Legal Corner

ADA 

Employee unable to wear safety shoes can be terminated

In Holmes v. General Dynamics Mission Systems Inc., a U.S. District Judge in Virginia dismissed an employee’s claims alleging violations of the ADA after she was terminated for being unable to perform the essential functions of her job, specifically, wear required safety shoes. She worked at the manufacturing facility for 18 years and was given an exemption in 2003, based on a note from her doctor.

However, the company stopped exempting her in 2013 because an outside auditor found violations of the protective footwear policy and stated that future violations could jeopardize the company’s certifications. The company did research and present alternative footwear to her and when none were acceptable, she was placed on an excused absence and encouraged her to seek custom-made safety shoes, which the company would reimburse.

After more than two years of absence and no evidence that she pursued the custom-made shoes, she was terminated.

Employer’s failure to raise “regarded as” defense results in jury award to employee

In Robinson v. First State Community Action Agency, a manager told an employee she either had dyslexia or didn’t know what she was doing and placed her on a performance plan. She sought a medical opinion about dyslexia, which was not conclusive, and gave it to her manager who gave it to HR. The HR Director told her the evaluation did not have any impact on her ability to perform essential job functions, and she was to follow the performance improvement plan and she then sought a reasonable accommodation. A few weeks later she was fired.

She sued, alleging the employer regarded her as disabled and failed to provide a reasonable accommodation and a jury agreed. The employer appealed, arguing that the jury instructions didn’t reflect changes that the ADA Amendments Act in 2008. While the 3rd Circuit agreed that the jury instruction was made in error, and “after the 2008 amendments went into effect, an individual who demonstrates that she is ‘regarded as’ disabled, but who fails to demonstrate that she is actually disabled, is not entitled to a reasonable accommodation,” the employer had waived the right to contest it because it had not opposed the use of the argument earlier.

The case is a harsh reminder of the importance of raising all possible defenses early in the litigation to preserve the rights on appeal.

Workers’ Compensation 

No liability for Six Flags in workers’ electrocution – California

In Ingram v. Six Flags Entertainment Corp., an appellate court declined to overturn a jury trial verdict that declared Six Flags was not negligent for the injuries suffered by two workers who were electrocuted while repairing a ride. Although one of the electricians thought he had deenergized the equipment at Magic Mountain, there was an arc flash explosion, which caused serious burns.

They sued the parent company, Six Flags, arguing it failed to provide appropriate personal protective equipment and made changes to its safety program after the incident. However, Six Flags has a policy that forbids working on energized electrical equipment, provides training on how to shut off power, and successfully argued to exclude its post-incident safety program changes from the trial.

Failure to return to light duty work nixes award of TPD – Florida

In MJM Electric Inc. v. Spencer, an appellate court reversed a judge of compensation claims’ decision in favor of an injured worker because the employer had offered suitable light duty work. The electrician was injured at work and saw an authorized physician, but never returned to work in spite of multiple messages from his employer that light-duty work that fell within his work restrictions was available.

After two weeks of no response, the company fired him for job abandonment. He argued he did not recognize the number and had no voice mails. The judge of compensation claims found he was not entitled to temporary partial disability benefits for the first two weeks after his accident, but he could receive disability benefits after his termination because the company failed to meet its burden of showing suitable employment opportunities. The appeals court reversed and remanded the case.

Tort suit against subcontractor can proceed – Florida

In Heredia v. John Beach & Associates, an appellate court ruled that a man working for a subcontractor can sue another subcontractor and an employee. The injured employee was working for QGS, a subcontractor doing roadwork for Lennar Homes LLC and was accidentally struck by a truck owned by another subcontractor, John Beach & Associates, that was doing surveying work.

Under the law, when a contractor sublets work to subcontractors, all employees of the contractor and subcontractors are considered employed in one and the same business and are protected by the exclusive remedy provision. However, the court found in this case, Lennar was not performing any work, was not subletting work, and therefore, was not a contractor. The case can proceed.

Average weekly wage should be based on actual earnings not pro-ration wage – Georgia

A school custodian worked a school year schedule, but had his wage spread out over a 12-month period. In Ware County Board of Education v. Taft, an appellate court ruled that his wages should be based on his contractual rate, not the lesser actual pro-rated amount he earned during the 13-weeks preceding his injury.

Supreme Court provides guidance on PTSD provisions – Minnesota

In Smith v. Carver County, the state Supreme Court reversed a decision by the state’s Workers’ Compensation Court of Appeals (“WCCA”), finding the 2013 PTSD statute does not require a compensation judge to conduct an independent assessment to verify that the diagnosis was in conformity with the Diagnostic and Statistical Manual of Mental Disorders (DSM) before accepting the expert’s diagnosis.

The case involved a deputy sheriff who resigned after 10 years and was diagnosed with PTSD by a licensed psychologist. However, an independent psychological evaluator opined that he did not have PTSD, although he had adjustment disorder with anxiety. A WCJ found this opinion more persuasive and denied the claim. The WCCA overturned, finding this opinion did not address the PTSD criteria in the latest version of the DSM.

Nonetheless, the Supreme Court reversed noting the compensation judge’s legalistic analysis of the DSM-5 was not to become a substitute for the professional judgment of psychiatrists and psychologists and the judge did not err in finding the independent evaluation more persuasive.

High court rules no fault auto insurer must pay for injured driver’s excess chiropractic charges – Minnesota

In Rodriguez v. State Farm Mut. Auto. Ins. Co., an injured bus driver received 12 weeks of chiropractic treatments, the maximum allowed under the state’s workers’ comp law. She then sought treatment from another chiropractor and payment from her personal automobile insurance policy, which denied payment based on the workers comp payments.

The case made its way to the Supreme Court, which ruled the additional care fell outside of the comp statute because it was with a separate provider whose services had never been characterized as excessive.

Jury verdict of $74.1 million upheld in worker’s death – Missouri

The Ford Motor Co. must pay the widow of a truck driver who was struck by machinery while making a delivery at the Kansas City Assembly Plant ruled an appellate court in Ford v. Ford Motor Co. The driver, who had worked for the trucking company for less than two weeks, was delivering vehicle seats, which were removed by an L-shaped pair of conveyor lines. He entered the area between the conveyor belts to manually clear a jam during seat removal and stepped into a “pinch point” between the tables and was crushed.

The company appealed a jury verdict that assigned the company 95% comparative fault for his death and awarded his widow and son $38 million in compensatory damages, and $38 million for aggravating circumstances. The appeals court disagreed and upheld the award. The company plans to appeal to the state Supreme Court.

Right to cross-examine employer’s expert wrongfully denied – New York

In Matter of Ferguson v. Eallonardo Construction, an appellate court ruled that a worker was wrongfully denied the opportunity to cross-examine the insurance carrier’s medical consultant on how the permanent impairment rating of 40% was reached. While the counsel for the injured worker did not file a competing report, the court ruled that the right to cross-examine the carrier’s consultant was not predicated upon the filing of a competing report. The only requirement is that a request be made at a hearing, prior to the judge’s ruling on the merits.

Failure to complete application sufficient for denial – New York

In Matter of Jones v. Human Resources Administration, an appellate court ruled that an attorney’s failure to fill out every section of an application for administrative review was a proper basis for the Workers’ Compensation Board to deny it. While the worker received benefits for an work-related injury, she was later denied the request to add additional consequential injuries to her claim. There was a no information in the box for question 13 of the RB-89 form, which requested hearing dates, transcripts, etc.

