Colorado Workers Comp Blog

Pinnacol Privatization Again in the News

2012-01-18T22:11:00.003-07:00

The Denver Post is reporting that business groups and others are upset with Pinnacol's ads touting the benefits of privatizing Pinnacol Assurance. It is asserted the ads violated an agreement not to lobby on the issue while the matter is under review by a task force. What the article points out is that Pinnacol is the state's insurer of last resort for high risk businesses. That is why Pinnacol was originally set up by the state of Colorado and then has grown to be the largest insurer in Colorado of workers compensation claims. This effort to privatize is not surprising. Pinnacol is large, apparently thriving, with ample funds available that in the past the state was interested in obtaining. My experience tells me that when a nonprofit becomes quite successful the entity wants to move out on its own. I saw that with Blue Cross Blue Shield when it became Anthem. There can be interest in expansion beyond the state borders and Pinnacol executives can operate unfettered by state oversight. In theory the state gets an investment apparently worth $340 million and a dividend every year. Of course Pinnacol's offers seem to vary which is, I suspect, just part of the negotiating. The real question I have is whether privatization might impair the very purpose for the state's interest which was to insure high risk ventures. The construction trades have many injuries and are costly to insure. Without state involvement might this endanger state businesses? Private insurers certainly have more freedom to operate than an entity with state oversight. Of course my other concern is valuation but that is negotiable.

Maximum Benefit Rates

2012-01-07T20:47:00.004-07:00

The calculations for top dollar benefits can vary in Colorado depending on your date of injury and the allowable maximum rate on your date of work injury. Let's say you lose an arm or leg but are not totally disabled. What is the highest permanent benefit you can receive? For injuries after July 1, 2011 the max is $54,202.72 but if you were hurt before July 1, 2010 it might be only $53,067.04 or even less. Be aware this is strictly for the loss of an arm or leg without more. Always review with an attorney all the injuries you sustained at work but also your past medical history. At times a rather minor injury may nonetheless be significant enough to make you totally disabled. The rating or per cent of your medical impairment is not always the end of the story. Impairment is not the same as disability in many cases. In this area, more then anywhere, a workers comp attorney can be invaluable in analyzing the situation. Getting back to discussing the maximum rates, effective for injuries after July 1, 2011 the highest scar benefit can be as much as $8,792.00. Next, the most you can collect when you combine temporary and permanent benefits is $153,210.00 although this cap does not apply to those totally disabled. Be aware that these amounts are not the minimum you can collect so benefits can be less or even zero if your claim is not compensable(many claims are disputed). There are many factors that go into assessing impairment and disability but the caps do remain a top dollar limit on benefits in most cases. Those totally disabled or with a need for long term medical care may still have higher benefits. By way of example a few years ago I had a case where the claimant had a high rating but had collected all but a few thousand more before reaching the cap for combined temporary and permanent benefits. The case settled for much much more because of a concern he was totally disabled. However for those able to return to work the caps must be a consideration. Credit goes to Judge Eley for calculating the above figures for us.

Merry Christmas 2011!

2011-12-23T10:36:00.002-07:00

Walmart and Concentra to Pay $8,000,000 Settlement

2011-12-22T09:44:00.006-07:00

In the Gianzero federal case Wal-Mart and Concentra were sued in a class action lawsuit alleging various violations including of the Colorado Workers Compensation Act, bad faith, RICO, and much more. The basics of the case was the assertion that Wal-Mart and its insurer conspired to dictate, withhold, delay, deny or interfere with the medical care of injured workers. The case made a big impression and received commentary elsewhere. The allegations involved setting forth protocols for treatment and referrals which violated the Workers Comp Act and which restricted or denied or dictated care. As alleged, Concentra then implemented "flowsheets" which were then imposed on its doctors which preempted the exercise of independent medical judgment. In my view the adjuster could control treatment which I see as the inherent conflict in most health insurance situations. He who has the money can be expected to try to set the rules! Naturally all of this was hotly contested but in the proposed settlement Wal-Mart, Concentra and their insurers have recently agreed to pay $8,000,000 to settle the case without formally admitting they were out of line. Class members would receive up to $520 each if they were treated at a Concentra facility between 2001 and November 1, 2011. The detailed proposal sets forth the proposed settlement and more is available at this website including the original complaint and the notice of the proposed settlement to potential class members. If you were injured working at Wal-Mart you may be eligible for a check should it all be approved. Added expenses are also sought by the attorneys for fees and costs. Moreover as part of the settlement they are to cease the disputed activity for 4 years and have educational training for adjusters and certain staff of Concentra regarding the prohibition on dictation of care provisions of the Workers Compensation Act. In my view this is a significant victory for doctors and claimants who deserve to have medical treatment handled as a medical matter and not unduly influenced by non-medical personnel who work for the employer or its insurer.

Social Security seeks to review the disability process

2011-12-15T19:45:00.008-07:00

Over at the Wall Street Journal they are reporting that the Social Security Administration is obtaining an "independent" review of the disability hearing process. The article appears to emphasize that too many judges are approving cases at the hearing stage. It asserts that some judges approve 99% of claimants that have sought a hearing after a denial. Of course it also notes some judges approve very little like the judge who approves just 13% of the claims at the hearing stage. They indicate funds will run out by 2017 at the current rate but this statistic is open to dispute. Depending on your political persuasion Social Security is in such bad shape that we should phase it out or it is fine and with tweaks can last indefintely. I am closer to the latter then the former but that is a long story. I do know that judges have their own stats on granting/denying benefits. But concentrating on judges who grant benefits is not the right approach. Being concerned about too many favorable decisions but not those judges who deny excessively is too one sided. I am all for saving money but not at the expense of the truly disabled which I consider ghoulish. There should be some accountability for all judges. The article also points out that the federal courts seem to be overturning denials 51% of the time as if the federal judge is off base. My experience is just the reverse. Most federal judges who overturn a decision are quite right. Even the government attorneys often stipulate the SS judge made a mistake. SS judges do make mistakes and at times the denial of benefits seems off base. Implying the federal judge is interpreting the rules improperly is absurd. Most decisions are far better reasoned then the decision denying benefits. However to be fair many of these overturned decisions are just being sent back to the original SS judge for more workup on a remand. My experience with claimants is that the vast majority are truly disabled and unemployable so we should be focusing on speeding up the process (for time to a hearing click here)and quit trying to label Social Security as the problem. Instead we should be fixing it for all future generations.

Issues to Think About for 2012

2011-12-08T22:00:00.002-07:00

Around this time of the year I look back at the year and ahead too. Someone asked me about national issues in the field of workers comp but really not much has changed over the last year in Colorado. By that I do not mean that there were no changes or interesting developments but that it was a year of slow or minimal changes in the law. Still there were some developments. For the statutory developments just click here for an overview. For what is new at the Division of Workers Compensation you can click here. For caselaw we cover this in our blog. But as for the national or evolving issues in this field I guess the overriding issue is the economy. Still that is not unique to workers comp. What I have noticed over the years is there are increasingly technical or more precisely medical issues in workers comp. They usually trigger a battle of experts. What you then see are many cases that have become medical battlegrounds. The battling experts are the doctors. In such battles the advantage is often with the insurer. First, the treating doctor is usually selected by the insurer or the employer. Not exactly a good deal for the employee especially when there is a controversy. Next they cultivate those doctors who issue reports and testify to the benefit of the insurer position. It's expensive for a claimant to use his or her own doctors. Testimony expenses are billed at $450 an hour in most cases and includes commuting and wait time too. It is easy to spend over $2000 for one such expert. Advantage? Insurer (I have had insurance defense attorneys tell me they can pay $5000 or even $10000 for their experts). This can cripple a claimant's case. It strikes me that this is impairing a fair fight or what I would call access to the system. In civil matters there is a growing awareness of a need to simplify proceedings because when matters are complex or highly technical it works to the advantage of those with the money. In Colorado there is a interesting new seminar on this as relates to civil proceedings other then workers comp but it strikes me that improving access in workers comp is extremely important. By permitting many experts we skyrocket the costs of a hearing. It may be wise to limit this. Perhaps for a fair fight we should let the claimant have his expert as a covered benefit but that is not the current law. In my opinion any effort that speeds the process, makes it a fair fight and reduces something that is complicated to what the computer crowd would call user friendly is to be lauded. The workers compensation system was not intended to be unfriendly to injured workers. It was intended to be an efficient way to deal with work injuries and hopefully protect the worker while he recovers from his injury. In my view that is not happening and perhaps we need address this so we get back to the original purpose of the workers comp laws...to assist injured workers even if benefits are limited by statute. Otherwise the problem is shifted to all of us.

Pinnacol again seeks privatization

2011-11-20T19:56:00.002-07:00

The Denver Post is reporting how once again there is an effort to privatize Pinnacol Assurance, the state's quasi public/private workers comp insurer. Pinnacol is also the largest insurer in Colorado in this area. Now they are reviewing the proposal that the state gets a 40% stake worth $340 million dollars in return for greater autonomy for Pinnacol. What sticks with me is that the state saw big cash amounts held by Pinnacol and wanted a piece of that to help with the state budget. Pinnacol then sought to get away from state influence and control. This is a story that reminds me of the old serial thrillers. This version is still controversial as I suspect some may question the wisdom of the state agreeing to this. Colorado created Pinnacol to make it easier for businesses, especially high risk businesses to obtain workers compensation insurance for a fair price. I remember getting claimant benefit checks from the state accounts but that was years ago. The point is that it has thrived and been effective in Colorado with state backing and now that it is doing well wants more autonomy. Control and money issues are involved so of course with such issues comes controversy.

Top Workers Compensation Blogs for 2011

2011-11-08T10:06:00.006-07:00

This blog has again been honored by its 2011 selection into the top 25 worker's comp blogs in the country by LexisNexis. This is our fourth year in a row. But I really liked what they said about this blog because it brings home the point that good writing about this tough area need not be boring at all and perhaps even worthwhile to our readers. Here from the LexisNexis website is what was said:

" Who says workers' comp writing has to be boring? Colorado Workers' Comp Blog, offered by Colorado Springs Attorney Richard Falcone, is an excellent example of an attorney who writes with depth and clarity, all the while sprinkled with flair and even humor. Falcone, who writes from the perspective of the injured and disabled worker, continues to provide readers with commentary and analysis. Falcone's September 16, 2011 post, entitled "New Court Case on Medical Benefits," and his May 13, 2011 article, "Munoz Court Case on DIME waiver," sift through complex medical issues with relative ease. He also enjoys the hypothetical-his February 4, 2011, "Does Charlie Sheen Have a Workers' Comp Claim," reacts to a whimsical question posted on a satirical blog, "the Spoof," regarding the antics of the former star of television's Two and a Half Men."

Administrative Law Judge Orders for September 2011

2011-11-05T21:23:00.003-06:00

I have indicated in the past that the Office of Administrative Courts will post just about all the orders issued in the state of Colorado following hearings in workers compensation cases. In September they posted the orders and it covers some 470 pages. I skimmed through all of them and many are quite interesting reads. A great many of them involve medical legal issues so they have opinions by numerous doctors. In one early case I counted 8 doctors. Often such cases involve causality questions pertaining to whether or not a claim is work related or questions regarding treatment. I should remind claimants to discuss all your complaints at every visit with the doctor. In my experience some of the doctors do not document as we would expect them to do. As such you can provide the doctor with your history in writing if need be. By history I mean a dated statement of your current problems which you bring to your doctor each visit. Always make a copy for your records. This can prevent any misunderstandings later on. In at least one of these cases it appears the claimant asserted he was telling and telling the doctor at every visit something which never was noted by the doctor. Of course the decision went against the claimant on that point. I have had clients take a written history into their doctor every time just to keep all the details accurate. A failure to complain can be assumed to mean an absence of pain or limitation. Anyway these cases tell us what sorts of issues are going to hearing in Colorado.

