HR Tip: New EEOC guidance related to COVID-19 and family members

In recent guidance (Question D.13), the EEOC said that the Americans with Disabilities Act (ADA) does not require employers to accommodate workers who want to avoid exposing family members who are at higher risk of severe illness from COVID-19.

“The ADA does not require that an employer accommodate an employee without a disability based on the disability-related needs of a family member or other person with whom she is associated. For example, an employee without a disability is not entitled under the ADA to telework as an accommodation in order to protect a family member with a disability from potential COVID-19 exposure. Of course, an employer is free to provide such flexibilities if it chooses to do so. An employer choosing to offer additional flexibilities beyond what the law requires should be careful not to engage in disparate treatment on a protected EEO basis.”

For Cutting-Edge Strategies on Managing Risks and Slashing Insurance Costs visit www.StopBeingFrustrated.com

Controlling workers comp costs: insights from five studies

Study: 2020 workplace safety index – Liberty Mutual Holding Co. Inc.

Findings: Each year this study researches the top 10 causes of the most serious workplace injuries, those that cause employees to miss work for more than five days, and ranks the causes by their direct cost to employers, based on medical and lost-wage expense. Further, it drills down this data for eight specific industries: construction, health care and social assistance, manufacturing, professional services, retail, transportation and warehousing, hospitality and leisure, and wholesale.

Overexertion from handling objects accounted for nearly a quarter of all workplace injuries and cost employers $13.98 billion, according to the index. Falls on the same level accounted for 18% of injuries at a cost of $10.84 billion, and struck-by injuries from objects or equipment made up 10% of injuries, costing $6.12 billion.

Takeaway: This helps employers understand the top risks in the workplace to better allocate safety resources.

 

Study: Top 10 Most Dangerous Jobs of 2020 – EHS Today

Findings: This list of the top ten most dangerous jobs is based on the fatal work injury rate, which is calculated per 100,000 full-time equivalent workers. Loggers were the number one most dangerous profession followed by fishers and related fishing workers.

Takeaway: Rather than looking at the total number of workplace deaths, this study offers a closer look at exactly how often a worker dies while employed in a specific industry. It enables employers to know when the chances of a fatality are high.

 

Study: Motor Vehicle Accidents in Workers Compensation – National Council on Compensation Insurance (NCCI)

Findings: From 2011 to 2016, the frequency of all workers compensation claims decreased by 20.1 percent while claims caused by motor vehicle accidents increased by 4.9 percent. Motor vehicle accident lost-time claims continue to cost over 80% more than the average lost-time claim because such claims tend to involve severe injuries to such body parts as head, neck, and spine. The study points to the rapid expansion of smartphone use as a possible cause.

Takeaway: An effective and consistently implemented distracted driving policy is critical for any business with employees who drive as part of their job.

 

Study: Comparing Physician Services in Workers Compensation and Group Health – NCCI

Findings: Injuries cost more, much more for some conditions, when they’re covered by workers’ compensation rather than group health insurance. Overall, comp costs are about 177% of group health costs. The costs for treatment are only slightly higher than group, but the utilization (number of treatments) is significantly higher.

Takeaway: The author suggests, “Some workers’ compensation claimants and claimant attorneys may find an incentive to seek additional medical care to support wage replacement benefits over a longer healing period or to negotiate a better settlement.” Partnering with an occupation medicine provider can help control the quantity and efficiency of medical services.

 

Study: Biopsychosocial Approach to Identify and Treat At-Risk Injured Workers – One Call Care Management Inc.

Findings: A small percentage of claims (five percent) account for a disproportionate percentage (25 percent) of the costs of physical therapy and rehabilitation. In fact, the average cost associated with that top five percent is more than five times the average cost. These cases are often not identified as problematic until after a treatment plan exceeded the initial guidelines. Predictive analytics can help identify at-risk workers early in the process and lead to an intervention plan that improves outcomes.

Takeaway: Share all you legally can about an injured worker’s type of work and medical history that can help flag at-risk cases.

For Cutting-Edge Strategies on Managing Risks and Slashing Insurance Costs visit www.StopBeingFrustrated.com

OSHA PPE requirements and COVID-19

COVID-19 has not changed an employer’s responsibilities nor the primary tenets of OSHA’s PPE Standard. Employers must begin by conducting a hazard assessment in accordance with the PPE standard (29 CFR 1910.132) to determine the PPE requirements for their unique work site. PPE should be treated as the “last line of defense” in the Hierarchy of Controls. Since elimination or replacing the hazard is unfeasible, the first line of defense is engineering controls. These are mechanical methods of separating an employee from the exposure to COVID-19, such as improved air filtration systems, increasing ventilation rates, or installing physical barriers, such as clear plastic sneeze guards.

