the premises to work, workers’ compensation laws apply.  It does not matter that one may be returning from lunch or returning from an off-premises shopping errand: the mere presence on the premises to renew work is enough to bring the worker within the protection of workers’ compensation.  In this case Washington fought hard to be outside workers’ compensation because the potential for damages is often far greater in the civil courts than in workers’ compensation.

Thanks to our friend, Ron Siegel, Esq. for bringing this interesting case to our attention.

 

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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. 

  West Virginia Supreme Court Impeachments - Latest Developments and Update

August 14, 2018

 August 14, 2018 update

 There have been significant developments in recent days regarding the Articles of Impeachment brought against the four remaining Justices of the Supreme Court of Appeals of West Virginia.   

 On August 9, 2018, Chief Justice Workman issued an Administrative Order temporarily appointing the Honorable Paul T. Ferrell, Judge of the Sixth Judicial Circuit, to serve on the Supreme Court during Justice Loughry's suspension. Judge Ferrell's assignment commenced immediately and will continue until the Chief Justice determines such assistance is no longer necessary. Justice Workman's Order further notes that should the Articles of Impeachment brought forth by the House Judiciary Committee proceed to the Senate for trial, Judge Ferrell will serve at the Acting Chief Justice for any impeachment proceedings. 

 On Monday, August 13, the House of Delegates convened for a 14-hour floor session and voted to adopt eleven separate Articles of Impeachment put forth by the Judiciary Committee. 

 Following the votes in the House of Delegates, on August 14, 2018, Justice Robin Davis announced her immediate retirement from the Supreme Court. Justice Davis's retirement means that the unexpired six years of her term (until 2024) will also be on the ballot in the November 2018 general election. As previously reported, Justice Ketchum's seat will also be on the ballot in the November 2018 general election. Prior to that election, Justice Davis's position on the Supreme Court could be filled by an appointee of the Governor of West Virginia, or Chief Justice Workman could fill the seat through use of temporary appointment powers.

The remaining articles of impeachment approved by the House of Delegates against Justices Loughry, Walker, and Workman will go to the State Senate for trial. At this time, there is no timetable for any proceedings before the Senate, however, impeachment of any Justice would require a 2/3 vote in the Senate for conviction and potential removal from office. 

 The Supreme Court's Fall Term is scheduled to begin on September 5, 2018.

 If you have specific questions, reach out either to your Spilman contact, or Andrew P. Arbogast (Chair, Litigation Department), or Don C. A. Parker (Chair, Appellate Group) for more information. 

New Jersey has a sensible provision that protects employees of subcontractors who are injured on construction jobs.  If an employee of a subcontractor is injured on a job, and the subcontractor has no workers’ compensation insurance, the injured employee becomes covered by the general contractor’s workers’ compensation policy.  But what if the injured employee instead decides to file a civil suit against the general contractor for negligence?  Does the general contractor’s liability insurance policy cover the civil suit? Can the injured employee sue the general contractor and obtain workers’ compensation from the general contractor?

These questions were answered in DaSilva v. JDDM Enterprises, LLC, David Cohen, t/a JDDM Custom Construction, A-3302-16T2 (July 27, 2018).  The case involved an injury to Mr. DaSilva.  He was working for Hand Brothers on a construction job.  Hand Brothers was a subcontractor of JDDM, the general contractor.  DaSilva fell one story through a cut-out stairwell on the job and suffered injuries.  Hand Brothers had allegedly presented a fake certificate of insurance to JDDM and actually had no compensation coverage.

DaSilva sued JDDM and its principal, David Cohen, seeking damages in a civil action.  JDDM referred the suit to Utica Insurance, its liability carrier.  Utica declined coverage because its policy excluded workers’ compensation injuries.  JDDM and Cohen then filed a third-party declaratory judgment action against Utica, seeking an injunction to compel Utica to defend NJJD and Cohen in the civil action.  Utica then moved for summary judgement arguing that the declaratory judgment suit must be dismissed as Mr. DaSilva’s injuries arose from work. Utica further contended that DaSilva was covered by JDDM under N.J.S.A. 34:15-79 because JDDM was the general contractor.

The trial judge granted summary judgment in favor of Utica.  JDDM and Cohen settled the civil claim with DaSilva and then appealed the decision to let Utica out of the case.  The Appellate Division reviewed the language contained in Section 79.  “Under this provision, a contractor who retains a subcontractor becomes liable for workers’ compensation benefits owed to the subcontractor’s employees if the subcontractor does not provide workers’ compensation insurance.”