Colorado workers comp insurance rates to go up

2011-10-29T10:38:00.008-06:00

The Denver Post is reporting that businesses can expect a rate increase on their workers compensation insurance coverage. This after a few years of declines. Why? The number of claims is not going up. The explanation appears to be in the continuous and unrelenting increase in medical costs. Here is the Colorado statement on all this. This rise in medical costs when the economy is not inflating remains ominous for all of us. The failure of society to address this is rather sad. We all talk about it but it takes a concerted effort and in our politically charged country we are less interested in problem solving and more in ideology. Wouldn't it be nice if they set up a task force to address such costs in a sensible way? I mean an across the board analytical review. If medications are a big factor find ways to lower that expense. If we need more nurses or practitioners find ways to increase the numbers with educational incentives. If caution leads to the running of multiple and usually unneeded tests find ways to prioritize those tests rather then run all of them at a time. If malpractice rates are too high find ways to make providers accountable without increasing those rates. I mean weed out the bad apples especially in workers compensation. Simplify the paperwork too! While I do like the medical treatment guidelines I saw recently what appears to be making it more complicated to obtain prior authorization. In workers compensation there are many disputes in what I see as primarily medical legal issues. When we go to a hearing and it seems to be a legal issue on compensability in reality many such cases involve medical causality. So some of these rising costs involve insurers hiring experts to question causality and treatment. As an example an attorney related to me that he had obtained a DIME opinion that the claimant is not at MMI. In the past this just led to more treatment and a reassessment. Overcoming a DIME historically has not been easy but the pattern is now to question everything. There are doctors out there that will nearly always assert an injury is not work related or that the DIME doctor made a mistake. A DIME would cost $675 but they spend $5000 or more fighting it. The point is not all the rising costs in workers compensation are based on purely medical matters. Some come from the insurer disputing matters. It also drags out the proceedings which I do not really see as helping the claimant needing treatment and it is costly. In any event businesses can expect higher workers comp premiums next year.

Court Allows TTD After MMI in Loofbourrow Case

2011-10-14T22:38:00.007-06:00

In Loofbourrow the Colorado Court of Appeals dealt with a case where the claimant had been placed at MMI (maximum medical improvement)by the authorized medical physician at the time. He returned to work and then worsened. At that point he requested medical treatment and the situation deteriorated as the Respondents denied the claim and did not provide treatment. Even the AWW (average weekly wage) was disputed. At the hearing the judge ruled in favor of the claimant on the issues. He was granted TTD (temporary total disability) benefits even though he had been previously placed at MMI and never contested that. The claim was determined to be compensable and claimant had the right to pick his doctor given the lack of medical treatment. He even won on the AWW issue which seemed to involve reduced hours after the original injury but the judge provided a higher figure. The other side appealed and ICAP (Industrial Claim Appeals Panel) overturned the award of TTD which led to the court decision just issued this week. The court affirmed the judge and reversed ICAP. The Respondents asserted that after being placed at MMI which was never disputed the claimant could not receive TTD. That legal position is a correct one when a claimant has been receiving TTD and reaches MMI. However in this case the court reasoned that after MMI he worsened so the claim remained open to further review. He did not need to seek to reopen and his right to challenge the earlier MMI could not happen until after a FAL (Final Admission of Liability) was filed which had yet to happen. Can you imagine the position this claimant was in? He is hurt at work but seemingly quickly recovers. But his hours are reduced and when he worsens the Respondents decide to fight everything. It is appealed and then appealed again to the court. How long did this person go without benefits as the administrative process went through all the appeals? It appears the last work was in August 2009 so while the court ruled in the claimants favor it took quite a while to obtain benefits and that is assuming there will not be a further appeal.

Chavez: Court Decision on Subrogation Rights

2011-10-14T09:31:00.005-06:00

In the Chavez decision the Colorado Court of Appeals ruled against Pinnacol's efforts to obtain or share in a settlement made between the injured worker and a third party. Subrogation can give the workers comp insurer rights to obtain reimbursement from some other responsible party. Here the claimant was injured in an auto accident but received workers comp benefits. He then sought to pursue a tort claim on the accident against others. Pinnacol joined that case because it can assert its right to reimbursement should there be a big recovery. However in this case the employee settled what was called his non-economic damages such as pain and suffering. The settlement was set up not to prejudice Pinnacol's right to proceed but Pinnacol felt it was entitled to approve the settlement or at least that it was entitled to some portion of that settlement. The court ruled that the settlement was reasonable and did not affect Pinnacol's rights. As set up by the language in the settlement Pinnacol's ability to pursue its claims was not affected by all this so it was not entitled to any of the settlement. Here the non-economic damages that were settled involve matters never paid through workers comp by Pinnacol. Pain and suffering for example is not a workers comp benefit but Pinnacol felt it was wronged anyway. It lost in the original case and then in this appeal.

RIP Curt Kriksciun

2011-10-06T09:12:00.005-06:00

Former prehearing Administrative Law Judge and Industrial Claims Appeal Panel member Curt Kriksciun passed away on October 4, 2011. While I may not have always agreed with his views he was truly a gentleman. As a prehearing judge especially in handling settlement conferences he was usually seeking compromise whenever possible. To do so he would chat and provide comments from his experience. This usually would have a calming effect with my clients who were often stressed by the process. My impression is that he always sought to be neutral and objective...even if it was difficult. But by being friendly and relaxed in his approach he would lower the stress level. I am sure he had this effect with many people that had matters before him. He then became a decision maker or member of the panel reviewing cases appealed after the initial decision. He performed well in this last position and I daresay the quality of those decisions improved with his involvement.
Services will be Tuesday October 11th.

New Court Case on Medical Benefits

2011-09-16T11:37:00.006-06:00

The Colorado Court of Appeals issued a decision yesterday that concerns ongoing medical benefits. In the Hire Quest case we have a rather technical argument that is addressed by the court. It seems an example of how technical arguments get in workers compensation proceedings. In this case the parties went forward at a first hearing which addressed a safety rule violation, credits for paid temporary benefits and the permanent impairment based on a DIME (Division Independent Medical Examination). Before the hearing the issue of permanency became uncontested because the employer/insurer withdrew the opposition to the DIME doctors impairment rating. So the first hearing addressed permanency, temporary and safety rule violation issues but that judge said issues not expressly decided are reserved for future determination. Well claimant later went forward on the issue of ongoing medical treatment needed and the other side said he could not because he never raised the issue at the first hearing and it was waived. They also asserted that the judge reserving issues was not specific enough so that prior hearing closed out the matter. The court decided that the reservation was good enough to preserve the right to address medical benefits after the first hearing so they found in favor of the claimant. Common sense would tell you that medical benefits could be addressed later but the insurer tried to use a prior court decision to say the claimant was required to add the medical issues at the first hearing or else it was waived. This waiver argument is essentially saying address all issues at once or the insurer saves money by alleging too bad so sad you lose (waive) your potential right to further treatment. Even if the judge reserves matters it is not good enough unless it is a specific reservation of a medical issue according to the insurer's view of an early case they were citing. The court disagreed with that interpretation. My view is that workers comp should handle all treatment that is needed for a work injury and not made into a game of technicalities which passes the buck on treatment to others such as the taxpayers. In this case we did have the DIME doctor saying more treatment was needed and I am not sure why it was not made an issue but it could be that there was no dispute made by the insurer until later. To me you have to wonder if the insurer waived objecting to further treatment but anyway the claimant prevailed.

Recent Social Security Rule Hinders Claimants

2011-09-02T21:44:00.004-06:00

Just recently effective the Social Security Administration issued SSR 11-1p which affects those appealing a denial after a hearing. The appeal process is an ongoing process and after a hearing you can seek an Appeals Council review and thereafter also can proceed into the federal courts. So you wait for a hearing and if, for some reason, you are denied benefits after a hearing you can pursue further appeals. This takes time but I have seen appeals take several years but finally be successful. But to any claimant this new policy is bad news. For some time if you lost at the hearing and appealed further you often would be told to file another application for benefits with a date after the hearing decision. Then you would have two proceedings going primarily to preserve your right to several months of benefits. The theory is that if you just waited on the appeal and it took 6 months or longer then when you get around to trying all over again you lost those months of waiting. Now the agency has decided not to allow that new application or so it seems on first impression. Imagine having cancer but losing at the hearing on some basis. Then you take a turn for the worst but are told by this policy that any new application has to wait on your appeal or give up your appeal to file a new application. I understand the need not to complicate matters but this policy may result in denials of due process. At least those representing claimants are quite disturbed by it. Here is one view on this and here is another and still another. I would say that this is an area that requires proceeding very carefully. This ruling is new and untested and may well be attacked by those who believe you have a right to file a new application but for now I am just letting you know about it. Time will tell how this is best handled.

Division IME Forms Including a new one WC78

2011-08-29T21:19:00.002-06:00

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?

2011-08-21T20:29:00.007-06:00

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

2011-08-17T11:26:00.005-06:00

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

2011-08-08T22:05:00.002-06:00

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

2011-08-05T10:41:00.002-06:00

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

2011-08-02T21:45:00.004-06:00

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

2011-08-01T12:20:00.003-06:00

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.

Rule 16 and 18 Proposed Changes

2011-07-22T08:37:00.004-06:00

The Division lets us know about proposed rule changes and this change concerns Rules 16 and 18. These are medical matters which are changed just about every year because medical costs keep rising. Rule 18 involves medical billing and Rule 16 utilization review. The proposed rules are posted and then adopted after comments are received and reviewed. Most of this is not very exciting information except for doctors and other providers although at times a claimant or claimant's attorney does have to look at the rules. What a doctor can charge for legal things like testimony, consultations, reports and the like are important to know. Such matters are often the responsibility of the claimant if he or she asks for any of them. So wanting to have the doctor come to the hearing is fine but it is also at a cost to the claimant. So while these rules seem complicated to read and perhaps not that important to claimants most of the time there are situations where a claimant needs to check on what the rule says. For example, in the past there has been litigation on the subject of what is called prior authorization. This area involves a provider getting advance approval for something and when approval is not forthcoming the doctor and perhaps the claimants attorney may wish to dispute it and even seek penalties. What is addressed in Rule 16 on the subject becomes quite important in such a situation.

Retirement is coming soon!

2011-07-04T11:15:00.006-06:00

While I shall continue to publish this blog it is just about my time to retire from an active law practice. I am not taking any new matters and only seeking to resolve all the remaining cases that I have. What I can say to all those thinking about and searching for an attorney is whenever possible at least consult with an attorney about your case. The laws and rules involving workers compensation and Social Security disability are quite complex. Thinking it is just common sense and form work is a major mistake. Deadlines are not to be ignored and some matters seem to go against common sense. The reason is that these areas are creatures of statute. Benefits, rights and responsibilities are what the law says they are not what you think it should be. Entire claims can be lost by assuming something that is not so. So it is better to consult to assess what can be done and if you need legal help. Claims that look like small matters or you are told are minor can be worth an enormous sum. Never rely on the accuracy of what you are being told by your employer or the insurer. Just protect yourself and the best way to do that may well be with an attorney. I have nothing to gain here because I am retiring but I know this...wherever possible use an experienced attorney. Even cases where you think the offer to settle is decent may actually be worth much more. Even where all is going along fine so you think you are being taken care of by the insurer please consult with an attorney. Too much may be at stake financially, medically and emotionally to not obtain good legal advice. And do not be afraid to check with more then one attorney. It is your claim and your future that is at stake. As I head into the sunset of my practice I can say that the legal profession has been rewarding not just financially but in making a difference for others. You usually do it one person and one case at a time but you also achieve real results for real people. You also stand up for those injured and disabled just when they are most vulnerable. For me that has been very special. So thanks for allowing me to help. I shall continue however to write and speak up in this blog for as long as I can.

Medicare Quickly Covers End Stage Renal Disease

2011-06-22T11:01:00.006-06:00

There need be no prolonged wait to obtain medicare if you have ESRD (end stage renal disease). Often those who obtain Social Security disability have to wait for medicare but in this situation no matter who you are or even if you have not obtained any disability benefits you can quickly get medicare coverage. This article which appears in this link addresses this matter along with other points. Sadly obtaining disability can be a prolonged process but it is good to know that in this area you can quickly get on medicare regardless of your age or circumstance. I still believe that leaving medical care in the hands of private insurance is not the best approach for those with serious injury or illness. We can believe in free enterprise but also realize that society has to step in when it affects all of us. We see this with fire protection and police and the military and education. Also we should see that in the human area of healthcare. Its high cost and immense impact on all of us should be a social or societal concern. In any event medicare can step in for you if you have ESRD without much waiting around.

