Colorado General Assembly

Ever want to check on bills being passed or that are pending at the Colorado legislature? It is important if you have any interest in changing the law that you be active or at least educated about bills that seek to become new laws. Here is a site to visit that can tell you about current bills. For example plug into the site HB 1407 and see what comes up. This is a bill just recently filed to take it to insurance companies that unreasonably deny benefits. Will it pass? Well the insurance lobby spends much to prevent such bills from passing. They may advertise that it will be disastrous for Colorado. You have heard such ads before when they proclaim businesses and the taxpayer will be hurt and costs will rise if this bill or that bill passes etc. etc. etc. I just think we need to look at the bigger picture and do the right thing. I also know that public relations campaigns may or may not be truthful. It seems nowadays that negative campaigning is the way to go...not just in elections but with anything you want to stop in its tracks. Anyway here is the link to the Colorado General Assembly.

TV Advertising lawyer sued.

Today the local newspaper for Colorado Springs indicated that a Colorado attorney is being sued. He touts himself and the firm as the "Strong Arm". He does what I consider massive advertising. This is bound to lead to many cases and some are upset with the results obtained by him. Of course no one can guarantee results and such advertising is expensive. But it does mean a very heavy caseload is likely. Also it can be suggestive of a settlement mill where cases are moved along and settled fast. The article reports the cost of the ads exceeds $100000 a month. That expense and the overall expense of more then one office and staff does complicate a practice. My preference is a one on one practice where each case is handled thoroughly and the goal is to protect and maximize benefits. It is personal and labor intensive. I do see where that effort can be compromised if you have too many cases or too much overhead to feed. In any event a lawsuit is just a claim and we'll have to see what comes of it. My concern is not that there is heavy TV advertising. That is one way to get your name out there. My concern is with the content of some of the ads. In 15 or 30 seconds the lawyer may be made out to be a legal magician. And that is pure fantasy. Anyway here is the article.

The Safeway Mileage Case decided today

Today the Colorado Court of Appeals decided a case in which Safeway appealed. They wanted to limit the mileage benefits owed to a claimant. It seems this claimant waited 3 years to submit to be reimbursed on her mileage to doctor appointments and the like. She submitted for over 5000 miles and Safeway disputed it. Safeway lost the appeal. Safeway said the claimant was limited to seeking reimbursement to 120 days of mileage not three years. If you looked at just 120 days the claimant would have received far less of a reimbursement. The Safeway theory was a technical one. They decided to assert the claimant was a "provider." All providers of services have to comply with the 120 day rule. So how could the claimant be a provider? They reasoned that since the claimant was driving herself to medical appointments she was providing the service to herself! The court disagreed with Safeway and ordered them to reimburse the claimant for the full 3 years. View the case here.

September 11th Responders still hurting

Here is a link to a recent article that tells us that many who responded with courage and dedication have not been compensated for efforts once they developed health problems. Many such problems seem related to their work and rescue activities at the 9-11 site in NYC. I expect it is relatively simple to defend claims made because the medical evidence can be subject to different interpretations. We all assume that injuries and disabilities will be taken care of but many cases are contested. The contest is often because insurers can question the cause of the injury or disability. Yet it is a shame when we see this happen to those who were involved with 9-11 efforts at the site of an American Tragedy. Click here for the article.

Customer Service in Workers Comp

In Colorado they have developed a customer service section at the state Division of Workers Compensation. They are there to help to the extent they can in some basic areas though of course they do not go to hearings or otherwise perform legal duties. In some cases the claimant cannot find an attorney or feels they do not need one and at least the customer service people try to help out. But the statistics maintained by the state also seem to tell us that claims or inquiries about claims in workers comp are down. Despite increases in population the customer service stats say that less people are calling them or dropping by. In 1997-8 there were over 83000 calls/drop ins at the office yet by 2005-6 the number had dropped to some 58000. As I noted back in July 2007 the number of hearings also went down. Why? Are there less workers in Colorado? Nope. My view is that we have to conclude that either less people are getting hurt or that more claims are not being prosecuted or pushed as hard as they could be. I do know that in the old days you'd almost always be able to find an attorney to take your case but that is changing. In any event if you wish to contact customer service click here for the number.

Injured Workers Bill of Rights

At another website they have posted the Injured Workers Bill of Rights. This is not Colorado law but perhaps should be. What concerns me is that the injured and disabled are not afforded fair benefits and treatment. What is provided is limited. For example the law has offsets so that if you are totally disabled you are not going to get a full workers comp check and a full Social Security disability check even if you are totally unable to work. The theory is why should you get double benefits. Therefore the state says there is an offset. You get one benefit check in full but the other is lowered. In Colorado you would have your ongoing workers comp checks reduced by one-half of your initial Social Security check. Is that really fair? If you had two life insurance policies is one reduced because you get the other? Plus once you can no longer work you lose the capacity to grow your income and receive other benefits of employment (such as stock options, retirement plans, medical insurance). Once you are totally disabled you are stuck in a rut. It is good to have the benefits but you receive fixed amounts although Social Security has a small cost of living increase. If the injured worker were getting a windfall I'd agree with offsets but that is not the case. Plus workers comp is capped meaning your checks have a dollar limit even if you made a very high wage. Sorry but I feel the truly disabled deserve full benefits. What I've commented on here is in there (Right 12). Maybe its too idealistic but it asks of us...do we care about people or profits? Review the Bill of Rights by clicking here.