Heart injury hours after accident compensable – North Carolina

In Holland v. Parrish Tire Co., a three-judge panel of the Court of Appeals reversed the Industrial Commission’s decision that a worker’s heart injury that occurred hours after he was hit in the chest with a tire was not compensable. While unloading tires for a delivery, he was hit in the chest by a tire that weighed between 100 and 200 pounds. The owner transported him to an urgent care center because he had turned gray and was uncharacteristically slow, where he was sent to an emergency room. There he was diagnosed with an aortic dissection and a collapsed lung and admitted to the intensive care unit.

He underwent surgery and was told he would have a work restriction of being unable to lift more than 40 pounds indefinitely, and was diagnosed with major neurocognitive disorder due to the open-heart surgery, adjustment disorder, and depression. Later, he was rated permanently disabled and unable to work by a treating physician and filed for workers’ comp, which was denied.

The appellate court found that the commission had not adequately considered physicians’ testimony that aortic dissections could be caused by trauma.

No comp for traveling salesman for car accident after celebration with coworkers – Pennsylvania

In Peters v. Workers Compensation Appeals Board (WCAB), a traveling salesperson drove past his house on his way to a happy hour with colleagues and was injured in a car accident when returning home. Although he argued that he was traveling home from a work-sponsored event in a work van, and that as a traveling employee, his accident should be compensable, a judge, the WCAB, and the Commonwealth Court disagreed. It found that the gathering was not furthering the interest of the employer, but rather was a social gathering. Further, while a traveling employee is presumed to be within the course and scope of employment when he is driving to or from work, he had abandoned his employment by driving past his house on his way to the happy hour with colleagues.

Failure to use an automated external defibrillator not breach of duty – Pennsylvania

In Desher v. Southeastern Pennsylvania Transportation Authority, an appellate court judge affirmed a trial court ruling denying the guardian of a worker, who suffered a cardiac arrest and a subsequent brain injury at work, damages under the Federal Employers Liability Act (FELA). The guardian claimed the former employer was liable for the incident for not administering an automated external defibrillator (AED).

While the company had an AED within 100 yards of the incident, it did not use it and paramedics arrived within two minutes and used one. There was no evidence suggesting a heightened risk of cardiac events for employees or that it provide assistance in the form of an AED.

Continuing denial of opioids affirmed – Pennsylvania

In Jason Golembesky v. Workers’ Compensation Appeal Board (Worth & Co. Inc.), a manufacturing worker had been on high doses of opioid oxycodone since his injury in 2010. In 2016, the employer filed a utilization review petition, and the reviewing doctor opined that the opioid prescription was excessive. The worker filed a petition for review of the findings, arguing he had tried alternative methods of controlling the pain, which had not worked. The employer also presented evidence from an independent review doctor who noted the worker was taking massive dosages, essentially three times what is considered a high dose of morphine equivalent.

A WCJ and the WCAB found the opinions of the independent reviewers more credible than those of the worker’s providers.

More than ten years after injury, worker awarded benefits for right knee condition – Virginia

In Nanochemonics Holdings, LLC v. McKinney, a worker sustained a work-related left knee injury. More than ten years later, he filed a claim for a right knee condition. Stressing that the employer is responsible for all sequelae that flow from the primary work-related injury, an appellate court affirmed the award benefits, noting that the problem was caused, at least in part, by an altered gait brought about by his earlier left knee injury. While it acknowledged that the worker was morbidly obese, this did not amount to a sufficient break in causation.

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

12 mistakes employers make when an OSHA inspector knocks unexpectedly

Even well-prepared employers can panic when an OSHA inspector arrives unexpectedly at the door. Why are they here and are we really prepared?

While the chances of an inspection are small (there are about 8,000,000 workplaces and OSHA and its State Plans average about 73,000 annually), advance notice is rare. In fact, Compliance Safety & Health Officers (CSHO) are prohibited by law from providing employers with advanced notice of pending inspections, with limited exceptions (see p. 3-3 of field operations manual).

Employers who are ill-prepared for an inspection and make bad decisions during an inspection face unwelcome and costly fines. Even well-prepared employers find it difficult to escape an inspection without a citation – there is a 75% chance that at least one violation will be found.

Here are 12 mistakes commonly made by employers:

  1. Refuse to let OSHA enter the worksite. While most inspections are surprises, many experts and former inspectors advise against requiring a warrant. This is likely to bring enhanced scrutiny and create an adversarial tone. A cooperative attitude is important; however, this is a good time to negotiate the limit and scope of the inspection.
  2. Fail to consider the personality of the employee designated to meet with and accompany the inspector. While it’s critical the employee be knowledgeable and intimately familiar with the operations and safety policies of the business, personality and attitude play a major role. Someone who is defensive, arrogant, or a know-it-all is likely to irritate the CSHO. The inspector’s report includes a place to note lack of cooperation. And don’t designate someone who loves to talk and tell how wonderful the company is. It’s going to fall on deaf ears and they probably will volunteer too much information. Best to designate someone who is polite, professional, can stay focused, and who is confident and willing to ask questions.
  3. Don’t have a backup for the designated employee. Inspectors will wait a “reasonable” amount of time – usually a half hour to an hour. While that might be a good opportunity to correct some small hazards and tidy up housekeeping, delaying the inspection will be noted on the form and it’s unlikely anything you do in that time is going to make a significant difference.
  4. Fail to limit the scope of the inspection. This is perhaps most important. Employers have a right to know the purpose of the inspection and to have a “reasonable inspection” at a “reasonable time.” Employers should insist on an opening conference when the CSHO explains the reason for the inspection and the employer can negotiate the scope. It’s also an opportunity to ask questions and to try to establish ground rules about how the inspection will proceed, including interviews, collection of documents, and the physical access to the facility.

    Some inspections, such as those under the Site-Specific Targeting Enforcement Program, can be wall-to-wall but most unprogrammed inspections can be limited. If the inspection was prompted by an employee complaint, the employer has a right to see the complaint and limit the inspection to related areas. If the CSHO is there to investigate an incident, take the most direct route to the site of the incident. Minimize exposure to the rest of the facility. Everything inspectors see is fair game for citations, such a missing handrails, poor housekeeping, improper signage, fire extinguishers, etc. If an officer tries to do a wall-to-wall inspection when there is a specific reason for the inspection, the employer should push back.

  5. Don’t know the criteria for emphasis program or compliance directive inspections. If there is a programmed inspection under an emphasis program or compliance directive, an employer can refuse, if they know they don’t fit the criteria.
  6. Don’t replicate the photos, videos, and notes the inspector makes. It’s important to escort the CSHO at all times and to mirror the actions of the inspector during the walkthrough. Take the same photos, videos, notes, measurements, sampling etc. so you have a clear record of what they captured. OSHA has a six-month statute of limitations to issue citations.
  7. Admit to violations. There may be violations pointed out during a walk through. For example, if an inspector points out an unguarded machine, say you will address it, but don’t admit the violation or try to go into a lengthy explanation of why it is not guarded.
  8. Don’t insist that document requests be in writing. At the opening conference, it’s best to agree that document requests, except OSHA Recordkeeping forms, be made in writing (it can be handwritten) so that there is no confusion over what documents are being requested and so that the employer is not cited for failure to produce a document it did not believe was requested. It is important to remember that the employer has no duty to produce certain documents (e.g., post-accident investigations, insurance audits, consultant reports, employee personnel information) if a regulation does not require such production. Any documents produced can be utilized to issue citations. If you don’t have the document, say so. Don’t rush to produce a new document.

    While not a comprehensive list, long-time OSHA employee and Area Director John Newquist recently published the “Scary 13” – documents employers can’t produce during an inspection – in The National Safety Council’s June Safety Health magazine.

