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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Mental health post-pandemic


Our friends at IMO just published a new article that discusses many of the current stressors we are all facing that have led to an increase in mental health issues and it offers helpful strategies to maintain good mental health.  It’s well worth a read: Mental Health — Managing the Growing Chaos Among Us.

Copyright 2024, Stone Loughlin & Swanson, LLP

DWC closes medical billing complaint loophole


On May 7, 2024, DWC adopted amendments to rule 180.2 concerning filing a complaint.  The amendments prevent health care providers from using the complaint process to circumvent the one-year filing deadline for medical fee disputes. The amended rule states:    
A health care provider cannot submit a complaint about a medical billing issue if the date of service for the medical billing issue was more than 12 months before the date of the complaint, unless the issue qualifies for an exception to the filing deadline under §133.307(c)(1)(B) of this title, concerning medical fee dispute resolution. If the issue qualifies for an exception to the medical fee dispute resolution filing deadline under §133.307(c)(1)(B), then a health care provider cannot submit a complaint about that issue if the medical fee dispute resolution filing deadline in §133.307(c)(1)(B) has passed. 
The rule also notes, “This subsection does not apply to a health care provider submitting a complaint under Insurance Code Chapter 1305.”  Section 1305.401 of the Workers’ Compensation Health Care Network Act requires each network to implement and maintain a complaint system to resolve complaints.  A health care provider may submit a complaint to the network over a fee dispute and if dissatisfied with the outcome, the provider may file a complaint with TDI’s complaint resolution process.

In-network fee disputes are not governed by Section 413.031 of the Workers’ Compensation Act and so there is not a one-year filing deadline for those disputes. DWC also does not have jurisdiction to resolve disputes over fees for medical services provided subject to a network contract.  Those are contract disputes that are governed by the terms of the contract between the network and health care provider and if the dispute is not resolved through the complaint process, it can be resolved through litigation or arbitration, if the contract mandates arbitration.


DWC offers educational resources to help avoid penalties


Texas has a very robust enforcement system as demonstrated by the numerous disciplinary orders issued each month. While some system participants may view administrative penalties as part of the “cost of doing business” in this state, for those that don’t like to pay fines, DWC now offers its CompCourses live webinar series where system participants can learn more about the Texas workers’ compensation system.
 
The most recent CompCourses live webinar was presented on May 22, 2024 and covered presiding officer directives (PODs). The recording is now available on DWC’s website and can also be viewed here. As an added bonus, attendees also receive continuing education credit for attending a live CompCourses webinar so stay tuned for upcoming webinars.


Movin’ on up!


Amanda Barlow, Administrative Law Judge in the Fort Worth Field Office since 2015, is joining the Division Appeals Panel.  Judge Barlow is the current Secretary of the Texas State Bar workers’ compensation section.    Judge Barlow obtained her law degree in 2007 from Texas Wesleyan University which was acquired by Texas A&M in 2013 and is now known as the Texas A&M University School of Law.  In 2024, it was named the 26th best law school in the country by U.S. News & World Report. Gig Em, Aggies!  We look forward to her bringing her nine years of practical experience to the jurisprudence of the Appeals Panel.    

Copyright 2024, Stone Loughlin & Swanson, LLP

The Nebraska Workers' Compensation Court will hold the swearing-in ceremony for Judge Brynne Holsten Puhl today at 2 p.m. The public is invited to the ceremony, which will take place in the Warner Chamber of the Nebraska State Capitol, located off the Rotunda on the 2nd Floor, 1445 K St., Lincoln, NE. The newly appointed judge will be the guest of honor at a reception following the ceremony at the Nebraska Workers’ Compensation Court.

Select this link to view the news release.

Select this link to view the event's live video stream, provided by Nebraska Public Media.