The second line of defense is administrative controls, which include focusing on changing human behavior to reduce exposure to a hazard. Examples include asking sick employees to stay home, minimizing contact with virtual meetings, telework, making it easier for workers to stay six feet apart from each other, staggered shifts, and training workers on COVID-19 risk factors and protective behaviors. It also includes providing the resources for safe work practices such as face coverings, no-touch trash cans, hand soap, alcohol-based hand sanitizers, disinfectants, and disposable towels for cleaning work surfaces.

After considering engineering and administrative controls as well as safe work practices, employers must determine if PPE (such as gloves, gowns, surgical masks, and face shields) is necessary for employees to work safely.

In its recent Guidance on Returning to Work, OSHA reminds employers to reduce the need for PPE in light of potential equipment shortages. “If PPE is necessary to protect workers from exposure to SARS-CoV-2 during particular work tasks when other controls are insufficient or infeasible, or in the process of being implemented, employers should either consider delaying those work tasks until the risk of SARS-CoV-2 exposure subsides or utilize alternative means to accomplish business needs and provide goods and services to customers. If PPE is needed, but not available, and employers cannot identify alternative means to accomplish business needs safely, the work tasks must be discontinued.”

Special considerations related to COVID-19:

  • If temperature screening of employees and/or visitors is part of your safety program, be sure the temperature taker is trained and protected from exposure with the proper PPE.
  • Cloth face coverings are not PPE. However, they are intended to reduce the spread of potentially infectious respiratory droplets from the wearer to others. Since they are not considered PPE the employer doesn’t have to pay for them, however, it is a smart move and reassuring message to employees. OSHA has taken the position that the General Duty Clause, Section 5(a)(1), may require employers to provide such masks as they are a feasible means of abatement in a control plan. Moreover, some state and/or local governments are not only requiring employees to wear face coverings at work but are also requiring employers to provide the cloth masks.

    For more information, review OSHA’s recent Q & A on face coverings.

  • When employers require employees to wear masks, there should be specific written regulations about when they must be worn, how to care for them, what medical or other protected reasons are valid exceptions, and what are the consequences if employees decline to wear them and do not meet the exception criteria. Training also is a good idea so employees can understand they do not substitute for social distancing or other administrative controls.
  • Employers must also be aware of situations where mask wearing can make it harder to breathe and do not in themselves create a hazard. For example, the California Department of Industrial Relations, in issuing its annual summer notice to employers on heat illness prevention noted, “Employers should be aware that wearing face coverings can make it more difficult to breathe and harder for a worker to cool off, so additional breaks may be needed to prevent overheating. Workers should have face coverings at all times, but they should be removed in outdoor high heat conditions to help prevent overheating as long as physical distancing can be maintained.”
  • N95 masks are considered respirators and if required in the workplace are subject to significant regulatory obligations under 1910.14. However, if an employee brings their own N95 or similar filtering facemask, they should be allowed to voluntarily wear them. The only regulatory burden is to provide the employee Appendix D of 1910.134. It is recommended that other types of respirators such as half-and-full-face, tight-fitting respirators, and PAPR’s be prohibited.
  • In March and April, OSHA issued temporary enforcement memoranda on relaxing respiratory protection enforcement.
  • Some employers have opted to make gloves available to workers, particularly those in work settings where employees are frequently touching the same surfaces or objects. Gloves should cover the entire hand, up to the wrist and employees need to be instructed on the proper way to remove clothes to ensure that it does not cause contamination.

What type of PPE is best for your workplace?

OSHA’s Guidance on Preparing Workplaces for COVID-19 identifies PPE requirements based on four risk categories of worker exposure to COVID-19. Workers in the very high-risk exposure level, such as healthcare, laboratory, and morgue workers are likely to need to wear gloves, a gown, a face shield or goggles and either a face mask or a respirator. Workers who interact with known or suspected COVID-19 patients should wear a respirator. The same PPE use is recommended for workers in the high exposure risk category, including healthcare delivery and support staff, medical transport workers, and mortuary worker.

The moderate exposure risk category includes those that require frequent and/or close contact with the general public in areas with community transmission of COVID-19, such as teachers, retail outlets, restaurants, and other public businesses. OSHA recommends that workers in this category wear some combination of gloves, a mask, gown and/or a face shield or goggles based on the level of exposure. For those in the low exposure risk category, such as teleworkers, OSHA does not recommend PPE.

