Thursday, May 31, 2007

SB07-258 signed today by Colorado Governor

This bill pertains to many different workers comp matters which needed adjusting. For example for many years the most you could "lump sum" was $37500 but this is increased to $60000. Let's say the insurer admits for your permanent impairment that it owes you $70000 (with a serious back injury and decent pay rate this can happen). Under the old law you could take an advance of $37500 and the rest was paid out biweekly till exhausted. Now you can lump sum up to $60000 of the awarded benefits. Another provision spruces up some procedural matters and requires for example that all relevant medical and expert records be exchanged with the other side at least 20 days prior to the hearing date. I saw 10 or more law changes in this just passed bill but most make sense to me. One I do question is that a hearing can be postponed or extended but some may only be for 20 days and I doubt this is workable in my locale but guess we'll see how it goes. The bill has too many details to review here but here is a link to it:

Tuesday, May 29, 2007

Updates on Holnam and Sigala cases

Back on Dec 28, 2006 I commented on two cases decided at the Colorado Court of Appeals. The first was Sigala and involved a decision that if your temporary benefits are suspended for not making a doctors appointment sent to you by certified mail (by special rule) that suspended means terminated even if later you do see the doctor. So if you were foolish and missed a specially arranged medical appointment and later make it up you still lost some of your temporary benefits. This issue has been granted review today by the Colorado Supreme Court. The court wants to hear from each side on what the word "suspension" is supposed to mean. The second case, Holnam involved trying to have two hearings on compensability using two different theories to obtain coverage for a claimant (one theory was accident and the second was occupational disease). On Holnam further review was denied by the Supreme Court and the claimant lost his case to show it was an on the job injury. As is clear from these two examples caselaw in workers compensation matters is happening on a regular basis. Nothing simple about this field as often the arguments pertain to highly technical matters.

By the way as always my comments are simply my opinions and for simplicity sake I do tend to abbreviate the details. Otherwise you'd have boring and long winded materials on this blog. For the most accurate details you can read the actual case, statute or rule or review further with your attorney.

Sunday, May 27, 2007

Medical Ops Investigation Considered

As reported by Channel 7 Denver someone in the company called Medical Ops Management may be investigated after allegations that he was altering reports and pressuring doctors to issue Independent Medical Examinations favorable to the insurance. In Colorado workers comp this company has been frequently used by insurers who wish to have the claimant examined for a medical opinion. It is also reported to be used in Social Security cases. In other words the doctor may have dictated but not signed off on the report and it was then altered. Many claimants were sent to a doctor going through Medical Ops Management...and this raises many questions about the accuracy of many medical reports. Since this can affect medical and even money compensation it is a disturbing story. Here is the most recent link:

Here is the earlier story which is quite disturbing in its allegations:

Sunday, May 13, 2007

What is sedentary or light work?

Whether in workers comp or Social Security disability we often come across the term sedentary or light duty. For example it is common for someone with a back injury to be at light duty levels or have even more restrictions so he is at sedentary levels. The importance (in a legal sense) to this is that it can relate to how employable a person really is and the answer to this can greatly affect his or her benefits. Especially in Social Security cases age and restrictions play a major role in qualifying for benefits. In workers compensation cases they are also significant although it is more complicated since they play a role with temporary and permanent benefits but impairment ratings may also be significant. Strictly from a safety standpoint I've always felt that obtaining restrictions lets you and possible employers know what is the extent of safe phyiscal activity. In any event here is a link to a "disability doc" who sets forth the accepted definitions of sedentary, light, medium and beyond levels of activities:

Monday, May 07, 2007

The Fera case decided May 3, 2007

This case involved a denial of preauthorization by the insurer. Typically when something like surgery is needed the doctor seeks to have the surgery preauthorized so it will be paid. Here that was sought and the insurer denied it. The claimant sought penalties but the insurer said it had promptly run the need for surgery by a physician and he said it was not needed so they could deny it. The claimant however had other physicians who said it was needed so he felt the denial was unreasonable. The case went against the claimant at the lower levels as it seemed the insurer had acted promptly and had a basis for denial so the effort to seek penalties was struck down. However at the Court of Appeals level it was decided that merely acting promptly and having one physician advise them the surgery was not needed may not be reasonable given all the evidence and it should go to a hearing not be struck down by summary judgement. Here is the link to the decision: