State News

 In Appeal of Northridge Environmental, LLC, the New Hampshire Supreme Court held that home care services provided to the injured worker by his non-medically trained spouse qualify as a compensable medical expense under New Hampshire’s workers’ compensation law.

In Northridge, the claimant sustained serious injuries at work.  After his release from the hospital he required constant care that included cleaning of his wounds and assistance with moving, bathing, and dressing, all of which was provided by his spouse. The claimant sought payment for his spouse’s services from his workers’ compensation carrier, under the theory that but for his spouse’s care he would have needed to hire a medical professional to perform the home care.

The New Hampshire Department of Labor initially denied reimbursement for the spouse’s home care services and the Compensation Appeals Board (CAB) upheld the decision. After an initial appeal to the New Hampshire Supreme Court, the case was remanded to the CAB with instructions to revisit the issue and determine whether, and to what extent, the services provided by the claimant’s wife were reimbursable. On remand, the CAB determined that the claimant was entitled to reimbursement for the services his spouse provided, noting that RSA 281-A:2, XII-b of the workers’ compensation statute “does not exclude a spouse as a home health care provider and should include a spouse as a home health care provider because the workers[‘] compensation statute is a remedial statute and a spouse is not excluded as a provider.” Appeal of Northridge, Case No.: 2014-0776, March 22, 2016, 2. The Court affirmed the decision of the CAB and stated that “the CAB did not err when it decided that the petitioner was entitled to reimbursement for his wife’s services.” Id., 5.

The workers’ compensation carrier also had objected to the CAB’s finding concerning the amount of reimbursement to be provided to the claimant for the services rendered by his wife. After the initial appeal and remand to the CAB, the CAB determined that the claimant should be reimbursed at the rate of $15 an hour, 12 hours a day for the care provided by his wife. The carrier argued there were no time cards or other records available, and that the CAB should not have determined that “twelve hours per day, every day” is “an appropriate reimbursement rate in this instance.” Id., 6. The Court held that it could not “conclude that the CAB erred when it determined that reimbursement for 12 hours per day was reasonable.” Id., 6.

The Court also considered whether the claimant’s attorney was entitled to attorney’s fees. The Court determined the claimant’s attorney had “prevailed” under the definition in RSA 281-A:44, I as the attorney had obtained a remand from the Supreme Court and obtained relief at the remand CAB hearing. Although it “did not award benefits to the petitioner in the earlier appeal, [its] prior decision was an essential step in the process that eventually led to the CAB awarding reimbursement.” Id., 9. As such, the Court determined that the petitioner was entitled to reasonable attorney’s fees and costs incurred in the earlier appeal to the Court.

 This ruling potentially exposes employers, carriers, and third party administrators to liability for reimbursement for care provided by the spouses and other non-medically trained individuals who provide care to an injured worker. In Northridge, the carrier had offered to pay for a licensed healthcare provider to perform the in-home services which were prescribed.  The claimant declined the offer. If the injured employee requires medically necessary homecare and foregoes a visiting nurse or other medical professional, this case supports the argument that the statute does not preclude reimbursement for a spouse or other non-medically trained individual who provides that care. Furthermore, nothing in the decision appears to limit this holding to a spouse. 

The Court’s second consideration – that the claimant’s attorney was due reasonable fees and costs for an earlier appeal when prevailing at the remand hearing – also exposes employers, carriers, and third party administrators to potential liability for payment of attorney’s fees. Claimants’ attorneys will undoubtedly request their fees be paid by carriers for their time before the Supreme Court when they obtain a remand from the Supreme Court that results in a favorable decision before the CAB.

 Bill 1084 went into effect on July 1, 2016.　 This legislation abrogates the holding inWheeler, and sets forth the applicable law as it relates to aggregate wages for an employee when calculating an employee’s average weekly wage.　 While we suggest reading the entirety of Bill 1084 and, of course, calling us for any questions you may have, keep the following in mind:

To be prudent, you should ask an injured employee if they are employed in any other position and ask that they provide wage information to support the same and note your file accordingly.

 If you have any questions relating to calculating the comp rate, what needs to be included, or general questions on South Dakota law, please contact Charlie Larson atcalarson@boycelaw.com or 605-336-2424. 　

The maximum rate changed on July 1, 2016 to $762 a week.  The minimum work comp rate has increased to $381 a week. 

If you have any questions on work comp rates or general questions, please feel free to contact Charlie Larson atcalarson@boycelaw.com or 605-336-2424.   

Beginning July 1, 2016, the maximum worker’s compensation payable was raised to $832 per week and the minimum was raised to $229 per week. This change was based on the Commissioner of Labor’s determination that the State’s average weekly wage was $831.88 in the calendar year 2015, and the change is effective for any injury occurring on or after July 1, 2016.

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About the Author

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.

