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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Early this month, Kevin Williams, M.D. voluntarily surrendered his medical license. The Division audited Dr. Williams in 2016, and found that he prescribed compound medications which were not reasonable and/or medically necessary for his patients, and that he failed to follow the Division's fee and treatment guidelines. Dr. Williams was ordered to pay an administrative penalty of $10,000.00, to cease and desist from prescribing compound medications as routine practice in the Texas Workers’ Compensation system, and to attend further record keeping courses. 

The Texas Medical Board also investigated Dr. Williams for his excessive compound drug prescribing practices. Rather than face continued investigation, Dr. Williams agreed to surrender his license. In the Board Order, Dr. Williams neither admits nor denies the accusations, but rather, he chooses to voluntarily surrender his Texas Medical License in lieu of further disciplinary proceedings. The voluntary surrender of his license becomes effective on March 29, 2019. 

Dr. Williams may petition the Texas Medical Board to reissue his Texas Medical License in one year.    
 

-  Copyright 2019, Stone Loughlin & Swanson, LLP.

We are glad to report that Governor Abbott reappointed Jessica Barta as the Injured Employee Counsel. Not only does OIEC provide excellent assistance to injured workers, Jessica and her staff have been an invaluable resource for Kids’ Chance of Texas. Jessica serves on the board and has transformed Kids’ Chance’s outreach program out of the dark ages and into the light of the tech-savvy potential scholarship applicants . . . Kids’ Chance not only tweets now, it is also on FaceBook!  Check it out atwww.kidschanceoftexas.org. Please do not forget to refer to Kids’s Chance children of any age who have had a parent killed or catastrophically injured while working in Texas. Outreach and fundraising efforts are underway for 2019! 


-  Copyright 2019, Stone Loughlin & Swanson, LLP.

It is no secret that opioid addiction is a major problem in this county. In 2017, President Trump declared the opioid crisis a national emergency, and states have started fighting back. The Oklahoma attorney general recently announced a $270 million settlement the state reached with Purdue Pharma, the largest manufacturer of prescription opioids. Nevada, Texas, Florida, North Carolina, North Dakota, and Tennessee also filed suit against Purdue Pharma alleging violations of state consumer protection laws by falsely denying or downplaying the addiction risk while overstating the benefits of opioids. Several municipal and county governments in New York are also pursuing litigation against leading opioid manufacturers, including Purdue Pharma, to recover the medical, public health, and law enforcement costs related to opioid abuse.      
   
It seems doctors have heeded the public outcry, as opioid prescriptions are down. A study done by the California Workers’ Compensation Institute found that previously, nearly 33% of medications prescribed in its system were opioids. Now, opioids account for about 18% of the medications. 

The fact that opioid prescriptions are down does not mean we are out of the woods.  Efforts to curb unnecessary opioids should not result in simply replacing those drugs with others that may carry their own risks. The drug group that now accounts for a growing share of workers’ compensation prescriptions has its own set of risks, side effects, and potentially dangerous drug interactions. Benzodiazepines, for example, are highly addictive and have been implicated in overdose deaths. Originally prescribed as tranquilizers, they are found in multiple therapeutic drug groups, such as anticonvulsants and NSAIDs.  Recent research published in the Journal of the American Medical Association shows that prescriptions for these drugs for conditions such as back pain, chronic pain, anxiety, and insomnia are increasingly common. 


-  Copyright 2019, Stone Loughlin & Swanson, LLP.

