Recently in Law Category

April 9, 2014

 

The U.S. Food and Drug Administration (FDA) has acknowledged that prescription drug overdoses are now the leading cause of injury-related death in America, surpassing auto accidents. Couple that with the Agency's approval last October of Zohydro ER, the first pure opiate painkiller, and you begin to understand why many lawmakers are left scratching their heads. More than half the states' attorneys general have asked the FDA to withdraw approval of the drug. But the Agency is unrepentant. FDA Commissioner Margaret Hamburg told the Senate that the drug is a safe and effective option for patients with excruciating pain.

In late March, a stymied Governor Deval Patrick took the highly unusual step of banning the sale in Massachusetts of the controversial opioid made by California-based Zogenix, Inc. Many in the Massachusetts legislature as well as a number of workers compensation claims professionals thought it was the best thing any governor had ever done, a bold step to protect the citizenry.

Only it's not as simple as that. It's turning out that, however well-intentioned Governor Patrick may be, he probably can't ban the sale of the drug, after all. Yesterday, US District Court Judge Rya W. Zobel told state lawyers that by Monday she wanted to see a lot more research that would buttress the Governor's ban. Nonetheless, she said that she would more than likely grant a preliminary injunction on behalf of Zogenix that would allow Zohydro ER's sale in Massachusetts. Said Zobel, "I think, frankly, the governor is out of line on this."

According to Patrick, his issue with Zohydro ER is that it is not in "an abuse-resistant form," meaning that it is not crush-resistant. Consequently, addicts (or anyone else who has the drug, for that matter,) can crush it and snort it or inject it.

Why would anyone want to do that instead of simply washing it down with a sip of water? Because in its pill form Zohydro ER is an "extended release" medication. That's what the ER stands for. In fact, Zohydro's full legal name is Zohydro ER (hydrocodone bitartrate) Extended Release Capsules. Crushing and snorting or injecting simply bazookas the whole dose at one time, which can be a deadly proposition.

Zogenix's President, Steven J. Farr, attended yesterday's hearing and, afterwards, took pains to let everyone know that Zohydro ER is safer than other hydrocodone drugs because it does not contain Acetaminophen, which can cause liver damage and failure with prolonged, high-dose usage. Farr did not mention that Zohydro ER contains up to five times the hydrocodone found in Vicodin. He did say that the company is in early stage development of abuse-deterrent formulations of the drug. That gave cold comfort to the Governor.

Whatever happens, it is hard to believe that Governor Patrick, a very smart lawyer, actually thinks he's on firm legal footing here, although outside the courthouse that's exactly what he said. As Judge Zobel pointed out (and she was decidedly irate that Patrick banned the drug without ever talking with Zogenix), Patrick cannot blame the Massachusetts opioid epidemic on Zohydro ER because the drug has yet to be dispensed in the state. She urged lawyers for the state and Zogenix to meet before the hearing scheduled for Monday, but she told everyone that Zogenix "probably will prevail."

I have a few thoughts about this little mess:

First, it is not the fault of Zogenix that we have an opioid epidemic in Massachusetts or anywhere else. Yes, there's an epidemic, but drug makers didn't cause it. Irresponsible physicians, doctors who consider the Hippocratic Oath to be a mere suggestion, have placed their patients on the slippery slope to hell by prescribing over and over again strong and addictive narcotics for conditions for which those narcotics were never intended.

Second, the vast majority of physicians would never knowingly over-prescribe any medication. They have not forgotten that Oath and why they went to medical school. The ones I know resent and cannot understand the over-prescribers.

Third, although I wish it had built crush-resistance into Zohydro ER from the beginning, Zogenix did nothing wrong here. In fact, the Zogenix complaint notes: "When FDA approved Zohydro, it considered but rejected the idea of requiring the drug to utilize abuse-deterrent technology." The company did everything it was supposed to do in gaining FDA approval. And that isn't easy. One of the more difficult tasks in the universe is to get FDA approval for a new drug. The camel through the eye of the needle doesn't even begin to describe the process. It takes many years and boatloads of money. So, you can understand that after all those years and money devoted to bringing this drug to market, to have it summarily banned is a bit hard to take.

Fourth, there are many people who suffer with agonizing pain. Think end-stage cancer. Those human beings need and deserve the best pain amelioration they can get, and the goal of the pharmaceutical industry, in addition to making money, is to give them that relief.

Finally, ending the opioid epidemic will require political courage and a much more highly-regulated process to oversee and assure that the relatively few ethically-challenged, weak-kneed and overly greedy physicians who now abuse their privilege are forced to change their bad behavior and follow that "do no harm" rule. If it weren't for them, there would be no epidemic.

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May 28, 2013

 

The folks at Murray Bresky Consultants are just trying to scratch out a living by raising chickens - not just any chickens, but free range chickens that are "happy and healthy." Their signature breed is "fed an all-natural and all-vegetable diet that, combined with plenty of exercise, makes our birds the leanest on the market. The leisurely lifestyle eliminates the need for antibiotics to prevent diseases commonly found in chickens as a result of stress and confined living conditions. Minimally processed, without the use of preservatives or other artificial ingredients, Murray's Certified Humane Chicken is truly all chicken."

Unfortunately for the company, they secured workers comp insurance through New York Compensation Managers (NYCM), the now defunct operator of a dozen self-insurance groups in New York. NYCM claimed to offer favorable rates, strict underwriting standards and exemplary claims services. They ended up with egg on their face with their inadequate rates, suspect underwriting and rampant under-reserving of claims. In retrospect, the operation ran around like a chicken with its head cut off. By the time the problems emerged (in 2006), it was too late to shake a feather and correct the problems.

Following the SIG's failure, Murray Bresky Associates was hit with a $1.2 million assessment to make up their share of the SIG's deficit. That ain't chicken feed.

A Game of Chicken
Murray Bresky is not chickening out of a fight. Indeed, the chickens have come home to roost in the form of a lawsuit filed against NYCM and its board of trustees. The lawsuit seeks to recover the $1.2 million and then some, alleging breach of contract and breach of fiduciary duty. The case worked its way up to the NY Supreme Court, Appellate Division, where the motion by the defendents to dismiss the lawsuit was, for the most part, dismissed.

Now the defendents are walking on egg shells, facing the prospect of personal liability for the failures of the SIG. Where they once feathered their nests with the proceeds of the operation, their financial security has flown the coop. This is a legal mess perhaps best described by the late Lyndon Baines Johnson: "Boys, I may not know much, but I know chicken poop from chicken salad."

Roles and Irresponsibilities
One of the former trustees of the SIG is squawking that he was not aware that he was, in fact, a trustee. He may have signed off on a few trustee documents, he may have performed some of the functions of a trustee, but he insists that he had no memory of being appointed. He insisted that he was not a bad egg and claimed that he had no place in the pecking order. The court, however, ruled otherwise.

As the saying goes, you have to break eggs to make an omelette. Quite a few more eggs will be broken before this particular concoction is served up. Hard-boiled attorneys will parse the details to figure out who, if anyone, owes Murray Bresky Consultants and exactly how much they owe.

Pecking Orders
The courts now rule the roost. They have upheld Murray Bresky's right to sue, with the exception of some actions that are time-barred. There may well be a sunny side up in the chicken company's quest for justice. We look forward to the final resolution of this stew, the chicken scratch of a judge's signature that will put a final number on the liability of an insurance operation that flaps my wattles (ie., annoys me).

Here's a little unsolicited advice to Murray Bresky Consultants: don't count your chickens before they hatch. This one has a long way to go before the company can feather its nest with the proceeds of a complex litigation. In the meantime, their free range chickens have the run of the coop, enjoying their cage-free, stress-free lives right up to the very end. Bon appetite!


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April 30, 2013

 

When Jakob Hutter founded the Hutterian Brethren Church in the 1530s, he was not worried about workers comp (which would not exist for another 350 years). He just wanted the freedom to practice his communal religion in what is now Germany/Austria. He incurred the wrath of Ferdinand I, who, in the name of the gentle Jesus, arrested and tortured Hutter and then burned him at the stake. An inauspicious beginning to what has proven to be a stubborn, if marginal sect.

The Hutterites eventually fled Europe and found their way to the western United States and Canada. Montana has about 30 Hutterite communities in the conservative Lehrerleut tradition, each involving about 100 or so members. Community members do not own property or earn wages, they do not pay for clothing and shelter and they receive free medical care, including care for any disabling injuries. (The Hutterites, surprisingly, do have a website.) For many years they worked on their farms and, like the Amish in Pennsylvania (blogged here), they were exempt from workers comp.

As the Lehrerleuts branched out into construction work beyond their own communities, the issue of unfair competition was raised by secular contractors. As a direct result, the Montana legislature passed HB 119, which defined religious communities as "employers" and community members as "employees." The Lehrerleuts sued (although normally participation in law suits is a violation of their faith). A deeply divided court ruled against the Lehrerleuts: they must participate in the state's workers comp system. The next step will be an appeal to the U.S Supreme Court.

A Bad Match
The complex relationship between employment laws and religious groups is far beyond the scope of this blog. We focus, instead, on the interesting conundrums raised by trying to force the Hutterites into the comp system. To put it mildly, this is an awkward fit.

First and foremost, the Hutterites do not pay wages. Without wages, there can be no comp premiums, as these are calculated by multiplying class rates times payroll. Perhaps the court would require that the Hutterites take the total cost of a job, subtract materials, and consider the remainder "payroll." But even so, this would be an approximation for what is an exacting requirement for other employers.

Then there is the issue of filing a claim. Every member of the Hutterite community signs a pledge not to file claims against the community and not to sue anyone for anything. Thus, even if a comp policy were to exist, it would never be used. To make this point even more dramatic, the majority of the Montana justices pointed out that the Hutterites were free to excommunicate any member who did file a claim. What an odd concession: the justices did not bother to explain how this would not be retaliation.
NOTE TO INSURERS: Write this policy! Even in the event of catastrophic injury, no claim will be filed.

And if Hutterites are subject to workers comp, what about the Fair Labor Standards Act and OSHA requirements? The Montana court has not imposed these virtually universal standards on the Hutterites, but why not? What happens to the minimum wage when there are no wages? Can you limit hours worked when there is no payroll to track? How will you monitor underage community members operating equipment?