Maximum rates and the caps

2011-06-21T18:14:00.006-06:00

The Division of Workers Compensation has just posted the rates for maximum benefits and related math calculations. For example they indicate that as of January 1, 2012 the caps are to be $76605.00 and $153210.00. Maximum rates are usually related to your average weekly wage not to the severity of your injury. Those with a workers compensation injury are paid two thirds of their average weekly wage for temporary benefits in the majority of times. There are exceptions that can lower this amount and there are occasions when the average weekly wage should be adjusted higher. If you are a claimant never assume the figure your employer or its insurer says is your wage. Never assume they are right no matter what is told you. If you are an employer or insurer never assume the figure provided by a boss is correct. A wage calculation is not a simple matter and there can be many variables that affect the calculation. However the fact you sustained a horrific injury is not going to affect the math. It is based on the math and when in doubt is determined by a judge when someone takes it to a hearing. In a typical situation the injured worker receives two thirds of his average weekly wage during the time he is temporarily disabled which s adjusted if you work part time. If a claimant returns to work full time temporary benefits stop. Such benefits can stop for other reasons as well as provided by law. You can review that with your attorney or seek help from the Division to understand it. Customer Service phone is (303) 318-8700. Please note the two thirds figure has not been considered taxable but it is not the same as your paycheck amount. It is what it is as set forth by law. But each year there can be adjustments and that is what has been done and posted at the Division today. Caps are amounts that place a limit on your compensation. They do not apply to medical benefits which are not capped (at least not yet) and they do not apply to those permanently and totally disabled. But if you are drawing temporary benefits and then entitled to permanent benefits those amounts can be capped when added up. Temporary benefits alone are not capped but if added to permanent benefits the law can apply a cap. Regretably this is a tough matter for claimants but the state has decided through its elected representatives to place limits in certain areas. In a sense most insurance policies have limits and workers compensation is no different.

Claimant Arrested for Fraud

2011-06-13T23:55:00.004-06:00

As reported in this article a claimant was indicted on suspicion of stealing $140000 in funds from Pinnacol Assurance, the insurer handling more workers compensation claims in Colorado then anyone else. The spouse was also indicted. In my experience this is relatively rare. A claimant may exaggerate his condition but seldom is it outright fraud. Some employers are much more likely in my experience to intentionally coverup claims made by employees. In any event this news is unfortunate as it suggests that surveillance be used in many cases. There are many claimants who must be put through this process even though they have legitimate injuries. Yet insurers do not just look for fraud they also look for any possible evidence that helps them to defend the claim. There are very few arrests but there are many cases where the insurer has evidence the claimant can do more then is recommended by his doctors. So judges may be shown this but also doctors. If you exceed your restrictions and that is videotaped then your case has not only been weakened but your doctor may become quite upset with you which also makes him question your treatment and future needs.

Colorado Springs News on Dr Shockney

2011-06-06T19:10:00.009-06:00

I am providing a link to a Gazette newspaper article on a local psychotherapist Dr Shockney. It is a detailed article which questions the credentials and expertise of this individual. Dr Shockney was sometimes involved in workers compensation cases and also in many other matters, civil and criminal. I am not sure what the outcome of this will be but today another article was posted over at the Gazette. I imagine that more will be forthcoming. A psychiatrist is an M.D., but there are other professionals in the mental health field and the article suggests that the state does not regulate psychotherapists very well. The original article was explosive to say the least. It certainly appears to be highly researched but we will have to wait for further developments. Some fields do not require an extensive education and testing or life experiences can be part of your expertise.
UPDATE: The Gazette on June 22, 2011 is reporting that Dr. Shockney is retiring immediately.

DIME Brochure

2011-06-05T09:29:00.004-06:00

A DIME or Division Independent Medical Examination is a very unique process which allows those requesting it to seek to obtain a truly neutral evaluation of a claimant's impairment and treatment plus even more. It is a powerful force in keeping the system honest since most treating physicians have been selected by the employer/insurer and many claimants remain suspicious of that. To claimants such physicians often seem not to be on their side. In point of fact they may be quite capable but there are others who may be less then thorough or devoted to the patient/claimant. A DIME affords a claimant or even the other side the opportunity to have treatment and impairment reviewed. Moreover the law has made a DIME a strong force that can only be overcome by clear and convincing evidence in most cases. There are exceptions but the general rule requires strong evidence to overcome the DIME opinion especially on the issue of MMI or impairment. The Division has a brochure available to review the DIME process and it is worth reading. In my practice we use the DIME process in the vast majority of cases though in some cases we do accept the treaters opinion. By the way you can agree with the treaters rating but still seek permanent total disability by objecting and following through as set forth by the law. A physician may say you have 20% impairment but for you perhaps you can no longer work. You have the right to seek total disability but you must act timely and sensibly to make your case. A lawyer is usually essential here.

State Social Security Polls

2011-05-27T10:11:00.005-06:00

The uproar over possible cuts in Social Security and Medicare continues. At this polling website they show us the Colorado polls and they assert we should strengthen Social Security not cut it. However the so called voucher system touted by some politicians appears to push more of a burden on seniors to fund their medical care at the very time their income is reduced. No doubt there is much to criticize with any government program but turning matters over to private insurance is like turning over all our finances to the bankers. While free enterprise is great it can also lead to abuses based on financial power. "He who has the gold makes the rules" can be very harmful to a society. As a society we need certain basic matters covered and others regulated. It is a price you pay for being in the society and yet also it is a value to all of us to have some benefits. Moreover, historically we have tried as a society to protect the old, the young and the disabled and hopefully that will continue. Clearly most Americans feel the same. It will be interesting to follow this debate as it strikes me as an effort to begin eliminating programs that only need tweaking while not really addressing jobs and the budget. By the way watch out for those who are using the word "reform" to discuss Social Security/Medicare. Most of us in Colorado went through the "reform" of workers compensation. It was a euphemism for cuts in benefits to the harm of claimants.

SB 11-199

2011-05-24T07:36:00.007-06:00

While this senate bill 11-199 is awaiting the governor's signature I expect it to become law. There are 4 provisions in the bill worth noting. First, it requires that the insurer pay costs in advance, if requested by the claimant, for an insurer IME or vocational evaluation. This means the cost for the claimant to travel, food and even a hotel must be paid or the claimant can refuse to attend. If they pay and claimant does not attend they can get an offset from future compensation due the claimant. Next, a Final Admission must admit for future recommended treatment by the authorized doctor unless there is a record of a contrary medical opinion. This prevents the insurer from disregarding physician maintenance treatment once the claimant reaches MMI. At times insurers never admit for further treatment even though its need is undisputed. A claimant may think or even be told by the doctor he can get further treatment only to be denied by the insurer and the bill seeks to avoid such a practice. Third,procedurally it corrects a discovery matter by not requiring those represented by an attorney to first ask permission before starting discovery. That extra step (documenting you asked permission) seemed just a waste of time and paper. Last, the bill makes it clear that any lump sum request regardless of the date of injury is not a waiver of the right to seek permanent total benefits. For those readers not familiar with the last issue the history of it is a claimant would receive an admission for permanent partial benefits of a certain amount, let us say $30000.00, and yet feel he was much more disabled so he'd seek permanent total disability benefits. Since by law the admission had to be paid out every other week the claimant sought it in a lump sum. That was deemed a waiver of his claim for permanent total benefits. The poor claimant was stopped in his tracks by accepting the lump sum perhaps just to pay bills and other expenses. You had to be careful to avoid this but the law has been changed. A total disability claim is no longer waived by accepting a lump sum.

Health Coverage in Colorado

2011-05-22T08:27:00.003-06:00

If you have had a work injury or disability you or other family members may need health insurance for any future problems. Perhaps you qualify for medicare once you are disabled or retire but what about your spouse? Perhaps you are running out of any continuation health coverage. For those of us in Colorado here are a couple of websites that provide information you may find useful. The first site is for those who are not insured. Is coverage possible? Yes so click here for this website. Anyone with a preexisting condition (and that means most of us) should not be unable to obtain insurance coverage. While many politicos preach about this way or that the fact is that times have been tough for the uninsured and those with preexisting conditions. Group coverage is fine until you lose your job. At this website if you have had coverage within the last 6 months you may be able to use the information to obtain further coverage. After all COBRA coverage does not last forever so this site may help you out. Last I did want to include a link to Andrew Mersereau of Premier Insurance. He has been quite helpful on a personal basis on health coverage. Don't be afraid to call an agent for help when you cannot do it yourself.

Munoz Court Case on DIME waiver

2011-05-13T11:25:00.007-06:00

The Court of Appeals decided yesterday to reverse ICAP and the hearing judge on an issue concerning seeking a DIME. The claimant requested a DIME to review the treating doctors opinion. A DIME is a Division Independent Medical Examination which involves a process to select a doctor to conduct the examination on various medical matters such as MMI and impairment. In Munoz the claimant sought a DIME and requested a specific type of doctor. However that was not provided so he applied for a hearing to address the selection. In the meantime he did not schedule the appointment with the physician in question then set to do the DIME. Instead he filed a second application seeking penalties against the state agency for not staying the matter pending resolution of his hearing issue A hearing judge and ICAP decided he had not stayed the process by filing an application for hearing so he lost by waiver his right to seek the DIME. The claimant argued the application for hearing was sufficient to stay the DIME process. The judge and ICAP decided any stay had to be by law a motion and an application did not do it. They concluded he waived his right by not filing the motion. The appellate court reversed ICAP and determined an application for hearing was good enough to preserve the claimants right to have his DIME concerns addressed before proceeding. This appeal was more complicated then what I have indicated as it was argued the claimant did not even preserve his right to appeal and also the claimant wanted to penalize the state Division of Workers Compensation for not staying the process when he sought a hearing. Usually appeals are not simplistic but the key part of the decision involved a claimants right to stay a DIME process to address his concerns on the selection process. You can read the case here.

Totally disabled 74 year old denied permanent total benefits

2011-05-04T08:15:00.005-06:00

In a recent ICAP case the claimant Lane was 74 years old and admittedly totally disabled. However he was denied permanent total disability benefits after a hearing and this was affirmed by ICAP. The claimant was injured in September 2008 and eventually received an impairment of 13% of an upper extremity which equaled a 8% whole person rating. There was some dispute on his restrictions but both vocational experts provided credible opinions the man was not likely employable. The claimant did have multiple non-work related conditions such as hip pain, hearing loss, balance problems and an abdominal aortic aneurysm. So what happened? The ALJ determined the claimant had failed to show that the industrial injury was a significant causative factor in his inability to earn wages. In the case there was evidence presented that the claimant had no restrictions from his work injury and also evidence he had restrictions. The claimant was working for the employer after maximum medical improvement (MMI see glossary) but was let go for an alleged failure to do something and this was given weight by the hearing judge. So being no longer employable at the conclusion of a workers compensation case does not mean permanent total benefits are awarded. The key is whether the work injury is a significant causative factor. In this case the medical evidence of post injury restrictions was not present so claimants should always focus on obtaining medical restrictions and establishing the work injury was a significant factor in being unemployable. Often with older workers they do have many health problems and actually those problems plus a significant work injury can make for a good case of permanent total disability but it is not an automatic award as the Lane case points out.

Social Networking and Online Privacy

2011-04-15T16:02:00.003-06:00

Over at the Legal Talk Network there was a recent podcast that details much information about how websites like Facebook can affect a workers comp claim. For that matter anything online can be information that is used by the other side. Even employers can check into employees or prospective employees online. Investigators or insurance adjustors are very interested in finding out about claimants. Moreover the information you post is forever online or so it seems. In this podcast there is a very interesting discussion on this and it can also be useful for attorneys. I also noticed another podcast on surveillance and it is also revealing about what is done when surveillance is requested. Both of these podcasts are fascinating but are provided here for general information. Much of this may apply to Colorado but perhaps not all. I can say that if a claimant has a high value claim or claim for a serious injury or has something that raises a red flag that insurers will gather up information which can be from online sources or private investigators. Every claimant should be careful with their online or public activities. Even discussions with friends, neighbors or co-workers can affect the claim.

Medicare Rights Group Against GOP Changes

2011-04-08T10:14:00.005-06:00

There seems to be a constant assault on Social Security and Medicare/Medicaid coming from I would call the far right of the political spectrum. The fact that Social Security has not been the real problem with the federal deficits and actually was borrowed against to fund government spending does not matter now. While there is no question that structural changes to make it more solvent may be soon needed the current effort seems nothing short of inhumane in its consequences if enacted. While that will not happen I find it amazing after all these years to see some questioning the usefulness of such benefits. The inability of some to accept the notion that we just need to cover the old, the disabled and the young astounds me but I guess they do not generate much income so we should minimize them is their attitude. Anyway this medicare rights group notes their disagreement with the GOP effort of one representative to pare down benefits. Also the Alliance for Retired Americans is voicing its concerns. Lastly at another site for the "middle class" they are also critical of this proposed legislation.