The Texas legislature is busy at work in the capital. There are several pieces of proposed legislation affecting workers’ compensation. The following are some of the more notable bills:

  • Senate Bill 4418 would allow a licensed advanced practice registered nurse to complete and sign required reports such as DWC-73s.
  • House Bill 3537 effectively destroys the intoxication presumption provided in §401.013(c) by limiting it to a specimen taken within four hours of the injury.   
  • House Bill 4300 would allow Texas workers’ compensation insurance carriers and injured workers to reach a settlement of medical benefits if: (1) the injured worker enters into a workers’ compensation Medicare set-aside arrangement; (2) the arrangement is approved by the federal Centers for Medicare and Medicaid Services, if the proposed amount of the settlement is eligible for review by that agency; and (3) the settlement provides for oversight of the arrangement by a corporate trustee or other professional administrator, and a reversionary interest on the employee's death allowing the expended funds to be shared by the injured employee's beneficiary and the payor. The proposed legislation also would require that the Texas workers’ compensation insurance carrier and injured worker resolve, to the extent possible, all extent of injury issues before reaching an agreement on any issue. 
  • House Bill 1305 would require death benefits to be adjusted at the end of each calendar year as necessary to reflect inflation.
  • Senate Bill 2181 would expand lifetime income benefits to include third-degree burns covering the majority of both feet, one hand and one foot, or one hand or foot and the face. An injured worker who is determined permanently and totally disabled by the Bureau of Justice Assistance of the United States Department of Justice would also be eligible for lifetime income benefits if the injured worker is a first responder or “employed by a political subdivision that self-insures.” The bill also provides expanded provisions for coverage of traumatic brain injuries resulting in “permanent cognitive deficits” that render the injured worker permanently unemployable without significant accommodations or affect the injured workers’ non-vocational quality of life “so as to eliminate the employee's ability to engage in a range of usual cognitive processes.”
  • House Bill 536 would require that all opioid prescriptions be dispensed only in bottles with red caps. The hope is that the distinctive red caps will serve as a clear notice to “that opioids are unlike milder forms of prescription pain relievers” and “will help to eliminate accidental use and abuse leading to addiction and fatalities,” said Rep. Shawn Thierry who proposed the bill.


 -  Copyright 2019, Stone Loughlin & Swanson, LLP.

PHI Air Medical, the global helicopter transport company at the heart of the dispute over whether air ambulance firms can be bound by workers’ compensation fee schedules, filed for Chapter 11 bankruptcy protection this month.  The move came as no surprise following the company’s widely reported financial struggles in recent months. PHI’s bankruptcy filing has put the air ambulance litigation at the Texas Supreme Court on hold.   On March 22, 2019, the Texas Supreme Court abated the case until further order of the Court.  The Court has asked the parties to file a status report no later than May 21, 2019. 

PHI’s bankruptcy is the third among major helicopter service companies in recent years, including CHC Helicopters and Erickson in 2016.  Jeff Frazier, a partner with Sentinel Air Medical Alliance, indicated that PHI’s bankruptcy could signal the beginning of a shakeout that could lead to lower fees.  He indicated that PHI's, and other air ambulance companies, bankruptcy may lead to a restructuring of the industry, including a move to more hospital-based air services, which could lead to more reasonable rates. 

Whatever the effect of PHI’s bankruptcy, it is clear that the current business model is not working.  Air ambulance services borrow heavy to buy more helicopters, and then charge exorbitant prices to help pay the debt.  Some air ambulance services have loads of debt and reported profits have dropped sharply in recent years.  Air Evan EMS wrote in a court brief that it “faces market pressure in Texas” and, from 2012 through 2017, “suffered net losses in three years and posted minimum profits in the others.”  Evidently, billing patients for the balance did not really help air ambulance companies’ bottom line . . . .


-  Copyright 2019, Stone Loughlin & Swanson, LLP.

 

On March 29, 2019, the Alabama Court of Civil Appeals released its opinion in Ex parte Trusswalk, Inc. wherein it addressed a trial court’s ability to order pain management in the absence of a supporting medical necessity opinion from a doctor.  InTrusswalk, the trial court ordered the employer to send the injured employee to pain management despite the fact that no doctor had recommended it.  In issuing the order, the trial court relied on the fact that, after 5 back surgeries, the employee claimed to have chronic low back pain.  The employer promptly filed a petition for a writ of mandamus. 

 

In its petition, the employer argued that the trial judge lacked the authority to direct a referral for pain management where the authorized treating physician had not recommended same. In its brief and during oral argument, the employer argued that the trial court lacked the authority to order pain management in the absence of a supporting medical necessity opinion from any doctor.