OSHA has also published guidance for many specific industries that offers recommendations for engineering and administrative controls as well as PPE. The PPE Safety and Health Topics page provides additional information about PPE selection, provision, use, and other related topics.

Takeaway:

Employers can help protect themselves from OSHA fines and enhance their return-to-work protocols by:

  • Updating their Injury and Illness Prevention Program to align with Fed and State OSHA guidance and any specific industry guidance.
  • Implementing the generally applicable infection prevention control measures identified above.
  • Maintaining any records on safety and health measures implemented.
  • Documenting all training provided to employees.
  • Recognize that new guidance is being issued at the federal and state level almost daily and stay up to date.

For Cutting-Edge Strategies on Managing Risks and Slashing Insurance Costs visit www.StopBeingFrustrated.com

OSHA Watch 1

New resources – COVID-19

 

California becomes first state to adopt standard to protect agricultural employees working at night

A new workplace safety standard to protect agricultural employees who work at night became effective July 1 and will be enforced by Cal/OSHA. It’s designed to protect agricultural workers who harvest, operate vehicles, and do other jobs between sunset and sunrise.

Judge rejects AFL-CIO lawsuit calling for emergency temporary standard on infectious disease

The U.S. Court of Appeals for the District of Columbia Circuit on June 11 rejected an AFL-CIO lawsuit calling on the Department of Labor and OSHA to issue an emergency temporary standard on infectious diseases.

Virginia is creating COVID-19 emergency workplace standard

The state’s Safety and Health Codes Board voted June 24 to create an emergency temporary standard, which essentially requires employers to follow CDC guidelines or face fines. The proposed standards are expected to go into effect July 15.

DOL Inspector General review of OSHA actions during pandemic

Faced with mounting criticism about the agency’s response to the pandemic, the Department of Labor Office of the Inspector General issued a three-page report on June 17. The report notes responding to the “significant increase” in worker and whistleblower complaints during the COVID-19 pandemic, along with completing inspections and investigations, all in a timely manner, are among the challenges facing OSHA and the Mine Safety and Health Administration, given the limited resources available. OSHA has six months to issue a citation and proposed penalties.

Employers’ injury, illness data is public information

Data from Form 300A is not confidential and there are no restrictions on its dissemination according to a court ruling from the U.S. District Court for the Northern District of California. The ruling stemmed from a lawsuit made by the nonprofit news organization Center for Investigative Reporting under the Freedom of Information Act, seeking information from OSHA Forms 300A, 300 and 301 forms. The agency no longer collects information from Forms 300 and 301.

For Cutting-Edge Strategies on Managing Risks and Slashing Insurance Costs visit www.StopBeingFrustrated.com

Early data guides employers on three key workers’ comp issues and COVID-19

Background: Divergent pressures on premiums

There’s been much speculation that workers’ comp will drive significant losses in the property/casualty industry as a result of COVID-19. On the one hand, there is the explosion of presumption laws that discard the basic tenet of workers’ comp that employees must prove they were exposed to the virus during the course of their employment and on the other hand, there are plummeting premiums driven by business closures and dramatic declines in payrolls.

In June, Arkansas, Illinois, and Michigan joined 13 other states in extending COVID-19 presumptive coverage and 12 other states are considering new laws or executive orders. The laws vary significantly, covering different groups of workers and some are rebuttable while others are conclusive. Some are retroactive, while others go into effect in conjunction with the order or law. Employers should keep up-to-date with these rules as they continue to evolve. The National Council on Compensation Insurance (NCCI) has a helpful tracker.

How this impacts premium will also depend on the state Rating Bureau’s position on including or excluding COVID-10 workers’ compensation claims on the experience mod. To date, the following states have adopted rules that exclude COVID-19 claims from the experience mod: Alabama, Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, Florida, Georgia, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Michigan, Mississippi, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Oklahoma, Pennsylvania, Rhode Island, South Dakota, Tennessee,Vermont, Virginia, West Virginia, and Wisconsin.

Also, the costs of many existing claims are rising. The restrictions on nonemergency medical care have meant longer recovery periods and delayed surgeries for injured employees. Delays in adjudication have also extended the life of claims.

Countering this upward pressure on premiums is the dramatic decline in payrolls from furloughs, layoffs, reclassifications, and exclusions of money paid to employees who are not working. PPP dollars ran out at the end of June and employers who had to keep workers on the payroll to qualify, won’t have to keep them “employed.”