Recent Hearing Decisions

2011-04-07T12:07:00.003-06:00

Over at the website for the Office of Administrative Courts they do, from time to time, post all or most of the workers comp hearing decisions. They redact or edit out certain parts especially the claimant's name but the reasoning and facts found are all there for anyone to review. The latest they have is for February 2011 and the decisions start with a claimant wanting botox to matters involving compensability and a host of other matters. It is always interesting to read what is happening at the local level. Moreover they do include names of doctors or other experts so you can see what case that doctor has been involved with. If you want to see how complex this field can get go ahead and look at these cases. Moreover the cases do set forth what the hearing judge believes is the law with citations though any of the cases can be subject to an appeal.

First Comp-Appellate case on a battle between insurers

2011-03-31T23:28:00.008-06:00

The Colorado Court of Appeals issued a decision today involving a dispute between two insurers. The claimant was injured and in the case there were two employers. The direct employer had Pinnacol Assurance and the statutory employer had First Comp as its workers comp insurer. Pinnacol alleged it had cancelled the policy so the direct employer had no coverage leaving the statutory employer and its insurer to be responsible in the case. There was evidence presented and the hearing judge ruled that First Comp was the insurer in this case. First Comp, appealed and the Court concluded it had no standing to appeal the cancellation determination. In effect the cancellation statute was between the direct employer and Pinnacol and the injured worker but not with First Comp. It sounds to me a bit like the legal concept of privity. Even though First Comp takes a direct hit when the direct insurer is able to walk away because it cancelled the policy the lack of a close statutory relationship or benefit then prevents First Comp from appealing the issue. It lacks standing said the court so First Comp's appeal was dismissed. Certainly here the legal concept of standing to appeal was raised to prevent issues remote from the claimant from interfering with the compensation process. Perhaps an insurer would not pay benefits pending an appeal which can take over a year to the harm of the claimant or his dependents (in this case the injured worker had died). Imagine waiting for benefits while two insurers battled it out!

All About Claims Newsletter March 2011

2011-03-29T20:20:00.005-06:00

The Colorado Division of Workers Compensation has just released a new newsletter. In it you can read the comments of former Judge Jaynes who recently passed away. There is also something on the DIME (Division Independent Medical Exam) process. The newsletter approach is a good one and would be even better if it were a regular feature. Giving us a glimpse inside the state agency makes it rather unique. Being able to just talk about things in a very informal way is helpful. It puts a face on what we sometimes see as bureaucratic when actually it is human. Many good people do their best in this field. The field itself may need much improvement but those who work in it have not been the problem. In fact looking back on the many years I have been doing it I have to acknowledge that the people at the Division and those handling hearings have been, for the most part, very decent and intelligent people. They are decent because they are respectful of others even when they must follow the rules. They are intelligent in doing their best to be fair and legally accurate in what is often a very complex field. Most of them and most who practice in this area believe they are making a difference as do I. Having said that I should add that some adjusters and employers do not play fair at all. Yet dealing with them can be difficult but also very rewarding when done right.

Colorado Injured Workers Survey

2011-03-22T13:57:00.004-06:00

Over at the Colorado Division of Workers Compensation they just posted the results of a survey now required by law. Once the case is over or close to over a survey request is sent out to the claimant. For this first survey not that many responded but it is enough to tell us something. The survey itself asks about courtesy, promptness, medical care and overall satisfaction. The weakest area, according to claimants finishing their case, is in disputes being promptly resolved. Amen to that as delays are common in a field originally set up with good intentions. Most cases seem to take 2 years if they involve a serious injury and an attorney. Some cases go much faster but often it is because they are being treated as minor. I have always planned on at least a year but it does depend on the injury and how much medical care is needed. Even then many cases seem to drag on largely because the system has remedies that take time to work through. A Division IME adds a minimum of 3 or 4 months to the process. You file this paper and wait for the other side. Then they file and you respond. Then you wait for the Division to give you doctor names and then once selected there is a window within which you must set the appointment. Even then it takes time to receive the report and more time for the insurer to act before the claimant can act. It is a bit like a baseball game as the law gives each side a time at bat so no matter how fast you want to go it takes time to line it all up. As for the survey results you can access them by clicking here. Pinnacol received a 3.6 grade out of 5 for overall satisfation. Zurich Insurance was a 4 and the worst among the larger companies was Kroger at 2.5 but all the results have been posted. You may need a spreadsheet program to look at it all but what it tells me is that the overall grade is like a C or C plus. Let me add this...it is not good enough for those disabled and relying on a government mandated compensation program to say it was just okay. Claimants are often hurting physically, financially and are also stressed by the situation even under the best of circumstances. They deserve courtesy, promptness and decent medical care. To me the lower the grade the more adversarial the company. Persistent low grades on surveys may warrant further review or further regulation.

Social Security Compassionate Allowances

2011-03-13T09:31:00.004-06:00

Those seeking Social Security Disability often have to go through a long and tedious process. You file, get evaluated which takes weeks if not months and very often are then denied. In Colorado you can then appeal and seek a hearing. However any hearing date is delayed for many months. I have been figuring on it taking a year or longer for the hearing and decision. Even when you win the matter must be processed for you to begin receiving benefits. If I had to estimate the time from beginning to end I would have to say the process will take over 1 1/2 years. Typically from the time you start to the receiving of benefits is long but I say that if you can no longer work get the ball rolling on this. Doing nothing is foolish as there may be things you or your attorney can do to get ready. But there are exceptions to all this. Sometimes people are granted benefits right off the bat. Most of us are not that lucky. Despite any delay if you obtain benefits you may get them backdated to a point 6 months from when your total disability actually started. That is the rule for everyone and the date of disability or onset is not always easy to figure out. Often the judge will do so in his decision. Anyway the point of this blog posting is to make you aware that the agency does have a fast track in certain cases. It is called Compassionate Allowances. For example if the person has early onset Alzheimer's disease they can be fast tracked. In other words certain serious problems can be expedited so benefits flow faster. There are at present some 88 diseases and conditions but this list can get expanded from time to time.

The Zolman Case on Bad Faith

2011-03-04T18:09:00.003-07:00

The Colorado Court of Appeals just issued the Zolman decision on March 3, 2011 that concerns a civil claim for bad faith against Pinnacol. In this case which arose out of a workers comp case the claimant was upset with Pinnacol denying treatment and denying a change of physicians. A separate lawsuit was started alleging bad faith. This can mean a trial by jury on whether Pinnacol acted in bad faith which involves acting unreasonably. Pinnacol filed a motion for summary judgment against the civil case which was granted. This was affirmed by the Court of Appeals. So the claimant or rather the plaintiff in the bad faith case lost the case. Summary Judgment is a severe action and historically is not granted if there are questions of fact that should go to a jury. In Zolman there certainly were questions of fact on what is appropriate treatment so you would think the issue of how reasonable Pinnacol was should go to a jury. That is Pinnacol had what it believed were good reasons for denying and the claimant had reasons for saying it was unreasonable. It was a battle of medical experts which is common in this area. Yet the Court decided Pinnacol acted reasonably as a matter of law. Certainly when there are no genuine issues then a summary judgment is appropriate and that is what the case says. What I find puzzling is the use of the concept of "fairly debatable" apparently as a basis for concluding Pinnacol acted reasonably as a matter of law. As I understand it they are saying that the need for treatment was fairly debatable given doctors did side with Pinnacol but to me if there are doctors going the other way even if the dispute could be reasonable you still could go to a jury. On November 10, 2010 another panel of the Court of Appeals in Sanderson did decide that fair debatability alone does not defeat a bad faith claim. You have to wonder if these two cases are reconciliable on the basis to grant or deny summary judgment. In any event Zolman does have the Court deciding that Pinnacol's actions did not rise to the level of bad faith.

Pinnacol Has 3 New Board Members

2011-03-01T07:19:00.005-07:00

The Denver Business Journal is reporting that 3 new people were voted onto the Pinnacol board by the legislature. One of them was highly critical of Pinnacol so it will be interesting to see what comes of this. Pinnacol Assurance is Colorado's largest workers comp insurer and has a long history. It was originally set up by the state and is a hybrid of public and private interests. Pinnacol wants more autonomy and yet many in the state legislature are upset with how it now operates. See for example one recent legislative effort in an article in the Denver Post. However Pinnacol does have points going for it. I have previously reported on this so this is just another entry in an ongoing story.
UPDATE: New Board votes to take away the CEO's bonus and in this article in the Denver Post more is discussed about Pinnacol.

Colorado Drug Card

2011-02-25T10:08:00.006-07:00

In that many Colorado residents on Social Security or with work injuries may have financial problems or even denials of coverage Colorado does have a Colorado Drug Card. Moreover anyone at all can obtain the drug card so it does not matter what your income. Locally KRDO did an investigation which can give you a better idea about the card. Does it work? Yes although not every pharmacy may know about it. Seniors and those on a tight budget should especially take heed. While it may not always be a big benefit the card is free to all and just let them know by asking for the discount. Additionally for injured workers there is the Injured Worker Pharmacy which has its own website. Apparently a number of attorneys do let their clients know about it so it is another resource that may lower the stress level for claimants. Often a claimant cannot obtain a medication and my view is that you should try to follow through with what your doctor has prescribed. It may turn out to be covered or not but your health should be a primary. In any event always keep receipts if you pay out of pocket as perhaps reimbursement may happen.
Also...El Paso County also has a free drug card that may be helpful too.

Unrepresented Claimants Revisited

2011-02-23T21:34:00.007-07:00

In 2006 I posted on what resources were available for those who do not have an attorney to handle their case. That is now outdated. Sometimes attorneys will not take your case. There are many reasons for this and not always personal to your case. You may have a very good case but the attorney is busy or going in a different direction. Other times the attorney may conclude that your case has merit but does not fall into an area he wants to handle. Still other times an attorney decides there is not enough at stake to commit himself and his staff to your case. By all means keep looking for an attorney even going outside your locale if you have to do so. But if you must proceed on your own the state does provide useful information for you. You should contact the customer service people at the Division. They can assist when you do not have an attorney. There are many resources and much information available to you but I caution you to be thorough and not assume it is all common sense. Workers comp is a creature of statute, cases, rules and guidelines. All of this except the cases are available to you on the web. On this blog we often will post appellate cases. Also there are lower level decisions with caselaw you can review. Also read the publication for injured workers. At this link learn about non-lawyer workers compensation. Also at this link you can read an Overview of the Worker's Compensation Claim Process. Also from this page you can read more about representing yourself in proceedings including a non-lawyers guide. Be aware that anyone involved with a claim may also be involved with two agencies the Division of Workers Compensation and the Office of Administrative Courts. Information on this distinction can be read here. These links are important pages but really just explore what Colorado does have on the web so that you are as informed as you can be. A word of caution: represent yourself only as a last resort...this area of law is complex and difficult to navigate. But it is not impossible and if you must handle it yourself read the above and use customer service noted above.

Retaliatory Discharge and Temporary Benefits

2011-02-19T08:40:00.004-07:00

In a recent Industrial Claim Appeals Panel decision I'll call Gaines there was a retaliatory discharge of an injured worker. The worker was hurt and complaining about the employer not filing a report of injury or providing further medical help. As a result she was taken off the work schedule. Since she was not working and attributed it to the reprisal for her work injury she sought temporary benefits. The hearing judge denied her such benefits saying a reprisal is not a reason for temporary benefits. She appealed and the Panel agreed that the reprisal alone is not a proper statutory basis for temporary benefits but then remanded the case to the hearing judge to address whether her possible restrictions from the injury should entitle her to temporary benefits. Apparently this was not fully looked at by the hearing judge. There was evidence of restrictions but the judge did not adequately address that issue. The reasoning here appears to say that a claimant has to show both a medical problem and loss of wage due to an inability to work or restrictions which impair that ability. A reprisal alone is not enough. However such a reprisal may result in a separate civil claim for retaliatory discharge. The point being made is there is a distinction between a reprisal for having a claim and actual time and wage loss due to an injury. Let's say you fall out of your chair, complain it hurts even if temporary and want to file a claim. Your boss then just takes you off the schedule. So you are fully able to work but in reprisal they give you no hours. Under the Gaines case, as I read it, you'd receive no temporary benefits because you can work and really have no injury. It may be wrongful but your loss of pay is due to reprisal not to the injury. My preference is that this loss due to reprisal or retaliation be able to proceed in the workers comp case rather then in a separate civil case. The reason is that any separate civil case can take many months but the worker is receiving no income directly due to a work injury incident. But my preference is not the law. It takes disability not just reprisal to obtain temporary benefits though in Gaines the remand was to force the hearing judge to decide the disability issue.