 

In its opinion, the Court of Appeals cited to the Alabama Administrative Code for both the Board of Medical Examiners and the Department of Labor for the proposition that pain management is a specialty that necessitates a supporting opinion from a medical expert. Since no doctor had offered such an opinion, the Court granted the petition and directed the trial court to vacate its order.

 

My Two Cents

 

It is well settled in Alabama that a trial court cannot compel medical treatment when the issue of compensability remains in dispute. So as not to lose control of treatment, employers will sometimes agree to direct medical care while, at the same time, deny the claim.  In Trusswalk, the employer denied all the material allegations of the Complaint in its Answer and, therefore, the issue of compensability remained in dispute.  This was not raised in the employer’s petition and so it was not addressed by the Court of Appeals.   

 

Two More Cents

 

Following the hearing on the plaintiff’s motion to compel pain management, the trial court issued an order that included findings of fact and conclusions of law. Interestingly, one of the findings of fact was that the employee suffered a work-related back injury.  The trial court also held that the employee’s chronic pain condition arose out of his work related accident and injury.  Such findings should have only been made following a trial on the merits.  If the judge elected to treat the hearing on the employee’s motion as a trial, then the employer’s right to 60 days’ notice was violated.  If the hearing was not treated as a trial, then the issues of compensability and chronic pain should remain at issue.  Unless the employer can get another Marshall County judge to handle the trial, the proverbial cards on these important issues have already been laid down.


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 practitioners well know, many ADA law suits begin with a workers’ compensation injury.  But where is the line between an issue that must be handled in workers’ compensation and one that can be brought in civil court?  That was the issue that the New Jersey Supreme Court decided on March 25, 2019 in Caraballo v. City of Jersey City Police Department (A-71-17) (080467).

Caraballo joined the Jersey City Police Department (hereinafter JCPD) as a police officer in February 1973.  He injured his hands, back, and legs in August 1999 during a motor vehicle accident and filed a workers’ compensation claim.  He underwent anterior cruciate ligament reconstruction surgery on his left knee.

Two city-appointed physicians gave opinions that Caraballo would eventually need bilateral knee replacement surgery.  Caraballo’s workers’ compensation attorney contacted defense counsel for JCPD in 2008 and requested approval for the knee replacement surgery. Caraballo’s attorney also requested a specific physician to perform the surgery, noting that Risk Management had approved that physician.

Surgery did not take place for reasons that are not clear in the opinion.  In August 2010, Caraballo put in his retirement papers with the New Jersey Division of Pensions and Benefits effective March 1, 2011. Lieutenant John McLellan of the JCPD Medical Bureau was of the impression that Caraballo did not  intend to pursue the surgery.  McLellan also noted that Caraballo refused to see a certain doctor “who would be able to determine unequivocally whether or not he should have the surgery.”

Caraballo retired on March 1, 2011.  Thereafter Risk Management authorized an orthopedic surgeon to evaluate Caraballo for bilateral knee replacement surgery.  The doctor told Caraballo to contact the office to pick a date for surgery pending medical and cardiac clearance.  However, Caraballo never called the doctor’s office to schedule a date for surgery.

On March 4, 2013, Caraballo finally settled his workers’ compensation claim.  A short time later, he brought a civil suit alleging that the City violated his rights under the New Jersey Law Against Discrimination for failing to authorized the knee replacement surgery and failing to make reasonable accommodations to his disability.

The trial court ruled against Caraballo because he failed to enforce his rights to have knee surgery in workers’ compensation court.  Apparently, he never filed a motion for medical and temporary disability benefits. The Appellate Division reversed in favor of Caraballo.  The Appellate Division observed that Caraballo may have been able to perform the essential functions of his job had he obtained a reasonable accommodation of knee surgery.