  9. Don’t protect their trade secrets and business confidential information from disclosure to third parties. This is an employer’s right, but it is critical to keep a record and identify the documents as confidential.
  10. Don’t sit in on management interviews. A supervisor’s comments are imputed to the employer and, for this reason, employers have the right to and should be present and participate in interviews of management, regardless of whether the manager wants the representative there. That right does not exist with non-management employees, but it’s important for employees to know their rights about interviews and that they will not suffer adverse employment actions. While it’s important to be careful not to coerce, intimidate, or influence, employers can prepare employees for interviews. Also, the employer can request that “on floor” interviews be limited to five-minutes on production and processes. Employers should attempt to schedule more extensive interviews about training, background, etc. that should take place in a conference room with a table and chairs, but no white boards or documents present.
  11. Consider only the cost of the penalty. Employers have the critical right to contest OSHA’s citations, but some employers want to move on quickly, and consider only the monetary amount when deciding whether to contest, particularly when the cost is low. A recent webinar, Prepare for and Manage an OSHA Inspection by the Conn Maciel Carey law group, notes that there are several goals an employer should consider before accepting a citation, as well as strategies to reduce the impact. Accepting a citation can open the door to future, more costly repeat violations ($132,598), impact civil wrongful death or personal injury actions, affect bidding, harm customer and employee relationships, increase possibilities of being placed in the Severe Violators Enforcement Program, and affect insurance costs and coverage.
  12. Don’t immediately correct hazards, when possible. The closing conference usually takes place one to six weeks after the inspection. This is a good time to demonstrate cooperation by showing that hazards identified during the inspection have been corrected or abated.

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

Insights from OSHA’s recently released enforcement summary

While many anticipated a relaxing of OSHA’s enforcement actions under the Trump administration, the recently released enforcement summary tells a different story. There were 32,023 federal inspections in FY 2018, a number that has remained relatively stable over the past three fiscal years. The continued aggressive inspection strategies under the Trump administration has confounded many. There’s been a record number of $100,000+ citations, higher penalties, continuing increase in willful and repeat citations, as well as worker safety criminal prosecutions; yet, the number of inspectors has declined raising concerns of safety advocates. Also, the figures are for federal inspections. OSHA only covers about 50% of employers-state plans handle enforcement in the private sector in 22 states. State plans must be as effective as federal OSHA, but some states, such as California, have adopted stricter standards.

The enforcement summary provides valuable insight into what triggers an inspection. Over 56% of the inspections were unprogrammed inspections. These include employee complaints, injuries/fatalities, follow up inspections, and referrals. In FY 2018 (Oct. 1, 2017 – Sept. 30, 2018), OSHA conducted 941 fatality/catastrophe investigations, the highest number of such investigations in more than a decade and a 12.4% increase from 2017.

Employee complaints triggered 41% (7,489) of the unprogrammed inspections and over 23% of all inspections. Under the OSHA Act, every employee has the right to complain to OSHA and request an inspection, if they feel there is a violation of a health and safety standard. OSHA does not have the resources to conduct an inspection for every complaint, but evaluates each complaint to determine how it can be handled best – an off-site investigation or an on-site inspection. For an on-site inspection, at least one of eight criteria must be met.

Referrals prompted 6,463, about 36% of unprogrammed inspections and 20% of all inspections. Theses encompass all subtypes of referrals such as those received from compliance safety and health officers, safety and health agencies, other city/county/state/federal governments, media, and employer-reported.

A programmed inspection occurs when the inspection is scheduled because of OSHA selection criteria, such as emphasis programs or compliance directives. They tend to focus on the industries and operations where known hazards exist (e.g., combustible dusts, chemical processing, ship-breaking, falls in construction are some examples), including those that fall under an OSHA emphasis program, and accounted for 44% of the inspections.

In October, the agency launched a Site-Specific Targeting program using data from 2016 Form 300A to target non-construction workplaces with 20 or more employees. While workplaces with high DART rates and those that did not submit the required data are OSHA’s primary enforcement focus, there is also a random sample of low injury rate establishments on the inspection list for quality control purposes. What’s important to know is that these inspections are comprehensive – they are wall-to-wall.

Employer takeaway: While the data provides clues as to the situations that will trigger an inspection, all employers should recognize an inspection can be random and be prepared. If there’s been a fatality or catastrophic injury at a worksite, a legitimate employee complaint, a referral, or a previous inspection with citation, an inspection is likely.

In addition, those industries subject to local (LEP) or national emphasis programs (NEP) and worksites with high DART rates are more vulnerable. It’s important to know the criteria for LEP’s and NEP’s. If OSHA shows up for an inspection at a workplace under one of these programs when the company doesn’t fit the criteria, the employer has a right to refuse the inspection.

Employers should be cognizant of the high number of inspections prompted by employee complaints. Managers who are dismissive of safety concerns or hostile toward those who raise them expose the company to costly consequences. Those who foster a strong safety culture and encourage feedback are less likely to receive complaints or be cited by OSHA.

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

Legal Corner

Workers’ Compensation 

WCAB does not have authority to overturn award of medically necessary housekeeping services – California

When housekeeping services are requested by a physician and are reasonably required for an injured worker, they qualify as medical treatment. As such, the Court of Appeals for the 2nd District ruled that if a physician makes a request for a medical treatment, an employer cannot deny it unless a utilization reviewer determines that it is medically unnecessary.

In Allied Signal Aerospace, Constitution State Service Company v. Workers’ Compensation Appeals Board and Maxine Wiggs, the injured worker was receiving housekeeping services twice a month, but the physician requested a change to every week. The company submitted the request to utilization review. The reviewer found the more frequent schedule was not medically necessary. However, the WCAB supported a judge’s ruling to submit the records to a registered nurse who had made an earlier assessment of need for review.

The 2nd DCA vacated the WCAB’s ruling noting that since there was no stipulation to displace the provision of housekeeping from the UR-IMR process, the WCAB had no jurisdiction to review the medical necessity and reasonableness of service.

Exclusive remedy bars personal injury claim by firefighter kicked in the groin by supervisor – California

In Tibbett v. Los Angeles County Fire Department an appellate court affirmed a jury’s ruling that a firefighter’s unintentional injuries were barred by the exclusive remedy of workers’ compensation. The incident occurred when the firefighter complained to a supervisor about how a situation with a hostile victim was handled. The fire captain said he was showing a maneuver to keep volatile patients away by obstructing their vision, but the firefighter moved and he kicked him in the groin with a steel-toed shoe.

The firefighter had emergency surgery to remove his left testicle and underwent more surgeries that rendered him sterile. The court agreed with the jury, finding the fire captain did not intend to harm the firefighter; therefore, workers’ comp was the exclusive remedy.

Challenge to the presumption of correction for the opinions of EMAs rejected – Florida

In De Jesus Abreu v. Riverland Elementary School, the 1st District Court of Appeal rejected a constitutional challenge to the statutory presumption of correctness for the opinions of expert medical advisers (EMA). The employee suffered a compensable injury to her shoulder and an arthroscopic shoulder surgery was performed to address a partial rotator cuff tear.

While the physician deemed she had reached MMI, she continued to report pain and she sought care from an unauthorized orthopedic physician who recommended further surgery. The company authorized another orthopedist, who did not recommend further surgery. However, the employee obtained an IME from a doctor who thought surgery was appropriate.

Because of the conflicting opinions, a JCC appointed an EMA who opined that no further surgery was recommended or medically necessary. The JCC denied surgery because state statutes provide that the opinion of an EMA is presumed to be correct unless there is clear and convincing evidence to the contrary.