No Simple Solution
Forcing the Hutterites into the comp system may sound simple, but surely it is not. The majority quotes retired Supreme Court Justice Sandra Day O'Connor, who rejected a challenge brought by Native Americans to enjoin a United States forest service road through sacred areas:

However much we might wish that it were otherwise, government simply could not operate if it were required to satisfy every citizen's religious needs and desires. A broad range of government activities -- from social welfare programs to foreign aid to conservation projects -- will always be considered essential to the spiritual well-being of some citizens, often on the basis of sincerely held religious beliefs. Others will find the very same activities deeply offensive, and perhaps incompatible with their own search for spiritual fulfillment and with the tenets of their religion. The First Amendment must apply to all citizens alike, and it can give to none of them a veto over public programs that do not prohibit the free exercise of religion. The Constitution does not, and courts cannot, offer to reconcile the various competing demands on government, many of them rooted in sincere religious belief, that inevitably arise in so diverse a society as ours. That task, to the extent that it is feasible, is for the legislatures and other institutions.

In the specific instance of religious communities and workers comp, the record across the United States is fairly consistent, for the most part favoring religion. The Amish have a specific exemption from workers comp in Indiana, Pennsylvania, Missouri, Kentucky and Ohio. There are pending requests for exemptions in Minnesota and Tennessee. Supreme Courts in a number of states have upheld the right of churches to govern their internal affairs. Federal legislation exempts the Amish from collecting Social Security taxes.

The Hutterites are no flash-in-the-pan phenomenon. For nearly 500 years they have wandered the earth, seeking the right to worship in a manner of their own choosing. Work, like everything they do, is an integral part of their worship. In telling them how to work, we are telling them how to worship - and that is a line that we cross at our collective peril. If the community were abusing its members, government intervention would be necessary. But if the goal is simply to level the free enterprise playing field, that is hardly sufficient cause for imposing conventional standards on a highly unconventional community.

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February 7, 2013

 

The Insider is very much looking forward to the Workers Compensation Research Institute (WCRI) annual conference, taking place on February 27-28 in the virtual epicenter of wonkiness, Cambridge MA. There is always much food for thought in these annual gatherings of insurance execs, state officials, policy makers, attorneys, medical specialists, employers and safety/loss control practitioners.

This year's agenda has zeroed in on the fundamental medicine-related conundrums facing workers comp systems across the country. All of us in workers comp long for insights into the following:
- Unnecessary medical care and its impact on treatment guidelines. (Back surgery, anyone?)
- Medical price regulation: what are the essential elements of an effective fee schedule? (Beware of the state where the doctors love comp...did someone mention "Connecticut"?)
- The Opioid epidemic: treatment protocols involving the generous and prolonged distribution of opioids are destroying lives across the country. Why are so many doctors so clueless about the proper use of pain killers? Whatever happened to "do no harm"?

WCRI's head honcho, Dr. Richard Victor, will host a discussion on health care policy involving (the presumably liberal) Howard Dean and (the assuredly conservative) Greg Judd. The dialogue might not equal the fireworks of July 4th on the Esplanade, but it might come close. The Insider will be listening closely for any indications of that rarest of phenomena: a common ground.

From Gorilla to ?
Last year, Dr. Victor concluded the conference with a discussion of the "gorilla in the room": the enormous and perhaps insoluble problem of structural unemployment among the 20 million people who lost jobs in the recent recession. For many of these people, especially those in their 50s and 60s, there is little prospect of returning to jobs with anywhere near the same rate of pay as before. Many will find themselves lost in the new economy, cobbling together part-time employment without benefits, while struggling to hold onto housing where mortgages exceed the value of the home. Tough times and, so far, not much in the way of effective solutions.

This year Dr. Victor will have to find some other animal analogy to glean lessons from history: Giraffe in the closet? Rhino in the den? He tells us that the lesson might have something to do with the first century Ephesians, toward whom St. Paul addressed some rather famous snail mail. While some might find such a teaser a bit obscure and full of religious overtones, the Insider looks forward to the story. Indeed, we look forward to this year's entire conference with great anticipation. There are few things better for policy wonks - our people! - than listening to the latest research from WCRI. Diligent note-taking will be in order.

If you count yourself among those with wonkish tendencies and you haven't signed up yet, you'd best jump on it immediately. If you have any questions about the conference, contact Andrew Kenneally at WCRI: 617-661-9274.

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December 26, 2012

 

As the New Year looms, the 100 year old workers compensation system continues its awkward foray into the 21st century, it encounters problems beyond its original design: the widespread availability of opioids, increasing sophistication in medical interventions, and an aging workforce. Today we examine a formerly inconceivable conundrum: can an 80 year old man be expected to return to work after an injury?

Kenneth Brunner graduated high school in 1949 and worked steadily all his life: From 1951 through 1993 he ran the family dairy farm with help from his wife, an accountant. Brunner raised crops; used a tractor, plow and other farm machines, kept track of feed and each animal's output. He took milk samples from each cow and sent them for analysis; after receiving reports, he adjusted feed for each animal to maximize output. He supervised two to three individuals on the farm.

From 1954 through 1984 he supplemented his farm income by driving a school bus - work which, in the view of the Ohio workers comp commission, required the ability to work independently and use judgment.

From 1968 through 2000 Brunner also was employed as an insurance adjuster. He estimated crop loss for an insurance company, a job that required using scales, taking samples and writing reports. In 1990, at age 58, he was certified for insurance sales.

In January 2011, at age 77, he was working in a maintenance job, when he tripped on a drain pipe and fell face first onto pavement. His injuries were severe:bilateral frontal bone fracture; fracture lateral wall right maxilla; fracture bilateral paranasal sinuses; closed fracture bilateral nasal bone; open wound of forehead; abrasion face; closed fracture C2 vertebra.

He received workers comp benefits. A couple of years into his recovery, he filed for permanent total benefits (PTD). Brunner was 80 years out and had had enough of working.

Brunner's treating doctor concluded that he would never work again:

This claimant has an injury that is permanent and for which there is no curative therapy. This claimant has progressively suffered loss of function and has had to endure progressively more pain. The exam above shows that there is so little functional capacity and that the claimant is so affected by his condition and its required care, that there is no capacity for sustained remunerative employment and that there is no reasonable employer that would ever hire the claimant expecting any work capacity.

Based on the examination above, review of documents, and based on sound medical reasoning I find that the allowed physical conditions, independently and by themselves, render the claimant permanently and totally disabled and unfit for all sustained remunerative employment.

Once a Worker, Always a Worker?
The Ohio workers comp commission reviewed Brunner's claim for PTD benefits. They took into account his age, as well as his resume in determining that he was still capable of working. While most of his living involved physical labor, throughout his working life Brunner had displayed skills that at least theoretically were transferable to sedentary work. As a result, they rejected Brunner's request for PTD benefits. The commission did not address the likelihood of anyone offering Brunner a sedentary job.

An appeals court upheld the denial of the claim, finding that the commission did not abuse its discretion: (1) in weighing Brunner's age in assessing the non-medical factors; and (2) in determining that Brunner has some transferable skills.

It appears that Brunner's longevity worked against him. He labored well into his 70s and displayed unusual fortitude in recovery from serious injuries. Because the premise of PTD payments is protection for disabled workers who are available for work but no longer able to do it, Brunner finds himself ineligible for benefits. In a supreme irony, his ability to work as an older worker precluded the conclusion that he was unable - even at 80 - to continue working.

Brunner's dilemma is by no means unique. As the workforce ages, as more and more workers continue labor late into their seventies and even 80s, a paradox emerges: the point where one is too old to work recedes into the haze of the future, leaving injured older workers in a gray zone where their permanent injuries may or may not be compensable and where their (theoretical) ability to work mitigates against their being paid not to work.

In the months and years ahead we will see more and more litigation involving the claims of "older" workers with ages far beyond what was contemplated in the original workers comp system. State by state, the system will have to respond, becoming the focal point of economic, social and even psychological forces that are far larger than workers, comp stakeholders and state policy makers combined. This is an evolving narrative of surpassing interest. Stay tuned.

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November 16, 2012

 

John Pearson was diagnosed in his mid-20s with diabetes and was insulin dependent. About fifteen years after the diagnosis, he was working for an Arkansas temporary placement agency, Worksource, which sent him to a steel fabricator. His temporary employer gave him a pair of steel toe boots and assigned him the task of covering warm steel bundles with blankets. The job required a lot of rapid walking across a large field, as the bundles emerged from the plant at odd intervals. In the course of the day he experienced discomfort in his left foot and at the end of the day he found a blister on his left great toe. The next day he requested a wider pair of boots, but none were available. The employer suggested he buy them, but he could not afford to do so before being paid - and payday was still a couple weeks away.

Two weeks later Pearson was diagnosed with "diabetic neuropathy and cellulitis." Worksource sent him to another doctor, who diagnosed a diabetic ulcer and cellulitis and placed him on light duty, restricting his standing and walking. (The court is silent on how long Pearson continued to work at the steel fabricator.) Ultimately, surgery was performed on the toe, which fortunately did not require amputation, and Pearson was able to begin working again, albeit with (temporary) restrictions. Pearson took a job in a Waffle House, where he was able to resume full time work. In the meantime, he was faced with lost wages and formidable medical bills.

Proving Compensability
Pearson filed a workers comp claim, which at first was accepted and then denied on appeal to the Arkansas Workers Compensation Commission. The denial was based upon an interpretation of state law:

(4)(A) "Compensable injury" means: (i) An accidental injury causing internal or external physical harm to the body or accidental injury to prosthetic appliances, including eyeglasses, contact lenses, or hearing aids, arising out of and in the course of employment and which requires medical services or results in disability or death. An injury is "accidental" only if it is caused by a specific incident and is identifiable by time and place of occurrence; (ii) An injury causing internal or external physical harm to the body and arising out of and in the course of employment if it is not caused by a specific incident or is not identifiable by time and place of occurrence, if the injury is: (a) Caused by rapid repetitive motion. [Arkansas Code Annotated section 11-9-102(4)(A) (Supp. 2011)]

The Arkansas Court of Appeals agreed with the commission that the injury did not meet first criteria: there was no specific incident identifiable by time and place. However, the Court found that the injury was caused by "rapid repetitive motion," applying a two-pronged test that is stunning in its obviousness: did injury involve "repetition" and did it involve "rapidity"?