As you know, Kids’ Chance is a scholarship program for children whose parents have been killed

or seriously injured at work. Donations are tax deductible and we welcome contributions. More

important is that we are looking for eligible scholarship recipients. If you know of an eligible child,

please contact Kids’ Chance in care of Jane Stone, who is on the founding board, at

jstone@slsaustin.com, or call her at 512-343-1300. A big kick-off event is planned for the Fall, too,

and if you or your company are interested in being a sponsor (with appropriate attribution), please

let us know. The deadline for sponsorships is fast approaching.

The US National Toxicology Program, a federal interagency group under the NIH, is said to have

linked radiation from cell phone exposure to cancer in rats in a new study. The researchers exposed

rodents for two years (apparently, a rodents’s life span) to radiation levels designed to roughly match

what a human with heavy cell phone use or exposure might experience. The study results are a long

way from determining if the results of the experiments would be the same if the subjects were

humans. We wonder if the danger to humans will be more or less than the dangers of using a cell

phone while driving (or walking). In any event, if cell phone usage is a work requirement for a

particular injured worker who develops cancer, or gets hit by a bus while distracted by his phone,

there may be some workers’ compensation claims filed.

As many of you know, a broad-based conference was recently held in Dallas by invitation only to

discuss common national issues in workers’ compensation in light of a perceived trend to “opt-out”

plans and the specter of nationalization or doing away with a workers’ compensation system altogether. SLS partner Jane Stone was invited to the Summit as a representative of the National

Workers’ Compensation Defense Network. You may have been following the progress of the

Summit on Bob Wilson’s website. The purpose was to open a dialogue as to what is right in

worker’s compensation programs, and what can be improved. The discussions were lively to say

the least, given that the attendees were so diverse in their views and experiences. The conversations

lasted for 2 days among regulators, judges, insurance professionals, physicians, academics, union

representatives, lawyers (from all sides), and injured workers (both satisfied with the system and

unhappy with it). After the initial conference, the attendees responded to a survey to determine the

priority of topics that were most important. The results of the survey will be published sometime

after July 4th.

Treatment for opioid dependence has long been an issue in workers’ compensation. Now that the

FDA has approved implants which will provide a constant, low dose of the drug buprenorphine to

a patient who is already stable on other forms of the drug, such as pills or sublingual films, requests

for the implant should begin to show up in preauthorization requests, given that buprenorphine is

an “N” drug.

The State Office of Administrative Hearings recently decided to deny payment for compounded

medications which are usually various topical creams which are touted as relieving pain or healing

scars. Texas insurance carriers have been seeing bills of more than $12,000 for a one month

prescription. It was thought by some that so long as the compound didn’t contain an “N” drug from

the DWC’s closed formulary, preauthorization under DWC Rule 134.600 was not required. But the

insurance carrier in this case decided to deny payment based on the defense that Rule 134.600

requires that investigational or experimental drugs be preauthorized. SOAH determined, based on

expert testimony from Dr. Suzanne Novak and her expertise in the application of the ODG treatment

guidelines, that compounded drugs are by their very nature investigational and experimental. That

being the case, the creams would require preauthorization. Many in the pharmacy and treatment

industries disagree, but for now, at least we know which way the wind is blowing.

The Texas Supreme Court issued a decision blowing apart an attempt at settlement of a partial SIBs

quarter. Bonnie Jones and the workers’ comp carrier had taken a dispute over the 14th quarter of

SIBs through the agency and into district court. The DWC had determined that Ms. Jones was not entitled to benefits for that quarter and Ms. Jones took the case up. In the district court proceedings,

Ms. Jones agreed to a partial payment for the quarter and the proposed judgment incorporating the

settlement was sent to the DWC. The Labor Code requires that all proposed judgments be submitted

to the DWC so the agency can decide if there is a reason to intervene in the case. After reviewing

the proposed judgment, the DWC exercised its right to intervene and oppose the judgment on the

basis that the agency had already found that Jones had not fulfilled the mandatory work search

requirements for the 14th quarter, and that a partial SIBs award, even if both parties agreed, “flouts

the statutory formula’s edict to calculate the monetary entitlement in a precise way.” The trial court

went ahead and granted the judgment anyway, and the court of appeals affirmed, citing the longstanding

general policy of encouraging settlement. But, as stated in the Supreme Court’s opinion,

the trial court and court of appeals“ignor[ed] the particularities that the revamped workers’ comp

scheme provides.” Bottom line: SIBs entitlement is all or nothing for each quarter – no partial

settlements allowed. One wonders whether the parties attempted the same settlement at the agency

level. It seems an odd case for the agency to spend resources to pursue what seems to be an issue

of minor significance. Texas Dept. of Ins., Division of Workers’ Compensation v. Bonnie Jones and

American Home Assurance Company, (Tex. 2016) No. 15-0025, opinion issued June 24, 2016.