Tackling Colorado Health Insurance Rates

This is a bit off topic but it relates to a health issue just as workers comp and Social Security disability also have health issues. Rep. Carroll who I earlier posted on is active in trying to stem the uncontrolled hikes in health insurance rates. Personally I have come around to believe in a National Health policy. I just do not believe that our medical care should be in the hands of for profit companies. It forces conflict and waste. It should be paid for but under some universal system. In Colorado we are actually healthier then the national average and spend less then average on health care yet we are 7th highest in insurance rates. Rep. Carroll is introducing a bill to regulate this and not simply allow unlimited rate increases without going through the insurance commissioner. While I believe in free enterprise health like utilities or fire protection is too big a social concern to be left to profit making companies. The social compact we have as a country needs free enterprise but when it simply can't work and harms the country we need a different approach. Police, fire, the military and other safety minded agencies (FTC, FDA, SEC, the Fed etc.) exist because without them life would degenerate to survival of the fittest, wealthiest and most powerful. For now any approach to regulate health insurance is better than none so I support it. Intense lobbying will happen to kill this so watch for the insurance companies to try overwhelm us with fear ads as we get closer to a vote. For more information on this bill click here.

Colorado Labor Market Services

Anyone hurt on the job or just with many health problems often is faced with worries. Aside from workers compensation or Social Security disability they often have to deal with seeking work or changing occupations. I have already provided an earlier link to the Colorado Division of Vocational Rehabilitation. If you cannot return to your job most know they may be eligible for unemployment benefits after they reach maximum medical improvement (but don't delay on this and get going within 30 days). Yep...if you were laid off and received workers comp benefits you may still get unemployment afterwards if you act promptly. But aside from this many seem at a loss as to what to do besides just find work on their own. Well here is a link to the state site that may interest you. It even has career services information. Click here to go there and then look around there for helpful information. Apparently they let you know what is available in your areas of interest. They even have where you can try to figure out what are your career interests. Anyone losing a trade or job due to injury or health may want to see what else might look worthwhile. Explore the site. I noticed even the listing specific available jobs. Check it out.

Claimant Fraud or How Not to Be Well Heeled

The typical claimant on workers comp seeks to maximize his benefits. There is no reason to not receive all available benefits. However in this link we have a claimant in Connecticut that went beyond that. Insurers love to use such stories of fraud to justify tightening up on workers comp rules and laws. Such instances of fraud then can hurt the average claimant. By and large most claimants just want to get treated and back to work if at all possible. But at times someone decides to be false and deceptive. Not only can that be criminal it also affects all the other claimants. It can result in insurance adjustors and employers thinking all claims are suspect. By the way the instances of employer wrongdoing are actually more common. Many times employees with legitimate claims are treated poorly by their employer. Claimants are fired or demoted or ostracized. To save a few bucks I've seen employers put claimants back to work reading the phone book just to have them collecting regular pay rather then workers comp. In any event all claimants should know they are not invisible and surveillance is common. Check out the Connecticut story here.

Idaho is Number 1!

Here is a link to another site that makes us aware that Idaho is the fastest in the country in processing Social Security claims. They are weeks faster then the average plus they handle more cases per day then average. So in terms of efficiency they beat the rest. However it does make you wonder if they can be speedier and handle more cases why cannot the other states learn from them to improve their time/efficiency? The delays in any claim for Social Security disability are well known but it is always sad to see deserving people wait. Anyway here is the link.

