Division IME Forms Including a new one WC78

You can access numerous forms pertaining to DIME's or Division IME's at this webpage maintained by the Division. It includes a new form which pertains to requesting a DIME to assess maximum medical improvement (MMI) after 18 months. Usually your treating physician determines MMI as soon as possible but there are times when he has not addressed it despite the passage of much time and treatment. The insurer may then seek to arrange a DIME to determine MMI. This new form WC78 is part of that process. Be aware that this 18 month DIME is addressing MMI. If impairment is also addressed it does not mean that is anything more then informational. In a recent Industrial Claims Appeal case I call Baca the insurer went with an 18 month DIME and then went with that DIME's impairment rating which was zero. They filed a Final Admission trying to close the case. The local judge ruled against them and struck the Final Admission. directing that the claimant return to the treating physician for the rating. The higher panel in effect stopped the appeal because that ruling did not deal with money or benefits but the case makes us all aware that an 18 month DIME may not address impairment in a way that can be acted upon by the insurer. Of course the Baca case may not be over but the form WC78 issued shortly thereafter indicates any rating by a 18 month DIME is informational only.

Social Security Disability Close to Insolvent?

The AP news is reporting that Social Security disability is getting close to insolvent. The news article points out that with the aging of boomers and the economy more people are applying for disability benefits. So right when we are all concerned about debt and revenues we have another sign of the times. Despite the fact that for years the entire Social Security system was dipped into by the federal government instead of set aside we have another potential problem. I am not sure how many may think that those getting SSDI and SSI are not entitled but the vast majority of those drawing benefits have run a gauntlet to obtain benefits which are a fraction of what you can earn in the world of employment. I remember one time realizing how tough it must be for one client who was earning over $60000 a year to seek annual benefits that were perhaps 20% of what he had earned. Yet he had to go to a hearing (the wait took over a year) to prove he no longer was employable. When you are not working and in poor health the process can seem agonizingly slow. Sure some of those receiving benefits may not deserve them but almost all do deserve them and the program has worked for many years. There is a need for increased revenues into the system yet politics is getting in the way. I can say that some feel lifting the cap or lid for contributing into the system would make it solvent but that may not be passed. Currently all wage earners pay into it up to $106800. If you make more you do not pay more. So the athletes, the corporate executives and others making really good pay have a benefit none of the rest of us have. They do not pay a dime over $106800.
UPDATE AND A NEW VIEW ON THIS: Over at another website they are reporting that this story about insolvency is not totally accurate. The article points out SSD programs and the fund are not close to insolvent but that it is more of an accounting situation. In the past the disability fund and the retirement fund have separate accounts but have transferred funds between them from time to time. A simple accounting transfer and both are solvent until at least the year 2035. This should remind us to be careful about assuming all the stories swirling about Social Security are accurate. One source for further details to strengthen Social Security is here.

Workers Comp Costs Decline

As noted in this press release/article workers compensation costs have been declining. While medical costs are always high the fact is there is more unemployment and more hiring of overseas labor, especially in manufacturing. Construction is down. Hiring is down. With less workers there can be less claims and those working may hesitate to file a claim in such a tough economy. I also think that many claims are still contested and in medical matters the advantage is with the insurer/employer. You usually do not chose your doctor, they do. In many cases it can be difficult to prove you sustained a work injury when the other side fights it and brings in their doctors. The claimant, again in this tough economy, may not have the funds to make it a fair fight. I read case after case where I suspect claimants lose when the hired guns (experts hired by the other side) provide opinions which overwhelm what I consider common sense. Yet that is the way it is when a matter is medical in nature (such as did the claimant's problems come from work or elsewhere) and experts are required to analyze the claim. The smart claimant may fight back and spend the bucks but it remains a risk every time there is a hearing. The word spreads and some hurt at work decide it is not worth the hassle. Originally the workers compensation system was set up to provide prompt action and benefits. That has eroded away in recent years. Cases take months and often years to be settled or resolved. I have heard of people deciding to use their health insurance just to avoid the workers comp system. That is not only a shame and not only shameful it is also wrong. What does it mean? Employer costs for workers comp insurance are down to levels not seen in 30 years as noted in the article.

Pinnacol Withdraws Handling Cases for State

This article from the Pueblo Chieftain states that Pinnacol Assurance is withdrawing from being the adjustor or representative for the state of Colorado's workers comp cases. If you worked for the state and had a work injury Pinnacol would have handled the claim for the state. It charged for doing that and decided it no longer wanted to handle the claims. The state acted and replaced Pinnacol with another company, Broadspire. Some may be upset with Pinnacol since it was very closely associated with the state from its inception. The reason given...that state claims are hard to handle may or may not be so but Pinnacol may be setting up to break away from the state entirely too. I do know that in the past it was more difficult to settle when we had to go through an attorney who then went to Pinnacol who then had to go through the state agency/employer.

Colorado Governor Reviewing Privatization of Pinnacol

As noted today in this Denver Post article it appears there still is interest in privatizing Pinnacol. Pinnacol Assurance is the state's largest workers comp insurer and originally was set up by the state to assist businesses especially high risk businesses in obtaining workers comp insurance. Despite many insurers saying otherwise usually premiums generate decent revenues. The so called cash reserves are amounts set aside to deal with claims or matters that require reserves but they do seem like profits when they get pretty high. Colorado legislators, in the past, thought about taking some of that to help with the budget problems but it never happened. New board members were appointed and there remains interest in exploring privitizing Pinnacol. The last time Pinnacol was willing to pay to obtain more private operations. One Republican legislator has said any cash to do so should go to the business owners who paid Pinnacol and are considered policyholders but of course Pinnacol also has a public side so once again we will see what happens.

New Policy on Prehearings

In an email sent to many representatives the word is out on some changes in setting up prehearings in Colorado workers compensation cases. Prehearings are useful in clearing up some disputes. For example if the other side has not provided discovery you might ask for a prehearing to compel the disclosures. Imagine going into a real hearing without disclosures of what the witnesses may say and what evidence will be submitted. A prehearing judge hears what is argued and decides on these preliminary but important matters. An order is issued which you disregard at your peril. A prehearing is not a full scale hearing with evidence and testimony but usually concerns legal arguments where the judge assists in moving the matter forward by issuing an order. In any event we are now told the email for this is dowc-phc@state.co.us. We are also told not to submit more then 10 pages by fax so seemingly they prefer that you email the materials. Should you do so at the last minute call them at 303-866-5508 (the number to set a prehearing)so they can retrieve the email in time for the prehearing. They also want you, when setting a prehearing, to confirm the date and time with the other side and provide email addresses to the prehearing unit. They also request being notified as soon as possible when a party is cancelling a settlement conference. Most of this is just common sense and contact information. No one likes it when someone is a no show or the proceeding is slowed. The prehearing judge does not have unlimited time to wait on faxed materials or emails so the point of this is to speed the process along. I can say that often in the past settlement conferences were cancelled at the last minute by the respondents. Usually it was because the respondent attorney did not have the dollar authority to settle.

Australian Woman Claims sex accident is work related

This recent news article caught my eye so it makes for a good read. I am posting it here without any further comment other than to say that most of us in the field have had unusual situations that require research to assess if an injury could be considered compensable. Never let it be said that the law is boring! Those traveling for a company or stationed at some distance from their home are not simply limited to asserting a claim for injuries sustained during working hours. The average employee goes home and has his own time in his own home but when you are stationed elsewhere other factors may apply. Here this young lady in Australia was having sex in her hotel room when the activity caused an accident resulting in injury. Workers comp? In Colorado and elsewhere you should review the law for that jurisdiction.