According to CalMatters, only 1,098 workers comp claims were filed in California in May, compared with more than 50,000 in January. Although some states have urged insurers to refund premiums, similar to what was done for auto insurance, reflecting businesses’ decreased exposure to workplace injuries during the COVID-19 pandemic, California became the first state to pass regulation requiring insurance companies to reduce premiums paid by employers for workers compensation insurance. This emergency regulation is effective July 1, applicable to all employers in the state, retroactive to the state’s March 19 stay-at-home order and expires 60 days after the order is lifted. The amount of refund has not been calculated.

While it’s clear that these trends dramatically alter the workers’ comp landscape, uncertainty abounds and it’s too early to determine the overall impact. However, early claims data shed light on what’s occurring now.

COVID-19 claims

In Florida, the Division of Workers’ Compensation reported that there were 3,807 indemnity virus-related claims filed as of May 31. About 45% (1,718) of the claims were denied. Health care workers and those working in protective services accounted for 83.3% of the claims. About 55% of the claims from protective service workers were denied and 30% for health care workers. Service industry workers represented 9.1% of claims, office workers 6.1%, and airline workers 1.5%.

While the data did not include medical-only claims, experts have said that most coronavirus claims involve time off from work. The claims amounted to more than $3.4 million in benefits paid so far, or about 3% of the total amount of comp benefits paid for all types of claims from January through May.

Florida has a limited presumption for frontline state employees including first responders, corrections officers, child safety investigators, members of the Florida National Guard, and others who are required to contact people infected with COVID-19.

In Ohio, a monopolistic state but one without a presumption rule, some 23% of claims were denied by the state-run comp program, and 35% of COVID claims were denied by self-insurers.

In Colorado, where a presumption law was introduced in the Senate on June 2, the state’s largest workers’ comp insurer, Pinnacol Assurance, reported to the Colorado Sun that as of mid-May, it had received nearly 1,000 coronavirus-related claims. “But it said the majority of those – 60% – were filed out of an abundance of caution and were dismissed after it was later determined that the worker did not contract COVID-19.”

Of the roughly 400 claims remaining, Pinnacol said it has agreed to pay out on the majority of them, with the average claim amount running around $13,000, The majority of claims has come from first responders and healthcare workers.

According to the article, a spokesperson for Pinnacol said that if the presumption for first responders, health care workers, food-processing workers, and grocery store workers who test positive for COVID-19 passes, there could be a 27 percent increase in workers’ compensation premiums for employers in those industries. If the presumption just applies to first responders and health care workers, the premiums in those industries would triple.

The state has received 1,425 claims, about 60% have been denied by employers and about 27% approved by employers. The remainder are still being processed and investigated. The claims submitted include six for worker deaths; one approved and five remain under investigation.

In California, more than 5,000 COVID-19 related claims were filed from January to May, according to CalMatters. More than 1,000 were denied, but that was before the Governor signed an Executive Order extending protections for essential workers infected on the job on or after March 19.

According to a report by the California Workers’ Compensation Institute that examined over 1,000 claims filed as of April 30, 35% were denied, 28% accepted, and the remainder under investigation. The primary reason for denial was negative results on COVID-19 tests (70%). Lack of exposure at work accounted for 15% of denials and other reasons included refusal to take a test, working from home, and lack of symptoms. About 41 percent of workers’ comp claims were made by health workers, with another 32 percent by first responders including police and firefighters.

In the blog, Managed Care Matters, Joe Paduda of Health Strategy Associates reports that 35 workers’ comp insurers, state funds, TPAs, and service providers and large self-insured/self-administered employers were surveyed on the impact of COVID-19 claims. Payers have received about 33,000 COVID-19 claims to date and accepted just over 20% of all claims filed. The most common reasons for denial are a lack of a diagnosis, no symptoms, and/or a negative test for COVID-19.

The good news is that only a few have been very expensive claims (>$200,000) involving ICU and ventilator care.

The survey also reported on the “non-COVID” effects:

  • a drop of 25% to 50% in new injury claims since the outbreak
  • slower return to work due to an inability or unwillingness to access care and/or adjudication processes
  • respondents’ estimate that 2020 will end with a 20% decrease in the total number of claims

Of course, the impact will vary by industry with disproportionate COVID-19 claims in public entities and healthcare, and small businesses, retail, hospitality, and travel hardest hit by declining payrolls.

Takeaway

It is premature to make predictions bases on this data, particularly since much comes from the early months when there was a shortage of diagnostic tests. However, it does provide guidance on how employers should proceed when faced with a COVID-19 claim.

