Monday, January 26, 2015

All About Claims newsletter of December 2014

In December the division posted another newsletter. Realistically it is not all about claims. That is just the name they gave the newsletter. They publish the newsletter every so often and its purpose is to provide information to claims practitioners. Actually it has some good reading in it for many of
those involved with a claim. The December 2014 newsletter has an excellent story about prehearing judge Tom McBride. What I like about it is that it humanizes the judge. We can get all wrapped up about a claim and the issues that we forget that those that decide any issues or assist us with settlement are quite human even if very experienced. The newsletter also touches on other subjects such as the new streamlined electronic settlement approval process and the new reporting requirements of OSHA. you can read about it and other resources in this latest newsletter. While the topics may not be relevant to any ongoing cases they do explore areas of interest to many in the field. Certainly anyone practicing should take a look at these newsletters as they come out but it also gives all of us another form of communication from the division to those involved with workers compensation in Colorado.

Wednesday, December 31, 2014

So Long 2014 and Happy New Year 2015!

Well in Colorado we are approaching the new year. The year 2014 was "okay" for workers compensation in the sense that nothing horrific happened to reduce rights or benefits for claimants. The Division did post a new website appearance and there were some changes which can be seen in the prior postings on this blog and on the Division website. I am sure that 2015 will produce new cases and changes in rules or guidelines. From my perspective 2014 was fairly tame in Colorado workers compensation. Of course those claimants that had adverse decisions were not happy but nothing dramatic happened to greatly alter the state of affairs in this field. I still have concerns in some areas which I have commented on in the past but at least the field has been reasonably stable. Hopefully in 2015 every claimant will have experienced representation and fair treatment by the system. I WISH ALL CLAIMANTS THE VERY BEST IN THE NEW YEAR!

Wednesday, October 22, 2014

Court of Appeals case decided October 9, 2014

Just recently decided the Hoff case concerned workers compensation insurance coverage and the assertion by a party of promissory estoppel. In this case the claimant sustained serious work
related injuries. Hoff owned a rental property which had hail damage. She hired a contractor to deal with the insurance and then to repair roof damage. That contractor subcontracted the work to another contractor. The original contractor sought to make sure the roofing contractor had workers comp coverage. This was provided but when the injury happened the workers comp insurer denied coverage due to nonpayment of premium (cancellation of coverage). Hoff asserted they had no notice of the cancellation and relied on the promise of coverage that was initially provided. The hearing judge and ICAP decided that Hoff had no standing to question the cancellation and this appeal followed. The court concluded there was a basis to assert promissory estoppel and Hoff had standing. While this case is a dispute between various contractors it is always good that a claimant brings in enough parties that may have insurance coverage. Lack of coverage can harm the claimants ability to be compensated and have his medical bills paid. In any event read the case for the details.

Tuesday, September 30, 2014

The Coats case Oral Arguments

On September 30th, 2014 the Colorado Supreme Court held oral arguments on the Coats case. This case involved the termination of an employee after a random drug test for having the presence of marijuana in their body. It was consumed off work and yet the employer had a no tolerance policy. The lower court dismissed the wrongful termination case even though the employee argued he was disabled and it was medically prescribed marijuana. I reported on this in an earlier post. Todays oral arguments were quite interesting even if the discussion seemed to center on technical points. The Denver Post has an article on it which it posted today. You can read the article which also has a link to the oral arguments. By clicking there you can at least for a while see a video of the arguments. A big part of the case is that while Colorado has a law permitting medical use of marijuana the federal law makes it illegal. Mr Coats was asserting he was doing something lawfully permitted off work premises so the termination was wrong by Colorado law. The employer also argued so the outcome is uncertain. In any event a decision can be expected which I will await. In the meantime the case has been interesting to follow. While not a workers comp case this case has an effect in workers compensation cases. Perhaps an injured worker will be prescribed marijuana or perhaps such a worker will be terminated after his work injury if he is tested for marijuana in his system. Employers may seek to terminate and stop temporary benefits in such a case. I guess we shall see what recourse the employee may have. Given also that recreational use of marijuana is permitted now in Colorado what about these no tolerance policies? The court may address this or may simply choose to avoid the issue on some technicality. Time will tell.