The "repetitive" part involved walking itself: Pearson walked up and down the field in tight boots, watching for the steel bundles as they emerged from the plant. The rapid part involved his walking briskly to protect the bundles as they appeared. He walked from bundle to bundle, as fast as he could, performing the job as instructed. In doing so, the boots rubbed his toe continuously over the course of the day, resulting in a blister. For most people, a blister is no big deal. For a diabetic, it could lead directly to amputation.

Lessons for management?
It is difficult to draw conclusions from this unusual case. Because Pearson was a temporary employee, the steel company had no awareness of his diabetes and no reason to be aware of it: he was able to perform the work as assigned. Theoretically, they could have done better on Pearson's request for wider boots, but they had no reason to anticipate a serious problem beyond a bit of discomfort. Pearson himself was probably unaware of the risks involved in wearing the tight boots. He obviously was feeling pressure to earn money and probably thought the discomfort, while painful, was not a serious matter.

Perhaps the most important aspect of this case is Pearson himself: despite a life-altering health problem, he is strongly motivated to work. In the few months described in the court narrative, he tries hard to do what he's supposed to do and he keeps working as best he can. Given comfortable footwear, Pearson will do just fine.

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November 15, 2012

 

OK, this is something we never contemplated...straight from the Seattle Police Department's Blotter, we bring you Marijwhatnow? A Guide to Legal Marijuana Use In Seattle.

The guide offers an FAQ for citizens about the recently enacted Washington law, which decriminalizes possession of small amounts of marijuana by adults over the age of 21. And Washington is not alone... in Colorado, 55% of the voters recently voted to legalize individual possession of small "recreational" amounts of marijuana. Contrary to what you might think, the vote wasn't all cast by erstwhile hippies and young pot aficionados - some conservative proponents cited the potential billions in tax revenue and the benefits of unclogging the court systems and freeing police time by removing nettlesome petty criminal prosecutions

These voter approvals for recreational use mark a new twist - prior legislative approvals have dealt with medical use of the drug. Last week's election saw other marijuana ballot initiatives in this vein - medical marijuana use was approved in Massachusetts, making it the 18th state (plus DC) to give the nod to medical marijuana use; however, Arkansas voters nixed their ballot initiative 51% to 48%.

The Devil is in the Details
Even with state initiatives, marijuana is still illegal at the federal level. Plus, as with most things, the devil is in the details and most states are scrambling to figure things out. But the train has left the station and is definitely gathering steam so this is an issue that employers need to take seriously. In the Seattle Police guide linked above, we note that the police are looking at the employment-related implications of the law, as well as other matters.

Q. Will police officers be able to smoke marijuana? A. As of right now, no. This is still a very complicated issue.

Q. If I apply for a job at the Seattle Police Department, will past (or current) marijuana use be held against me?
A. The current standard for applicants is that they have not used marijuana in the previous three years. In light of I-502, the department will consult with the City Attorney and the State Attorney General to see if and how that standard may be revised.

"Complicated issue" sums things up nicely. We've compiled some commentary on the matter from various employment law authorities (and will no doubt bring you more in the future!)

Over at the LexisNexis Employment Law Community, attorney Donna Ballman reminds employees that Legal Marijuana Use Can Still Get You Fired. She cites case law on issues ranging from drug testing to the ADA. Most interestingly, she also discusses state laws that prohibit discrimination against medical marijuana users and prohibitions against termination/discrimination based upon an employee's lawful activities off-duty.

Vance O. Knapp writes about Amendment 64: how do employers address the legalization of marijuana in Colorado? He discusses this new law and the state's prior law allowing for medical marijuana use, and offers thoughts for employers. He cites this passage from Colorado's law:

Nothing in this Section is intended to require an employer to permit or to accommodate the use, consumption, possession, transfer, display, transportation, sale or growing of marijuana in the workplace or to affect the ability of employers to have policies restricting the use of marijuana by employees.

His post appears at Lexology, which has a good library of employment-law related articles on medical marijuana

Greg Lamm of the Puget Sound Business Journal spoke with labor and employment attorney James Shore, who offered five tips for employers to prepare for the new law. You should read his comments in full detail, but here's a quick summary of key points:
1. Have a written policy covering substances such as drugs and alcohol.
2. Make sure that policy covers any drugs that are illegal under state, federal and local law
3. Make sure that the policy prohibits any detectable amount of illegal drugs, as opposed to using an "under the influence" standard.
4. Employers with multiple locations in multiple states should have one consistent policy
5. Be prepared to see marijuana come up in collective-bargaining and termination negotiations with unionized employees.

We've also dusted off a few prior posts that we made on medical marijuana because they outline some issues employers will need to consider.

The current buzz on medical marijuana and the workplace

One Toke Over the Line

You can find more of our blog posts about pot by searching "marijuana."


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November 13, 2012

 

The last time we encountered Clayton Osbon, he was strapped to a gurney after being forcibly removed from an airplane. Osbon was a Jet Blue pilot who had a psychotic break during a flight from New York to Las Vegas back in March. He randomly flipped switches in the cockpit, turned off the radio and told his co-pilot that "things just don't matter." When he left the cockpit to go to the bathroom, the co-pilot locked him out of the cabin, after which he ran up the aisles, shouting incoherently about religion and terrorists. The flight was diverted to Amarillo Texas, where Osbon was arrested and charged with interfering with a flight crew - his own, as he was crew leader.

The psychotic episode lasted about a week. After a July trial, Osbon was sent to a prison medical facility in North Carolina for evaluation. He apparently suffered another psychotic episode in prison - a significant event, as it demonstrated that his illness was not a one-time incident caused by the combination of sleep deprivation and substance abuse.

At a recent hearing in Amarillo, a forensic neuropsychiatirst testified that Osbon had experienced a "brief psychotic episode" brought on by lack of sleep. Osbon was found not guilty by reason of insanity. The medical records are sealed - as they should be - but the requirement that Osbon attend a treatment program for substance abuse makes it clear that drugs or alcohol were a factor in the incident. U.S. District Judge Mary Lou Robinson has prohibited Osbon from boarding an airplane without the court's permission; he and a Jet Blue colleague had to drive the 1,300 miles from Georgia to Amarillo for the hearing. The court has also ordered him to seek alternative employment, as his prospects for flying an aircraft are likely gone forever.

Living with Mental Illness
Given his age (49) and the court directive to find alternative employment, Osbon finds himself in the same position as injured workers in the comp system whose disabilities prevent them from returning to their original jobs. As a pilot, Osbon has a formidable set of transferable skills, which theoretically should make finding a new career relatively easy. It is likely, however, that his earnings capacity will be severely reduced. In addition, given the fragility of his current mental state, he may be months away from being able to function in a work environment.

In the course of a few days in March, Osbon went from being a skilled and productive member of society to a confused, fragile individual incapable of functioning in the world as we know it. He is fortunate to be supported by his family - often the sine qua non of survival for people with mental illness. In rebuilding his life, Osbon faces the burden of demonstrating to others - and to himself - that he can once again be sane, reliable and stable.

Osbon's story embodies mystery - and agony - of mental illness. In his case, psychosis appears to have been triggered by a combination of sleep deprivation and substance abuse. But taking it one step further, perhaps the sleep deprivation and substance abuse were part of a desperate effort to mask and subdue a more primal turmoil in his mind. We only know the end result of that fierce inner struggle: a battle was lost, at least for the moment, and Osbon now faces a future where every gesture is scrutinized with fear and every day looms with uncertainty.

Formidable challenges now confront Osbon and those who support him: the search for a return to the simple joys of everyday life, where he can be comfortable in knowing who he is and what he needs to do. We can only wish him well.


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October 1, 2012

 

Over eight years ago, my colleague Julie Ferguson blogged on the issue of workplace heart attacks: compensable or not? (Workers Comp Insider just passed its ninth birthday, but we've been too busy to celebrate.) Heart attacks present a unique challenge to the courts overseeing workers comp. The general standard requires that something unusually stressful happened at work in the moments leading up to the incident; if people are doing their usual work in the usual manner, the heart attack does not arise "out of" employment. If, on the other hand, the demands of work are unusually stressful and beyond the ordinary, the incident might well be compensable.

Today's case raises the isse of whether anything that happens on Super Bowl Sunday can be ordinary. Colleen Robert's husband (no first name given in the court documents) normally worked as a receiver for Waldbaum's Supermarkets in New York. While the 2010 superbowl did not involve any New York teams - the contest featured the Indianapolis Colts versus the New Orleans Saints - Super Bowl Sundays are always busy for super markets. Roberts was asked to manage the store during the unusually busy day. At one point, he engaged in a verbal altercation with a customer (which in itself may not be unusual for those working in New York). Later that same day, while still at work, Roberts suffered a myocardial infarction and died.

The case was first deemed compensable, then denied by an administrative law judge, and then finally adjudicated by the Appelate Division of the New York Supreme Court. The judges noted that any death at work is presumed to be work related, but they also looked for a causal connection between the fatal attack and the work being performed. The autopsy revealed that Roberts suffered from extensive cardiovascular disease and thus was a good candidate for a myocardial infarction. In arguing against compensability, the defense pointed to the lapse of time between the verbal altercation with a customer and the attack itself. However, the judges noted that the entire day was full of stress and excitement for Roberts, who was not performing his usual job in the usual manner. They determined that the fatal heart attack was compensable.

Best Practices
In a similar case involving a supermarket in Massachusetts, a 70 year-old man with a pacemaker collapsed and died on his break. Because he had a known heart condition, and because of his age, the market assumed the fatality was not work related and failed to report it to their insurer. Months later, the widow filed for comp benefits. Due to the absence of timely interviews with co-workers and supervisors, and due to the "death at work" presumption, the case was deemed compensable.

The lesson for employers is both simple and straight-forward: report any and all incidents of heart problems immediately. Regardless of the state jurisdiction, the courts are likely to apply the same standards as in New York. And if a heart attack occurs on Super Bowl Sunday, defense may have a tough time proving it was just another working day.


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June 28, 2012

 

Big day today! We're on the case.

We point you to the SCOTUS Blog - Live Blogging Coverage - this is the best place to be for informed commentary on the Supreme Court decision and what it means. They say that "We expect the health care decision to be announced at roughly 10:15a. 1045a-1p - live coverage and analysis."

We'll update this post periodically through the day with links and info as the day progresses so check back!

MSNBC: Supreme Court upheld the individual mandate as constitutional -- but under taxing authority. News media are scrambling to make sense of things.

