SET Family Medical Clinics

A couple of posts ago I noted that low income people can seek out Peak Vista for medical assistance. But there is also another low income resource for medical assistance in this region that also deserves mention. One of my clients recently mentioned this to me and so here is a link to their website. If you are low income but can afford it they do charge a small fee but if not they still welcome you. The reason I mention this is that many people who are disabled or hurt do not realize there are medical resources out there willing to help. Some people have worked very hard all their lives and when trouble comes they lack knowledge of these resources. If you've been working hard and supporting yourself but find yourself knocked down its good to know that this exists. Legally it is important when you have a disability or need treatment for something that it may be available. Our society has caused medical insurance rates to be unaffordable for many hard working people. That needs change but in the meantime use what's there. A Judge can wonder how hurt or disabled you are if you avoid treatment. We can say its because you cannot afford it but it can make them question your disability.

Mileage Reimbursement

A claimant with medical benefits is also entitled to submit for mileage reimbursement. Trips to the doctor, the therapist and anything related to medical treatment/evaluations also can mean mileage going and coming. When you track it then it usually can be submitted for reimbursement. It is best to submit on a monthly or semi-monthly basis and not let it accumulate. Wait too long and reimbursement can be questioned though it can also be disputed at any time. Usually the insurer reviews the mileage and reimburses using a set rate. That rate can be seen here in this link.
Be realistic in your miles (some insurers use mapquest.com to calculate your miles) because excessive miles can make the insurer question even more about your case. Also mileage checks can take some time to compute and issue so do not think you will be quickly paid. Give it a month to six weeks.

Peak Vista Registration

Back in December 2007 I mentioned Peak Vista. This facility provides medical care to the less fortunate. It is an excellent resource when you have no funds and need medical help. I am posting here a link to the Peak Vista registration page where you can check out eligibility. This place really helps people so use it if at all possible and you cannot afford a private doctor and have no other benefits. If your workers comp has been denied or you want Social Security disability but have no money then check into this. My only criticism of Peak Vista (one shared by other attorneys) is they usually do not fill out any paperwork to assist with your claim for benefits. I realize it is time consuming and their time is valuable but if someone can get workers comp or Social Security then medical benefits are usually provided to them. To me this would allow the patient to obtain other medical care (freeing up Peak Vista people to help others) or perhaps Peak Vista could then bill and receive medicare payments. Of course I also understand that they do the best they can with what they have. In that regard, by reputation, they are quite helpful for most people. Whenever possible if you hurt and are broke give them a try. Who knows they may just save your life.

We Are Rated in Top 25 Workers Comp Blogs!

Received a nice email today from LexisNexis a major publisher. They have included our blog in the Top 25 in the country! It is a nice honor and much appreciated. Of course in turn I can say its contents are primarily the result of the problems and disabilities of those injured workers who deserve fair treatment. It always amazes me when I work in this field to deal with those who seem to reduce the injured worker to a price tag. No question there are financial elements of a claim but many of the injured must now live with pain and limitation. Further many must deal with other problems such as loss of career, depression and changing their lifestyle. They deserve to have their story told and told and told. I'll help tell it as long as I can for many years to come. Here is the link to view the Top 25 Blogs .

Sept 4th, 2008 brings two cases against claimants

The Colorado Court of Appeals decided two cases on September 4th against claimants. Both cases have complicated legal arguments but the claimant lost out. In the first case, Feeley, the claimant sought to reopen and have his claim reviewed again after he lost his original appeal. He felt that there was a more recent Colorado Supreme Court decision which should have been abided by in his earlier case but the court decided his earlier case could not be reopened under the doctrine of claim preclusion. In other words his prior appeal was the end of the line despite a later Supreme Court decision that compels Respondents not to close a case without taking the right steps. It really meant that his claim was too late to take advantage of the more recent decision yet its clear the older law was a mistaken intrepretation. The second case, Heinicke, decided that a claimant who returns to an authorized doctor who states his impairment is higher cannot shift the burden to the other side to prove otherwise. The claimant sought to reopen but the decision indicates the claimant still has a high burden to prove his case should be reopened due to worsening. This case is strange because we all know that a higher rating means more damage and logically it must mean a worsening. The court seemed to emphasize the claimant still had to prove it relates to his work injury except you have to say that when an authorized doctor rates higher he must also (implicitly if not explicitly) be saying it's all work related. The case makes it clear that reopening is not easy and the burden is high. I side with the claimant in both cases but that is no surprise as I only represent claimants. I think legal mistakes made should be corrected and not perpetuated. Feeley says too bad. I think evidence from an authorized physician should shift the burden to the other side. Heinicke says no way yet it costs $450 an hour to have a doctor testify. Most injured workers are financially hurting so this seems to perhaps deny relief to those least able to afford it.

Politics and Social Security Disability?