The New Jersey Supreme Court accepted certification and reversed the Appellate Division.  The Court relied on prior case law to the effect that an employee must first exhaust all administrative remedies under workers’ compensation before seeking enforcement in the Law Division.  The Court said:

Here, Caraballo filed his workers’ compensation claim in 2001, retired in 2011, and settled his claim with the JCPD in 2013.  In the interim, Caraballo contacted Risk Management several times to obtain authorization for double knee replacement surgery but never sought to enforce his right to the surgery in the workers’ compensation court.  Caraballo’s failure to utilize the Act’s administrative remedies to obtain knee replacement surgery precludes his failure-to-accommodate claim under the LAD.

The court next went on to consider whether surgery can be considered a reasonable accommodation in New Jersey. The court first cited to the language in the LAD and ADA for specific examples of reasonable accommodation:  (i) making facilities used by employees readily accessible and usable by people with disabilities; (ii) job restructuring, part-time or modified work schedules or leaves of absence; (iii) acquisition or modification of equipment or devices; and (iv) job reassignment and other similar actions.

The Court observed that no New Jersey case prior to Caraballo had ever addressed the question of whether medical treatment qualifies as a reasonable accommodation under the LAD.  A case in Connecticut was instructive to the Court, Desmond v. Yale-New Haven Hosp., Inc., 738 F. Supp. 2d 331, 350 (D. Conn. 2010).  In that case the Connecticut District Court ruled against a workers’ compensation plaintiff who argued that in order to continue working she would need medical treatment, including pain management and physical therapy.  The Connecticut Court held that a reasonable accommodation must relate to workplace barriers.  There was no responsibility under the ADA or state civil rights law to make sure an injured employee is receiving appropriate medical treatment.

The New Jersey Supreme Court agreed with the ruling in Desmond:

The medical procedure sought by Caraballo – his double knee replacement surgery – is neither a modification to the work environment nor a removal of workplace barriers.  Rather, it is a means to treat or mitigate the effects of his injuries, like the treatments at issue in Desmond.  We therefore find it consistent with the LAD, the ADA, and their regulations that Caraballo’s total knee replacement surgery cannot qualify as a reasonable accommodation under the LAD.

This case is truly significant for practitioners, carriers, third party administrators and workers’ compensation professionals.  Had the ruling gone the other way, employees would have been able to pursue civil action against employers for potential denial of benefits in workers’ compensation. The Court is undoubtedly correct that this would violate the basic rule that workers’ compensation is the exclusive remedy for injured workers regarding medical benefits.

Thanks to Rick Rubenstein, 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. 

The ERISA Lien – – A Federal “Partner” In State Workers’ Compensation Litigation

By:  Alfred Vitarelli, Esq., Shareholder, Stark & Stark

If the workers’ compensation practitioner reading this otherwise dry blog finds his/her mind wandering to more exciting topics, let your mind focus on that ominous line from the 1987 classic “Fatal Attraction:” I will NOT be IGNORED!”

No, I am not comparing the great acting of Glenn Close to ERISA. I am, however, making the important point that like Close’s character, ERISA must never be ignored.

I’ll begin discussing ERISA liens by presenting a scenario played out with distressing frequency in New Jersey workers’ compensation courts. Petitioner’s attorney informs the Judge that a private disability plan (the plan) has provided treatment in the denied claim presently before the Court. An agreement has been reached with Respondent to settle the claim on a Section 20 dismissal. However, the plan has asserted a substantial lien for payments made on behalf of the petitioner. To make matters worse, the plan has not to date provided detailed billing records, medical documentation, etc., which the parties hope will allow the reduction of the amount of the lien, and this is delaying the settlement. Accordingly, petitioner’s attorney will be filing a motion requesting the court to rule out the lien if the plan does not appear on the return date of the motion.

See any problems with the above scenario? Well, yes. And yes.

First yes:  based on the facts given above there has been no consideration as to the status of the plan lien; since this is a discussion of ERISA, the parties are unaware if the plan is covered by ERISA. And why is this important? Because ERISA plans are created by federal law, and thus are subject only to federal jurisdiction. That’s why.

