Here are the latest Treatment Guidelines

A link is provided so you can see what the latest treatment guidelines are for Colorado physicians to treat in areas like chronic pain, lumbar, cervical, cumulative trauma and the like. These Guidelines are made part of the workers comp rules so they are important. Certainly the treating doctor should be able to treat as needed but the Guidelines are relevant to any treatment.

http://www.coworkforce.com/DWC/Rules/Rules%20pdf/RulesLinksTable.asp#Rule_17

Injured Worker Comments, Suggestions or Questions?

I've set it up so that anyone can comment or leave questions for me. Just click on the comments and leave your question or suggestion...but do so either anonymously or by first name only please. While I cannot guarantee an answer or reply I promise to look at any such comment/suggestion/question. Sometimes we just need to vent or provide our own personal views so if you feel the need then you are free to post your comment on our blog. For example I personally feel the workers comp system in Colorado can be improved upon with better laws. Change can come when we stand up and voice our concerns. Silence only validates the status quo. But if you need professional or individual advice and do not have a lawyer...call my office at 719-596-8900 or email me at workcomp@usa.net.

Workers Comp does not cover all losses

It is important to emphasize that coverage is limited in work injury cases. Workers comp is a creature of statute which sets forth what is covered and what is not. The biggest problem is when someone has a loss of his or her trade or occupation because of a permanent injury and permanent restrictions. Usually some permanent benefits are paid and an effort can be made to maximize these but nothing is paid for the loss of a trade or occupation unless you are permanently and totally disabled. Vocational rehab is seldom offered by the insurer so if this is your situation contact the State Department of Vocational Rehabilitation. This area remains an area of concern and on my wishlist for legislative change. I would strongly urge those who may be in this situation to consult with an experienced workers comp attorney. Never assume the insurers position on your entitlement to benefits is accurate. Moreover if the company designated doctor has released you without impairment or restrictions do not assume that is correct either. You do have recourse here. On numerous occasions such doctors have said no permanent injury and been flat wrong.

Social Security Backlogged

Both nationally and locally the process to obtain Social Security disability benefits is backlogged especially at the hearing level. If denied benefits a claimant can, if he timely acts, appeal for a hearing. It is taking over a year or longer to obtain that hearing in Colorado. Elsewhere the wait can even be longer. It does appear that justice delayed is justice denied. Hopefully over time this backlog can be cleaned up. At my last hearing the hearing Judge was in Tucson and we had the hearing by way of television. Documents are now being scanned in to make a CD so that they are easily handled. All of this provides some hope but it will take some time to speed up the process. Sometimes though it seems like one step forward and two steps back.

May 31, 2007 Court case on prosthetics

If your artificial hip is injured on the job is it covered to receive benefits? Yes said the Court of Appeals in this case. The insurer tried to rely on an old Colorado case that said if your wooden leg was hurt it was not a personal injury just injury to property which was not covered by workers comp. The court said the statutes now do cover injury to prosthetic devices so that old case no longer applies. But can you imagine in that old case being told it's your problem not a workers comp problem since only live legs are covered? At least now its covered though the statute does define what is covered and what is not. In any event here is a link to the case:
http://www.cobar.org/opinions/opinion.cfm?OpinionID=6163&CourtID=1

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:
http://www.leg.state.co.us/clics/clics2007a/csl.nsf/fsbillcont3/25F0E8DAEE0A8C3D872572C30052A494?Open&file=258_enr.pdf

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.

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:

http://www.thedenverchannel.com/news/13369088/detail.html

Here is the earlier story which is quite disturbing in its allegations:
http://www.thedenverchannel.com/7newsinvestigates/13326461/detail.html

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:
http://www.disabilitydoc.com/work-descriptions/

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:
http://www.cobar.org/opinions/opinion.cfm?OpinionID=6119&CourtID=1

Disfigurement New Law!

HB 1297 was just signed into law by Gov. Ritter. For many, many years an injured worker with a scar or disfigurement was limited to no more than $2000 for it. You would appear before the Judge or provide a photograph and from that the Judge would sign an order for a sum up to $2000 but no more. I've seen low amounts around $200 and other amounts that were higher awarded by a Judge. But if you had horrendous scars you were still limited to no more than $2000. Despite the passage of many years the top amount awarded stayed at $2000. Colorado legislators failed to consider increasing it and the disfigurement benefit was ignored. Today this was changed by HB 1297. The basic disfigurement benefit was increased to as much as $4000. But also for horrendous scars that deserve more the top dollar could go to $8000. Lastly they added a yearly review so it could even increase each year. Anyway here is the link to the bill:
http://www.leg.state.co.us/CLICS/CLICS2007A/csl.nsf/fsbillcont3/AF150CF1FE93E20E8725726C0065CB1D?Open&file=1297_enr.pdf

Refunds from Pinnacol to businesses

It appears from an article in the Denver Post that Pinnacol (the state's largest workers comp insurer) will be refunding or redistributing money back to employers. Quite a bit of money actually. One possibility is that there are less claims because everyone is safer. Another possibility is more ominous....money is being saved by not paying out enough benefits. I personally suspect the latter because the law and rules make it easier on insurers and harder on claimants. Read the article here:
http://www.denverpost.com/headlines/ci_5735325

All 50 States link to agencies

Here is a link that seems to have info on each state's agencies involved with workers comp. I provide it to make a point that each state has its own way to handle work injuries. While the laws and procedures can seem the same they are in fact different from one state to another. Workers compensation is a creature of statute (created by each state legislature) and the rules, procedures and caselaw vary from one state to another.
http://www.comp.state.nc.us/ncic/pages/all50.htm

State Representative Carroll

Rep. Carroll maintains a blog and this link shows her concern for injured workers. She is in the forefront of efforts to provide fairness in the law. She is pushing HB 1176 mentioned previously in this blog. Bravo !
http://www.repmorgancarroll.com/blog

Her current position is state senator and visit her blog by clicking here.

Social Security Disability Blog

Here is a link to a blog by an attorney in the Atlanta area who handles disability cases in his area. What makes it so good is that he answers specific questions on SSD and SSI claims in a very easygoing manner. Many topics are covered in his blog and it makes an excellent read. Most that he writes about concerning Social Security applies here in Colorado too. I notice that in his region getting a SS hearing can take over 2 years. There are delays here too and this is unfortunate. We tell people to expect a delay of one year or more. In any event since some injured workers may need to consider filing for SS benefits go ahead and explore this blog for some easy to understand information.
http://www.ssdanswers.com/