SCOTUS Twitter feed

There are more than 800,000 people following the SCOTUS live blog right now. Amazing the role blogging is playing in disseminating news. Here is an ignominious "Dewey Wins" style screw up headline from CNN captured for posterity.

Talking Points Memo: BREAKING: Supreme Court Upholds 'Obamacare'

Full decision available at Ezra Klein's WonkBlog

President to make a statement at 12:15. You can watch it live at whitehouse.gov/live.

Helathcare Reform Implementation Timeline

‏We're making more frequent updates on our Twitter feed.

Tom Lynch, our CEO, weighs in:

American health care costs more than twice as much as the average for the rest of the economically developed nations making up the Organization for Economic Cooperation and Development (OECD), but our healthcare outcomes are generally worse than the average. We don't live longer and we're not healthier than the others.
Today's Supreme Court ruling upholding the Affordable Care and Patient Protection Act (ACA)is a major step forward in reversing our less than enviable world ranking. But it is only a first step. America's health care tree, now planted, will require frequent attention and pruning. Congress and the States will modify and improve the law just as we have done in Massachusetts.
Our Massachusetts healthcare law, passed under Governor Romney and the model for the ACA , envisioned tackling this problem in a two step fashion. First, by making health insurance mandatory for all citizens, and, second, by attacking the high costs. We've succeeded with step one. About 98% of all Massachusetts citizens are now insured. Two years ago, we dove into the deep end of the pool to begin the serious work of controlling costs. Since then, we've seen improvement, but we still have a long way to go.
I'm hopeful that now that SCOTUS has ruled all of us can put our collective shoulder to the healthcare wheel and begin improving our nation's health and lowering our costs.

Related: The Best Health Care in The World (PDF)

Updates:
Ezra Klein: The political genius of John Roberts

Jonathan Cohn: Did Roberts Gut the Commerce Clause?

Kaiser Family Foundation: State Action Toward Creating Health Insurance Exchanges, as of June 18, 2012

Kaiser Health News: After The Ruling: A Consumer's Guide

Kaiser Health News: KHN legal analyst Stuart Taylor: 'Most Amazing Supreme Court Theater I've Ever Seen'

Kaiser Health News: Political Leaders Sounding Off On Health Law Decision With Speeches
Senate Majority Leader Harry Reid, House Speaker John Boehner, House Minority Leader Nancy Pelosi, GOP presidential candidate Mitt Romney and President Obama react to Thursday's Supreme Court decision on the health law with speeches.

Charles Ornstein, ProPublica: Mystery After the Health Care Ruling: Which States Will Refuse Medicaid Expansion?

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May 1, 2012

 

The courts have been giving Florida Governor Rick Scott a few lessons in the Bill of Rights. He does not appear to be listening, but perhaps the voters of Florida are. Scott wants the state to require drug testing of all welfare recipients and all state employees. A temporary injunction put a stop to the welfare testing and now federal judge Ursula Ungara has ended Scott's bizarre vision of every state employee peeing into a cup.

The state argued, in part, that the program was voluntary: people don't have to do it, they'll just lose their jobs if they don't. Some definition of "voluntary"!

There are times and circumstances where drug testing is useful and necessary. For jobs involving public safety and genuine risk, drug testing should be mandated. But courts remain sensitive to the constitutionally guaranteed right to privacy. Under the "probable cause" standard, courts look for specific risks and exposures, not for blanket policies that cover everyone. There should be evidence of a problem, possible harm if drug abuse takes place and an over-riding safety interest. This may well describe the situation of a police officer or firefighter, but not a clerk in the Registry of Motor Vehicles.

Insubstantial and Speculative Risk

Judge Ungaro pointed out the fundamental flaw of Scott's executive order: it infringes privacy interests in pursuit of a public interest which is both insubstantial and speculative. She writes that "the proffered special need for drug testing must be substantial- important enough to override the individual's acknowledged privacy interest, sufficiently vital to suppress the Fourth Amendment's normal requirement of individualized suspicion."

By trying to lump all state employees into one big drug testing net, Governor Scott displays his contempt for government and the people who carry out its work. Beyond that, his drug testing obsession runs contrary to a fundamental premise in the Bill of Rights. Someone needs to remind the governor that his job is to protect the rights of every Florida citizen, not compromise these rights in the interests of punitive and ill-conceived policies.


A Random Note on the Original "Great Scott"
The origin of the phrase "Great Scott" is unclear, but Wikipedia surmises that the reference is to U.S. Army, General Winfield Scott, known to his troops as Old Fuss and Feathers. He weighed 300 pounds in his later years and was too fat to ride a horse.

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April 25, 2012

 

We thought we had heard the last of the bizarre Virginia workers comp statute that denied benefits to workers who suffered brain injuries: under the old statute, if a worker survived an accident but was unable to testify about the incident, no benefits were to be paid. We blogged two cases where the injuries were clearly work related, but where the testimony of the worker was not available. The claims were denied.

Last year the legislature revised the statute to read in part:

In any claim for compensation where the employee is physically or mentally unable to testify as confirmed by competent medical evidence and where there is unrebutted prima facie evidence that indicates the injury was work-related, it should be presumed in the absence of a preponderance of evidence to the contrary that the injury was work related.

Reporter Dan Casey of the Roanoke News is on the case again: With the new statute's protections in place, a roofer named Herman Blair fell from a ladder and suffered multiple skull fractures. He filed a claim for indemnity and $350K in medical benefits. When he appeared for his workers comp hearing, he had no memory of the incident, but he was able to state his name and talk about other aspects of his life. On the basis of his ability to talk, Deputy Commissioner Phillip Burchett ruled that the injury was not compensable. Despite testimony from a co-worker, who heard a noise and saw Blair fall, Blair's ability to speak nullified the presumption in the revised statute. Burchett writes:

The only thing we can determine is that the claimant was on the roof some several feet above the ground and he fell; however, that in and of itself does not establish that the fall arose out of the employment.

Commissioner Burchett has set a very high standard, indeed. The man is on a roof installing tile. He gets onto a ladder to descend, and ends up on the ground. What does Burchett think he was doing - texting? surfing the net? In the commissioner's interpretation, if Blair had ended up in a coma, he would have had a compensable claim. But because he was conscious and able to talk, the claim had to be denied. [Burchett's nitpicking ruling can be found at WorkCompCentral, subscription required.]

The Fix is Not Quite In
There was an effort to amend the statute to include a presumption for workers able to testify about some things but not "about the circumstances of the accident," but the usual suspects (business and insurance advocates) pushed back by saying that this might open the door to abuse, with workers deliberately falling silent on the circumstances of their injuries. This, of course, is reminiscent of the original fear that workers would fake brain injuries. Sigh.

At some point Virginia will get this right and Herman Blair, having suffered insult after injury, will eventually collect his benefits. This fiasco illustrates how hard it is to get the language of a statute just right. You fix one problem and another arises. The only thing lacking in all of this is common sense and a little dignity: it should not require a legislative committee to determine that Herman Blair was injured on the job and is entitled to the life-enhancing benefits of the workers comp system.

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March 12, 2012

 

Here is a truly bizarre case from Illinois that will likely send our many attorney readers scrambling for their statute books.

Christopher Washkowiak worked as a pipefitter. He suffered a serious work-related injury in 2009. The following year, his marriage broke up (dissolved as of August) and he settled his workers comp case in December. The settlement totalled $365K, plus a Medicare Set Aside (MSA) for an additional $70K. Washkowiak's wife, Rosana, was entitled to 17.5% of the marital assets. She claimed not just 17.5% of the $365K lump sum settlement, but the same percentage of the MSA.

The initial trial court and the Illinois Appellate Court, 3rd District, ruled that Rosana was entitled to the money. Here is the Appeals Court ruling:

Unless there is something about an MSA that removes the MSA funds from the definition of "net proceeds," the funds fall squarely within the dissolution decrees's definition of "net proceeds" (paragraph 10).

The court goes on to say that "there is no question that the money is his [Christopher"s] and further that "it is not Medicare's or [the employer's] money" (paragraph 15).

Finally, the ruling goes on to state that "if he incurs no such [medical] bills, he gets the money back" (paragraph 17).

It is worth noting that Rosana apparently does not have to wait to see if the funds are needed for future medical expenses. The court has foreshortened this process to the point where she gets the money now, as part of the divorce settlement.

Attention All Attorneys!
There are a number of parties who will be alarmed by this ruling:
The Federal Government: Medicare will surely object to the expenditure of MSA funds for non-medical purposes, diluting what is available for future expenses (and thereby defeating the purpose of the MSA).
Insurers and self-insureds: will be shocked to see funds set aside for future medical expenses being used for other purposes; this will inevitably lead to further inflation of future MSAs. (Indeed, Medicare might hesitate to sign off on any settlement prior to determining the relative strength of the marriage - and we all know how much stress disability puts on a marriage...Yikes!)

What if this divorce entailed the conventional 50/50 division of assets? Half the money in the MSA could be spent before the account even got started.

I have never heard MSAs referred to as claimant assets. In my limited understanding, the amount awarded to the claimant is separate and distinct from the MSA. Funds in an MSA can be used only to pay medical bills. In addition, I have never heard of a situation where unspent MSA funds reverted directly to claimants; they would likely revert to the insurer or the self-insured, whoever set aside the money. (If any of our attorney readers have any knowledge to the contrary, please let us know!)

MSAs carry a lot of baggage already: the MSA process slows down settlements while stakeholders wait for federal bureaucrats to check the numbers; MSAs seriously inflate the current cost of settlements, complicating an already complicated process. If this ruling in Illinois is upheld, if MSAs are truly marital assets, then, as the saying goes, "we ain't seen nothing yet."

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February 24, 2012

 

You have to feel sorry for Erik Martin. He went to work for Quick Chek Corp in 1999 as an assistant store manager. He was promoted to store manager in the summer of 2000. He was diagnosed with Parkinson's disease that same year. After informing his supervisor of his diagnosis, she advised him to keep his illness "hush, hush." Martin complied, and never mentioned his illness to the company's HR director. Martin missed work in 2004 and 2006 due to two mini-strokes and took a two-week leave of absence in 2007 because of depression. Despite his formidable physical difficulties - unrelated to work - he returned to work as soon as he was able.