The employee appealed, arguing that the presumption improperly usurps the rulemaking authority of the state Supreme Court and that the presumption interferes with the executive branch’s ability to fairly adjudicate workers’ compensation claims. The court disagreed.

Restaurant manager shot in off-hours robbery can receive benefits – Georgia

In Kil v. Legend Brothers, the Court of Appeals overturned a denial of benefits to a restaurant manager who was shot as he was arriving home from work with the day’s receipts, which he regularly reviewed when he got home. The worker lived with the restaurant owner and his coworker. When he arrived home with his coworker, they were attacked by three men who demanded money. When the attackers realized the worker had a gun, they fled, but shot him in the forearm and he has not been able to work.

Both an administrative law judge and later the state Board of Workers’ Compensation awarded him comp benefits, ruling that his injury arose within the scope and course of employment. However, a state superior court reversed, finding that he was not at work at the time of the armed robbery and shooting-that he was home and that he was shot because he had a gun, which “had nothing to do with performing his duties for his employer.”

The Court of Appeals disagreed, noting one of the worker’s key job responsibilities was to spend around an hour every day going over the restaurant’s daily sales, receipts, accounts and inventory and that he was continuing his duties as manager.

Insurer must pay for injuries despite misinformation in policy – Georgia

In Grange Mutual Casualty Co. v. Bennett, several mistakes were made when an insurance agent took the company’s business information from its policy with a former insurer. She misclassified the company that was a construction company involved in greenhouse repair and maintenance as providing janitorial services and erroneously noted that employees did not travel out of state and that workers did not perform work above 15 feet. While the owner signed the policy, there was a dispute whether it was complete at the time.

When an injury that occurred out of state was denied, the company told the agent the policy had to be changed because most of its business was out of state. When the insurer learned more about the business operations it said it would not have issued the policy if the application had correctly stated that the company operated in 30 states because Grange Mutual was not licensed to issue policies in all of those states. It sent a cancellation notice but gave the company 90 days to find an alternative.

In less than 90 days, another worker was injured out of state, suffering extensive injuries in a truck accident. An administrative judge held that Grange Mutual’s policy covered the employee’s injuries and that by agreeing to pay for workers’ comp claims under the laws of Georgia, the Georgia-based company’s workers were covered even when out-of-state. Further, an appellate court held that Grange Mutual waived its void policy defense when, after discovering the inaccurate information on the application, it informed the company that its coverage would continue for 90 days. The court said that if the insurer “believed that the policy was void based on fraud, it should have immediately rescinded it.”

Borrowing employer’s immunity from tort liability not dependent on insurance – Illinois

In Holten v. Syncreon North America, an appellate court ruled that a temporary staffing service’s employee could not pursue a negligence suit against his borrowing employer for work injuries. The worker received comp benefits from the staffing agency for injuries resulting from a forklift accident, but filed suit against the borrowing employer, asserting its negligence had led to his injuries.

The state Workers’ Compensation Act provides that the lending and borrowing employers are jointly and severally liable for workers’ compensation benefits, but both do not have to provide the insurance. As long as one of the employers pays benefits, both have civil immunity. The immunity springs from the borrowed-employee relationship itself.

Employee can sue Canada – Massachusetts

Federal law immunizing foreign governments from liability does not protect Canada from being sued as an uninsured employer under the state’s workers’ compensation statute for injuries suffered by a consulate employee in Boston, the 1st U.S. Circuit Court of Appeals ruled in a 2-1 decision. In Merlini v. Canada, the Court found that the Foreign Sovereign Immunities Act provides an exception to immunity for a foreign state that engages in a “commercial activity.” The court said Canada entered into a contract for commercial services by hiring Merlini and failed to carry workers’ comp insurance as required of commercial employers in the state.

Worker who resigned after injury can collect unemployment – Minnesota

In Interplastic Corp. v. Rausch, a long-time employee injured his back and was transitioned to a lower job but received the same wage and accompanying pay raises over the next three years. He was then notified his wage was being reduced to align with the position and he was ineligible for future raises. About the same time, the workers’ compensation claim was settled and he received a $25,000 payout and agreed to “voluntarily terminate his employment.”

When he applied for unemployment benefits, he was denied because he had voluntarily quit. However, a three-judge appellate court panel affirmed an unemployment law judge’s decision that a substantial pay reduction, the lack of future earnings potential, and the claim settlement allowed the worker to fall under the state’s statutory exception for unemployment eligibility.

Worker’s manufacture of meth does not forfeit comp benefits – New York

In Robert Stone v. Saulsbury/Federal Signa et al., an appellate court ruled that a worker’s conviction for manufacturing methamphetamine did not forfeit his entitlement to benefits for two industrial injuries. The court upheld the WCB ruling that the man who had been collecting indemnity benefits for a compensable injury prior to his conviction and incarceration did not violate state workers’ compensation laws when he became involved in the production of illegal drugs.

The insurer contended that the manufacture of methamphetamine constituted “work”. The court disagreed, “substantial evidence supports the Board’s finding that the conviction alone is insufficient to establish any work activity by claimant or that he received any type of remuneration.”

Denial of occupational disease does not prevent new theory of accidental injury – New York

In Matter of Connolly v. Covanta Energy Corp., an appellate court reversed the state Workers’ Compensation Board’s finding that a worker suffered from an occupational disease (allergic bronchopulmonary aspergillosis) and remitted the matter to the Board for further proceedings. However, this would not prevent the worker from arguing an accidental injury claim on essentially the same facts. After remand, the Board was free to consider the new theory for the claim.

Elimination of labor attachment requirement for PPD not retroactive – New York

In Matter of the Claim of Scott v. Visiting Nurses Home Care, a worker who was classified as having a permanent partial disability, was found to have voluntarily withdrawn from the labor market and benefits were suspended twenty-two years after her injury. In 2017, the law was amended to provide that proving attachment to the labor market was no longer necessary for permanent partial disability compensation.

After the amendment took effect, she filed a request for reinstatement of benefits. A law judge, the Board, and the Appellate Division’s 3rd Department all agreed that the amendment did not apply retroactively.

Failure to mention side business not fraud – New York

In Matter of Permenter v. WRS Envtl. Servs. Inc., a truck driver’s failure to disclose his involvement in an online and retail flower business was not the sort of misrepresentation that should disqualify him from receiving workers’ compensation benefits according to an appellate court ruling. The employee had freely admitted that he owned a company engaged in the flower business, but the employee did not consider it work because it was not profitable.

Termination of benefits OK for a minor physical deformity, but no physical impairment – Pennsylvania

In Paolini v. Delaware County Memorial Hospital, the Workers’ Compensation Appeals Board held that the workers’ compensation judge (WCJ) did not err in awarding benefits to a nurse who sustained physical injuries and post-traumatic stress disorder as a result of a dog bite while performing a home visit. Her doctor provided unequivocal medical testimony that she had sustained PTSD as a result of her work injury, even though her Facebook page showed her swimming and parasailing.

However, the board reversed the WCJ’s denial of the employer’s termination petition, as the employer’s examining physician found that although the nurse had slight discoloration and subjective, mild numbness, she had fully recovered from the physical dog bite.

Injuries incurred on railroad bridge not covered by longshore comp – Virginia

In Muhammad v. Norfolk Southern Railway Co., a three-judge panel of the 4th U.S. Circuit Court of Appeals reversed and remanded a district court’s holding that the worker’s negligence claim was barred by the exclusive remedy under the Longshore and Harbor Workers’ Compensation Act (LHWCA). While working on a bridge that crosses a navigable river, a portion of the walkway collapsed beneath the employee and he sustained serious injuries.