The latest data on Social Security appeals and judges

2011-02-10T14:47:00.003-07:00

If you are wondering how long it may take to obtain a hearing once you appeal the answer depends on where you live. It is reported that in Colorado Springs the delay to a hearing or disposition is 431 days. While they have been trying for years to speed up the process over a year remains a long time to wait. An attorney may use that time to obtain more reports or assessments but the wait is still too long for many people. In Puerto Rico the wait is shorter. In one office (Mayaguez, PR) the wait is 177 days. Then again in Lansing Michigan you can take 566 days to a disposition. Yet have the claim in Livonia Michigan and the wait is 257 days. Seems not that complicated to smooth all this out but apparently it has been tough to achieve. Waiting too long is much tougher on the disabled so wish they'd get it right. I realize it can be a matter of staffing and numbers but when video hearings are now permitted I fail to see why such a huge variance is tolerated. Last you can look up the latest figures for any judge at the website that compiles this data. You can look up what each judge in Colorado Springs is doing with the cases he or she is handling. What I saw in the latest stats is that 4 out of the 5 judges are somewhat more favorable to claimants and one is statistically denying more claims then issuing favorable or partially favorable decisions. We all know that statistics can be misleading and the types of cases a judge may be involved in can make a difference. The problem is when we discuss the odds we have to say its 50 50 but for some judges your odds are over 60% of obtaining an award. No question the older you are and the more restricted you are the better your chances but each case requires a very individualized approach.

Does Charlie Sheen Have a Workers Comp claim?

2011-02-04T12:29:00.006-07:00

Here is just some humor: Over at The Spoof they posted a bit of satire about Charlie Sheen filing a workers compensation claim. If so does the rehab at home become a medical benefit? Of course any temporary benefits would be quite limited. They allege that given his job entails a certain lifestyle his "research" into his character should be covered since he sustained injury. I am not sure what injury but he was hospitalized so does he have a claim? Some might say he was on a frolic or detour of his own. In Colorado would his treatment even be deemed authorized? So many issues so little time. I would bet that at any hearing there would be very interesting testimony.

Retired Prehearing Judge Ron Jaynes Passes Away

2011-02-03T18:26:00.005-07:00

I was just notified today that retired Judge Jaynes passed away this morning after a long illness. There are no further details yet. Judge Jaynes retired in 2009. What most impressed me about him is that he was very down to earth and always polite. In a day and age when we are often having to pierce through a cloud of confusing details you always knew that he would try to keep it simple and understandable. He could do so with a sense of humor too. You can see him in this 2008 newsletter on page 3. Rest in peace.

Update: Services for Ron Jaynes are Friday, February 11, 2011 at 1:00 p.m. at Highline Community Church, 6325 South University Blvd, Denver.

The FCE in Workers Comp

2011-01-31T18:46:00.004-07:00

An FCE is a functional capacity evaluation. Often in a workers compensation case a doctor wants an FCE. It may be through his office or set up at another location. A true FCE may take several hours of testing a person's physical functioning or at least whatever functioning is sought by the doctor. You can consider it almost a tool used by the doctor to define your work related restrictions. Years ago the doctor would simply rely on his own best judgement to set your restrictions but the desire for a more accurate evaluation led to what we now call an FCE. Often it is done through a physical therapist and results in several pages of data which the doctor may or may not accept. Usually the doctor will accept the FCE results but the doctor has the option to form his own opinion. He can therefore totally adopt the FCE or adopt portions of it or only what he believes is appropriate. A claimant may be asked to lift various weights and perform other activities. Sometimes your blood pressure is taken since many in pain from activities can have a spike in their blood pressure. Similarly if you complain about high pain from an FCE activity but without any blood pressure elevation they can question your situation or so goes the theory. My impression is that an FCE can be useful information for the doctor but it does depend on the therapist and the doctor. In other words it is not purely objective. Also I have noticed that those with severe disabilities can have problems with an FCE. My guess is that they are more guarded or do not handle the structure of an FCE. Stamina may be a factor and of any results considered invalid my experience is that those most disabled have the hardest time with the testing. Last in my locale many FCE's include a claimant's range of motion measurements. While separate from an FCE the doctor may want the therapist to do the measurements that help the doctor with his impairment rating.

Repeal of Healthcare Effort and Medicare

2011-01-21T09:19:00.003-07:00

By now we all know of the effort to repeal what some call Obamacare. It cannot pass Congress and withstand a veto but the effort is being made anyway. The Medicare Rights Center has put out a press release which brings home the point that repeal will harm those on Medicare and also increase the federal deficit. They go into detail and alert us with real life stories. Sometimes in pursuit of an agenda many overlook the truth because it conflicts with their beliefs. Healthcare is so controversial that it makes for an adversarial situation which is obvious in today's political climate. We all lose when the problem is not addressed and solved.

Brown Bagging It on ICAP cases

2011-01-20T08:20:00.006-07:00

Once a month an administrative law judge has a brown bag lunch where he reviews cases of interest to those in the Colorado workers comp field. These cases are not readily available to the public although most attorneys in the field have access to the decisions. The Industrial Claim Appeals Office handles a great many appeals from hearings held at the local level. Many such cases never get appealed further and the next stage is to the Colorado Court of Appeals. Judge Eley is well liked and respected by most attorneys in this field and his free Brown Bag Lunch Seminar is well attended. Even if you cannot make it he emails you the materials and an audio of his presentation. Today is the January lunch and from the materials I have already received I note two cases that are exceptionally interesting to me and perhaps to most readers. The first can be called the Wheeler case. The claimant was admittedly permanently and totally disabled and thus entitled to PTD benefits. The issue was how to compute those benefits where they are paid out every two weeks perhaps for life. So the case involved AWW which is average weekly wage. The claimant when hurt at work was earning a very low figure if you look at her actual average wage. Respondents said it was under $75 a week. However vocational evidence was provided which helped show that the rate would be much higher then her actual wage at the time of the accident. While this must all relate to the date of the injury a Judge does have discretion to depart from your actual wage and consider loss of earning capacity. Here the difference was enormous though any calculations still are based upon the law as of the injury date. The judge applied the law as of the date of maximum improvement which was a mistake. The claimant still won big here.
The second case involved a fall at work. Caselaw tells us that not all falls at work are really work injuries entitled to benefits. The claimant in Landes was determined to have a work related tramatic brain injury injury which arose from work activities despite the fact he had amnesia and remembered nothing about the fall. Often Respondents will assert it is the claimants burden to prove his case and falls can come for many reasons. No change in the law from this ICAP decision favorable to the claimant so it is up to the hearing judge to decide on the evidence presented. There was a dissent that essentially said the evidence was speculative either way making the fall unexplained and not compensable.

Pinnacol Golf Junket for Executives in 2010 Hits News Again

2011-01-06T20:01:00.003-07:00

Channel 9 News and other media in Denver are reporting today on last years golf trip by Pinnacol executives. Pinnacol was required by a court order to disclose this information and as might be expected it is raising eyebrows. Some are saying the chief executive should resign. It does seem outrageous especially when you realize Pinnacol is meant to be nonprofit. Things like pink golf balls for the ladies, lavender pedicures, and even over $400 spent at the airport lounge and over $7000 in room charges for the chief executive. The total? Over $300000.00 for this Pebble Beach Golf trip. It is also reported that state auditors criticized Pinnacol for its lavish spending history in September. Pinnacol fought to prevent release of this information but had to do so. Now many are very upset at Pinnacol. Since Pinnacol is a mix of public and private the disclosure could not be kept a secret as can be the case with private companies. I imagine that compared to others such as the financial bank companies this is not that horrible or lavish but tell that to the injured worker of even the small business that is pinching pennies in these hard times.

Three Wishes

2010-12-30T20:44:00.003-07:00

As the year 2010 ends and we then head into 2011 let me express my 3 wishes for workers compensation in Colorado. They are major points and would have significant opposition yet they are sensible for workers comp to be fair and efficient. I acknowledge that workers comp is insurance and this can mean limiting benefits. That is not fair but we all know that insurance has its limits. But we can make the system better. As it is the current system is seriously flawed in 3 areas. Let me detail my concerns:
1. Colorado's definition of permanent total disability is unrealistic. If you can earn any employment wages whatsoever you are not totally disabled. It is quite unlike the way the Social Security Administration looks at total disability. Colorado at one time had a reasonable approach but intense efforts at "reform" some 20 years ago led to a very narrow way of defining total disability. Example, if you can work a few hours a week for minimum wage the other side will argue you lose on this issue even if it is below poverty level. While not perfect the SS view is more realistic. But then changing this could be costly to insurers.
2. My second wish is that our system dispense with the scheduled rating and add for loss of earning ability. In Colorado an arm, hand, foot, leg injury receives a specific quantity of benefits. A scheduled rating treats the human being as a mannequin. The problem is that we use our arms and legs at work a lot. Damage from a work injury can result in a loss of your occupation or trade. The claimant receives some money and then his claim may be over. How fair is losing your trade when you obtain permanant benefits of $10000 or $15000 based on the Colorado formula now in place in this state? It is simply wrong and most of us in the field know it. Insurers save but then the buck is passed to others or to society.
3. My third wish is meant to level the playing field in the area of medical disputes. Insurers can spend a considerable sum obtaining doctors who report and can testify against the claimant. It can mean losing your entire claim. A claimant has no such deep pocket and all of us in the field know it. I've seen the other side spend over $10000 on medical experts and what can the typical claimant afford? Currently a doctor can bill at $450 an hour for his testimony which includes travel and waiting around. If every claimant had access to an insurance fund in some reasonable amount then any battle could be a fair fight. A state fund set up for this purpose with contributions from all insurers could administer this. Insurers love the current system but we all know it is unfair. An injured worker may have no income and fairness suggests he or she should have a fair chance when such a dispute arises.
So there you have it. My concern is that if we truly want workers comp to be fair and efficient then these changes make sense. What happens currently is that someone else or society has to take on the burden of helping the injured worker. We pass the buck and most of us pay for what should be handled within the workers comp system. We must pay when the system is unfair whether it be all of us or those insuring you. By the way consider this an editorial opinion and Happy New Year!

Merry Christmas To All!

2010-12-23T18:48:00.002-07:00

Let Us Not Forget

2010-12-20T19:00:00.003-07:00

Over at another workers comp blog they posted a great article on one of the early twentieth century worker tragedies known as the Triangle Factory Fire. Factory workers died because doors were locked and a fire killed 146 women and girls. It was horrific and a wake up call for safety in the workplace. As the article notes now with outsourcing we are seeing it happening outside this country. This should make us mindful that workers and consumers should not tolerate poor safety and unsafe products. Actually the history of workers compensation goes back around 100 years in this country. An excellent brief history is available here. However in the last 20 years efforts have been made to get away from disability and focus on impairment. But we must not forget that work injuries can be devastating to some and workers comp was intended to provide treatment and benefits in an efficient way. Tragedies require safety measures and fair benefits or problems just get passed along to society as was the case in the days before workers compensation.

Here is a View of the Top 10 Workers Comp Issues in the Nation

2010-12-13T08:33:00.003-07:00

At the LexisNexis website there is an article that summarizes the top ten issues for workers compensation from a national perpective. It is an interesting read but workers compensation is very state specific. Colorado has its own sets of statutes, rules and cases that apply to workers compensation claims. Still some issues cut across all state laws. For instance medicare has certain aspects that can impact a claim. This is not state law but federal in scope and is meant to avoid passing the buck of future medical care for a work injury to medicare without considering medicare's interests. These national concepts and trends are important to stay informed about even if Colorado has its own laws. My experience over many years has been to observe the move away from disability to impairment as the single most important issue in workers comp. Impairment is a medical concept of damage which has been adopted in workers compensation and moved us away from the traditional concept of disability.