In March 2008, Martin requested and received a demotion because his medical condition, combined with the lack of an assistant manager, precluded him from satisfying his work obligations. Later that same month, Martin injured his back at work. He contacted his doctor, who instructed him to take a darvocet that was previously prescribed to Martin's mother-in-law. Martin visited the doctor the following day, at which time he was prescribed percocet to manage his pain.

Drug Policy
In keeping with company policy, Martin was drug tested two days after the injury. A few days later, he was contacted by the testing facility. They asked him to disclose the medications he was taking. He told them about his prescriptions, including the percocet, and also informed them about the darvocet he took on the day of the injury. Because he tested positive for darvocet without a prescription, the testing company reported a failed drug test and Quick Chek terminated Martin.

A reasonable person might think that Martin was in compliance with the company policy. He took a pill at the verbal direction of his doctor. Was this a "prescribed" medication? Well, that's where a problem arises.

The word "prescription" comes from the Latin "praescriptus" compounded from "prae", before + scribere, to write = to write before. Historically, a prescription was written before the drug was prepared and administered.

It appears that a "verbal prescription" is an oxymoron: if it isn't in writing, it isn't a prescription. [NOTE: the court ruling did not even address this issue.]

The HR director testified that his decision to terminate Martin was based on the failed drug test. He further testified that in his thirteen years managing human resources for Quick Chek, he never made an exception to the company's zero-tolerance drug abuse policy. The director also stated that he was not aware of Martin's Parkinson's disease until this litigation commenced.Thus Martin's termination was consistent with company policy. And in the view of the court, the termination was perfectly legal.

The court wrote:

Unquestionably, the company's drug policy was enforced in a harsh fashion against Martin. The company relied completely on the assessment of the testing company that Martin "failed" the drug test. Quick Chek operates in such a way as to delegate total discretion to interpret the drug test results to the testing company. Once deemed to have failed the drug test, an employee is terminated without exception with no apparent right of appeal. In Vargo v. National Exchange Carriers Assn., Inc., 376 N.J.Super. 364, 383 (App. Div. 2005), we held that a company need not investigate possible legal reasons for a positive drug test before taking action with regard to a prospective employee; nor should such a duty exist with respect to existing employees. NJLAD is not offended by a private company's lack of compassion in these circumstances.

Note how the court starts with a precedent involving a job applicant and then applies it to a loyal employee of long standing: "nor should such a duty exist with respect to existing employees." The court may not see any difference between an applicant and a loyal employee, but I do.

No Room for Compassion
The court "is not offended by a private company's lack of compassion." Well, I am. Zero tolerance policies back companies into a corner; their rigidity may eliminate the need for discretion, but in doing so, these policies also eliminate many good employees. A little discretion in the hands of good managers is a powerful tool toward building a positive work culture. By contrast, zero tolerance policies may provide an illusion of control over matters that are difficult to control, but they are not an effective way to run a company (or a school, for that matter). Indeed, the policy makes it difficult for the company to fulfill its promise as a great place to work:

Quick Chek is proud to be one of NJ's Best Places to Work! With 2,600 team members in over 120 stores, we strive to create a positive experience and fun environment where core values are nurtured, hard work is rewarded and leadership is cultivated.

I wonder what Erik Martin thinks of the company's "core values." When his illness prevented him from doing his job, he requested and was granted a demotion. When his illness prevented him from working, he took (unpaid) time off and focused on recovery. When he was injured at work, he followed his doctor's orders and his company's procedures. Martin's loyalty and perseverance are admirable qualities, but they did not buy him much in the corporate offices of Quick Chek or the courtrooms of New Jersey.

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February 21, 2012

 

Dr. Paul Volkman specialized in mitigation of pain. Did he ever. From 2003 to 2005 he was the most prolific prescriber of Oxycodone and related opioids in the entire country. He was recently sentenced to four life terms in prison for the deaths of four patients. There were eight additional overdose deaths associated with his practice, but these lacked enough evidence to prosecute. Patients came from hundreds of miles away and were charged $125 to $200 in cash for visits to see a doctor. Volkman's distribution system had a devastating effect on southern Ohio, where he based his practice.

Prosecutors said Volkman rarely, if ever, counseled patients on alternate treatments for pain, such as physical therapy, surgery or addiction counseling. Volkman denied the allegations and said he always acted in good faith. A month before his conviction, he dismissed his attorneys and defended himself. His skills as an attorney appear to be totally in sync with his skills as a physician.

Street Creds and Credentials
Volkman went to work at the Tri-State Health Care and Pain Management clinic in southern Ohio in 2003. The clinic was operated by Denise Huffman and her daughter Alice Huffman Ball, who have pled guilty to one count of operating Tri-State as a business whose primary goal was the illegal distribution of prescription drugs. Denise has been sentenced to 12 plus years in prison; her daughter is serving five years. Both testified against Volkman, as did a horde of witnesses including pharmacists, police investigators, clinic employees and patients who received pills from Volkman.

What is striking about this case is the harsh sentencing. Four life terms is the kind of sentence you rarely see applied to white collar criminals; Volkman was sentenced as if he were a run-of-the-mill (pun intended) drug kingpin, which, minor differences aside, he was.

Through the wonders of the internet, we learn that Volkman had a three star rating from his patients and earned his medical degree at the University of Chicago Pritzger School of Medicine in 1974, followed by a residency at Duke Medical Center. After that, well, something went terribly wrong. Nonetheless, with his impressive creds, he's sure to be a very popular man for the rest of his highly circumscribed life.


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February 13, 2012

 

A couple of years ago we blogged the performance incentive program at Smurfit-Stone Container Corporation in California. The performance numbers were stellar, but not necessarily because the work was performed safely. Instead, the company conspired with local medical providers to secure limited treatment outside of the workers comp system. Two supervisors pled no contest in conspiring to deny comp benefits to injured workers.

With the recent conviction of chiropractor Robert Schreiner, we see into the black box of the conspiracy. Workers complaining of work-related problems were referred to doctors like Schreiner - giving rise, alas, to a new and ominous definition of provider network. In one instance a worker complained about a neck and shoulder injury. Schreiner denied that the problem was work related, saying that it was caused by carrying a back pack as a child. He provided a handful of treatments and then encouraged the worker to file the claim under his health plan to continue treatments. When the worker persisted and filed a comp claim, he was fired.

Schreiner is headed to jail to serve a mostly symbolic sentence of 30 days, to be followed by three years of probation. Perhaps he can provide some adjustments to his fellow inmates. Confined spaces sure can mess up the spine.

Faking Safety
Smurfit-Stone was bought out last year by RockTenn. You can still read about the company in Wikipedia. Here is the (unattributed) description of the company's safety program:

Smurfit-Stone has been an industry leader in safety performance since 2001 [NOTE: the conspiracy to under-report claims began in 1999!]. In 2007, Smurfit-Stone's U.S. operations had an OSHA recordable case rate of 1.05, the best in company and industry history. This represents an 84 percent improvement in the company's recordable case rate since the implementation of Smurfit-Stone's SAFE process in 1995.The SAFE process, which stands for Smurfit-Stone Accident-Free Environment, promotes five core beliefs: 1.All injuries are preventable 2.Safety is everyone's responsibility 3.Working safely is a condition of employment 4.Training employees to work safely is essential 5.Safety is good business

As litigation has proven, Smurfit-Stone's low OSHA case rate has less to do with safety than with a conspiracy to under-report claims. Perhaps the SAFE program stood for something else: Screw All Forsaken Employees. Aggressive safety goals are a good business practice; circumventing the workers comp system is not just a bad practice, it's illegal. Just ask Robert Schreiber.

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February 7, 2012

 

I watched the Superbowl with a group of friends on a 60" High Definition TV, sipping a few beers and compulsively downing munchies. My team lost (but to my mind, second place in a league of 32 teams is not all that bad - kind of a silver medal). I find the organized mayhem of football fascinating, as if J. S. Bach were being performed by a deranged, full contact orchestra. A number of years ago, my then 4 year old daughter Julia called the game "all fall down." She was right in more ways than she knew.

We have been following two tracks in the saga of the NFL: the workers comp claims filed by former players in California (where benefits are easier to secure) and the lawsuits alleging that the league knowingly hid the effects of repeated concussions, resulting in dementia and other serious medical issues among retired players. While there are numerous lawsuits filed across the country, there is a movement to consolidate several of them into one big federal case, under Senior Judge Anita Brody in Philadelphia.

The stories of diminished mental capacity that have emerged over the last few years are disturbing - easily reaching the threshold where all of us who view the sport must question our complicity. For decades, the football mentality has been to keep the best players on the field, regardless of (future) consequences.

Touchdown Tony Dorsett
One of the parties to the lawsuits is the former Dallas Cowboy running back, Tony Dorsett. He was a smooth, electric runner on the field, but the mask of his helmet and pads only served to make invisible his considerable pain and suffering:

Dorsett's had surgery on both his knees, and problems with his left arm and right wrist. He says then-Cowboys coach Tom Landry once told him he could play despite a broken bone in his back. Not even the flak jacket Dorsett says he wore beneath his jersey could bring relief, the injury so painful that "tears would just start flowing out of my eyes, profusely and uncontrollably" during practices. "They would see me and just point to the training room. 'Go to the training room, get some ice and heat and come on back out here,'" Dorsett says.

That, indeed, was (and to some extent, still is) the coaching mantra: "Suck it up and get back out there!"

Presumption versus Denial
For many years, the NFL denied any relationship between the violence on the field and the subsequent mental traumas of former players. Much like the company doctors who once denied that smoking caused cancer, the league's doctors insisted that there was no demonstrable relationship between multiple concussions and dementia.

The systematic denial has ended, but the implications for hundreds of retired players are still not clear. I envision that they will eventually reach a settlement, where the league accepts responsibility for virtually any and all mental incapacity in its retirees. Much like the cancer and heart attack presumptions granted to public sector firefighters and police, the league would presume that mental disabilities among retirees are work related, with the burden of proof on a given owner to show that they are not.

While any such settlement will involved the commitment of millions of dollars, the league is so wildly popular, only a small percentage of gross income will be required.

Appetite for Sport
In the meantime, we face half a year without football. Come fall, there will be a Thursday night game every week, along with the full Sunday menu. To be sure, the players don't like the short week of preparation that Thursday games entail; they will lack the usual full week to recover from the bumps and bruises of the prior Sunday game. Oh, well, the public's appetite for America's Game is nearly insatiable. The players will just have to suck it up and get back out there...