He filed suit against the railway, asserting a negligence claim under the Federal Employers Liability Act, but the company argued the claim was subject to the LHWCA. The district court agreed, finding repairing and rebuilding the bridge was an “essential and integral element” of the maritime traffic flowing under the bridge, therefore, his work constituted as engaging in maritime employment.

Upon appeal, the 4th U.S. Circuit Court of Appeals reversed and remanded the district court’s decision. It noted that the LHWCA requires employee work “upon navigable waters” and that a bridge would not be covered by the statute.

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

Six studies: what does and doesn’t work to improve claims outcomes

Recently, there has been a plethora of studies related to claim outcomes in workers’ comp and group health, several with surprising conclusions. Here are six of them:

Workers’ Compensation Medical Prices and Outcomes of Injured Workers – Workers Compensation Research Institute (WCRI)

Study: This study addresses a long-standing policy debate about the role of workers’ compensation prices in outcomes of injured workers; specifically, what happens to outcomes of injured workers when prices increase or decrease. Survey data covered workers’ experiences across 14 states, and claims data provided information from across 30 states. It focused on the pricing of common office visits, which affect most injured workers, rather than specialty medical treatment prices that wouldn’t apply to all injured workers.

When examining the link between workers’ compensation prices and outcomes, the study focused on five specific outcomes:

  • Access to care
  • Nature of medical care
  • Change in physical health and functioning
  • Return to work
  • Temporary disability duration

Findings: There is a strong link between workers’ compensation prices and the first two outcomes – access to care and nature of medical care. For example, when workers’ compensation prices were relatively higher, workers were significantly more likely to receive physical therapy within the first six weeks of being injured and went to more office visits for evaluation and management services.

However, this did not have much of an impact on the last three outcomes. “While prices are related to measures of access to medical care and the nature of medical care provided, changes in these measures when prices increase are not material enough to result in improved recovery and faster return to work,” according to the report.

Takeaway: Factors other than price are important in shaping different outcomes. “Future studies may need to focus on other system features that may explain large differences in outcomes across states.”


Health Insurance and Outcomes of Injured Workers – WCRI

Study: The study provides new empirical evidence about workers with health insurance and what that means for workers after a work-related injury. Researchers surveyed injured workers in 15 states.

Findings: Injured workers with health benefits showed a 2.5% higher return-to-work and returned to substantial work on average one week faster than workers without health insurance. They received evaluation and management services more quickly, had higher rates of satisfaction with primary providers, and had lower rates of hiring an attorney for comp claims. However, there was little difference in the likelihood of workers reporting problems obtaining medical services, or in the kind of care received.

Takeaway: Workers’ comp historically was in one silo, with health programs in another. If you are still organized in traditional silos, it’s time to change. Smart companies have adopted a holistic approach to employee health to drive down costs, improve productivity, boost the bottom line, and help employees enjoy better health.


Effectiveness of a no-cost-to-workers, slip-resistant footwear program for reducing slipping-related injuries in food service workers: a cluster randomized trial – Scandinavian Journal of Work, Environment & Health

Study: This study evaluated the effectiveness of a no-cost-to-workers, slip-resistant footwear (SRF) program in preventing workers’ compensation injury claims caused by slipping on wet or greasy floors.Laboratory tests have shown that slip-resistant shoes designed with a special tread helped prevent slipping, but studies in actual workplaces were lacking. The study population was a dynamic cohort of food service workers from 226 school districts’ kindergarten through 12th-grade food service operations.

Findings: Food services operations where workers received free highly slip-resistant shoes showed a large reduction in workers’ compensation claims for slip injuries compared to food service operations where workers did not receive the shoes. School districts filed 67% fewer claims for slip injuries after being provided the slip-resistant shoes, compared to no reduction in claims for slip injuries at the school districts that did not receive the shoes.

Takeaway: Slips, trips, and falls are the third-leading cause of U.S. non-fatal work-related injuries involving days away from work across all industries. Almost 80% of these injuries are on the same level, and these injuries are estimated to cost nearly $13 billion in direct workers’ compensation-related costs annually. These results show that providing highly rated slip-resistant shoes can help reduce claims for slip injuries.


Opioids, Pain and Absence: The Productivity Implications of Substance Abuse Among US Workers – Integrated Benefits Institute

Study: The Oakland, CA-based research organization surveyed by phone 84,579 American workers over 18 years old between 2015 and 2017, with 74% of them reporting to be working full-time. The goal of the study was to examine productivity and days missed from work due to prescription drug use among workers.

Findings:

  • 33% of workers reported taking prescription painkillers.
  • Less than 1% reported any heroin use.
  • Rates of alcohol abuse and dependence exceed the problematic use of pain relievers and other prescription medications at 7% of the workforce interviewed.
  • Use of cocaine or methamphetamine was relatively uncommon, at less than 3% and 1%, respectively.
  • Excess work absences associated with pain relievers were greater than excess absences associated with any other substance. On average, non-problematic use of pain relievers was associated with 0.8 days of excess absences per month compared with non-users. The problematic use of pain relievers was associated with 2.0 absences, or 1.2 excess days per month compared with non-users.
  • Assuming a 20-day work month, the use of pain relievers was associated with a loss of about 1.3% of the monthly labor capacity of 1,000 workers. The non-problematic use of pain relievers accounted for 96% of those losses.

Takeaway: Managing pain is a major challenge in workers’ comp. The numbers are alarmingly high, suggesting a continued problem of over-prescribing and a workforce grappling with pain issues. Although a small percentage reported abuse of pain relievers or dependence, experts postulate that “problematic behaviors” such as addiction and dependence are likely to follow. Employers should be proactive in educating employees on the risk factors and nonpharmacologic approaches to pain and work with occupational medicine providers to help their employees prevent pain management from becoming abuse and improve productivity.


Association of Opioid, Anti-depressant, and Benzodiazepines with Workers’ Compensation Cost: A Cohort Study – Accident Fund (AF) Group

Study: This analysis evaluated the impact of benzodiazepines and antidepressants in combination with opioids on workers’ compensation claim cost and closure rates.

Findings: Concurrent treatment of chronic pain, depression, and/or anxiety and occupational injuries is associated with large increases in total workers’ compensation claim cost and delayed return to work. The slowest claim closure rate occurred among workers with prescriptions for all three types of medications (58.3%), followed by claims with both opioid and antidepressant (64.8%) prescriptions. The group without any medications had the highest closure rate (91.8%), followed by the group with only opioid (89.1%) prescriptions.

Even when controlling for age, chronic pain, medical complexity, and claim development (years), antidepressant claims, to a greater degree, were more likely to remain open at the end of the three-year study period.

Takeaway: The presence of anti-depressant medications on a claim is an indicator of a potentially costly claim. Early intervention is needed to minimize the impact of behavioral issues and psychotropic medications on workers’ compensation claim outcomes.


Integrated Physical Medicine at Employer-Sponsored Health Clinics Improves Quality of Care at Reduced Cost – Center for Primary Care and Outcomes Research, Stanford University, Crossover Health

 

Study: The aim of the study was to evaluate clinical and economic outcomes associated with integrating physical medicine in employer-sponsored clinics.

Findings: Integrating physical medicine in employer-sponsored clinics decreased wait times to access these services to 7 days (2 to 4x faster than in the community). Patients receiving care in employer-sponsored clinics experienced marked improvements in fear of pain avoidance behaviors (a strong predictor of disability) and functional status in eight fewer visits than in the community resulting in $472 to $630 savings/patient episode. Noncancer patients received 1/10th the opioid prescriptions in employer-sponsored clinics compared with the community (2.8% vs 20%). Patients were highly likely to recommend integrated employer-sponsored care (Net Promoter Score = 84.7).