The Appellate Division also took note of the fact that JDDM’s workers’ compensation carrier in fact admitted liability under Section 79 to DaSilva. The Appellate Division ruled that Utica’s policy excluding coverage for benefits that are provided or are required to be provided under workers’ compensation was valid.  Since JDDM was required to provide workers’ compensation coverage under Section 79, Utica was well within its rights to deny coverage on the civil suit.

What about the right of DaSilva to sue the general contractor while at the same time asserting coverage for workers’ compensation against the general contractor under Section 79?  Does the exclusive remedy provision apply barring his civil law suit?  The Appellate Division commented as follows: “Because general contractors are not part of an employment contract between a subcontractor and its employees, they are ‘not required to provide workers’ compensation coverage, and do not enjoy the immediate employer’s immunity from tort liability,” citing to Eger v. E. I. du Pont de Nemours Co., 110 N.J. 133, 137 (1988).

So the Court was saying that DaSilva’s civil law suit against the general contractor was not barred under the exclusive remedy provision. That may seem unfair to the general contractor.  However, Section 79 does allow the general contractor to full reimbursement from the subcontractor which failed to carry insurance.  In addition, there would be subrogation issues here under Section 40.  DaSilva had a double recovery here.  He settled his civil suit against the general contractor and obtained workers’ compensation benefits from the general contractor by virtue of Section 79.  Therefore, the worker’s compensation carrier would be entitled to assert subrogation rights and thereby reduce its obligation to DaSilva.

Thanks to our friend Ron Siegel, Esq. for bringing this case to our attention.

 

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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. 

West Virginia Supreme Court Impeachments - Latest Developments and Update

August 9, 2018

On August 7, 2018, the Judiciary Committee of the West Virginia House of Delegates voted to move forward with 12 articles of impeachment against four sitting justices of the Supreme Court of Appeals of West Virginia stemming from alleged overcompensation of senior status judges, improper use of state property, and inappropriate use of state funds. Articles of impeachment were brought against Justices Allen Loughry, Margaret Workman, Robin Davis, and Beth Walker. No articles were issued against Justice Menis Ketchum, who previously resigned his position on the Court. Justice Ketchum's seat will be on the ballot in the November 2018 general election. Prior to that election, his position on the Supreme Court could be filled by an appointee of the Governor of West Virginia.

The full House of Delegates is scheduled to convene on Monday, August 13 to consider the articles of impeachment put forth by the Judiciary Committee against the four remaining justices. Any articles of impeachment approved by the House of Delegates will go to the state Senate for trial. Impeachment of any justice would require a 2/3 vote in the Senate.

This is an historic event in West Virginia politics and for the judicial branch, for which the implications are unprecedented. Many questions remain regarding how cases on appeal before the Supreme Court will be addressed. The Supreme Court is currently in recess, with case conferences for the coming term scheduled to begin on August 28, 2018. The Court is scheduled to hear the first oral arguments of the new term on September 5, 2018.

This situation is fluid with many variables in play. Spilman is monitoring the situation on a daily basis, and will keep you updated with any breaking news. If you have specific questions, reach out either to your Spilman contact, or Andrew P. Arbogast (Chair, Litigation Department) aarbogast@spilmanlaw.com, or Don C. A. Parker (Chair, Appellate Group) dparker@spilmanlaw.com for more information.

 

Legislative Update by Attorney Alison Stewart       

WCES - Workers' Compensation Electronic System         

A new electronic filing system is tentatively scheduled to be implemented beginning in December of 2018. The new system will be known as Workers’ Compensation Electronic System, or WCES (pronounced “wick-ess”). Training will be provided by the Iowa Division of Workers’ Compensation for attorneys and other stakeholders who will be required to use the system. It is the intention of the Division that the system will provide for electronic filing of all pleadings and documents with the Division. The new system will also provide for more efficient scheduling of hearings, comprehensive case management, and greatly improved EDI transactions. The proposed administrative rules relating to the implementation of this system were recently sent out for comment and we are now waiting for them to be adopted. These rules will instruct parties how to appropriately navigate the new system.

CourtCall 

The Division of Workers’ Compensation is now providing a system to conduct hearings by phone or video through a system called CourtCall. This system allows attorneys and parties to avoid travel time and the cost of commuting to a hearing location. The system is currently available at the Des Moines hearing venue for any hearing the parties and the hearing deputy agree to. It may also be available for road venues with advanced arrangements. There are some expenses associated with use of this program. The cost is $45 for the first 45 minutes and $12.50 for each 15 minute increment thereafter. This could be an excellent tool for remote employer witnesses, for example.