 

WORKERS' COMPENSATION LAW

The Films Matter: Employer Beats Adjacent Segment Spinal Surgery

Claimant was involved in a 4/30/21 work accident. Employer accepted a C4-7 fusion surgery performed on 11/16/21. Following this procedure, Employer filed a Petition to Review seeking to terminate total disability benefits. Employer filed a cross Petition seeking payment of additional surgery done on 9/11/23, extending the fusion to cover the adjacent C3-4 level.

Accepting the opinion of defense medical expert Dr. Kahanovitz over claimant’s treating surgeon Dr. Eskander, the Board found claimant’s more recent neck surgery not reasonable or necessary treatment, and also terminated total disability. The Board noted that Dr. Kahanovitz personally reviewed flexion extension x-ray and MRI films, and observed no changes to the C3-4 level or progression of Claimant’s condition. There was no evidence of instability or significant neurological compression. Without these factors, there was no indication to extend the fusion. The Board also agreed with Dr. Kahanovitz that it was questionable to extend the fusion when both doctors agreed that the level above at C2-3 had evidence of instability, putting the claimant at further risk down the road. As to the Petition to Review, the Board commented that even claimant conceded on cross examination that she was capable of doing a part time work from home job. In this context, the testimony of Dr. Kahanovitz as to return to work capability was deemed more credible.

Should you have any questions concerning this Decision, please contact Greg Skolnik or any other attorney in our Workers’ Compensation Department.

Patricia Abrams v. State of Delaware, IAB Hrg. No. 1510985 (Mar. 27, 2024). 


Movin’ on Up!


We’ve learned that Angel Hendricks, a Proceedings Resolution Officer (PRO) in the TDI-DWC Tyler field office, has been promoted to Benefit Review Officer (BRO) and will replace Olivia Turner, who is embarking on a well-deserved retirement. 

Ms. Hendricks is to start in her new position on June 1, and we are delighted to begin working with her in that capacity. Congratulations Ms. Hendricks!


Copyright 2024, Stone Loughlin & Swanson, LLP


Division reminds carriers of their obligation to pay for preventative treatment 

 

On April 23, 2024, TDI-DWC’s General Counsel, Kara Mace, issued a memorandum to system participants regarding preventative treatment claims handling. In it, Ms. Mace stated that the Division “would like to remind insurance carriers of the rules associated with preventative treatment related to a physical injury and workers’ compensation claims handling.”

The memo notes that preventative treatment “may include medications such as rabies vaccines, tetanus shots, and post-exposure prophylaxis that are prescribed by a health care provider.” It also states that “an insurance carrier must follow treatment guidelines and pay for specified pharmaceutical services sufficient for the first seven days following the date of injury, regardless of issues of liability for or compensability of the injury,” citing Texas Labor Code §413.011 and DWC rules 134.501 and 137.100.
 
Rule 134.501, titled Initial Pharmaceutical Coverage, provides in part that:

The insurance carrier . . . shall pay for specified pharmaceutical services sufficient for the first seven days following the date of injury, regardless of issues of liability for or compensability of the injury that the carrier may have, if, prior to providing the pharmaceutical services, the health care provider  . . . obtains both a verification of insurance coverage, and an oral or written confirmation that an injury has been reported.

. . . Specified pharmaceutical services are prescription drugs and over-the-counter medications prescribed by a doctor that cure or relieve the effects naturally resulting from the compensable injury, promote recovery, or enhance the ability of the employee to return to or retain employment.

Ms. Mace ends the memo by noting that “failure to properly handle preventative treatment claims under these rules and other applicable laws may result in the assessment of administrative penalties not to exceed $25,000 per day per occurrence.”
 

Copyright 2024, Stone Loughlin & Swanson, LLP

 

You Can't Do That Either! 


ALJ abused discretion by relieving unrepresented claimant from effect of Benefit Dispute Agreement


In Appeal No. 240113, the TDI-DWC Appeals Panel has taken the unusual step of reversing an ALJ’s decision and rendering a new one on the grounds that ALJ abused his/her discretion by relieving a claimant from the effects of a DWC-24. 