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February 6, 2012

 

ABC news has picked up a story out of Arkansas: Zack Clement suffered a hernia while moving a refrigerator for his employer, Johnson's Warehouse Showroom. He underwent multiple surgeries, but the pain lingered, so he filed for a continuation of benefits. Among the pieces of evidence at his trial were party photos posted on his Facebook page, which show Clement drinking (and little else). When his claim for reinstatement was denied, Clement appealed, citing the unfairness of the Facebook evidence.

ABC wrote as follows:

In an opinion, written by Judge David M. Glover, the Arkansas Court of Appeals states: "We find no abuse of discretion in the allowance of photographs. Clement contended that he was in excruciating pain, but these pictures show him drinking and partying."

"Certainly these pictures could have a bearing on a Clement's credibility, albeit a negative effect that Clement might not wish to be demonstrated to the ALJ or the Commission, " Glover continues. "We hold that there was not an abuse of discretion in allowing the photographs."

Justice in the Details
At first glance, the judge's comments might be cause for alarm. An injured worker suffering from chronic pain might well be capable of having a few drinks with friends. (One can only hope that the alcohol does not interfere with any prescribed -or unprescribed - pain medications.) If the photos were the primary evidence of Clement's condition and the basis for denying the claim, Clement would have good reason to object. However, this is not the case.

In the course of his carefully reasoned findings, Judge Glover reviews in detail the medical history of Clement's claim. Even after multiple surgeries and several changes in treating doctors, Clement complained of ongoing pain. Extensive medical testing revealed no abnormalities and no evidence for the pain itself. He has been released to full duty. It is this detailed history and the lack of medical evidence that lead Glover to conclude that any further treatment would fall outside of the workers comp system. The Facebook photos are by no means the foundation of his findings. Nonetheless, he decides that the photos are a legitimate piece of the case file and admissable as evidence.

In my limited experience, Facebook seems to be a platform for superficial news and, for the most part, images of the good times. It is difficult to imagine that Clement would have used this public forum to post pictures of himself suffering excrutiating pain. If he had chosen to do so, this might have provided evidence in his favor. However, his friends would likely have chided him for being such a downer and even then, the court might have dismissed the images as theatrical exaggeration.

Facebook may now be the preferred means of presenting our personal narratives, but it is unlikely to help us make our case in a court of law.

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January 23, 2012

 

Yesterday the New York Sunday Times ran a fascinating piece on the manufacturing of iPhones. The making of 200 million phones is taking place in the far east, mostly in China. When President Obama asked Steve Jobs "why can't that work come home?" Jobs replied: "Those jobs aren't coming back." The article, written by Charles Duhigg and Keith Bradsher, describes the reasons why this work will never come back home (and why we wouldn't want them anyway).

In the months prior to the release of the iPhone, Steve Jobs carried a prototype in his pocket. He discovered that the plastic screen was easily scratched by the keys and loose change that people often have in their pockets. He informed his engineers that this was not acceptable and insisted - at the last minute - that they redesign the phone with a scratch- and break-resistant glass. Corning Glass was able to do this.

Corning (made in America!) shipped the new parts to China, where they arrived around midnight. Supervisors at the assembly plant woke up some 8,000 workers sleeping in company dorms, gave them tea and a biscuit and set them to work in 12 hour shifts installing the glass into bevelled frames. The plant churned out 10,000 phones per day.

It is impossible to envision an American workforce positioned to perform this kind of work under these conditions. We do not house our workers in dorms (except migrant farm workers). We do not suddenly change work schedules to begin at midnight. Even in the Republican dream of a post-union workforce, it is inconceivable that American workers would accept this kind of pressure - and be paid $17 per day or less.

iPhones and Pyramids
Nearly seven years ago we blogged the emerging issue of worker rights in China. While there is a bare-bones structure of rights, these are arbitrarily enforced and easily avoided. China is a single party state, run with ruthless efficiency by the Communist Party. Opposition is not tolerated; dissent is brutally suppressed; and workers are at the mercy of their employers. To enforce rights, you need a constitution and an infrastructure of laws and regulations. And you need lawyers to argue on behalf of workers. China has none of these crucial elements and, truth be told, no real interest in developing them. And that is why everything is made in China: quality is high, working conditions are whatever management wants them to be, and labor costs are low.

While technically not slaves, production workers in China labor under appalling conditions that do not and cannot exist in most western cultures. They may be paid better than the slaves who built the pyramids, but they are paid less - while working harder - than any comparable workforce in developed countries.

So the late Steve Jobs was correct: the jobs involved in assembling essential electronic devices will remain off shore. These jobs are never coming home, unless, of course, the economy collapses totally and our workers are reduced to accepting virtually any working conditions. Which leads to questions beyond the scope of a workers comp blog: what manufacturing jobs will remain domestic? What will happen to the millions of production workers in America who no longer have jobs? As the American middle class declines, how will the economy function? Who will buy the goods that drive the engine of capitalism?

Epilogue
I drove my American assembled Japanese car to the Verizon store yesterday and picked up my black 16 gig iPhone, designed by indisputable geniuses in America and assembled by an underclass in China. It's awesome. I can't imagine life without it.


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August 9, 2011

 

When we last left bodybuilding firefighter Felix Arroyo, his application for disability retirement ($65K per year, tax free) had been rejected and he had been offered back his (relatively light duty) job with the Boston Fire Department. Arroyo declined to accept the job and was fired. Now we read in the Boston Globe that he is facing criminal charges in federal court for mail fraud, the result of a seemingly able-bodied individual claiming to be disabled.

The case against Arroyo is as powerful as his biceps. Two back specialists have testified that there is no objective evidence of a back problem and that Arroyo's description of the pain ("8 out of 10") was inconsistent with his mobility. Testimony was also given by Dr. John Mahoney, the doctor who originally disabled Arroyo (and whose original diagnosis we termed "Mahoney's Baloney"). Mahoney testified that he would have changed his evaluation if he had known Arroyo was a body builder.

"If someone is bodybuilding, they're playing baseball, they're doing activities...that's not compliant" with their recovery," Mahoney said.

Good for Dr. Mahoney. He owned up to his mistake and assumed responsibility for it.

Tough Defense
Arroyo's attorney, Timothy Watkins, has his work cut out, for sure. He says that Arroyo was "working through the pain." (Aren't we all?) He also noted that the doctors's interpretations of the exams are subjective and that the pain Arroyo suffered could have been the result of stress (the stress, for example, of fabricating a disability?).

Perhaps the most damaging evidence is the video of Arroyo flexing for an audience at a bodybuilding competition a few weeks after he filed for disabiility. The video shows him prancing around the stage, stretching his ripped arms and chiseled legs in all directions and flexing the formidable muscles in his back. Then again, maybe he was just having a good day.

Arroyo is by no means alone in his attempt to take advantage of a lax system. He could argue that he was only doing what many other firefighters have done. True enough, but Arroyo alone is on trial here. Testimony continues. And while no trial result is a foregone conclusion (did someone say "Casey Anthony"?), Arroyo is likely to be working out for a while in a relatively confined space.

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July 12, 2011

 

Dr. Jean Zannoni, 77, runs a family practice in Parma, Ohio. It would be a mistake to assume that by specializing in families, she is not interested in treating injured workers. She treats them all right - to pill after pill after pill. She was recently sentenced to two years probation and ordered to pay more than $7,500 in fines and restitution after pleading guilty to theft, attempted workers' compensation fraud and telecommunications fraud.

According to authorities, two Ohio Bureau of Workers Compensation (BWC) undercover agents were provided narcotic medications without proper medical examinations and BWC was billed improperly for the office visit.

Dr. Zannoni instructed her staff (in writing!) to bill all injured workers under the same code and charge BWC $75, regardless of the circumstances of the visit. She also manipulated "pain" ratings to ensure that patients qualified for narcotics. And she continued to prescribe narcotics to patients who were known doctor shoppers, even after receiving warnings from pharmacies, parents, spouses, social service agencies and police departments. Some family, some practice.

A Microcosm
In the scheme of things, Dr. Zannoni is a bit player. But when you try to figure out how narcotics became such a major cost driver in workers comp, you have to take into account doctors like Zannoni, who parlay a little pain into big profits.

Given the scale of her crimes - she overbilled WBC by $65,000 - the penalties in this case (small fine plus probation) seem a bit modest. On the other hand, the (Feel)Good doctor, at 77, is probably nearing the end of her practice, which may well have played into the decision to let her off relatively lightly.

Ironically, if you Google her name, Zannoni's patient ratings are uniformly high (pun intended). One anonymous patient even commented on an article describing her conviction as follows:

This is one of the sweetest most nieve (sic) people on ths planet. I know her personally and she has no idea what goes on. All she knows is how to do is practice medicine and nothing about finances at all. God bless her and I hope everything works out for her sake.

We'll let that stand as written. And one thing is certain: those seeking pills in Parma may not be able to count on Dr. Zannoni any longer, but surely they will find other sources to make their pain go away, to get a little buzzed, and, who knows, make a little money on the side.

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May 25, 2011

 

Henry C. Becker Custom Building Limited was doing some construction work in Newburyport MA. They hired the Great Green Barrier Company to do some waterproofing. They apparently did not ask for a certificate of insurance; Great Green Barrier did not carry workers comp for their employees. There was an explosion on the jobsite. Timothy Wentworth, an employee of Great Green Barrier, was killed; his son, Ezekiel, was severely injured. As the employees of an uninsured subcontractor, the Wentworths collected workers comp through Becker's insurance company, which paid out substantial lump sum settlements to each.

Then the Wentworths sued Becker as a third party. Becker objected: comp, after all, is an exclusive remedy. Once the Wentworths collected comp benefits, they should be precluded from any other remedies. Becker sought and won a summary judgment dismissing the lawsuit.

The case wended its way to the MA Supreme Judicial Court, where the justices determined that the summary judgment was improper: the exclusive remedy provision of the comp statute applies only to employees. The Wentworths were not employees of Becker, but of Great Green Barrier. Becker, in other words, was a third party and thus, despite the payment of comp benefits, was not immune from lawsuit.