Everyone Seems to Benefit Except SS Recipients

2010-12-09T10:25:00.003-07:00

The tax cut extension certainly seems to be benefiting all Americans except those just drawing Social Security benefits. Those earning over $250,000 continue to receive a tax break estimated at a cost of $75 billion. But also the Social Security tax is reduced for one year from payroll deductions and this appears to cost about $120 billion. See this article at CNN Money. My concern is if that payroll deduction is made permanent it sets up Social Security to take the fall for being too costly so benefits need be cut. You take away the SS payroll collections and then blame it on Social Security itself! Additionally despite this enormous giveaway they then quietly killed any chance to help out those on Social Security with a one time $250 check to make up for two years of no cost of living increase. Cost for that? $14 billion. Reason given? It is too costly. Makes you wonder about our priorities.

Federal Subcommittee Examines State Workers Comp Systems

2010-11-30T15:55:00.010-07:00

On November 17th a congressional subcommittee looked into and expressed concern about state workers compensation systems. There was testimony taken and written statements provided which reflect what I see as legitimate concerns about many state systems. The link I have provided here takes you to the webpage and from there you can listen to and read much of what was provided. One concern was over the American Medical Association 6th edition for rating permanent impairment. Colorado still uses an older version. The 6th edition deviates from past editions in a significant way including what appears to be a lack of evidence based protocols. In any event more worrisome is the view that over the last 20 years benefits have been reduced and this may have increased other disability claims such as SSDI and SSI claims. What was historically intended to help injured workers in an efficient manner has, over time, become inadequate and not equitable. In Colorado you only have to look at the definition of permanent total disability to see how legislation has intentionally sought to cut benefits. At Colorado Revised Statutes 8-40-201(16.5) total disability is defined as being unable to earn any wages in any employment. Does this mean if you can only work a few hours for minimum wage you are not totally disabled? Insurers do so argue that very point and Colorado is tough compared even to Social Security disability. Harsh results? Often but insurers merely use existing Colorado law to keep benefits low. Other areas of controversy are pre-existing conditions or for that matter insurers questioning if work activities are responsible at all. In Colorado nearly 25% of workers comp claims are contested and never admitted without a hearing. Those interested can read the last published figures for the year 2005.

Impact on Disability Claims if the Retirement Age is Raised

2010-11-23T20:00:00.006-07:00

The Government Accounting Office has released a report on what I see as the impact on Social Security Disability if Retirement is raised. Let us say you can retire early at age 62 and reach full retirement age at 67. To save money some are proposing to raise the retirement age to retire early and for full retirement. One justification is people are living longer and can work longer. Another justification is an effort to reduce benefits perhaps even looking at dumping it at some point. Blaming Social Security is probably a mistake. It has stabilized or helped stabilize the elderly lifestyle and with medicare made sure they were medically insured. It needs improvement but from my own personal experience it helps the old and disabled to allow at least a modest but decent life. But what if they do tamper with it? This report raises the likelihood of increased disability claims. Perhaps it is wise to study all the ramifications of altering Social Security and not look for simplistic answers that some politicians promote. One man's agenda may be another man's loss. Do unto others may be the rule to abide by here.

Violent Threats to Social Security Judges

2010-11-14T21:07:00.004-07:00

It is being reported at The Huffington Post that the Association of Administrative Law Judges issued a release to the Associated Press that judges handling Social Security disability cases are facing an increasing number of violent threats from claimants angry over denials or delays. Historically in Colorado Springs it has been taking a year or so to obtain a hearing for most cases. Efforts are always being made to speed up the process but it is a national problem and in some places delays exceed a year. Video hearings are one way that judges can be utilized where they are most needed but the shear volume of cases is a factor. Also I have noticed that cases may have voluminous medical records or paperwork so even with modern technology it requires time to review. I would personally like to see vocational rehabilitation used to help those who really may have a disability but perhaps can work have a chance at staying productive. It could also help the judge should such rehab fail because it reveals the truth. Instead vocational experts are often called to the hearing to express opinions based on certain assumptions which may or may not reflect the truth. In any event angry people are a sign of the times but blaming judges and violence is not the answer.

Over 400 Pages of ALJ Orders

2010-11-06T09:24:00.006-06:00

Every now and then the Office of Administrative Courts posts the decisions made by the local ALJ's (Administrative Law Judges). The last month they posted this is for March 2010 but it remains interesting to browse and see what is happening out there. You can search in those decisions for a specific name or word that may be important so you do not have to scroll through hundreds of pages. What has been taken out are the names of the parties. When you read these decisions you can see the attention to detail and the complexity of the analysis. Attorneys also find them useful especially when they are asked to prepare a draft for the judge. Prior recent decisions may provide a starting point to work up the details of your case. Also doctors are often named in the decisions so you can search within those decisions for a doctor to see what he was involved in and how he helped or hurt a claimant's case. All these Orders are only at the first level so they are subject to appeal.

Some Question Proposed Social Security Mental Disability Rules

2010-11-01T20:23:00.004-06:00

Over at this website for the disabled they are saying the proposed Social Security rules regarding mental disability have a big problem. While some parts of the proposed rules are good there seems to be an effort to make automatic qualification based on meeting a mental listing tougher then the current mental listings. A Social Security listing is a means of obtaining a favorable decision based on specific factors that when they apply to a person result in automatic qualification for benefits. There are current physical and mental listings and this latest effort may mean certain standards or tests are created that are difficult to figure out. If so less will qualify under the listings. This action alert at the website calls for an effort to stop such a bad approach.

2010 Blog Award as Top 25 Workers Comp Blog

2010-11-01T13:48:00.003-06:00

For the third year we have been honored by LexisNexis for publishing this blog. For anyone wanting to see the list of all those honored click here. Some blogs, like this one are state specific while others touch on other matters. One blog deals with the weekly toll of deaths on the job. Still another addresses working immigrants. Workers Compensation is both a national and state matter. What makes it state specific is that each state has its own set of laws and rules so what applies in one state may not apply to another. Time limits to act are especially specific to state requirements. That is why trying to compare a work injury in Colorado with perhaps one in Kansas is a mistake.

Workers Comp Educational Conference

2010-10-23T21:03:00.003-06:00

The Colorado Division of Workers Compensation placed all of the written materials from its first annual educational conference online. You can access it here. The materials are fairly extensive and insightful. Be aware that some of the materials seem to be in outline form because these materials were handed out at an actual conference where the writer also lectured. The materials do presuppose some knowledge of workers compensation but I have to admit they are a valuable resource to anyone in this area. It helps to keep us up to date and to address areas where there may be questions.

High Heels = Work Injury and Discrimination Claim

2010-10-21T08:24:00.004-06:00

This case being reported by the American Lawyer and at Law.com is not a Colorado workers comp case. But what makes it interesting is the allegation that females at a law firm were required to wear high heels which then led to a workplace injury. Then the allegation is that no accomodation was made and there was reinjury and this went on until the lady lost her job. So the case goes beyond the routine work injury to result in an additional claim for discrimination. It is unusual enough that it seemed worthy to post here. High heels...work injury...seems like a blast from the past. In many Colorado law firms the dress is casual but even when it is not I am unaware of any required dress code that says you must wear high heels.

Annual Fall 2010 Workers Comp Seminar

2010-10-18T12:45:00.003-06:00

This is just to make you aware that Colorado has its annual fall update on workers compensation coming up soon. It is usually an excellent seminar and well worth it. It also provides attorneys with continuing legal education credits. Those who cannot attend can order the materials. Workers comp is quite technical in the sense it has a great many rules, cases, deadlines, forms, guidelines and much more. Staying on top of it is critical. Colorado has a rather large amount of available resources but it still requires being up to date. Aside from legislative changes there are cases and rules which may have been updated over the last year. The lecturers at this seminar are often quite good at presenting the materials in an interesting way. Those that attend also get a chance to interact with others in the field so the fall seminar is often the best one out there.

Medications Involved with Injury Claims

2010-10-13T11:09:00.002-06:00

Over at LexisNexis they posted about many of the common medications by name and generic version which are often prescribed for the injured. It is set up in a chart format but still you may need to scroll down as you look for the medication. It sometimes amazes me how many medications a person can be taking. Moreover those with Social Security disability claims can have multiple health problems. That can mean they may be taking a great many medications for pain, for the heart, for the stomach, for sleep, for anxiety, for diabetes and a host of other things. When I talk with people I must admit that some medications really do work. However it very much depends on the person. I can see the reason doctors have to try one thing and then another to see what works for you.

U.S. Supreme Court Audio Now in All Cases

2010-09-28T22:12:00.005-06:00

This is just plain interesting though not just for workers compensation or Social Security disability matters. The United States Supreme Court is opening up its website so that visitors can listen to audio recorded arguments for its cases. That is a big change as in the past it has greatly limited this to making such recordings available much later. So if you want to hear the lawyers arguing a recent case that is important to you then give it a try. By the way often we hear questions and concerns coming from the court itself so it is not boring at all if the subject is of interest. In Colorado we already have this and it is fascinating especially in a workers comp case. For example here is the Colorado Supreme Court site from which you can seek more information.

Misclassifying Employees as Independent Contractors

2010-09-27T08:14:00.003-06:00

The Denver Business Journal is reporting that the U.S. and Colorado are cracking down on businesses that misclassify employees as independent contractors. An independent contractor does not receive unemployment or workers compensation benefits. Most of us who represent claimants will question that an individual is an independent rather then an employee and it is wise to assume any claimant is an employee until the evidence is in. I would imagine that any government does not look with favor on those that try to avoid the requirements set by law. The definitions pertaining to what is an employee are at Colorado Revised Statutes 8-40-202.

Colorado Workplace Deaths in 2009 are lower

2010-09-23T09:41:00.003-06:00

The Denver Business Journal is reporting that Colorado had fewer workplace deaths in 2009. The last time we had so few deaths was in 1998. My concern is that these statistics tell us nothing about why this is the situation. Are we safer in the workplace? Is the economy, unemployment and loss of many jobs to overseas sources leaving us with less employees? The good news is that deaths are down. The actual records for Colorado with a breakdown are here. Just to compare here are the figures for 2007 and for 2005.

Pinnacol's Recap of 2010 Legislation

2010-09-13T07:36:00.002-06:00

Pinnacol at its website has neatly organized the 2010 legislation which it then reviews from its perspective. Included are links to each bill so you can read the bill itself. Pinnacol handles more workers comp claims then any other insurer in the state of Colorado. It certainly intends to be active in watching future legislative efforts and to be a voice for its point of view. The legislators noted are perhaps the most interested in fostering change in the system. How the political alignment changes after the coming elections may also affect future Colorado legislation in 2011. Injured workers are not as big or organized as business and insurance interests but should pay attention and support those legislators interested in change from their point of view.

Should you work while seeking Social Security Disability?

2010-08-31T22:05:00.003-06:00

At this posting by another blogger there is a discussion on working while you pursue Social Security disability. Those who do work must realize that their work efforts can mean a Judge at the appeal/hearing stage will deny the claim figuring you can work enough not to be disabled. So trying to just earn some money can be dangerous to your claim although it may also show you are doing the best you can and still cannot earn a substantial amount. Be aware that any claim in this area really is asserting you are entitled to total disability benefits so any work is carefully reviewed. In any event the topic is discussed in the link.

Partially Amputated Fingers are Stumps Court Says

2010-08-19T18:51:00.004-06:00

The Colorado Court of Appeals ruled in the Leffler case to uphold the decision to add $4800.00 for partial amputation of the index and middle finger. The claimant had this happen while involved with a sod harvesting machine. This added benefit decision was appealed by the insurer by asserting that benefit only applied to "stumps" and fingers are not "stumps". The case is a simple and quick read but it amazes me that the insurer appealed. The cost to appeal to the Court of Appeals is far more then $4800.00 since it goes from the deciding judge to the Industrial Claim Appeals Panel to the Court. Quite a bit of legal work is devoted to such an appeal. I am not saying the insurer did not have a right to address this issue in an appeal. But it seems impractical and going forward with an appeal to clear up what is a stump for all future cases seems a bit of a waste. After all how many such cases are there? I have always believed that extremity injuries to include hands and fingers can be devastating matters for some people. Imagine if you were a surgeon or piano player or even a carpenter. You can lose your trade and receive a low sum for the injury. So getting a few bucks such as was done in Leffler is better then nothing.