  • Understand the state’s position on presumption.
  • Know what information the insurance company wants to process the claim and how to identify it as a COVID-19 claim. Share any information about the job/employee that may relate to a perceived lower or higher risk of exposure from the workplace.
  • Be proactive. Find out when the symptoms began and if the diagnosis has been confirmed. Determine if the worker had contact with a person known to be infected with COVID-19 and when and where that contact occurred. Determine if immediate family members are currently showing similar symptoms or recently traveled to any high-risk areas.
  • Ask what other employees the worker may have had close contact with recently and begin contact tracing.

Substance abuse and mental health issues surge

The data indicates that employers can face a surge in addiction, stress, depression, and mental health issues as employees return to work. Isolation, uncertain job security, family distractions, and a lack of access to traditional support networks have caused some employees to turn to alcohol or drugs. At least 30 states are reporting increases in fatal opioid overdoses amid the COVID-19 pandemic. The percentages of individuals who sought screening for anxiety and depression in May were 370% and 394% higher, respectively, than in January, reported the nonprofit, Mental Health America.

Prescriptions in the U.S. for anti-anxiety medications and antidepressants rose 10.2% and 9.2%, respectively, in March compared with March 2019 according to health-research firm IQVIA Holdings Inc. Sales of alcoholic beverages in March were up 55% compared with March 2019 according to marketing research firm The Nielsen Co., and at least one state with legalized marijuana, Washington, reported record sales during the pandemic.

For many employees, the issues are not going to go away when they return to work, affecting employees’ well-being long after the crisis has passed. And it can continue for those who work remotely. A survey by alcohol.org found that one in three Americans are more likely to drink when working from home. The National Safety Council (NSC) is urging employers to implement substance abuse policies and procedures as part of their return to work strategy and offers free resources for employee mental health and wellbeing. Such issues can be a serious threat to worker safety and cost tens of thousands in productivity losses, absenteeism and presenteeism, and workers’ compensation claims if employers do not plan ahead.

Remote workers and cybersecurity

Almost as quickly as the pandemic brought the world to its knees, cybercriminals seized the opportunity to attack the millions working from home. Phishing attempts, the largest source of ransomware, are quickly increasing. According to Net Diligence, the average ransomware cost is $229,000 and the cost of a cyber breach for small businesses (85% of claims) is $673,787 and $8.8 million for large businesses.

In addition, data protection and managed services provider, Digital Guardian, published a report created by aggregating anonymized telemetry from January 1, 2020 through April 15, 2020, via 194 global companies. It found a 122% increase in employees copying company data to USB drives, 74% of that data was classified. Also, a 79% increase in data egress via all means (email, cloud, USB, etc.). More than 50% of observed data egress was classified data.

The Cybersecurity and Infrastructure Security Agency (CISA), a department of US Homeland Security, recently announced key cybersecurity recommendations for employees working from home.

  • Update VPNs, network infrastructure and devices used for remote work – as all devices are variables.
  • Notify employees of increased phishing attacks and offer training/guidance.
  • Ensure IT Security teams are proactively monitoring logs/devices and are prepared for incident response/recovery.
  • Implement Multifactor Authentication (MFA) on all VPN connections and wherever possible.
  • Routinely test VPN network for limitations of mass usage.
  • Do not use Public WIFI, even with a VPN.

A white paper prepared by TechAssure, a not-for-profit trade association for insurance brokers that specialize in technology-related risks, offers additional tips:

  • On all devices that employees are using to access their work environment, Multifactor authentication (MFA) is critically important.
  • Alert employees that fraudulent websites and apps are appearing daily claiming to contain COVID-19 resources, safety supplies, etc.
  • Password management is key. Reusing passwords is common, which increases vulnerability if one account is hacked.
  • Picking up the phone can avert a disaster if something appears suspicious. The client/vendor will appreciate the extra steps to confirm the request.

Cyber insurance policies might provide valuable coverage to mitigate against the possibility of a costly cyber incident during a time when many businesses can afford it the least.

For Cutting-Edge Strategies on Managing Risks and Slashing Insurance Costs visit www.StopBeingFrustrated.com

Things you should know

Database of EPA-approved disinfectants for COVID-19 pandemic available via app

The Environmental Protection Agency has released its List N Tool, a new web-based application (app) that allows smartphone users and others to quickly identify disinfectant products that meet EPA’s criteria for use against SARS-CoV-2, the virus that causes COVID-19.

States without fee schedules pay more

The Workers’ Compensation Research Institute’s (WCRI) medical price index study found states with no workers’ compensation fee schedule pay higher prices for professional services. In states without fee schedules, including Indiana, Iowa, Missouri, New Hampshire, New Jersey, and Wisconsin, prices paid for professional services were between 42% and 174% higher than the median of study states with fee schedules.