Second yes: because any order entered against an ERISA plan by a state court judge is ultra vires (meaning, acting beyond one’s legal power). Since ERISA plans are only subject to federal jurisdiction, they can ignore any such order as discussed above and sue in federal court to recover the amount of its lien. That’s why #2.

Ok, let’s get down to a serious discussion of ERISA. (Actually, I think this has been serious all along, but I’m sure there are those who will disagree).

Exactly what is ERISA? The Employment Retirement Income Security Act of 1974, ERISA, is a federal law which sets minimum standards for most voluntarily established pension, health and disability plans in private industry. ERISA allows an employer to establish self-funded plans. These plans are employee benefits which pay claims through either the assets of the employer or through a trust which is funded by contributions from the employer and employees. An ERISA health plan differs from a traditional health insurance policy which is purchased through premiums to provide coverage. ERISA expressly pre-empts “any and all state laws insofar as they may now or hereafter relate to any employee benefit plan.”

So, having said that, who or what entities are covered by ERISA? ERISA applies to private industry. In general, ERISA does not cover group health plans established or maintained by government entities, churches for their employees, or plans which are maintained solely to comply with workers’ compensation, unemployment or disability laws. A prime example of what plans are covered by ERISA are those provided to employees pursuant to a collective bargaining agreement between a labor union and an employer. These plans are funded either entirely by the employer or by contributions from the employees as called for by the employer/union agreement.

Ok, now we know what an ERISA plan is, and (hopefully) understand the necessity of directly addressing liens asserted by these plans. So how can an attorney faced with a private plan lien determine if the plan is covered by ERISA?  This can’t be determined by just looking at the client’s benefit card; they don’t say “This plan is covered by ERISA.”  When the status of a lien is in doubt the best way is to request from the Plan Administrator the Summary Plan Description, IRS Form 5500. The Administrator is required to furnish a copy of the latest updated plan documents, including the Master Plan Document. These should be reviewed carefully, since an ERISA plan must clearly state the existence of a right to recovery. NOTE: Never assume that because the lien is asserted by a “traditional” insurance carrier such as Aetna, Cigna, BlueCross/Blue Shield, etc., that the plan is paid by premiums and is therefore not a private benefit plan covered by ERISA. Such insurance carriers do act as TPAs for ERISA plans. When in doubt ask for the IRS form 5500. Another method to obtain the form 5500 is to register online at www.freeerisa.com. I have not used this yet, but some attorneys find this a very convenient method to obtain this information.

Federal Jurisdiction – what are the implications if a lien is not honored?

Earlier in this blog it was noted that ERISA plans are only subject to federal jurisdiction; the doctrine of federal preemption applies as well. If an ERISA lien is not honored when asserted in a workers’ compensation case the plan provider may file an action in federal court to enforce its right of subrogation as contained in the plan. This is authorized by Section 502(a)(3) creating an equitable form of relief in the recovery of payments. This equitable right of recovery was most famously recognized by the U.S. Supreme Court case of US Airways Inc. v. McCutchen, 133 S. Ct.1537 (2013). Here, the Court held that an equitable lien is created by the language of an ERISA Plan, and the language of the Plan controls absolutely, even to the exclusion of common-law principles of unjust enrichment, the make-whole doctrine and the common-fund rule.

Please note carefully, however, that McCutchen holds the language of the Plan controls. While most practitioners will be aware of the McCutchen decision, fewer know the ultimate outcome of the litigation. After the Supreme Court rendered its decision, it remanded the case to the lower court to review the language of the Plan documents. Surprise, surprise! It turns out that the attorneys in the case did not review the Plan documents before the Supreme Court remand. The lower court found that while the Summary Plan Description supported the recovery of the full lien, the Master Plan Document did not. As a result, US Airways was only entitled to a recovery on a small portion of the overall settlement below. ALWAYS READ THE DOCUMENTS!

The above points should make it clear that in ANY situation where a petitioner received unauthorized treatment through a private benefit plan his/her attorney must be aware as early as possible in the litigation whether the plan is covered by ERISA. There are too many pitfalls which may be encountered by ignoring the status of these Plans (including recovery of the lien by attaching attorney fees.) Of course, non-ERISA plan liens must also be addressed, but they at least may be covered by state laws on subrogation, something outside the topic of this blog.