In the DWC-24, the claimant and carrier agreed that the compensable injury extends to include right wrist volar carpal ganglion cyst and they agreed to adopt the date of MMI and the 2% impairment rating assigned by a designated doctor. Later, however, the claimant argued at a contested case hearing that she should be relieved from the effects of the agreement because she cannot read English and the ombudsman assisting her did not fully explain the agreement to her.

The ALJ found that no fraud or misrepresentation was involved in procuring the agreement and the claimant was provided with sufficient time to review the agreement before she signed it. However, the ALJ found that good cause existed to relive the claimant from the effects of the agreement because the 2% IR assigned by the designated doctor was a result of misapplication of the Guides to the Evaluation of Permanent Impairment

But the Appeals Panel concluded that the calculation of the claimant’s IR required rounding, which requires medical judgement, so the evidence did not support the ALJ’s determination that the 2% IR assigned by the designated doctor was a result of misapplication of the Guides. Accordingly, the Appeals Panel reversed the ALJ’s decision and rendered a new decision that there is no good cause for relieving the claimant from the effects of the agreement and it is final and binding. 


Copyright 2024, Stone Loughlin & Swanson, LLP 

 

You Can't Do That! 


Trial judge abused discretion by refusing to abate personal injury suite and consolidating it with judicial review of TDI-DWC decision

 

This month the 14th Court of Appeals in Houston agreed with arguments by Stone Loughlin & Swanson, LLP and other firms that Harris County District Court Judge Fredericka Phillips abused her discretion by (1) refusing to abate a personal injury action pending judicial review of a TDI-DWC decision on the worker’s employment status and (2) consolidating the two actions. 

In our law firm’s 20-year history we’ve seen some bizarre workers’ compensation claims, but this one might just take the cake. It's through-the-looking-glass procedural history began when, in September 2021, 16-year-old Romny Sanchez joined his uncle, Leonel Yanez, on a job providing remediation services to victims of Hurricane Ida in Louisiana. Both men were injured while riding as passengers in a van driven by Joe Saavedra, who fell asleep and crashed into a light pole. Saavedra was an employee of All Repair and Restoration, LLC, and Sanchez and Yanez filed a personal injury suit against All Repair in Harris County district court alleging everything but the kitchen sink -- asserting claims for negligence, vicarious liability, fraud, civil conspiracy, gross negligence, intentional infliction of emotional distress, and violations of the Fair Labor Standards Act and the Texas Payday Act. All Repair asserted the affirmative defense that Sanchez and Yanez were its employees and their exclusive remedy is workers’ compensation benefits under All Repair’s policy with National Casualty Company. 

Sanchez and Yanez disputed that they were All Repair’s employees, so National, represented by this firm, initiated dispute resolution proceedings at the TDI-DWC to determine their employment status. Even though the facts were largely the same for both men, the Division refused National’s request to hear the cases together. Instead, it insisted on conducting two separate contested case hearings by two different ALJs. And, as could be predicted, the ALJs reached different conclusions. The ALJ presiding over Yanez’ case concluded that he was All Repair’s employee, but the ALJ presiding over Sanchez’ case concluded that he was not All Repair’s employee. All Repair then filed a petition for judicial review of the decision regarding Sanchez. 

At Sanchez’ request, and over the objections of National and All Repair, Judge Phillips consolidated the two actions and denied a motion to abate the personal injury action pending resolution of the judicial review action. National and All Repair then took the extraordinary step of filing a petition for writ of mandamus with the court of appeals. 

The court of appeals found that Judge Phillips abused her discretion on both counts. It directed her to vacate her order of consolidation because, among other things, “a vast portion of the evidence to be expected in the personal injury suit is likely to be inadmissible in the judicial review suit due to the limited nature of the proceeding.” It also directed her to abate the personal injury suit pending the outcome of the petition for judicial review, citing its prior decisions in In re Tyler Asphalt & Gravel Co. and In re Luby’s Cafeterias, Inc. which hold that abatement is required under such circumstances. 


Copyright 2024, Stone Loughlin & Swanson, LLP