Takeaway: Musculoskeletal complaints represent the second largest cause of short-term or temporary work disability, and employers bear a disproportionate share of these costs, including approximately 290 million lost workdays annually. While the study focuses on how larger employers can strengthen onsite or near-site clinics, it notes employers should consider policies to reduce barriers to accessing physical medicine services such as direct patient access, sufficient availability of appointments, and benefit designs that incentivize use of physical medicine services before elective imaging and specialist visits.

A strategy of early access to physical therapy has been associated with a 36% improvement in patient outcomes, 52% less imaging, 56% fewer spinal injections, 59% fewer lumbar surgeries, and 62% less opioid use.

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

Five mistakes employers make when using data to develop risk control programs

Data analytics is a key driver in the development of business strategy and workers’ comp claims are a goldmine of information. Yet, when not used properly, the results can fall far short of expectations. Here are five common mistakes:

  1. Relying solely on the insurance company Some employers rely solely on the insurance company to analyze their claims and make recommendations to prevent injuries and control costs. In recent years, insurance companies have beefed up their analytics and embraced predictive analytics to manage claims. They use information from years of past claims to build models that will predict what may happen next in a particular claim. Indeed, such information benefits employers.Insurance companies also are a great resource for claims information in your industry. They can provide helpful guidance for how you stack up versus your peers.But it’s important to have realistic expectations and remember that the insurance company’s goal is to leverage data to improve their profits. This can lead to aggregate information or a cookie-cutter approach that falls short of your needs.
  2. Data such as injured-worker demographics, department, type and severity of injury, frequency, timelines and money set aside for reserves of claims, and if the claim ends up in litigation can all help employers guide future outcomes. Smart employers regularly review their loss run reports from the insurance company that includes this information, not only to ensure it is correct (errors mean increased premiums) but also to identify trends that lead to actionable insights. What are the main drivers of incidents in the organization and what can we do to change are the key questions to ask in analyzing data.
  3. Observing metrics at face value Each year, Risk & Insurance identifies “All Stars” who stand out from their peers by overcoming challenges through exceptional problem-solving, creativity, perseverance, and/or passion. One of the 2018 All-Stars was Kevin Farthing, environmental health and safety manager for Florida-based Sparton Electronics, a 600-employee company manufacturing sonobuoys for the navies of the world.The company faced a high number of musculoskeletal injuries and annual workers’ comp claim costs exceeding $500,000. Multiple modifications to the production processes and attempts to control ergonomic risk factors had not solved the problem.Digging through the data, he discovered that 40 percent of the musculoskeletal injuries were occurring during the first three years of employment. The company was hiring workers who were not capable of performing the physical demands of the job.
  4. He then took the logical next step and worked with a company to design specific post-offer, pre-employment tests to make sure candidates were up to the physical challenges. But he did not stop there.
  5. The failure rate on the test was high – 50%. Rather than lowering the demands of the tests, he identified which tests individuals were failing most and modified the actual work tasks. For example, they no longer require employees to manually move certain types of heavy loads. Coupled with other changes, a two-year investment of $174,000 has yielded an expected savings of more than $950,000.
  6. Not being objective or hanging on to old beliefs Commitment to the status quo or leadership thinking may limit taking action on data. Some rationalize that the incident rate is acceptable and changes will mean lower production. Or a belief that “injuries are part of the job” or simple complacency. Buy-in from management can take effort and tenacity.For many years, it was believed (and documented) that inexperience and inadequate onboarding put younger workers at increased risk and they were more likely to suffer a workplace injury. On the other hand, older workers would experience fewer injuries but would take longer to recover and have more costly claims. Recent research from the National Council on Compensation Insurance (NCCI) dispels this conventional wisdom and finds that younger workers are getting injured less often than their older peers.The workforce is changing and processes are becoming more automated. While the number of workers under 55 has remained more or less stable, the number of workers who are 55 or older has doubled since 2000. Women make up more than half of labor force growth. Relying on old data or beliefs leads to ineffective and costly programs.
  7. Year-over-year analysis will show how claims are changing. This will tell you if initiatives are working or if a new direction is warranted.
  8. Failing to segment An important finding of the NCCI research was that key injury risks vary by age group. Younger workers are prone to injuries from contact with objects or equipment, while overexertion injuries are most vexing for employees in the middle of the age spectrum. Meanwhile, slips, trips and falls disproportionately affect those over 55.There’s clear value for employers to mine their own claim data correlating type of injury with age and gender of workers. When younger male workers are experiencing a higher incidence of injuries from contact with objects or equipment, a change to interactive and technology-based training, rather than a dry manual, could be an effective way to improve safety.It’s not just age subsets that can help employers to be tactical in the way they manage their safety budget. Comparing similar departments can identify why one department may be functioning at a higher level than the others and then apply the best practices to other departments.
  9. Not looking beyond the data Although there are many sophisticated data tools, programs cannot rely on data alone. There is a myriad of subjective factors that affect incident rates. Production pressure, management safety practices, limiting mind-sets, and fear of automation are just a few.These factors cannot be quantified with statistics. Instead, organizations need to have subjective methods to review these factors that represent the “heart” of their workers’ comp program.

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

 

Things you should know

CDC: Half of workplaces offer health/wellness programs

Almost half of all U.S. worksites offered some type of health promotion or wellness program in 2017, according to a new study, Workplace Health in America 2017. This was the first government survey of workplace health promotion programs in 13 years.

Nationally, almost 30 percent of worksites offered some type of program to address physical activity, fitness, or sedentary behavior. Some 19 percent of worksites offered a program to help employees stop using tobacco products, and about 17 percent of worksites offered a program to address obesity or weight management.

FMCSA delays publication of proposed rule to amend trucker hours-of-service regs

The Federal Motor Carrier Safety Administration (FMCSA) has delayed until further notice the publication of a proposed rule intended to add flexibility to hours-of-service regulations for commercial truck drivers. The proposed rule remains under the Office of Management and Budget review.

NLRB gives employers greater discretion to limit union activity on their premises

The National Labor Relations Board (NLRB) recently issued a decision in UPMC Presbyterian Shadyside that reverses a longstanding precedent and holds that employers no longer have to allow nonemployee union representatives access to public areas of their property unless (1) the union has no other means of communicating with employees or (2) the employer discriminates against the union by allowing access to similar groups.

Study: Energy drinks take toll on heart health

Popular caffeine-packed beverages could affect heart rhythm, according to a new study. Research findings of a recent study published in the Journal of the American Heart Association (AHA) confirm the short-term risk consumers take when consuming energy drinks. Drinking 32 oz. of an energy drink in a 60-minute timeframe directly affected the heart rhythm of the study’s participants, a result bolstered by previous research.


State News

California

  • The Workers’ Compensation Appeals Board is planning to reorganize its Rules of Practice and Procedure, and is seeking comments from system users about other changes that it should consider. Comments can be sent to WCABRules@dir.ca.gov.

Georgia

  • A new law, the Georgia Long-Term Care Background Check Program will take effect Oct. 1, requiring nursing home and other long-term care workers to submit to extensive background checks.

Illinois

  • Illinois became the 11th state to legalize recreational marijuana.

Massachusetts

  • More changes to three key deadlines for the Paid Family Medical Leave (PFML) law.
    • September 30, 2019 – Employers and covered business entities are required to post a notice and provide written notice to their current workforce.
    • October 1, 2019 – Payroll withholdings begin for the October 1 to December 31 quarter.
    • December 20, 2019 – Deadline to file for a private plan exemption for first quarter contributions.
    • January 31, 2020 – First quarterly contribution payment due through MassTaxConnect.