Here is a link to one writer who reports on Social Security news. It appears that some claims are being processed faster by the Social Security Administration if they hit the newspapers or have much media attention. He believes this may be political in nature. In the past he relates this was not the case. He suspects such cases are being expedited to avoid further bad publicity during an election year. If true it is another reminder to all of us to look beyond the lip service and the posturing and get to the truth. In my mind there is absolutely no doubt that claimants have languished under an agency that has been underfunded and undermanned by the current administration. No human being should have to wait more then 6 months for a hearing but they do often wait over a year. In any event click here for the article.

2008 Amendments to workers compensation

The Colorado Division of Workers Compensation has posted on the latest changes made to the statutes on workers compensation. You can read them right here. One change made is to prevent insurers from arguing that they only have to pay a portion of temporary and medical benefits due to prior work injuries. Such an argument could cripple the rights of injured workers when they sustain further injury. Trying to say they only owe half your medical bills or half your temporary benefits because you have had prior work injuries is now gone. Imagine being hurt on the job and now needing back surgery but the insurer says they will only pay a portion of the cost because you had prior back injuries. Insurers did not feel they should be responsible for all the benefits to be paid out when they only covered the last injury. The problem is this argument would fail to realize the last injury really was causing all the need for benefits. These amendments all became effective on July 1, 2008.

Disaboom.com at the DNC

The Democratic National Convention starts today in Denver Colorado. One group for the disabled is indicating it will be there. The link to their site (disaboom.com)
is here.
According to an ongoing poll disaboom is conducting about 57% are for Obama and 26% for McCain with the rest undecided. Why? At least historically the Democratic party was more pro-labor and the Republican party more pro-business. In Colorado until recently we had a Republican state and it showed in workers compensation "reform" as benefits/rights were cut back over at least a dozen years. Since the Democrats now are in the majority at the legislature and we have a democratic governor some changes have happened. The stronger the Democratic party the more likely further change for the better for workers will occur. One change I'd like to see is to throw out the scheduled rating and have everyone apply a whole person rating to every case. My view is that every permanent injury has an impact on your earning capacity. A hand injury can mean loss of a trade so it should be as serious as any other injury. Nowadays a hand injury can mean a low ball recovery even if you lose your trade/occupation and that is flat wrong. In any event if you are disabled/hurt then when you follow this election pay attention to who seems serious about the disabled and who gives lip service to helping the disabled. The wait for Social Security hearings is directly attributable to poor funding under the current administration.

Lump Sum $10000.00

You are allowed in workers comp to lump sum $10000 and this is frequently done. When you have a Final Admission and the insurance indicates $10000 (more or less) is due a claimant then you can get an advance of up to $10000 without any effort except to send a letter for the funds. This is quite different from a Petition for Lump Sum which we seldom use. The latter may bind you to the Final Admission. But getting $10000 is usually fast and easy. Plus, it does not bind you to the figures used by the insurance. You still have the ability to dispute it provided you act promptly within 30 days as noted in the Final Admission and its accompanying paperwork. What many people do not know is when a Final Admission is sent the insurer is usually obligated to honor it and pay biweekly until the money runs out or until able to change it by law. It does not send you one big check. Can you object to the figures or to the doctor's report about maximum medical improvement or his rating of impairment? Yes and you can also get $10000 of the amount due you while you object or dispute it further. For example, the Final Admission admits for $20000 and you feel that is wrong. Usually you get the first $10000 and also receive biweekly checks until the $20000 runs out or as provided by law. Often this is done to assist the claimant as we proceed to take the dispute to the next level. That can take several more months and the funds can ease his or her financial fears. One last thing....when you ask for this sum it is discounted. It is like getting money you'd normally receive over time all at once so the law uses a 4% discount calulation. Colorado adjusts it each year but you can look at the chart right here. There is some difference between whole person (back, neck, head, etc) and schedule (fingers, arms, legs, etc) and this is noted on the chart since benefits are paid differently in this two areas.

Sometimes appeals are premature...case decided 8/7/08

This case just decided indicates the parties could not push the appeal along. The case, to date, decides that a traveling claimant who contracted West Nile virus while working in Colorado may be covered under workers comp while living and working in Colorado under the travel status doctrine. At first the claimant lost but he appealed to the Industrial Claim Appeals panel. The panel said the first judge had not correctly applied the law when he said the claimant had to contract it during work hours. In any event the next appeal goes to the Court of Appeals who said it was too early to decide the case because the panel had remanded it back down to have the judge take further action. This makes it premature as no benefits were yet ordered. It looks like the parties then tried to agree on a way to try to keep the appeal going but it did not work. I suspect the appeal will crank out all over again since the parties were trying to expedite it and not have to go through it again. The case took over 2 years to get to where it is now with more still to come! Read the case here.