Before ending, I feel it necessary to discuss the potential role of the respondent attorney in these situations. I can hear most of you already: ”what role? there is none…petitioner’s problem….not my fees that can be attached…that lien is just a darn nuisance, my role is to make it go away so I can close the file.” OK, so maybe that last comment was a stretch, but the others are heard…and wrong. Remember the definition of an ERISA plan? How it is funded? Entirely by employer or by employer and employees? Right, now you get it. Employer = Respondent (in many if not most cases.)

So, having also been a respondent attorney for many years, I feel that the employer should always be consulted in ERISA lien situations before settlement discussions begin considering the financial implications of the Plan paying for possibly work-related treatment. I have definite ideas about what approaches to take, but I’ll leave it to others to fill in the blanks.

Please keep in mind that both this blog and the study of ERISA liens generally are works in progress. This blog is intended to raise the awareness of the workers’ compensation bar of the necessity of seriously addressing ERISA liens, not to serve as a how-to guide in every case. Each case will have its own unique issues, so always keep this in mind, and whenever in doubt, request the documents, don’t ignore!!

(Editor’s Note:  Many thanks to Attorney Al Vitarelli for sharing this highly entertaining and educational blog on a topic most practitioners knew very little about but one that we all need to pay close attention to).


Editor:

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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. 

Legal Update by Attorney Alison Stewart

Recently, the Iowa Court of Appeals handed down some decisions relating to workers’ compensation.    

Timely Filing of a Review-Reopening Petition
Pella Corp. v. Winn,File No. 17-1545, 2019 WL 156579 (Iowa Ct. App. Jan. 9, 2019)

The Iowa Court of Appeals recently addressed the timely filing of a review-reopening petition and simultaneous payment of PPD and PTD benefits. InPella Corporation v. Winn, the Claimant applied for review-reopening of a prior award where only entitlement to medical benefits were addressed. The Court of Appeals held that it had no authority to disrupt the opinion of the Iowa Supreme Court inBeier Glass Company v. Brundige, wherein the Court held that where no weekly benefits have been paid, review-reopening is timely filed so long as it is within three years from the date of the award or memorandum of agreement. 329 N.W.2d 2d 280 (Iowa 1983). The Court of Appeals did indicate it sympathized with the employer’s position that the plain language of the statute compels a finding that an “award” eligible for review-reopening cannot include an award of only medical benefits, but that it had no authority to disrupt the authority of the Supreme Court. The Claimant was then allowed to have her entitlement to all benefits (weekly indemnity benefits included) reviewed.

Simultaneous Payment of PPD and PTD Benefits
This decision also addresses a Claimant’s ability to collect permanency benefits for one injury and permanent total disability injuries for another injury at the same time. This is something that has been addressed by the recently passed legislation in July of 2017, but the Court of Appeals confirmed here that it is possible for Claimants to receive such benefits at the same time for injuries occurring before the legislative changes.

Bad Faith Action Permitted Without Underlying Award of Penalty Benefits
Dunlap v. AIG, Inc., Commerce and Industry Insurance Company,File No. 17-1503, 2019 WL 141012 (Iowa Ct. App. Jan. 9, 2019)

In a bad faith case, the Iowa Court of Appeals faced whether it was reasonable for an employer to rely upon a medical opinion indicating medical causation did not exist where three other medical opinions indicated medical causation did exist. The Court of Appeals found that the district court erred when it dismissed the suit on Motion for Summary Judgment because a reasonable fact finder could find the defendant’s reliance was simply not reasonable since they were aware their other experts had opined causation existed and the expert opinion defendants relied upon clarified his opinion with a condition that could change his opinion from possible causation to probable causation. We do not have the ultimate outcome of this issue because the case was remanded, but it is significant because penalty benefits were not awarded at the agency level since a medical opinion supporting the causation denial was contained in the record; however, the bad faith survived Motion for Summary Judgment.