Compounded Liabilties
Becker is going to pay and pay again: first, under their workers comp policy, the payroll for Great Green Barrier employees will have been added to the Becker payroll in the premium audit; that's the chump change. Then, the substantial losses for the Wentworths - each likely exceeding the state rating point limit of $175,000 - will be added to the experience modification calculation for Becker over a three year period. That's serious bucks (but nowhere near the financial hit taken by Becker's comp carrier).

Then, given this ruling, the Becker company is vulnerable to a lawsuit, which is likely to result in additional payments to the Wentworth family. The MA Supreme Court has made it crystal clear: general contractors are liable for the comp costs of uninsured subs, but the acceptance of comp benefits does not preclude a third party lawsuit.

The lesson for GCs should be clear: proper risk transfer must be a fundamental part of the operation. Make sure subcontractors carry workers comp: require that any and all subs produce a certificate of insurance, with the GC named as an additional insured. Track the expiration dates on the certificates and do not allow subs on the job site unless they have shown that comp (and liability) policies are in place.

Henry C. Becker Custom Building has learned about risk transfer the hard way, an expensive lesson indeed. May a word to the wise be sufficient.


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April 13, 2011

 

In the ever-useful Oregon rankings, Montana has the dubious distinction of being the second most expensive state for workers compensation. Alaska, with its vast spaces and compelling views of the former Soviet Union, is number one. Gov. Brian Schweitzer recently signed HB 334, a bill designed to lower the mountainous rates. Only time will tell...

It's always interesting to see how a state legislature tackles high comp costs. In Montana, they set out to take a balanced approach, narrowing eligibility but enhancing benefits. While the legislators are patting themselves on the back for achieving their goals, unions have complained that too much of the cost reduction comes at the expense of workers. It usually does.

Here's a glimpse of the bill in action, trying to reduce employer liability for specific exposures:

(2) An injury does not arise out of and in the course of employment when the employee is:

(a) on a paid or unpaid break, is not at a worksite of the employer, and is not performing any specific tasks for the employer during the break; or

(b) engaged in a social or recreational activity, regardless of whether the employer pays for any portion of the activity. The exclusion from coverage of this subsection (2)(b) does not apply to an employee who, at the time of injury, is on paid time while participating in a social or recreational activity or whose presence at the activity is required or requested by the employer. For the purposes of this subsection (2)(b), "requested" means the employer asked the employee to assume duties for the activity so that the employee's presence is not completely voluntary and optional and the injury occurred in the performance of those duties.

At times the revised law reads like a monologue, with legislators trying to anticipate the circumstances of an injury and limiting the comp system in its ability to award benefits.

Rate Pain
The Oregon study illustrates some of the exorbitant (2008) rates paid by Montana employers. For a point of reference, we compare these rates (per $100 of payroll) to those in Massachusetts. (The MA rates are in brackets):

Carpentry shop (2802) $17.85 [$4.53]
Plumbing NOC (5183) $10.44 [$4.10]
Carpentry NOC (5403) $26.91 [$11.80]
Clerical (8810) $0.85 [$0.13]

Massachusetts employers, in a state with six times the population of Montana, spend about $650 million for comp premiums. Montana's current tab - $400 million - is expected to drop about 25 percent as a result of the new law. Even if you reduce the above Montana rates by 25 percent, employers are still confronted with big premium bills. Mount Comp might be substantially lower than it was, but it's still a grueling climb.

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February 24, 2011

 

Amid much controversy, the Texas Legislature is considering SB354, a bill that would allow licensed students and professors to carry concealed handguns on college campuses. The bill has passed a Senate committee and has been referred to the Committee of Criminal Justice, where it will be up for a hearing. (Follow SB354). With support from Governor Rick Perry and more than half the members of the House signing on as co-authors, most observers think that the bill will be passed. But according to an article by Patrick Williams in the Dallas Observer, concealed guns on campus is not necessarily a fait accompli: "[Similar] legislation has failed 43 times in 23 states since Virginia Tech," Malte says, referring to the 2007 campus mass murder that claimed 32 lives. "Every time somebody said this is a done deal over the last three years, it was defeated."

Utah is currently the only state that allows guns on campus, but legislation is on the docket in several other states. Fox Business News reports that eight other states currently have campus carry legislation underway. These include Arizona, Florida, Michigan, Mississippi, Oklahoma, Nebraska, New Mexico, and Tennessee.

With sympathetic Republicans at or approaching supermajority status in a few of these states, the political stars are in alignment for success. Ultimately, the deciding factor may come down to the strength of student and parental support or opposition. Keep Guns Off Campus says that the American Association of State Colleges and Universities (AASCU) and 271 colleges and universities in 36 states - 189 four-year colleges and universities and 82 community colleges and technical schools - have joined the Campaign to Keep Guns Off Campus. (See Listing). On the other hand,
Students for Concealed Carry on Campus point to widespread support - not the least of which is the mighty power and deep pockets of the NRA.

Follow-on to "Guns at Work"

The spate of campus carry legislation is a natural adjunct to the NRA's major "guns at work" legislative initiative, which has been sweeping the country in recent years to considerable success. According to the NRA, there are now 13 states that have laws permitting employees to have guns at work: Alaska, Arizona, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Minnesota, Mississippi, Oklahoma, and Utah. While the particulars of these laws vary, such laws generally allow licensed gun owners to keep guns locked in their cars at work, including on employer-owned parking lots. In some states, certain business such as hospitals, schools and prisons are exempt. This is an issue that has pitted the rights of an employer to establish policy for their private property (employer-owned parking lots) against second amendment rights. It's an issue that has been opposed by employer groups and associations.

For more history on the Guns at Work issue, see prior postings on the topic below.
Three new state laws limit employer restrictions on guns at work
Guns at work: coming to a neighborhood near you?
Workers with guns
Guns at work

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November 30, 2010

 

On a recent drive through rural Ohio, I was startled by an unusual image: a horse and buggy crossing over the interstate on a bridge. Later, at a rest stop, a long line of Amish folks, dressed as if from central casting, stood patiently in line at the Burger King. When they departed, I went up to the counter and asked what they had ordered. "Burgers and biscuits, mostly." The Amish get biscuits from Burger King?

This memory came to mind when reading at Philly.com of a clash involving roofers in the western suburbs of Philadelphia. It seems that the Amish have an unfair advantage when bidding for roofing jobs against non-Amish contractors. The latter must factor in the costs of social security and workers compensation when bidding for work - and as comp practitioners know, the cost of comp for roofers is, well, through the roof. Under federal law, the Amish are exempt from social security; their religion rejects any form of insurance other than Divine. Under Pennsylvania law, they may opt out of workers compensation as well (though some Amish contractors do not). When you factor the costs of these coverages into the work, it's no surprise that Amish bids are routinely 30% or more lower than non-exempt contractors.

In the good times (remember those?), these differences did not matter much, as there was plenty of work for everyone. Today, however, there is a hard-scrabble search for work. Non-Amish contractors complain that the Amish have an unfair competitive advantage.

Lifestyles of the Not-So-Rich and Famous
The Amish also have a lifestyle advantage. They reject many aspects of modern culture. Many, though not all, refuse to operate machinery. Most do not use electricity. They do not have to worry about flat screened TVs, cable, iPods, iPads, cell phones, etc. They cling to a simple lifestyle that explicitly turns its back on what most people think is essential and necessary.

This brings to mind one more image during my brief encounter with the Amish in Ohio. As I was entering the rest stop, an Amish family was exiting. The father, with his wife a few steps behind, led his six children (their families tend to be large). One of the daughters held the hand of the youngest, a sweet blond 4 year old, who was blind. Bringing up the rear came another daughter, about 16, in a long, plain cotton dress that covered her from neck to ankles, over which she wore big, clunky work boots, laced half way up. Her gaze was indefinite, as if she were oblivious to the prosaic surroundings. She was strikingly beautiful.

I could not help but wonder whether she would remain with the culture that nurtured her, or whether she would yield as most of us do to the temptations of the beckoning world, a world full of greed and gadgets, where insurance is an absolutely necessity ...and by no means divine.

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October 13, 2010

 

Obesity as a health problem is not going away, nor is the issue of whether obese people are considered disabled under the Americans with Disabilities Act (ADA). The latest iteration of this saga involves the late Lisa Harrison, a morbidly obese employee of Resources for Human Development (RHD) in New Orleans. Harrison, an intervention prevention/specialist, worked with the children of mothers undergoing treatment for addiction. By all accounts, she performed her job well, but RHD viewed her as limited in a number of major life activities, including walking, so they fired her. Harrison died before the EEOC filed suit, but the lawsuit lives on.

Keith Hill, the field director of the EEOC's New Orleans office, stated, "This is a classic case of disability bias, based on myths and stereotypes. The evidence shows that Ms. Harrison was a good and dedicated employee who did not deserve to be fired. All covered employers, whether for-profit or non-profit, must abide by the ADA's provisions."

It's important to note that the EEOC is not basing the lawsuit on obesity itself, but rather on the idea that RHD perceived Harrison to be disabled. That's why they fired her. The larger issue - so to speak - is whether morbid obesity in itself is a disability. This particular case will not attempt to resolve that condundrum. Thus far, the courts have resisted the idea that any and all obesity is a disability. They look for physiological causes for the obesity, including thyroid disorders and genetics. If there is no specific medical cause for the weight problem, obese people are generally not considered to be disabled.

It all comes down - as it usually does - to the ability to perform the essential functions of the job. Harrison did not seek any accommodation based upon a disability. She simply did her job and apparently did it well. It will be interesting to see whether the RHD defense raises the issue of risk: whether Harrison's morbid obesity placed her or her young charges at immediate risk of harm - not hypothetical, but imminent - a difficult standard to prove.

Related posts:
If you search the Insider for "obesity" you will find three pages of postings. Here are a couple of highlights:
The story of Adam Childers, the obese pizza maker whose stomach stapling operation was covered by workers comp.
The federal case involving Stephen Grindle, whose job loss due to obesity was not covered by the ADA.

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September 22, 2010

 

In the past, we've featured assorted news items about how employers and insurers are turning to social networks to monitor employees for potential fraud. In fact, just last week, we learned about how the New York State Insurance Department's Fraud Bureau recently cracked a case as a result of a Facebook posting. But social media and how it intersects with workers compensation is all still pretty uncharted territory.