Similarly, outpatient hospital payments are higher and growing at a faster rate in states without fee schedules. Comparing hospital payments from a group of common workers’ comp outpatient surgeries in 36 states from 2005 to 2018, WCRI researchers found that states that paid a percentage of charge versus a fixed-amount fee schedule paid as much as 168% more per surgical episode than the median of study states with flat-rate fee schedules in 2018.

Top 10 private industry occupations with the largest number of injuries and illnesses, 2018

The Insurance Information Institute released its list of the top ten private industry occupations with the largest number of injuries and illnesses. It may surprise you that retail salespeople and registered nurses had more injuries than construction laborers.

FMCSA final rule amends trucker hours-of-service regulations

The Federal Motor Carrier Safety Administration has unveiled a highly anticipated final rule the agency claims will add flexibility to hours-of-service regulations for commercial truck drivers.

CMS releases new WCMSA reference guide

The Centers for Medicare and Medicaid Services (CMS) released its latest version of the WCMSA reference guide version 3.1 (May 11, 2020). The link to the CDC life table has been updated to the current CDC life table (2017) CMS has been using as of April 25, 2020, to calculate an injured worker’s life expectancy for Workers’ Compensation Medicare Set-Aside. It should only result in minor differences.

Electrical safety group creates infographic for people working from home

Aiming to promote electrical safety among people who are working from home during the COVID-19 pandemic, the Electrical Safety Foundation International has published an infographic.

“Dirty Dozen” list of 12 most egregious employers focuses on coronavirus response

The National Council for Occupational Safety and Health (National COSH) releases the report each year and this year focused on companies and organizations that allegedly are failing at preventing their employees from exposure to the novel coronavirus.

Updated COBRA Model Notice issued

On May 1, 2020, the U.S. Department of Labor’s Employee Benefits Security Administration (EBSA) issued revised COBRA model notices (both the general notice and the election notice), along with brief Frequently Asked Questions related to the Consolidated Omnibus Budget Reconciliation Act (COBRA).

State News

California

  • Insurance Commissioner Ricardo Lara issued an order requiring insurers to provide an adjustment to the premium in the form of a premium credit, reduction, return of premium, or other adjustment as soon as possible and no later than Aug. 11, 2020. The order covers insurance lines including workers’ compensation, commercial automobile, commercial liability, commercial multiperil, medical malpractice, and any other insurance line where the risk of loss has fallen substantially as a result of the pandemic.
  • The Division of Workers’ Compensation (DWC) and Workers’ Compensation Appeals Board (WCAB) continue to expand the hearing schedule.
  • There was an 11.3% drop in workers’ compensation independent medical review letters in 2019 when compared with 2018, according to a report issued by the Workers’ Compensation Institute.

Georgia

Illinois

Massachusetts

  • Attorney General Maura Healey called on the state’s Division of Insurance (DOI) to take immediate steps to ensure that businesses pay fair workers’ compensation insurance premiums that reflect the businesses’ decreased exposure to workplace injuries during the COVID-19 pandemic.

Michigan

  • Pursuant to the Governor’s latest Executive Orders, the Workers’ Disability Compensation Board of Magistrates’ hearing schedule has been updated.

North Carolina

  • Furloughed employees who are paid will not be counted on payroll for premium calculations, the rate bureau announced in a recent circular.
  • Deputy Commissioner Hearings (Non-Medical-Motion Hearings) to Resume in June 2020 via Webex.

Virginia

  • Workers’ Compensation Commission has issued an order to return to in-person hearings on or after June 11, 2020.

For Cutting-Edge Strategies on Managing Risks and Slashing Insurance Costs visit www.StopBeingFrustrated.com

Legal Corner – including new COVID-19 Work Comp Cases

Workers’ Compensation

Attorney General sues Uber and Lyft over misclassifying drivers – California

Attorney General Xavier Becerra sued Uber Technologies Inc. and Lyft Inc. for classifying its drivers improperly as independent contractors instead of employees, evading workplace protections and withholding worker benefits. Several cities joined the state in its lawsuit, saying the companies’ misclassification harms workers, law-abiding businesses, taxpayers, and society more broadly.

Appeals court allows apportionment of permanent disability – California

In County of Santa Clara v. Workers’ Compensation Appeals Board and Barbara Justice, an employee suffered a compensable injury in a fall at work and was granted a 100% permanent disability. The county appealed, arguing that documented degenerative conditions in her knee caused part of her permanent disability. Noting the unrebutted substantial medical evidence, the appeals court agreed. The rule is that apportionment is precluded only where the industrial medical treatment is the sole cause of the permanent disability.