More information on these systems can be found at:  https://www.iowaworkcomp.gov/news-and-updates

 

H&W New York Workers' Compensation Defense Newsletter
Vol. 3, Issue 1

Board Announces Initiative to Replace C-4 Family of Forms with CMS-1500

The Board announced earlier this month that it will replace the C–4 family of forms (with the exception of the C-4.3 permanency evaluation form) with theCMS–1500 form.Board Subject Number 046-1079 describes technical specifications for the rollout and states that it will occur in 3 phases, the first of which will commence on 1/1/19. On that date, providers may begin voluntary transmission of CMS –1500 bills through an approved Board electronic clearinghouse and payers will also be expected to accept electronic receipt of same. On or about 1/1/20, the Board willrequire use of the electronic CMS–1500 billing form through its clearinghouse. Because the CMS-1500 form does not have the space on it for providers to write a history, opinion on causal relationship, or opinion on degree of disability, the Board will require providers to attach a narrative that includes this detail. The Board has provided a website outlining the CMS–1500 initiative which discusses the requirements it expects providers to adhere to in compiling narratives to attach to their billing forms in order to assist in the management and adjudication of claims.
 
In addition to the expected requirements of a history of the injury, a diagnosis, and an opinion on causal relationship, the Board also demands detail from the health provider concerning the specific functional work activities or activities of daily living that the patient cannot perform as a result of the injury or illness. This is another example of the Board’s continued emphasis on function as a significant factor in assessing impairment. We hope that the Board will enforce these requirements by supporting payer bill denials for inadequate narrative descriptions. We recommend that our clients carefully review the narrative submissions from providers and deny those bills with narratives that fail to adhere to the standard when the program goes live next year.
 
Providers can no longer simply “check the box” in order to provide an opinion on causal relationship. In addition to stating whether the incident described by the patient was the competent medical cause of the injury or illness, the provider must also indicate whether the complaints are consistent with the history provided and whether the history is consistent with the objective findings noted on examination. Of note, the Board’s recently revised C-4.3 Form will not be eliminated by the CMS-1500 initiative. Providers will still be expected to fully complete the C-4.3 Form to render a valid opinion on permanency.
 
There is a potential loophole for providers that wish to avoid the Board’s narrative attachment requirements. The CMS-1500 requirements website states that physicians can include page 2 of the Doctor’s Progress Report (Form C-4.2) “as an optional attachment with the CMS-1500 and medical narrative to provide concise information on the Doctor's Opinion and Return to Work.” It is unclear to us whether this means page 2 of the Form C-4.2 can be submitted in lieu of the required narrative or in addition to the required narrative. If it is the former, then physicians can avoid many of the new narrative requirements by simply attaching the form.
 
Given prior complaints from providers concerning the Boards suite of medical forms, it is unsurprising that the Board is moving forward with this initiative. In 2010,the Board went so far as to declare a provider shortage in the greater Rochester area, noted the burden on providers created by the Board’s forms requirement, and at that time authorized use of the CMS–1500 form with an attached narrative in lieu of completion of the required C-4 family of forms.

Board Eliminates Need to File C-8.1A with C-4AUTH Denial

In a welcome change, the Board has announced that Form C-8.1A will no longer need to be filed in cases where a carrier denies a request for authorization of a special service with Form C-4AUTH. In the past, a carrier’s denial of treatment requested by an attending physician on a C-4AUTH form required completion of 2 forms, as well as a conflicting medical opinion, resulting in the perverse and uniquely New York requirement of requiring 3 documents from the carrier to deny one request from the provider. The Board announcement is a step in the right direction, reducing the paperwork burden on carriers and eliminating a redundant form.
 
The Board’s announcement appears to be a policy statement following a decision inMatter of J&A Concrete Corporation, 2017 NY Work. Comp. G1078502 (filed 9/5/17), which held that the filing of a C-8.1A would be “redundant and unnecessary” where the carrier has already filed a C-4AUTH denial coupled with the filing of a contrary supporting medical opinion. This change is effective immediately.
 