Saturday, September 06, 2014

The Latest ICAP cases

Every month there is an update on the latest ICAP (Industrial Claim Appeals Panel) cases. These are not court appeal cases but rather are the next step to appeal after a hearing decision a party does not agree with. There are many such appeals monthly and from them
a selection is made to review. At least this provides us with some of the more interesting cases. Fortunately, these cases are posted at the Division website for anyone to read. The latest such review is shown here. There are 12 cases shown along with one court case of interest to the reviewer. These cases remind us of what is going on at recent hearings. Some of these cases may even be appealed further. Many may not be appealed. Many of us in this area enjoy getting these cases and the review which comes with them. For a list of several months of these cases you can click here. If you work in this field or even if you just wish to know what is happening in this area it is useful to have this resource. Attorneys even obtain continuing legal education credit for following this monthly program.

Tuesday, July 29, 2014

Marijuana and employment...the Coats case

Back in April 2013 the Colorado Court of Appeals issued the Coats case. It is not a workers compensation case but instead is a wrongful termination case. Still it will impact workers compensation. It is now on further appeal to the Colorado Supreme Court with oral arguments set for later this year with a decision to follow most likely in 2015. What makes it interesting and controversial is that it concerns marijuana. A worker was
terminated under the no tolerance policy of his employer when he tested positive for marijuana despite it being medicinal marijuana. The employee was a quadriplegic and did not use marijuana on his employers premises and his work was not affected. He sued and asserted the termination was wrongful. The court of appeals decided a dismissal of his case was proper despite medicinal marijuana use being lawful and permitted in Colorado based on its view it was unlawful by federal law. Imagine workers with various ailments taking medicinal marijuana after work hours being terminated based on a no tolerance policy. Imagine an injured worker being prescribed medicinal marijuana by his physician as part of his treatment. Can his employer validly terminate him? What will the Supreme Court say on this? That is to be determined. Meanwhile LexisNexis published an article on this case so you can read it here. Given the legalization of marijuana so its use is permitted, even recreational use, will employers be allowed to terminate you even where you use it after hours with no impact on your employee performance? All I can say is stay tuned for the answer come 2015. By the way LexisNexis asked for my comments on the case so they are included in the article.

Wednesday, June 18, 2014

Newsletter Issue 38

The Division of Workers Compensation issued a new newsletter, Issue 38. This issue is quite unique. It really provides a
review of the recent legislation. New laws that apply to cases are summarized in the issue and it has the actual statutory amendments as well. For example nowadays the injured worker needs to be provided with a list of four doctors from which he can choose to treat him for the injury. The law in this area has evolved over the years. The employer usually can select the doctor to send injured workers to for evaluation or treatment. Employees have been seeking more input in this process. Historically the employer selected doctor might be less on the side of the claimant and most of us expect the doctor to be for you not in the pocket of the employer or insurer. Even if not so the claimant could feel a let down. My experience has been that employer selected doctors tend to be quicker to release the claimant from treatment and to rate impairment lower then desired. So the latest law requires the employer to provide you with 4 names not just one doctors name. Personally I prefer that the employee choose his own doctor but at least this new law provides some choice. In any event this issue details out the recent law changes. Let me once again suggest that anyone with a work injury seek out an attorney to represent them if possible. This field is quite complex and doing it yourself is not advisable. Common sense is not enough.

Monday, May 12, 2014

Court of Appeals case on Firefighter coverage

On May 8th, 2014 the Colorado Court of Appeals issued a decision involving a firefighter
case. The claimant developed leukemia with an onset in November 2009. There is a statutory presumption that certain cancers arising within 5 years of firefighting service are covered or compensable. The city (Denver) defended by asserting it was not within 5 years of service by alleging they hired him in February 2005. The court affirmed the decision in favor of the firefighter by indicating that there was sufficient time as a firefighter. He had over 5 years of service (adding time as a volunteer and probationary fireman). However the city asserted it should only count the actual time firefighting. The court reasoned that few people would qualify for the coverage under that view. A firefighters entire time of service should be counted. Additionally Denver tried to assert it had a right to define "firefighter" as it sees fit. The court reasoned that firefighter coverage under the statute is a matter of statewide concern and not subject to any local city definition. Please refer to the actual case itself which you can read here.