PTD awarded 17 years after retirement – Florida

In Pannell v. Escambia County Sch. Dist., an appellate court ruled that a worker who retired for reasons unrelated to her workplace injuries before reaching maximum medical improvement was entitled to permanent total disability benefits after she exhausted her temporary total disability benefits. It noted that a JCC erred in focusing on her retirement date, as well as her age and disability status at that time, in finding that she did not qualify for PTD benefits.

To determine whether she qualified for PTD, the relevant date is either the date of overall MMI or the expiration of her entitlement to temporary benefits, whichever occurred first. She exhausted her entitlement to temporary benefits (TTD) as of December 30, 2004, well before she reached overall MMI in 2011. She had no substantial earning capacity when her TTD was exhausted and was incapable of gainful employment when she reached MMI. Therefore, she suffered a catastrophic injury and was entitled to PTD as of Dec. 31, 2004.

Phony COVID-19 medical note leads to business shutdown and arrest – Georgia

An employee with a past criminal record defrauded his employer with a phony medical excuse letter claiming COVID-19. The letter prompted the employer to stop business and sanitize the workplace, still paying other workers who were forced to stay home in quarantine, at a cost of over $100,000. The worker was arrested by the FBI.

McDonald workers file class-action suit over COVID-19 safety – Illinois

Five workers in Chicago filed a class-action lawsuit against McDonald’s accusing it of failing to adopt government safety guidance on COVID-19 and endangering employees and their families.The lawsuit does not seek money for sick staff, but compliance with health guidance such as not having to reuse masks, mandating face coverings for customers, and requiring the company to inform employees if a co-worker becomes infected.

Judge dismisses lawsuit over safety concerns at pork processing plant – Missouri

A U.S. federal judge has dismissed a worker advocacy group’s lawsuit accusing Smithfield Foods Inc., the world’s largest pork processor, of failing to adequately protect employees from the novel coronavirus at a plant in Milan. The judge ruled that the company was taking many of the health precautions asked for and that it was not the court’s purview to oversee working conditions. Under President Donald Trump’s executive order in April requiring meatpacking plants to remain open during the pandemic, the federal government is responsible for overseeing working conditions. The company said the lawsuit should be dismissed because OSHA is already investigating. The attorney for the workers did not rule out an appeal; however, he acknowledged that the lawsuit prompted beneficial changes at the plant.

Compensability sought for family of health care worker who dies from COVID-19 – Missouri

The family of a Kansas City nurse, Celia Yap-Banago, who died from COVID-19 has filed for death benefits with the Missouri Division of Workers’ Compensation.The claim could prove to be the first major test case on compensability for virus-sickened health care workers.

Missouri’s presumption law covers firefighters, law enforcement officers, and emergency medical technicians, but not nurses.

Fireworks injury not compensable – Nebraska

In Webber v. Webber, an appeals court upheld the denial of benefits to a self-employed truck driver who was injured in a fireworks mishap. The injury occurred when he was entertaining a warehouse manager on his route. On appeal, he argued he was responsible for rapport-building with clients as part of his job providing moving services and that this was work-related horseplay. The court found that was not grounds for a claim and lighting a firework at a warehouse was not within the scope of his job.

Benefits denied to worker injured in car accident riding to lunch with boss – New York

In Matter of Scriven v. Davis Ulmer Sprinkler Co., an appellate court overturned previous rulings and found an employee who was injured in a car accident while riding to lunch with his supervisor is not eligible for workers compensation. The court noted that he was not paid during his lunch break and that he was not “obligated” to go to lunch with his supervisor, along with three co-workers. Lunchtime injuries are generally deemed to occur outside the scope of employment except under limited circumstances where the employer continues to exercise authority over the employee.

“Gray area” rule does not apply to worker struck by car while crossing public street – New York

In Matter of Johnson v. New York City Tr. Auth., an appellate court ruled that a worker was not entitled to benefits for his injuries when he was struck by a car as he was crossing a street to get to work. At the time of the accident, the worker had arrived more than one hour early for his shift, had not yet reported to work, and was not approved for overtime. The case falls under York’s special “gray area” rule, where the mere fact that the accident took place on a public road or sidewalk did not ipso facto negate the right to compensation.

Under the rule, injuries will be compensable only if there was a special hazard at the particular off-premises point and a close association of the access route with the premises, so far as going and coming are concerned. In this case, the court concluded that the risk of getting hit by a car while crossing the public road was unrelated to the worker’s employment and a danger that “existed to any passerby traveling along the street in that location.”