Michigan

  • The governor issued an executive order creating a separate workers’ compensation appeals commission. The action separates the Unemployment Insurance Appeals Commission from the Workers’ Disability Compensation Appeals Commission.

Minnesota

  • Enacted detailed new recordkeeping requirements for employers, effective July 1, 2019, and wage theft protections for employees, effective August 1, 2019. For more information.
  • Department of Labor and Industry is urging all employers to examine their safety programs, after a spike in reported amputations this year.

Missouri

  • Department of Labor is offering confidential safety and health consultations aimed at helping employers build safer workplaces. Businesses must have no more than 250 employees at any one site, and fewer than 500 total employees, to qualify.

New York

  • The Workers’ Compensation Board formally adopted its drug formulary and prescribing rules for injured workers, set to go into effect Jan. 5, 2020.

Tennessee

  • Rejecting the strict “ABC” test adopted by its appellate court, that state has enacted a new law (H.B. 539) adopting a 20-factor test to determine employee-versus-independent contractor status. The new law becomes effective January 1, 2020.
  • An NCCI study found that prescription drug utilization decreased across all categories, regardless of whether they required prior authorization. After the Official Disability Guidelines Workers’ Compensation Drug Formulary was adopted, the utilization of N-drugs, which require prior authorization, dropped by 23.2%.

Virginia

  • On July 1, 2019, a new amendment to Virginia Code Section 8.01-413.1 will take effect, requiring all employers to provide copies of employment records to employees upon written request.


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Legal Corner

ADA 
Trucking firm settles suit over pre-employment screenings

Greeley, Colorado-based JBS Carriers Inc., which is the transportation affiliate of multinational meat processor JBS USA Holdings Inc., contracted with a third-party administrator, Denver-based ErgoMed Systems, to administer pre-employment screenings. The EEOC found that all applicants were subjected to a medical history questionnaire, a physical examination and nine physical abilities tests, and if an applicant failed any one of the tests, ErgoMed sent a negative job recommendation to JBS, which withdrew conditional job offers based on its recommendations.

The EEOC alleged this process unlawfully screened out people with disabilities and reached a $250,000 settlement with JBS. Under terms of the settlement, JBS will not contract with ErgoMed for three years and not implement any physical or medical screening for conditional hires apart from the DOT medical certification and urine analysis, among other provisions.

Perceived disability sufficient to reinstate suit

In Jonathan C. Baum v. Metro Restoration Services, an employee who worked as a scheduler for Louisville, Kentucky-based Metro Restoration Services Inc., began having heart problems and occasionally missed work for medical concerns. After a severe weather hit in 2015, he worked remotely to coordinate crews. He was fired a week later and the company’s owner told him it was because of his health issues and doctors’ appointments.

He filed suit, charging he was fired both because he was disabled and because the company regarded him as disabled. A lower court dismissed the case because he did not present an expert witness, but an appellate court found a jury could find that Metro fired him because the owner thought he was disabled, and reinstated the case.

Workers’ Compensation 
Widow loses civil suit based on “power press” exception to exclusive remedy – California

In Ochoa v. Setton Pistachio of Terra Bella Inc., a widow of a man who died when another worker accidentally started the machine he was maintaining filed a wrongful death suit, arguing the machine was a power press that, under certain conditions, can be exempt from exclusive remedy. The court agreed with the defendants that the machine in question was a conveyor-style “auger” and not a press that used a die. A product liability claim was also rejected.

Sawmill pays $375,000 in settlement of civil suit related to workers’ death – California

Morgan Hill-based Pacific States Industries Inc., doing business as Redwood Empire Sawmill, was sued by the district attorney following the death of a millworker, who died in a bark conveyor that the employees regularly walked on while they were unjamming it. The DA’s office investigation found a culture of production over safety at the mill and that the sawmill and its two other facilities in Sonoma County did not have written procedures for employees to work on, unjam or clean machinery and equipment.

Secondary treatment issues clarified – California

In a panel decision, Pena v. Aqua Systems, it was clarified that secondary treatment requests do not have to be initiated by the PTP and that selection of a secondary treater is not subject to Utilization Review (UR) and, therefore, does not require a Request for Authorization (RFA). Failure to promptly respond to and approve secondary treatment requests is likely to result in a penalty assessment.

Six-month limit on mental injuries upheld – Florida

In Kneer v. Lincare & Travelers Ins., an appellate court ruled that an employee was not eligible for benefits for psychiatric injuries because they occurred more than a year after he had reached MMI on his back injury. The court said the claim for temporary benefits for the mental condition was untimely because there is a six-month limitation for temporary benefits for psychiatric injuries (which follow a physical injury).

Remote workers beware: trip over dog not compensable – Florida

In a 12-2 decision, Sedgwick CMS v. Valcourt-Williams, an appeals court reversed the decision of a workers’ compensation judge. Working in Arizona, a home-based workers’ comp claims adjuster tripped over one of her two dogs, causing her to fall and sustain injuries to her knee, hip and shoulder as she was getting coffee in her kitchen. The court noted that there are limitations to the “arising out of” rule when risks unrelated to work lead to the injury. In this case, her non-employment life (her dog, her kitchen, reaching for a coffee cup) caused the accident, not her employment.

“One Day Rest in Seven” can’t circumvent exclusive remedy – Illinois

In Webster v. FirstExpress, Inc., a federal district court held that the state’s “One Day Rest in Seven Act” may not be used to circumvent the exclusive remedy of the Workers’ Compensation Act. An employee of a tire service company was killed in a collision with a vehicle owned by FirstExpress, Inc. It was argued that the worker had been required to work mandatory overtime and failed to get a full day of rest as called for in the statute. However, the court ruled that the employer was immune from tort liability because its actions did not rise to the level of “specific intent” to harm.

High court clarifies application of treatment guidelines – Minnesota

In Johnson v. Darchuks Fabrication, an employee was diagnosed with complex regional pain syndrome following a work-related incident. As part of the settlement, the company paid for ongoing medical expenses, which included over ten years of opioids. The employee was asked to go through a fourth IME, and for the first time, the medical examiner expressed doubt about the diagnosis. As a result, the company notified the employee it was discontinuing coverage for the medication. It argued the complex regional pain syndrome had been resolved and that the long-term opioid use did not comply with the workers’ compensation treatment parameters.

The case found its way to the Supreme Court and the company argued that the treatment parameters applied in this case. The court agreed, noting the treatment parameters do not apply when liability for the benefits has been denied, but a challenge to the reasonableness and necessity of treatment is not a denial of liability. It ordered the case remanded for further proceedings.

PPD award for fall in employer’s parking garage affirmed – Missouri

In McDowell v. St. Luke’s Hosp., an appellate court affirmed a decision by the state’s Labor and Industrial Relations Commission awarding workers’ compensation benefits to an employee who fell while bringing her belongings from the garage to her work station. While the state statute generally means benefits are denied when the hazard or risk is one to which the worker would have been “equally exposed outside of and unrelated to the employment in normal nonemployment life,” the court found that her fall was the result of her need to pull and maneuver a two-wheeled cart containing work-related supplies through a congested entryway and, therefore, was compensable. She did not face such a hazard in her non-employment life.

The worker, who had worked for the hospital for 45 years, had undergone a hip replacement and used a cane. The hospital had provided her with the two-wheeled cart to transport her belongings from the garage during her recovery.