Employee’s Failure to Preserve Error Resulted in Reversal
Lynch Livestock, Inc. and Nationwide Agribusiness Ins. Co.,v. Kenneth Bursell, File No. 17-1629 (Iowa Ct. App. Mar. 6, 2019)

The Court of Appeals confirmed Claimant failed to preserve the issue of whether substantial evidence supported the agency finding that Claimant’s unauthorized treatment was reasonable and beneficial. As such, the district court had erred in concluding the employer owed the medical.  

 

In May of 2017, we reported that an Alabama Circuit Court Judge issued an Order declaring the entire Alabama Workers’ Compensation Act unconstitutional.  In June of 2017, we reported onwhat needed to happen to fix the Alabama Workers’ Compensation Act.  In November of 2017, we reported that theAlabama State Bar Association had appointed a task force to review the Act and make recommendations on how to fix it.  In April of last year, we reported onthe types of changes the task force was looking at making.  On October 17, 2019, the task force unanimously approved a proposed bill that would make substantial changes to the Act.  Unfortunately, the Alabama Council of Association Workers’ Compensation Self Insurance Funds was not invited to participate on the task force.  This was a major oversite as the Council represents self-insurance funds providing workers' compensation coverage for 16,200 Alabama businesses employing 375,000 people.  The Councilvoted against the proposed bill primarily because it raises legal fees for plaintiff attorneys by one-third and does nothing in the short run to reign in hospital, doctor, and other medical costs. It also more than doubles the cap on certain disability payments to injured workers and adds an inflationary adjustment.  Although it voted no to the proposed bill as drafted, it did state that it was open to discussing change. 

The Alabama legislature began its regular session this month.  Although our Governor called a special session to tackle Alabama’s “crumbling infrastructure,” nothing has been introduced regarding the workers compensation system.  Some would argue that the Alabama House and Senate have many new faces this year and, therefore, it would be difficult, if not impossible, to quickly effectuate any major change to the Workers’ Compensation Act.  But then it would be difficult to explain how a55% gas tax hike that was largely unpopular with the electorate was rushed through the legislature and signed into law in just 5 days.   

Despite forming the task force, the Alabama Bar Association is prohibited from throwing its support behind any proposed legislation.  Therefore, there is no organization pushing for immediate change at this time.  According to the Alabama Department of Labor, it is a state regulatory agency tasked with the responsibility of following and enforcing the laws put in place by the legislature.  As the regulator, it typically does not comment on proposed legislation.  However, it acknowledges that the current workers’ compensation laws are not ideal and that amendments are needed that benefit both injured workers and employers.  It will follow and enforce any changes that are made, if any. 

Meanwhile, our neighbor to the east has wasted no time pushing for change.  During its 2019 legislative session, the Georgia Senate unanimously passed abill that would raise the maximum weekly benefit for temporary total and permanent partial disability.  If approved by the House and signed by the governor, it would mark the largest increase to the caps in decades.  Is this change in response to a Georgia court recently declaring the entire Georgia Workers’ Compensation Act unconstitutional?  No.  Rather, it is the result of all interested parties progressively working together to effectuate needed change.  The last time that happened in Alabama was 1992.

What Happens Now?

Unless something is done legislatively, it is inevitable that another circuit court judge will, again, address the constitutionality of the Act.  Since nothing is going to be introduced or passed during this legislative session, at a bare minimum a committee comprised of all interested parties needs to be formed that can make recommendations for change.  The 1992 reforms were passed as the result of the Department of Industrial Relations (now Department of Labor) initiating discussions between the interested parties.  Informal discussions resulted in a reform bill being introduced in 1991.  The bill easily passed the House but was not voted on by the Senate.  Negotiations continued through the remainder of 1991 and into 1992.  Prior to the next legislative session (special session in January), Governor Hunt called for formal negotiations.  Still no consensus was reached.   Negotiations and lobbying continued and a revised bill was finally passed in the regular session a few months later.   If history is any indicator, negotiations need to begin now if there is to be any chance of change in 2020.

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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.