Social Security 75 Years Old: President's Address

2010-08-17T12:21:00.003-06:00

TLC Pharmacy

2010-08-06T14:11:00.004-06:00

There are times when some are poor or disabled with no way to obtain needed medications. In this article from the Gazette in Colorado Springs we see where there is one resource for those who cannot afford it and have no insurance coverage. Those involved with TLC Pharmacy deserve a great big thank you from all of us! In any event please be aware that they can be another source of help when insurers are playing the denial game or where there is no insurance coverage. A fair number of workers comp cases are contested and as such they are disputing that there is any insurance at all. Sometimes the claim never is allowed. At least there is one resource out there that may help with your medications.

Pinnacol CEO Interviewed

2010-08-03T20:57:00.002-06:00

A few weeks ago the Pinnacol CEO was interviewed. I just came across it and thought it would be interesting to see what he had to say. You can read what he said here. Pinnacol is still interested in what he calls "separation" from the state which to me still means autonomy. He points out that premiums for businesses have been reduced by 50% over the past 5 years. He also believes the economy is still not that great. Pinnacol tracks payrolls and they are not picking up. My impression and the statistics I've seen suggest that claims are down and have been declining for several years. In fact in my view it started even before the latest economic turndown. Are jobs being shipped overseas? What do you think? The problem this country may be facing is how do you remain a consumer when your income is down? But whether injured or unemployed we really should make a committment as a nation to retraining and vocational rehabilitation. If we are losing assembly line jobs we need to replace them with desk and tech and skilled trade jobs.

Social Security Disability Filing Online

2010-07-23T09:57:00.004-06:00

The traditional way to ask questions and also apply for Social Security disability benefits is to go down to a local SSA office. Any such filing is a bit time consuming as information needs to be supplied and the forms are somewhat complicated. Another option is to file the application online starting here. Be aware that it still takes a lot of your time and can be confusing. It also appears that one form has to be mailed in or dropped off at the agency office. I had one client file online but it was reported that it was not as easy as it might seem. My view is that you do so in person if you can. If not call them up or try the online approach. Any application takes time to process and that includes gathering up some if not all of your medical records. If you are denied be aware that such denials are common and you have the right to appeal provided you promptly act. By all means consult with an attorney especially if you've been denied as there can be many reasons for the denial that justify an appeal.

The New Surveillance

2010-07-15T12:50:00.009-06:00

Years ago I would tell claimants that they must be careful as they often are followed and videotaped. Often this is not just to find out if you are a faker. It may also show how functional you are compared to what a doctor may be saying. If you doctor says stay off your feet or don't lift more then 10 lbs and you are videotaped walking around for a prolonged time or lifting 20 lbs it hurts your case even if it were one time or after taking pain medication or whatever. Such surveillance does not show the details or that what you did may have exhausted you. It just shows you more functional then what your doctor may have said. I would tell them to follow your doctors restrictions or if you are really having problems to limit your activities at all times. No one is invisible when they go out in public or can be seen from a parked vehicle. Surveillance videos can be shown to a judge and to your doctor so be careful. Doing something one time just because you push through the pain or take something to help with pain is using poor judgement. Get help when you need it or as with shopping shop more often but never disregard your doctor or your own well being. Anyway those were simpler times and now we must all think about new ways to find out about you. Be aware that going online or posting information on Facebook or wherever can be located and often obtained as noted at this other blog. Your activities, your resume, your dreams, your abilities and your goals should be kept private during the workers compensation claim process. To me private means don't do it at all as thinking you can restrict access is foolish thinking. Further be extra careful with emails too. Those you think are your friends or co-workers can retain emails and they may in some way be used against you. Discussions about your health, your job, your claim and others related to any of that should be severely restricted and ideally eliminated during your claim. A failure to act wisely can mean losing your doctor even your attorney and perhaps your case. Surveillance nowadays is not to be taken lightly.
UPDATE Sep. 29, 2010: If anyone thinks that Facebook or other online social networks are not being noticed by attorneys and insurers please look at this detailed legal article that reviews the situation. Moreover investigators can have a motherload of information to use against claimants. Restricting access may not stop them. You may not even realize how it can be used but others know better. For example you go to a rock concert and post about it. It was fun; it lasted 2 hours and everyone was on their feet the entire time. But what did your doctor say? Did he restrict your standing? So now you are seen disregarding your doctor. My view...anyone with such an account should cease posting for the duration of your case or be at risk.

The Survey

2010-07-13T20:51:00.002-06:00

Insurers are now required to survey each claimant after the case is over as set forth in this rule just posted by the Division of Workers Compensation. This is then yearly reported by them. I wonder how many angry claimants will respond to the few questions posed to them. They relate to claimant satisfaction and this mandatory survey may reveal how many are dissatisfied. Many are not pleased by the process which originally was designed to promote the prompt and efficient delivery of benefits. Nowadays we have disputes all over the place which if not quickly resolved proceed to hearings and sometimes to appeals.

Settlement Documents

2010-07-11T15:05:00.003-06:00

This link to the Division website lets you take a look at the standardized workers compensation settlement agreements. These documents are uniform so the language is the same for just about everybody. That said there are ways to make some changes or attach other documents that may be side deals between the parties. If you've been provided documents and want to see if they conform or where they differ check it out.

Maximum Rates

2010-07-02T10:20:00.003-06:00

Workers Compensation benefits are all set by statute. Benefits are a form of insurance coverage for those who have been shown hurt at work. But like any insurance it does not pay unlimited benefits. Benefits are restricted by what we call caps and that means they are limited depending on the situation. Anyone's true losses and pain may be much higher but workers comp given it is insurance only covers what the state sets forth it will cover. Even then disputes are common especially over the severity of the injury and whether work activities caused or aggravated your condition. There may also be disputes on wage calculations, dates, doctors or medical care, job termination, and much more. One cap noted is on maximum rates. Each year this figure can change but what it means is that you can get less but never more then the cap if your wage exceeds $1216 a week (which can include certain other wage related benefits if applicable). Given this figure it means that the top amount of $810.67 is the maximum figure for temporary total disability (2/3rds of the $1216.00).

Legislative Advisory 2010

2010-06-24T07:28:00.003-06:00

The Colorado Division of Workers Compensation has posted a legislative advisory that briefly reviews the 2010 legislation that is applicable to workers compensation. While the legislative session is over the Division will proceed forward with rule making that may pertain to the recent legislation. Some of this recent legislation is significant. The advisory is just 6 pages so you can easily see for yourself.

Supreme Court reverses Court of Appeals in Ruff

2010-06-22T12:36:00.007-06:00

Yesterday the Colorado Supreme Court issued a decision in the Ruff case. The issue posed to the court and at the original hearing was over a possible conflict of interest in a Division Independent Medical Examination (DIME). The claimant argued that the physician had at least the appearance of a conflict of interest so how can the exam be fair and impartial. In the case the physician selected had received some $600 a month from Pinnacol (the insurer in the case) for being an advisor and also was in Selectnet the Pinnacol endorsed medical group. So it was argued that it was inappropriate and should have led to a disqualification of the physician. The ALJ (Administrative Law Judge) decided it was not a conflict and the Court of Appeals decided it might require more review by the ALJ. The Supreme Court decided the Court of Appeals went too far and that there was no conflict on the facts of the case. Merely receiving some money and being in Selectnet was not enough to establish the sort of conflict of interest to disqualify the doctor. The dissent noted that in Selectnet the physician received 25% of his income and since this might raise questions about impartiality that the Court of Appeals should have been affirmed. There really was no evidence that the doctor was not professional and objective but his status as a Pinnacol advisor and being in Selectnet seemed to raise a question about his objectivity.

SB 10-187 Impacts Claims on or after July 1, 2010

2010-06-15T18:30:00.004-06:00

In Senate Bill 10-187 Colorado is making some significant changes in workers compensation claims. For a complete reading just look at the bill but here are the highlights as I see them (effective only for injuries on or after July 1, 2010):

1. If the claimant has to seek a hearing to continue to obtain maintenance medical care then should the other side give in within 20 days from the hearing the claimant can seek his costs to support his effort to continue maintenance care. I see this as trying to stop the other side from objecting to care and forcing the claimant at some expense to try prove his ongoing entitlement but then backing off.
2. Two matters pertain to calculating average weekly wage. One, stops the effort to not count the claimants cost of converting from employer health coverage when he gets medicaid or indigent medical care. A recent case said do not add or adjust for a claimants cost of health insurance when he gets indigent care for free. My view is that the employer health benefit was worth something and should be a wage benefit that is counted in calculating your wage. Second, any wage calculation is to be based on your accident date or based on a judge using his discretion to figure what is appropriate. To me this just codifies what is the law today anyway.
3. Permanent partial disability benefits are no longer to be reduced if you receive Social Security benefits or an employer financed pension/disability plan. I recall one case where the fellow had a reduction of his benefits to zero because of the statutory offset which is corrected by this bill. However these offsets do apply to other benefits such as permanent total disability.
4. A modified job offer may be refused under some circumstances and not result in job termination and asserting the claimant by refusing was responsible for his own termination so his temporary benefits should stop. Personally I wish they had simply repealed the existing law on this which triggers much litigation. In the old days if you were fired when disabled you were often not cut off your temporary benefits as you were still disabled and other work was not that simple to obtain.
5. The caps or limits of top dollar compensation are to be adjusted each year for any claim for injury on or after Jan. 1. 2012.
6. Lastly it is said that there is no waiver of your right to pursue permanent total disability by seeking a lump sum of all the admitted permanent benefits.
Every point raised in the new law was important to correct problems or other interpretations of the law. I'd encourage all to look at the bill as this just represents my simplified take on it.

The Franz Case

2010-06-08T09:22:00.005-06:00

The Franz case was decided on May 13, 2010 by the Court of Appeals. It concerns utilization review which is a process to review a treating physician. It can lead to the replacement of that physician or other consequences that directly impact a claimant. In this case the claimant addressed two points both of which were shot down by the court yet both have some logic to them. First he said the process violated his right to due process because he had no opportunity to discover and present evidence. Second he asserts a potential conflict of interest argument which was not permitted in the process. The court essentially said that there was no violation of Rule 10 which governs the process. The claimant had no right to assert a due process argument since it did not affect a property interest as only retroactive denial of treatment or benefits allows for such a due process argument said the court. It also said the rule was not violated as there was no conflict of interest as defined by the rule. Essentially the claimant could not explore and discover nor could he present evidence on any conflict of interest. In this case the claimant believed there was an inherent conflict because the committee members are closely involved with the insurer and SelectNet a provider organization. This case is disturbing as it deprives the claimant, in the end, of his doctor and he sought review by an ALJ who said he had not overcome the decision by clear and convincing evidence. Let's see now...if you stop the claimant from presenting evidence in the UR proceeding and prevent discovery exactly how can he even try to overcome the decision by clear and convincing evidence? So here Pinnacol was the insurer and it sought to replace the physician and the UR committee involved members of SelectNet which Pinnacol has a pretty cozy relationship with and sure enough they recommend to replace the treating physician for the claimant. Does it seem fundamentally fair? Not to me but the case really narrowly defines due process and the Rule in this matter at least in my opinion.

Pinnacol Bonuses and Travel audited

2010-06-07T14:03:00.003-06:00

The Denver Post is indicating that Pinnacol was audited by the state in this article. Pinnacol Assurance is the state's largest workers compensation insurer and has been in the news often in the last year. The criticism is that Pinnacol pays higher then average bonuses and its travel benefits were also high. Of course Pinnacol is not completely public and operates also as a private insurer so it is a hybrid. In any event the criticism continues though it is nothing like the Wall Street bonuses we have read about. Pinnacol seems to be doing pretty well though the state and many others are dealing with the recession. Some would say it is at the expense of claimants and business owners. Others would say it is just doing a good job. This story is being reported everywhere. It is on Channel 7 News. At the Denver Business Journal it is reported with the attached audit should you wish to read the details.