Monday, April 07, 2014

Colorado Bar Association List of Attorneys

The latest list of attorneys who handle workers comp matters has been put out by the Bar Association. By no means is this an exclusive list. There are attorneys not on the list who have experience handling workers compensation cases. But the list does contain helpful names of experienced attorneys in various communities. This field is highly complex and where possible an injured worker should obtain legal representation. Waiting on this could be damaging to your case. It is the preference with most experienced attorneys to become involved early on in the case. But if that did not happen then consider acting now to find an attorney. The sooner the better. There are no guarantees in any case. What can seem to be clear and simple may deteriorate in a heartbeat. A claim can be contested or in conflict at any time. Moreover it can take planning and effort to maximize the claim. You can bet the adjustor has access to an attorney at all times. After years practicing in this field even though I am now retired I truly believe a claimant should try to obtain an experienced attorney as soon as possible. Not doing so likely means the loss of thousands or even the loss of the claim. Even a nice adjustor has a duty to his or her employer, the insurance company. They want to minimize benefits. In any event this list is one resource for those seeking an attorney.

Saturday, March 15, 2014

Apex Court of Appeals case on worsening

The Apex case was just published on March 13, 2014. It actually was originally decided in January but the court decided to publish it now. When published the case applies to all not just the parties. It can be cited as precedent in legal research. The case involves worsening. The claimant sustained a shoulder injury. Initially he was given no work restrictions but he was also terminated from his job. Apparently for pain he had taken a pain pill from his brother. Unfortunately his employer had a no tolerance policy and when discovered it resulted in his termination. Several days later he returned to the authorized physician who noted his pain and took him off work. Thereafter the claimant sought temporary benefits and asserted his condition had worsened enough to be entitled to temporary benefits. With his termination for cause he had to show a worsening to receive such benefits. So the case involved the issue of worsening. Now most of us would believe that going from a work status to a no work status is a worsening. However the court concluded that this fact alone does not establish a worsening. The court indicated the physician had not documented a worsening. Of course being now unable to work seems to be a worsening. Functionally going from work to no work is significant to me but that is just my view. Whether this case will be appealed further I do not know but as of now the rule is that increased work restrictions alone are not sufficient to establish a worsening. Read the case for the perspective of the court.

Saturday, February 15, 2014

Video Presentations of Recent Cases

I really like that the Division has a page devoted to video presentations which discuss recent cases. This has been done monthly for quite a while. Many attorneys enjoy the monthly live presentation but these cases are then posted on a web page so anyone can read and listen to a review about the cases. Not every case is reviewed just those deemed significant but I have found this process to be very educational. In any event to gain some insight about what issues are being heard anyone can access this page and listen to the monthly presentation. Often these cases contain cutting edge issues in the workers comp field in Colorado. After all a case may be quite complex and listening to a review or analysis gives you a good sense or perspective about the case.

Tuesday, February 04, 2014

Unexplained Falls at work...the Rodriguez Supreme Court case

This week the Colorado Supreme Court in Rodriguez affirmed the lower court decision that the claimant had a compensable work injury. I reported the earlier decision by the lower court on August 20, 2012. In this case the claimant had an unexplained fall at work. But then the insurer admitted coverage and only later sought to amend or change that to a denial. The lower court held that the burden to prove it was not caused by work activities was on the insurer and when all they could show was that it was unexplained then they failed to carry their burden. The insurer appealed and this week the Supreme Court issued its decision. What impresses me most about the case is that the court actually had different reasoning then the lower court. It essentially concluded that an unexplained fall at work is compensable in all circumstances. It decided an unexplained fall is not caused by an employment related risk (like a slippery fall or dangerous condition) and it is not a personal or idiopathic risk (caused by personal health issues). It then carved out a new risk, a neutral risk. Quoting from the decision: "Because Rodriguez’s fall would not have occurred but for the fact that the conditions and obligations of her employment -- namely, walking to her office during her work day -- placed her on the stairs where she fell, her injury “arose out of” employment and is compensable." For claimants this is a great decision. We were always worried that falls without any explanation might be tough to attribute to work activities. Now falls shall be compensable unless they are because of personal health factors under this "but for" test. At least that's my view of the case. There was a dissent who said the majority by its decision significantly expands the scope of workers compensation coverage in Colorado. To me I like the decision. The insurance side will always try to attribute injuries to unrelated things if it can. Claimants might then have to try obtain evidence to support them. But insurers have the resources to obtain medical experts and a claimant may not consider that a fair fight. In any event this case is very interesting to read as it discusses several types of injuries. It is an exciting case in the field.