Three Choices

Many times there is a point where a claimant has 3 choices to choose from in a case. He is faced with a Final Admission after treatment where he is likely rated by the treating doctor as to his impairment. He is given a 30 day deadline to act. His choices are to accept the Final Admission filed by the insurer or to seek a DIME (Division Independent Medical Exam) or to try to settle out without a DIME. He's on a deadline so it can be a tough choice to make. Questions to consider include are you at MMI (maximum medical improvement)? At times treatment ends too soon and more can be done. Another consideration is the rating. Is it too low or high enough to worry that if you go for a DIME will that doctor lower the rating? Yes that can happen when you open the door to a medical review of the treating doctors rating. What about future care such as ongoing medications? Is that allowed for or is it less then expected or desired? What about your restrictions? Can you barely lift a gallon of water yet the doctor said you can lift 20 pounds? Some decisions are easy. If the treating doctor releases you without impairment or anything further and returns you to full duty and you disagree that choice is easy. You go for a DIME (after objecting to the Final Admission which the insurer rushed to you). Each case is different but the statistics seem to show that many try for a DIME. This occurs because the treating doctor who was handpicked by your employer may be less favorable to you. But if the rating is high enough then we have a tougher decision to make. Each of the three choices comes with a negative. If you go for a DIME the new opinion may lower the rating or agree with the treating doctor or alter something else like your maintenance care. If you accept the Final Admission then your case closes based on that Final Admission (read it carefully because it is what is in writing that counts not what the adjustor tells you). You do keep your right to petition to reopen for a while (6 years from date of injury or 2 years from date of last money payable) but that does not mean if you worsen you can reopen the claim easily. It can take a battle. Insurers often question reopening especially when a new job or event has aggravated it. You can just try to settle it all out but that means closure forever in most cases. So you may get extra dollars but don't plan to be able to return for care if you get worse or if it turns out you cannot work at all. Again for most cases the choice is to go for a DIME but each choice has consequences so in some ways it is a choice between evils. We all want open medical benefits and high compensation but seldom is that provided. Lastly each person has personal factors to consider. Some can be ready to work and just want it over with. Others may have lost their trade and need to maximize benefits. Still others really feel they need more treatment. Tough choices and asking others for advice can be tricky. Only your lawyer knows the current state of the law. He also knows the doctors involved whichever way you go. Beyond that you may have to consider if you are permanently and totally disabled and this enters into any review of the choices. The point is that it is never a simple matter and each case is unique so take the time to think it through with your lawyers help. Going it alone is seldom wise as the decision you make you will carry with you the rest of your life.

Odds When You Appeal in Workers Comp

Here is a statistic mentioned at a recent seminar I attended. Going back over ten years anyone who appeals a workers comp decision only has a 17% chance of any success. The odds are very much against you although some appeals are easy to decide against the appealing party. If you are untimely in an appeal it gets dismissed. If you missed a deadline that can mean a dismissal. If you simply disagree with the Judge's weighing of the evidence the odds are a fairly clear your appeal will be dismissed. But it is still sad that so many appeals are a waste of time. Of course we are talking about the rate of dismissals at the next level up from the hearing judge. That level is called ICAP which stands for the Industrial Claim Appeals Panel. Beyond that level is the Court of Appeals and then the Colorado Supreme Court for a few cases. You can lose at the hearing, at the first appeal, at the Court of Appeals and then win at the Supreme Court. So odds mean little if you have a good argument with a solid legal basis. The problem is that few losing cases are that solid and most appeals simply result in a dead end. Being upset at the hearing judge is not enough to appeal...it takes a solid legal argument. So if you are convinced you are right and appeal be aware that 83% of the time appeals are lost at the ICAP level.

Randy Golob and Social Security

I saw this clip on another website but it is about a local (Pueblo) man and how he waits for benefits. It ran on KOAA television. Click right here.

What is appealable? Recent Case

We all believe in the right to appeal. It applies to both sides and until we have an infallible local Judge the right to appeal permits us to point out legal errors the Judge made. Appeals, when we do not like the Judge's weighing the evidence are often foolish. The local Judge is the fact finder and higher courts seldom reverse the choices made on the evidence by the Judge. In other words you do not have the right to ask the higher court to try the case all over again. Instead appeals usually involve an assertion the Judge made a legal error that warrants reversal or another hearing. In the case decided today at the Court of Appeals the court pointed out that you cannot appeal a workers comp case when it is not timely. I am posting the decision here as an example of how complicated the workers comp system can be. If you read it you quickly realize that the decision may be proper but it may seem bewildering to the average person. Here the insurer lost the appeal but it also involved a complicated review by the Court of Appeals. It makes you want to say...please make the rules simple and clear so the system moves faster and with less confusion. As lawyers we love to question and challenge and analyze but the parties usually just want to move along matters.

Expedited Hearings

When there is a dispute that requires a hearing an Application For Hearing must be filed and you must comply with the appropriate rules to follow through and have the hearing. So when they contest your claim or do not provide benefits or when there is some dispute that can take a Judge to resolve it takes a hearing. We can seek hearings on a variety of matters. Examples include disputes on what is the correct average weekly wage (this is important and can result in higher computed benefits), on medical care, on temporary or permanent benefits and much more. Of course you cannot just seek a hearing anytime you want to do so. It does take a dispute and timely action by you as provided by the rules and law. Respondents too can seek hearings and often do when they have a dispute that should go before a Judge. I cannot provide a detailed list but be aware any side may need a hearing depending on the situation. Hearings at best are scheduled out around 3 months from when you apply (80-100 days). Is there any way to speed this up? There is but it is very limited. There is a 40 day expedited hearing but only on issues of compensability and medical matters from the claimants point of view. Other issues pertain to the affirmative defenses of the other side and trying to get prior authorization for medical treatment. The parties can agree to add issues but that is rare so if you are seeking money it is best to file the regular Application for hearing. Forms are located online. This means almost always we use the regular route to a hearing. Actually whenever there is a dispute it takes time to investigate, gather up the evidence and get ready. 80-100 days may seem long when you have no income or must wait for resolution of the dispute but it is much faster then civil cases at the courthouse. In any event it is all regulated by rule and law so we must abide by it.