Supreme Court issues decision on AWW

2010-06-01T11:39:00.010-06:00

In the Simpson/Bennett cases the Colorado Supreme Court reversed the Court of Appeals to the extent it used the concept of date of disablement to determine a claimant's average weekly wage or AWW by applying a higher maximum rate in effect years later. The wage calculation can be a very important figure that is used to pay out benefits. The higher the calculation the higher the benefits may be. The case reviews the two ways a judge can determine AWW. One way is the statutory way which can involve computing your wage as of the date of injury. Another allows a judge to use his discretion when another way would be more appropriate. For the last year we also dealt with the concept of date of disablement which suggests another approach. Actually most of us in the field realized that the date of disablement concept is unnecessary anyway in most cases. The discretion given a judge is enough to afford him the ability to figure an appropriate wage if he exercises that discretion. Usually your wage at time of injury includes tips and overtime, perhaps room and board and perhaps even the cost of health insurance if it was paid in part by your employer and can be cancelled. Using some other concept seemed to be somewhat confusing but it came because of a prior Supreme Court case called Avalanche. Now the court simply corrected itself although the rest of that prior case still holds that wage calculations may include a subsequent wage if the judge in exercising his discretion decides it is appropriate.

Memorial Day...for our heroes thank you!

2010-05-31T17:18:00.002-06:00

So many of us owe so much to those who served and stood up for this country. Today is special as we pause to thank them and celebrate their efforts. From the Revolutionary War where heroes starved and froze at Valley Forge to every war and action since where they dared to go to protect our country we honor them today. They were and still are placed at risk for all of us. To those who served and stayed true to the spirit of this country we cannot forget the effort they made was to be there for every American. One reported story seemed a special one to me of a good man who served his country at war and at peace. Now he rests at Arlington in a simple grave that only shows him as a soldier. May we all be inspired to do what is right not just what is popular.

Workers Comp Penalties are Increased

2010-05-28T08:01:00.004-06:00

One statutory change that was signed as law by the governor pertains to penalties. The maximum penalty for a violation of a workers comp law/order is now $1000.00 a day although it can be apportioned or split with half or more to the party and the rest to a fund. Any penalty remains in the discretion of the judge. I would prefer that penalties be imposed more often in workers compensation proceedings where benefits are withheld. I would also prefer that they have some teeth rather then be a minimal amount. If a penalty is meant to punish or teach a lesson it fails to do that if the time and expense of proceeding makes it not wise to proceed. The victim if you will should not be the one punished. That just fails to enforce the intent of the provision. In any event the legislature is increasing the amount that can be imposed as a penalty.

Pinnacol Again in the news...for golf getaway.

2010-05-25T18:17:00.005-06:00

The Denver Post is reporting that Pinnacol Board members were at a Pebble Beach golf resort where a round is $500 and the room rate starts at nearly $700 a night. Pinnacol is partly private and partly public. They are the largest workers compensation insurer in Colorado. Looks like the media is investigating the expenses of the trip and Pinnacol is asserting its records are confidential business documents. Pinnacol has been a state agency/political subdivision since 1915 but has been given more autonomy over the years. It has sought even more independence but is also under some scrutiny. This latest news is certainly keeping them in the public eye. Pinnacol can surveil injured workers. Looks like the shoe is on the other foot right now. The comments following the news article are also interesting.
UPDATE: This is an interesting read but mostly focuses on Pinnacol must change its ways.

Brochure Now Required in all Workers Comp cases

2010-05-20T21:06:00.003-06:00

A new Colorado statute has addressed a disclosure brochure to be provided to all claimants. It is a very concise disclosure on the subject of workers compensation. Seems like an advisory of the claim process and your rights as a claimant. That claim process is indeed quite complicated and the "brochure" seems designed to provide basic information and is required to be provided to you. No amount of disclosures will ever simplify the process but it does give the claimant a heads up on it. The problem with information is not that it is bad but that it can be incomplete. In workers compensation it is not possible to be completely accurate on all matters at all times. There are simply too many cases, too many rules, too many statutes and much more. For example there are tips for physicians and AMA Guides that are outdated but part of the workers comp process. Then as laws change you may come under old law or the new law or both. As recently as in the Nelson case we can see the clash of the old and new. Looking at the brochure I can say it is also not entirely accurate. One example is that it says an Admission will contain your wage but that is not always accurate. My office received a recently filed Admission without any wage figure. The point is this new Brochure can be helpful but also use your common sense and when possible obtain legal representation.

Update on the Status of Colorado Bills

2010-05-17T07:56:00.003-06:00

Here is a link to a summary on the status of the various bills which may impact Colorado workers compensation matters. I'll comment in a later post on some of these but for the time being the link really does a very good job of giving us a heads up on the proposed bills some of which have passed and been signed by the governor. It appears for this year the legislative activity is just about over but it may take a several more days to see what is passed and signed by the governor.

Supreme Court Affirms the Nelson case

2010-05-10T21:25:00.004-06:00

The Colorado Supreme Court affirmed the Court of Appeals decision in the Nelson case. In Nelson the claimant had obtained an advance lump sum of future permanent total benefits and years later sought another advance. The problem posed by the case is that the claimant had exhausted the advance amount earlier and only sought the new advance when the law was changed. The original statutory top dollar advance was $26292 and the statute was changed to allow a $60000 advance. Is the insurer liable for this higher advance when it was not the law back when the claimant was injured? The Supreme Court said yes it was. This decision was not unanimous and 3 judges dissented. But the majority controls. Both sides recognized that the law was not to be applied retroactively but the majority indicated that the law change was procedural so it would apply to anyone applying for a lump sum as of today. Procedural laws are not really changing rights or liabilities as compared to laws which are substantive changes in rights or liabilities. A substantive law change cannot be imposed on the parties covered by an older law. For example if the benefits were increased by a statutory change to 100% wage loss it could not be imposed on the parties later on. The higher wage would be a substantive change. So in this case it seems the majority and dissenters disagreed on whether the law change was procedural or substantive. The majority felt the advance was not extra compensation and the dissent seems to view it as giving the claimant a higher benefit because he receives value sooner then spread out over his lifetime. Mathematically when we do present value analysis there is no real difference. Of course people can die young or outlive expectations so either side may have the advantage here and now we come to another point I have not heard recently. The court said that the law should be liberally construed in favor of the injured worker so it did not split hairs here and ruled in favor of the claimant getting another advance. I posted on the Court of Appeals decision earlier.

Notices of Rulemaking

2010-05-07T09:04:00.005-06:00

Based on statutory changes and a need to make rules to comply with law changes the Colorado Division of Workers Compensation is moving forward with proposed new rules in certain areas. The Division lets us know ahead of time what is coming up to consider and this can be viewed here. One proposed change which will likely be approved is a new and more current life expectancy table. Such a table is primarily used in the computations for permanent total disability. Those benefits are paid out every other week and when we try to settle them we have to mathematically estimate the present value of those checks allowing for inflation and other factors. It is a bit like a home mortgage in that the cash price for the house is one figure and the monthly mortgage over many years adds up to a much higher number. Life expectancy is plugged into the math calculations to help compute the cash or present value of your biweekly checks. The longer you are figured to live the higher the cash value. The table now in use has not been updated in years. I took a quick look at the new proposed table. In one example the table changes the expectancy from 23.1 to 27 for a 58 year old. The other proposed rules concern surveys of claimants and insurance IME matters.

Colorado Labor Department on Twitter

2010-04-30T08:51:00.003-06:00

Colorado presses on into the 21st Century! They twitter...or is it tweat? In any event these are short comments which you can access or have sent to you. The subjects vary a great deal but can include workers compensation, unemployment or other areas within the purview of the Colorado Department of Labor. My view is more is better then less...I recall the days when obtaining information was not so easy. Now we can do our legal research online. In the old days legal research was very time consuming and meant handling many big law books. You then copied pages by taking the book to the copier and page by page making a copy of a case. Now I can be on a laptop and directing a wireless printer to copy the case. With the development of the computer age we have seen an enormous increase in knowledge and efficiency even if at times we are all frustrated by technology. Just some 30 years ago we were in its infancy. In any event Colorado is active on the internet. It is making available many resources for all of us.

ICAP says no wage adjustment in Whalen case

2010-04-20T21:02:00.008-06:00

In Whalen the claimant appealed a decision by the hearing judge not to make any adjustment in the wage calculations when the claimant lost his employer health coverage and went on medicaid. Normally when you have health coverage through your employer then the cost of obtaining similar coverage is added into the wage calculations. This often results in higher temporary and permanent benefits. In a sense being provided health coverage by your employer is a wage benefit so losing it should mean an adjustment must be made. But in this case ICAP (the Industrial Claim Appeals Panel) decided the appeal against the claimant. ICAP reviewed the law and decided that medicaid was an equivalent insurance and since it was at no cost to the claimant then nothing gets added into the wage calculations. There was a dissent so perhaps this case will be appealed to a higher court. ICAP did reason that since medicare was an equivalent health insurance (based on an older case) then medicaid was also. The problem for me is that medicaid is provided at no cost to the poor. So a claimant with an employer health insurance who loses it and then cannot afford anything turns to medicaid. He may be on medicaid for only a short period yet this case says the fact it is free means no added benefit for the loss of the employer health insurance. His inability to purchase health coverage is then used against him. The statute on wages is at 8-40-201(19). In 2006 the Colorado Supreme Court decided in the Ray case that you add the cost to purchase health coverage to the wage figures and if the claimant cannot or does not actually purchase it then it is still added. Medicaid is a non-purchase matter and it would be interesting to see what a higher court would decide.
Pending legislation also may change this. SB 10-187.

Humphrey...a case on what is a statutory employer

2010-04-12T08:29:00.006-06:00

On April 1, 2010 the Colorado Court of Appeals decided the Humphrey case. It addressed the question of what is a statutory employer. An important purpose of a statutory employer is to impose responsibility often on the general contractor when a worker for a subcontractor is injured but that subcontractor has no workers compensation insurance. By statute the coverage is then to go through the general contractors insurance because it is deemed by statute the employer. But another impact of this is to prevent any further claims against the general contractor outside of workers compensation. So when the subcontactor does have workers comp and the employee does receive benefits but thinks there was negligence by the general and he tries to sue in a civil proceeding the general can assert it was a statutory employer and can't be sued even if it was negligent. In Humphrey a delivery person for Phil's burritos was hurt while in Whole Foods delivering and stocking Phil's burritos. He received workers compensation through Phil but then sued Whole Foods asserting they were negligent. Whole Foods said it was a statutory employer and can't be sued given he had workers compensation coverage. The court agreed. In a basic sense it is important to be aware that workers compensation law is set up to prevent an injured worker from suing his employer and yet also receiving workers compensation coverage. It is often considered to be an exclusive remedy. Clearly what is a statutory employer can turn on the facts. In Humphrey the court felt the delivery person was stocking and removing outdated burritos from Whole Foods shelves and active enough such that Whole Foods was a statutory employer. In any event it makes for interesting reading.

Work Injury Statistics in the USA

2010-04-11T10:34:00.010-06:00

I have not yet found any statistics for last year but for prior years there are statistics on work injuries available at the national level. You can check it out at this link. I am not sure why Colorado only reports on fatal injuries to the US Bureau of Labor Statistics but the overall statistics show that for 2008 there were work injuries in 3.9% of the working population. This has been trending down over the last several years. Of those injuries about one-third or so result in time lost from work. Are these statistics accurate? I suspect it is much like auto accidents...only some are reported. Colorado has its last reported year as 2005 and is based on the actual filings of claims. In 2005 there were some 29000 lost time claims in Colorado. Does the poor economy affect anything? Probably so since the unemployed never have work injuries.

No Deal for Pinnacol This Year

2010-03-30T19:49:00.004-06:00

The Denver Post is reporting that there will be no deal for Pinnacol this year. I've posted on Pinnacol numerous times here and more recently Pinnacol was trying to put together a deal for greater autonomy from state control. Pinnacol was originally set up by the state to help Colorado businesses obtain decent workers compensation coverage. Over the years it has worked itself into a major force in the workers compensation market. It handles the biggest share of work injury claims in this state. Given its size and revenues the state sought to obtain income to help with the state budget and also had increased interest in Pinnacol. In any event Pinnacol and the state ended any effort this year to work something out. Pinnacol wanted to pay for greater autonomy and that is out for now. I expect more on this next year. The story does not impact claimants except that some legislators have been unhappy with what they perceive is Pinnacol's power and unfair treatment of claimants. It can lead to law changes that benefit all claimants.
Update: View a more detailed story on this here.