Given this, we were delighted to learn of a recent paper specifically dealing with this area of law: Social Networking and Workers' Compensation Law at the Crossroads, authored by Gregory M. Duhl of William Mitchell College of Law and Jaclyn S. Millner of Fitch, Johnson, Larson & Held, P.A. It's a substantial document - 75 pages, to be precise, that looks at the use of social networking evidence in workers' compensation litigation. It's scheduled to be published in the Pace Law Review, but you can download a free copy of the report at the above link. We'd encourage you to run, not walk, to get your copy - it's interesting, well written, and thoroughly annotated, and you don't need to be an attorney to find it valuable.

We think that the remarks which the authors make at the conclusion of their paper do an excellent job of explaining the importance of both the issues at hand and the value of this work in particular, so we are taking the liberty of reproducing them:

"The lawyers, judges, insurance companies, and parties within workers' compensation systems will increasingly confront the discovery, privacy, professional responsibility, and evidentiary issues that arise at the crossroads of workers' compensation law and social networking. In the absence of case law and ethics opinions that discuss these exact issues, this article starts with the rules that govern workers' compensation cases, and discusses how they might apply to lawyers gathering, producing, and introducing evidence from social networking sites. But this article is only a starting point. As workers' compensation systems are built on efficiency, flexibility, and discretion, workers' compensation is an ideal area of law for lawyers and judges to experiment with how to address some of the unique challenges and opportunities that social networking poses in litigation.

While there is a lack of legal authority on these issues, that should not cloud the reality that many employees are using social networking in their daily lives. One thing of which we are certain is that lawyers who practice in the workers' compensation field need to be able to navigate around social networking sites such as Facebook, LinkedIn, and MySpace, and know how they work. Social networking is no longer a new technology, and ignorance should not be an excuse to the applicability of evidence from social networking sites in litigation."

In the spirit of those remarks, we'd like to leave you with this video clip which gives a good overview of how social media is changing the landscape. Startling as it is, it's already almost a year out of date.

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September 20, 2010

 

Last year the Insider blogged the unfortunate fate of Arthur Pierce, who died in a work-related accident, but whose claim was denied due to a glitch in the Virginia comp statute. Fearing a rash of bogus claims by workers faking severe brain injuries, the lawmakers allow insurers to deny any unwitnessed incident where the injured worker cannot testify to what happened. If Pierce had died instantly, his claim would have been accepted. By surviving for months without being able to talk, he never collected a dime.

Dan Casey, a columnist for the Roanoke Times, brings us the saga of Mike Gentry, who fell off a roof while installing a satellite dish. He survived, but suffered brain damage and severe physical trauma. While paying the claim at first (Gentry was in a coma and rehab for weeks), the insurer finally got to talk to him. Here is Mike and his wife Andrea's summary of the exchange with the claims adjuster:

"She asked me,'Ever jumped off a roof before? Ever thought of killing yourself?'"

"I said, 'No, and no.'"

And then she said, "Do you remember what happened?"

"And he said no," Andrea interjected. "Because he didn't. And she said, 'OK, that's all I need.'"

Thus, in accordance with the peculiar and patently unfair Virginia law, the claim was denied. Ironically, just 12 days before Gentry fell off the roof, an attempt to change the Virginia statute, instigated by Arthur Pierce's widow, was defeated in committee. The revision would have allowed brain injured workers the same presumption of compensability as workers killed on the job. In the words of insurance lobbyist and attorney Charles Midkiff, any changes in the current law would be "an invitation to fraud."

It was only through the kindness of strangers that Gentry and his family were able to survive the months without any insurance benefits. Then a minor miracle occurred: Gentry's memory of the incident came back. Not all at once, but gradually. First, he remembered that the battery on his power drill died. A few more memories filtered in. Finally, about a month after the initial recall, he remembered everything. He was climbing down to get a replacement battery from his truck, when the ladder slid and he fell.

(Over)Due Process
Armed with this new information, Gentry filed for benefits. The carrier, defended by - who woulda guessed? - attorney Midkiff, managed to delay the hearing for months (from December 2009 until April 2010). Finally, three hours before the rescheduled hearing, the carrier caved and accepted the claim.

Mike Gentry will never work again. He has double vision, his speech is slurred and he is frequently exhausted. He has severe seizures and difficulty thinking. He takes 10 medications daily. But he and his family are finally protected by the workers comp safety net - no thanks to a carrier following the letter of the law, and no thanks to the legislators who think workers are going to fake brain injuries in order to qualify for benefits.

In the words of the immortal Frank Zappa: "The United States is a nation of laws: badly written and randomly enforced." Not true of most laws, but certainly applicable to this bizarre and completely unnecessary provision of Virginia's comp statute.

NOTE: The Insider is quoted in course of Casey's fine article.

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August 11, 2008

 

Is a suicide compensable? In certain circumstances it is, according to a recent ruling by the Nevada Supreme Court in Sharon Vredenburg v. Sedgwick CMA and Flamingo Hilton-Laughlin. While Nevada state law prohibits benefits if a worker's death occurs due to a "willful intention to injure himself," this does not apply if a "sufficient chain of causation is established." Roberto Ceniceros of Business Insurance noted that, "To establish such a chain, claimants must demonstrate that the employee suffered an industrial injury that in turn caused a psychological injury severe enough to override rational judgment. Claimants must then establish that the psychological injury caused the employee to commit suicide, the court said.

Dan Vredenburg was a bartender for the Flamingo Hilton in Laughlin. He suffered back injuries in a fall down stairs while working and was compensated for his injuries. According to the ReviewJournal.com, he suffered relentless pain. He couldn't keep food down and spent his life in bed. Nealy three years after this accident, he killed himself. Under the state's "willful intention" clause, his widow was denied benefits several times until the matter reached the Supreme Court and the precedent-setting determination was made.

Other workers comp-suicide rulings: MA, WY, ND
There have been other cases involving suicide where workers comp has been awarded to surviving spouses. This past November, we covered a suicide that was deemed compensable in Massachusetts. In that case, Gilbert Dube injured his back at work. When he tried to return to work on light duty, he was terminated. He then grew depressed and commit suicide a few weeks later. The insurer made the case that his termination was an independent, intervening event that broke the chain of causation. At the hearing, the claimant's attorney introduced medical evidence that the employee's back injury caused him to become clinically depressed, and that the termination exacerbated his depression to a degree that he was acting irrationally when he commit suicide. The justices concluded that the injury and termination were inextricably connected.

In the 1992 case of State ex rel. Wyoming Workers' Compensation Div. v. Ramsey, an Appeals Court upheld benefits for a decedent's widow using the chain of causation test as the predominating principle in its decision.

Steven R. Ramsey was receiving workers compensation benefits after suffering a severe 1988 industrial accident that left him unable to resume work. In 1990, about 5 weeks after his pain medication was mostly discontinued, his pain increased, he became depressed, and he killed himself. In determining to continue benefits, the Court agreed with his widow:

"The circumstances of this case are clear. Steve Ramsey would not have committed suicide if not for his work place injuries. There were no pre-existing conditions that caused him to be susceptible or prone to suicide, there were not intervening conditions or situations that occurred between the time of his work place injury and his death, and Steve Ramsey continued to do all those things necessary to try and get well. But for the injury at the Wydak Power Plant, Steve Ramsey would not have committed suicide."
In the same year, a North Dakota Appeals Court denied benefits to the widow of Richard L. Kackman in the wake of his suicide, finding no cause and effect relationship between Richard's work injuries and his suicide. In this case, two doctors presented conflicting testimony. One doctor concluded that Richard's work injuries caused chronic illness, which caused depression, which in turn caused him to take his life. The other physician stated that Richard had a prior history of interpersonal problems, delusions, and a paranoid disorder before any work injuries occurred, and those preexisting conditions were what caused Richard to commit suicide. The Court agreed and denied benefits.

These cases show the importance of addressing pain and depression in recovery plans, particularly those involving life-altering injuries. Suicides in workers comp will likely continue to be outliers, but state courts have shown sympathy to the idea that pain and depression can pierce a "willful intention" defense by the insurer. The courts seem consistent from state-to-state in requiring a chain of causation. But despite the precedent-setting nature, we note Jane Ann Morrison's observation in the Nevada ruling: "None of the lawyers I spoke to thought there would be a rash of suicides by injured workers as a result of this ruling."

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March 23, 2006

 

Few think of health care as one of the nation's most hazardous professions, but there you have it: nurses, nursing home attendants, and other health care workers are among the nation's most frequently injured work population, suffering from a high incidence of musculoskeletal injuries. Patient care calls for frequent lifting and moving, and this wreaks havoc with the back and shoulders. It's estimated that as many as 12 to 18% of all nurses stop practicing due to chronic back pain. The nursing shortage means that many health care workers have to do more with less, increasing the likelihood of injury; ironically, these injuries may be a primary culprit in exacerbating the nursing shortage.

Not to mention the hazards to the patient. When you are at your most vulnerable, do you really want a single nurse to be heaving you about? Bill Cosby used to have a stand-up routine about how you never wanted to hear a doctor say "oops." Similarly, When you are taking your first steps after major surgery, you don't really want the nurse who is helping you to say "ouch" - a helper who is writhing in pain may not be in your best interests.

Legislators in Washington - prompted by the Washington State Nurses Association, United Food and Commercial Workers Local 141 and Service Employees International Union 1199NW - just passed a Safe Patient Handling law that requires hospitals to provide mechanical lift equipment for the safe lifting and movement of patients. According to Occupational Hazards:

"On a timeline between Feb. 1, 2007, and Jan. 30, 2010, Washington hospitals must take measures including implementation of a safe patient handling policy and acquisition of their choice of either one readily available lift per acute-care unit on the same floor, one lift for every 10 acute-care inpatient beds or lift equipment for use by specially trained lift teams."

In August, we reported on Texas legislation that required nursing homes and hospitals to implement safe patient handling and movement programs. Most importantly, both laws have provisions that protect health care workers from reprisals should they refuse to perform patient handling that they deem potentially harmful to themselves or their patients.

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January 25, 2004

 

If you have multi-state exposure, keeping up on the various laws can be a challenge. Here are two handy tools:

The Department of Labor's State Workers' Compensation Laws & List of Benefit Tables offers 20 separate tables available in either html (web) or pdf (adobe) formats.

The workers compensation insurance law tool at insure.com offers four search tools: a search for a summary of individual state laws; a sort of states by whether the employer or the employee has choice of physician; a sort of states by availability of a state fund; and a sort of states that allow self insurance for employers or employer groups.

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