Contact Us

Hamberger & Weiss - Buffalo Office
700 Main Place Tower
350 Main Street
Buffalo, NY 14202
716-852-5200
buffalo@hwcomp.com

Hamberger & Weiss - Rochester Office
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Suite 500
Rochester, NY 14614
585-262-6390
rochester@hwcomp.com

As discussed in last month’s newsletter, attorneys’ fees are a hot topic of discussion in the Texas workers’ compensation system. With the recent indictment of a claimant’s attorney alleging fraudulent billing, as well as the revelations of some incredibly high hourly billers in the system, the Division is now weighing in on the issue. Tim Riley, Deputy Commissioner for Compliance and Investigations, issued a July 11 memo to remind attorneys of the Division’s requirements for submitting fee applications as well as the Division’s right to enforce compliance. Deputy Commissioner Riley specifically warns attorneys that approval of an application for attorney’s fees does not foreclose the possibility of an enforcement action related to the application.

The full memo is available on the TDI Website.

-  Copyright 2018, Stone Loughlin & Swanson, LLP

According to an article in The Texas Tribune, Governor Greg Abbott’s office will be reviewing all Texas agency rules before they are posted in the Texas Register for public comment. Luis Saenz, the Governor’s Chief of Staff, wrote a letter to the agencies saying, “Prior to publication of a proposed rule in the Texas Register, the Office of the Governor will review the Notice of Proposed Rule as well as the agency’s internal analysis of the rule.”

Governor Abbott claims this approach will “eliminate redundancies and inefficiencies, and provide a dispassionate ‘second opinion” to the proposed agency’s rules.

While the move is intended to promote efficiency, it also significantly expands the power of his office. The process will ensure the involvement of the Governor’s Office in all agency rule-making decisions, including the Texas Department of Insurance and the Division of Workers’ Compensation.

Texas agencies have been directed to provide certain information to the Governor—including the draft rule and its expected impact on local employment and the economy—before posting the proposed rule in the Texas Register. The letter does not specify what power the Governor has over those proposed rules. 

For agencies that have statutory or programmatic deadlines for rule promulgation, this mandate will require them to reconsider their timelines, adding extra time to allow for gubernatorial review.

Click the link to read Governor Abbott's letter.

-  Copyright 2018, Stone Loughlin & Swanson, LLP

Computers, smartphones, and tablets are everywhere and seemingly make peoples’ lives easier.  A study conducted by UCLA found that young people spend upwards of 7 hours a day attached to their devices. Garry W. Small, et. al.,Healthy behavior and memory self-reports in young, middle-aged, and older adults, 26.6International Psycogeriatrics 981-989. 

The consistent use and dependence on these devices comes with some negative consequences.  Individuals who rely heavily on technology may suffer deterioration in cerebral performance such as short-term memory dysfunction. Research has shown that reliance on devices can lead to issues with memory and cognitive skills, dubbed “digital dementia.” “Digital Dementia” is a term coined by Manfred Spitzer and is used to describe how overuse of digital technology can result in the breakdown of cognitive abilities in ways that are commonly seen in people who have suffered head injuries or psychiatric illness. 

What impact does this have for employers and workers’ compensation carriers?  Digital dementia may become the new carpel tunnel syndrome, especially with older generations who were not exposed to technology before entering the workforce.  An employee could argue digital dementia is an “occupational disease” that naturally results from working with technology.

These “digital dementia” claims will likely be decided in a manner similar to “job stress” or mental trauma claims. The Texas Supreme Court has held that damage or harm caused by repetitious mentally traumatic activities does not constitute an occupational disease and is not considered a compensable injury under the Act.  However, if the event can be traced to a definite time, place, and cause, it could produce a compensable injury.  In most cases, it will be difficult for an injured employee to pinpoint a discernable time, place, and cause to the alleged “digital dementia,” because it is a “repetitive” type injury that occurs over time.

Click the link to learn more aboutDigital Dementia and the effects it has on the brain. 

-  Copyright 2018,Stone Loughlin & Swanson, LLP

Enrique Colon, a healthcare worker, was convicted of falsifying workers’ compensation claims.  Mr. Colon was indicted along with EME International, Inc. and two others on charges of engaging in organized criminal activity for over-billing for the exams. Mr. Colon was found guilty of submitting false medical claims to an insurer for more time than it actually took to perform functional capacity evaluations.

In response to the conviction, Cassie Brown, Commissioner of Workers’ Compensation, said: “Addressing fraud is vital to the health and success of the workers’ comp system here in Texas.  The [D]ivision is committed to protecting injured employees and policyholders from these schemes.”

Report suspected cases of insurance fraud by calling 1-800-252-3439 or visit www.tdi.texas.gov/fraud/.

-  Copyright 2018, Stone Loughlin & Swanson, LLP