Industrial Commission erred in dismissing claim – North Carolina

In Lauziere v. Stanley Martin Communities LLC, a real estate agent claimed an injury which her employer contested. The company sought medical records, moved to compel her to respond, and ultimately challenged the sufficiency of the documents. More than one year passed and she did not act so the company moved to dismiss the claim because of failure to prosecute. The Industrial Commission granted the motion and dismissed the case.

Upon appeal, the court overturned, noting the company had not been materially prejudiced. The company offered no evidence to show how the delay impaired its ability to locate witnesses, medical records, treating physicians, or any other data. The company argued it was prejudiced because it was unable to direct the agent’s medical care, however, the court said the company didn’t have the right to control since it had not accepted her claim as compensable.

Protz decision applies to cases pending at time of decision – Pennsylvania

In Weidenhammer v. Workers’ Comp. Appeal Bd., the Commonwealth Court ruled that an injured worker was not entitled to the automatic reinstatement of her total disability compensation after Protz II struck down Section 306(a.2) [77 P.S. §511.2(1)] of the state’s Workers’ Compensation Act as unconstitutional because the statute’s language requiring use of “the most recent edition” of the AMA Guides amounted to an impermissible delegation of legislative power to the American Medical Association. It noted that since the high court’s decision was not fully retroactive, it applied to all parties in all cases still pending at the time the decision was announced and only where the issue of the statute’s constitutionality had been raised and preserved at all stages of litigation.

Section 413 of the Workers’ Compensation Act provides that no award can be modified or reinstated unless a petition is filed within three years of the most recent payment of compensation. She had filed her reinstatement petition almost four years after her last payment. Since her petition was not so pending at that time of the decision and more than three years had passed since her last receipt of benefits, her petition was properly denied.

Exclusive remedy prohibits sexual harassment claim – Tennessee

In Karen Potter v. YAPP USA Automotive Systems Inc., an appeals court ruled that workers’ compensation exclusive remedy provision prohibits a woman from filing sexual harassment and hostile worker environment claims under state human rights law because her injury did not involve previously reported harassment. She had suffered injuries when a co-worker, who she had previously reported for sexual harassment, spit on and pushed her. The court found, however, that her physical injuries did not involve sexual harassment and began with a discussion about work.

PPD award based on functional loss before hip replacement surgery – Virginia

In Loudoun County v. Richardson, a divided Supreme Court ruled that a firefighter was entitled to permanent partial disability benefits based on the extent of his impairment before undergoing hip replacement surgery. A physician determined that a loss-of-use rating of 74% before surgery and 11% after surgery. Affirming lower court decisions, the court noted that using a pre-surgery loss-of-use rating recognizes that a work-related injury has permanently deprived the employee of natural functionality and that hip replacement procedure came with the expectation that the prosthetic will eventually fail and require subsequent surgical revision. It acknowledged the irreplaceable loss of the natural joint, the nonmonetary costs associated with the corrective surgery, and the permanent restrictions on the employee’s activities resulting from the work-related injury.


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OSHA watch (part 2)

Heat illness prevention

new video on heat hazard recognition and prevention is available.

Cal/OSHA issued a news release reminding employers to protect outdoor workers from heat illness.

Construction safety

A virtual stand-down to prevent struck-by incidents in construction is now available to view.

Recent fines and awards

Florida

  • Jax Utilities Management Inc. was cited for exposing employees to cave-in hazards at a Jacksonville worksite. Inspected as part of the National Emphasis Program on Trenching and Excavation, the construction contractor faces $56,405 in penalties.
  • Two contractors, Prestige Estates Property Management LLC of North Miami and Jesus Balbuena of Miami, face $44,146 in penalties for failure to protect employees from fall hazards at a construction worksite in North Miami. The investigation followed an employee’s 20-foot fall from an aerial lift that led to fatal injuries.
  • Flat Glass Distributors Inc. was cited for exposing employees to unguarded machinery, failure to implement and have a written lockout/tagout program, and electrical hazards at the Jacksonville fabrication and distribution facility. Inspected as part of the National Emphasis Program on Amputations, the custom glass shaping and cutting distributor faces $121,446 in penalties.
  • Crown Roofing LLC was cited for exposing employees to fall hazards at a residential worksite in Tamarac. The Sarasota-based contractor faces penalties of $134,937. The inspection was initiated under the Regional Emphasis Program for Falls in Construction after inspectors observed employees working on roofs without fall protection.

For additional information.

For Cutting-Edge Strategies on Managing Risks and Slashing Insurance Costs visit www.StopBeingFrustrated.com