Wednesday, January 08, 2014

All About Claims Newsletter, Issue 37

The Colorado Division of Workers Compensation has issued a new newsletter, issue number 37. A newsletter is an informal way of providing insight as to what is happening at the Division. This latest newsletter contains an interview with Chief Administrative Law Judge Goldstein. It provides his history and experiences. In addition the newsletter gives us other news such as the addresses for prehearings and the Office of Administrative Courts. It also discusses some changes in the Division IME (DIME) law. I enjoy the newsletters and expect that many others do too. Reading about the people involved with workers compensation and getting insight on changes as they come along are both informative and enjoyable. I would love to see these newsletters issued with regularity.

Tuesday, January 07, 2014

Labor pushing for WC Reforms

It is being reported there is interest by labor in some workers comp reforms. Articles on this appear here and there. Over the years my experience with reforms has been to see a reduction in benefits disguised as reform. This has led to lower workers compensation premiums for employers. I've always wondered why employers can select the treating doctors.
My experience is that these selected doctors are not always loyal to their patient the claimant. I've seen cozy relationships with many of them with the insurance. I've seen lack of interest in the welfare of the claimant. Of course there have been other doctors who have been on the claimants side too. But by and large I've wondered why the claimant cannot pick his own doctor. In any event this is one area of interest by labor which may mean an effort to give the claimant more choice. In another area it's been my experience that most injured workers with a serious injury do not stay with their employer. Perhaps they do with a minor injury but anything significant almost always led to some form of job termination. I can understand where this can happen aside from the obvious cases where the employer wants to get rid of the injured worker. Often the claimant is left with restrictions and disability which cannot be accommodated. Others are truly totally disabled. But in some cases the employee wants to work but can no longer do his existing job. Receiving a modest benefit is not enough. Again in this area there is labor interest in reform. Lastly there is interest in changing the penalty portion of the law which permits a 50 per cent reduction in benefits for safety rule violations. I've often wondered how they can say workers comp is no fault and then introduce fault into it as a way to reduce worker benefits. While I am on the side of the injured worker I can see the other side has some points too. Businesses want healthy workers and smart ones too. Injuries or rule violations are an expense they want to minimize. Hopefully there is room to compromise here. For the present the news is that there appears to be an effort in 2014, by labor, to help the injured worker by reforming parts of existing law.

Tuesday, December 17, 2013

Two new Prehearing Judges Coming in 2014

We have learned of two new prehearing judges that will be coming on board in early 2014. Barbara Henk will be active as of February 1, 2014 and Patricia Clisham as of March 1, 2014. They are both highly experienced and well respected in the workers compensation community. They have both
been judges at hearings and active at the OAC. Prehearing judges are quite important in the workers compensation system. They handle prehearings on various preliminary matters. They address motions when brought to them. They are also involved in settlement conferences. I recall many a conference where the claimant took the position he was totally and permanently disabled and the other side was certain he was employable. The attorneys can do a lot of talking but the input of the judge was often critical in moving the parties to a reasonable compromise. The judge might educate the claimant to the risks of a hearing and appeals but also educate the other side on the merits of the permanent total claim which could mean a very high monetary risk to the other side. Settlements are often smart resolutions of cases. Hearings may be necessary at times but most cases can be settled with solid effort by the parties and the aid of the prehearing judge at a settlement conference. The new judges should be helpful in this area. They bring a wealth of talent and wisdom from their experiences. So I can only say that they are good additions to the process.