Waiting for Social Security Disability in Oregon

In this link to an excellent article in the Oregonian we see the terrible effects of the delays in processing and approving Social Security disability benefits. Years can go by and people can die just waiting. There can be appeals and more appeals. Even in the best of cases many months go by. There are simply more claims and less people to handle them but in addition there seems a concerted effort to deny the disabled a fair assessment in the early stages. Some cases astound me. A clearly disabled person who can no longer work is denied benefits and forced to wait for his hearing a year or more. Sometimes this person earned quite good pay and to think he'd give that up for a reduced benefit is plain crazy. Many would prefer to work. The stories in this article remind us that we can do better for the disabled. Congress needs to appropriate more and the process itself needs to be realistic not so technical we lose sight of the human side. As seen in this article linked here the human side is hurting.

All About Claims...August 2008 Newsletter

The Division of Workers Compensation has just put out its latest newsletter. They call it "All About Claims" and though it is late July they have it as August 2008. That is close enough for me. Anyway this is an excellent newsletter that I wish was published more often. In this latest one they review some new law/procedural matters (on apportionment and aggravation) and also present to the public photos and information about some Judges. It highlights Judge DeMarino who is highly capable and experienced. The Judges noted are handling prehearings and settlement conferences as promptly and wisely as they can. I appreciate their involvement in these areas. Otherwise we'd be left with a slower and more adversarial system. Their mere presence in a settlement conference makes the parties and the attorneys far more amenable to a reasonable compromise. Clients who are present come away with a more realistic understanding of the process and what has to be considered in a compromise. Anyway read the newsletter here.

Conflict of Interest Recent Case

On July 24, 2008 the Colorado Court of Appeals issued a case dealing with conflict of interest. The claimant was involved with the Division IME process. The DIME doctor received over 1/3 of his income from the insurance company as a regularly used provider and advisor to the insurance (Pinnacol). A DIME doctor is supposed to be truly independent and medically provide an opinion on treatment and impairment. He or she is not a treating doctor who is often designated by the employer/insurance to treat a claimant. Here the DIME doctor had close ties with the insurer but not on the specific case itself. The ties were from other activities although anyone receiving 1/3 of your income from contractual arrangements would seem pretty close to an insurer. The Court of Appeals determined this was not a conflict of interest and upheld the DIME doctors opinion in the case. Now many of us, even claimant attorneys obtain much income from insurance companies although we obtain it in an adversarial way (we battle with them). But having close contractual ties does seem to be at least an apparent conflict of interest. The mere receipt of money from insurance companies is not a conflict because if it were nearly all doctors would be deemed in a conflict of interest situation. So it is not an easy task to assume a conflict of interest exists from dealings with the insurance. It can be a question of fact but I am personally uncomfortable with the decision. If an attorney had a rather close relationship with an insurer he would likely not take a case against them. But doctors are not usually adversarial and getting paid by insurance does not mean there is a conflict. Anyway read the case here.

Free Consultations

Many attorneys in the injury and disability field state that they offer free consultations or a free initial office visit. That makes sense because most of the injured or disabled do not have the means to pay $100 or $200 or $300 or more to even see an attorney. Such a visit often takes more then one hour to be thorough. Usually mine take 1 1/2 hours as I really like to review much at the meeting. The paperwork, medical records or related legal/correspondence have to be reviewed to get an accurate picture. So talking by telephone is simply not good enough. The same with emails...just not good enough. Looking at the documentation and chatting is important to shed light on the situation. Is there some sort of catch to this free appointment? Absolutely not. It is free no matter whether you or the attorney do anything further. Of course it is also a way for the attorney to eventually earn fees but that is down the line. However do not expect the attorney to discuss other legal problems not related to your claim. The one thing that does amaze me is when someone calls and wants a free consultation but it is not something we handle or where we are not available for an appointment. When that happens most people understand and just keep seeking someone who can help them. But a few seem to think that "free" means they are entitled to it or an attorney has to see them. Nope. It just means the consultation or appointment is free when it is set by us. It is not required an attorney must consult with you only that if he does then it be free.

Colorado Minimum Wage

As of January 2008 the minimum wage in Colorado is $7.02. The federal law has minimum wages going to $6.55 an hour as of this week and to $7.25 an hour by next July 2009. Colorado's will likely be higher by then. So if you are making $15000.00 a year you are over the minimum wage! Still many business owners complain and may even cut back on their employees. Costs are rising. For example in the pizza business costs of the food items are going up just as they are in the grocery store. So either a business owner will try raise prices or cut back. This all seems rather sad to me. The problem with service industries is that it is not as profitable as manufacturing can be. Our growth was for a long time tied to manufacturing and that is now going downhill as it is outsourced to other countries. That leaves us with more low paying jobs. Some then sought wealth in finance and global corporations. We all know of the quite high compensation in those areas at least until the recent slowdown in the economy. But the average american sure isn't benefiting from this as he downsizes his house, his vehicle, his job. This is just my observation but it does make you wonder how it will all play out.