No survivor benefits for daughter of deputy killed in car crash while exchanging shift information on his cell phone – Nebraska

In Coughlin v County of Colfax, a deputy sheriff was driving home and on his cell phone exchanging shift information with another officer who just came on duty when his vehicle hit a deer’s carcass. He lost control of the car, collided with another vehicle driving in the opposite lane of traffic, and died.

His brother filed a workers’ comp claim, which was denied based on the going and coming rule. The course and scope of employment had not been expanded by the cell phone conversation, in spite of its work-relatedness. It was determined that he was in his personal vehicle and off duty at the time of the accident.

An appellate court considered whether the cell phone communication was an employer-created condition that rendered the going and coming rule inapplicable. It found that although the Department expected the deputy to exchange shift-change information, it did not prescribe any one way of doing so and, in fact, had a cellphone policy that prohibited using a cell phone while driving a county-owned vehicle. The denial was affirmed.

Appellate court overturns decision to disqualify worker from future benefits – New York

In Matter of Persons v Halmar Intl, an appellate court overturned a decision by the Workers’ Compensation Board that disqualified an injured construction laborer from receiving future wage replacement benefits because he made false statements about his physical condition in violation of the law. The appellate court found that the Board’s findings based on video footage of his work as a volunteer firefighter and another video were inaccurate and could not be ascertained without further medical testimony. Further, the worker had acknowledged and disclosed his work as a volunteer firefighter.

The court concluded, “Simply put, our review of the record reflects that the Board’s decision [was] not supported by substantial evidence as it [was] based upon speculation, surmise and mischaracterizations.”

Law barring undocumented workers from additional benefits upheld by high court – Tennessee

The Supreme Court ruled that a state statute limiting the benefits available to a worker without legal authorization to work in the United States is not pre-empted by federal immigration law. The case, Salvador Sandoval V Mark Williamson, involved an undocumented worker for Tennessee Steel Structure who was injured on the job and received PPD benefits. He did not return to work after benefits ended and filed for additional benefits, but state law precludes benefits for anyone who is not eligible or authorized to work legally in the US.

The worker argued the law was unconstitutional because it was pre-empted by the federal Immigration Reform and Control Act (IRCA). The Supreme Court concurred with the Special Workers’ Compensation Appeals Panel that the law does not conflict with any provision of the IRCA.

Attempt to guide hand truck does not constitute “lifting” in violation of safety rules – Virginia

In Snelling Staffing/Chesapeake & Ace Am. Ins. Co. v. Edwards, the employer argued that an employee violated a known rule that prohibited lifting more than 40 pounds without assistance when he was injured. The worker and a co-worker stacked three boxes of computers, each weighing approximately 120 pounds, on a hand truck. When the worker attempted to pull back on the truck, the weight shifted and he tried to steady it with his leg, injuring his back.

The appellate court agreed with the Commission that the employee’s actions did not constitute “lifting” in violation of employer’s safety rule.

Police officer’s slip on the grass not compensable – Virginia

In Conner v. City of Danville, a police officer was part of a surveillance team at a duplex and was interviewing a homicide suspect outside with a colleague. Rain turned to hail and a tornado was moving through, so they decided to seek shelter. She twisted her knee when she slipped on the grass and almost fell and reported the injury. Through treatment, it was found that three discs in her back had apparently been affected and that surgery was needed.

Her comp claim was denied by the deputy commissioner and affirmed by the Commission and an appellate court because her risk of exposure to the tornado was not increased because of her employment. The interview was suspended while they attempted to get out of the weather, which is an act of God. Therefore, this was not a work-related injury.

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

OSHA watch

Anti-retaliation provisions of electronic record-keeping rule survives employer challenge

An Occupational Safety and Health Review Commission (OSHRC) administrative law judge’s decision to reject two defenses offered by the U.S. Postal Service to a citation preserves the controversial anti-retaliation provisions under its electronic record-keeping rule. The USPS allegedly issued a seven-day working suspension to a carrier because he reported a work-related injury. The USPS argued that the alleged standard and/or penalties were invalid because they were beyond the legal power or authority of OSHA and/or were arbitrary and capricious.

Process Safety Management standard extended beyond hazardous chemicals in ruling

Legal experts warn that a recent OSHRC ruling regarding safety violations in a deadly oil refinery explosion in 2012 could have wider implications for companies dealing with highly hazardous chemicals. OSHRC affirmed 12 violations of Process Safety Management standard by Wynnewood Refining Co, which argued the PSM was never intended to include processes that do not manage such chemicals – such as the steam boiler involved.

Prior to this ruling, it was widely understood that utilities unrelated to the manufacturing process were not included in the requirements for PSM. Experts say it is unclear how far the standard extends now.

Social media campaign to educate young workers

#MySafeSummerJob, a social media campaign to educate young workers about their rights in the workplace, how to speak up about dangerous work conditions, and how to protect themselves on the job, was launched in concert with several worker safety organizations. From April 15 through May 17 outreach will promote safety among young workers. Check out materials and ideas at the #MySafeSummerJob website.

Regional construction safety campaign shifts focus to falls

In concert with the Mid-Atlantic Construction Safety Council, a four-month campaign was launched to address the four leading causes of fatal injuries in construction. In March, the campaign focused on electrical hazards, and during April the emphasis was on struck-by hazards. This month is falls, and caught-in / between hazards will be the focus in June. The campaign serves employers and employees in Delaware, the District of Columbia, Maryland, Pennsylvania, Virginia, and West Virginia.

Email OSHA-Focus4-Region3@dol.gov for more information.

OSHRC finalizes revisions to its procedural rules

The OSHRC has finalized what it calls “comprehensive” revisions to its procedural rules, in part to reflect technological advances. Slated to take effect June 10, the changes include mandatory electronic filing for “represented” parties and a new method intended to streamline calculating time periods.

Proposal to watch: joint employer revisions

The Department of Labor announced a proposal to “revise and clarify” the issue of joint employers. The department is proposing a four-factor test “based on well-established precedent” that would consider whether the potential joint employer actually exercises the power to hire or fire the employee; supervise and control the employee’s work schedules or conditions of employment; determine the employee’s rate and method of payment; and maintain the employee’s employment records.

The proposal could differ from the interpretations put forth by other federal agencies and would not nullify regulations promulgated by individual states that have different standards.

The public has 60 days from April 1 to comment on the proposal.

Webpage on radiation emergency preparedness and response launched

A webpage intended to educate workers about how to protect themselves in radiation-related situations ranging from a small, isolated spill in a laboratory to a potentially catastrophic release at a nuclear facility is now live. The Radiation Emergency Preparedness and Response webpage provides resources on health and safety planning, medical monitoring and dosimetry, and other relevant topics for workers “who may be impacted by radiation emergencies” or “who may be involved in emergency response operations or related activities.”

Cal/OSHA proposing to re-adopt emergency rules for e-filing injury reports

Emergency rules were adopted Nov. 1, 2018 and the re-adoption would give additional time to proceed with regular rulemaking on a permanent basis. In addition to requiring electronic reporting for companies with at least 250 workers, the rules require businesses with 20 to 249 employees in industries such as construction, manufacturing and agriculture to electronically file injury logs.

A notice for proposed permanent rules is expected to be published by May 10.

MIOSHA launches emphasis program on roadway accident

The state emphasis program on roadway accidents will run through December 31, 2019 and is intended to increase the priority of inspections related to construction roadway safety and initiate inspections upon observing a roadway project with workers present.

Enforcement notes

California

  • Cal North Farm Labor Inc., a farm labor contractor and Crain Walnut Shelling Inc. face more than $100,000 combined in proposed penalties after a worker was fatally crushed by a bin dumper at a walnut processing and packing facility in Los Molinos.
  • Staffing agency Priority Workforce Inc. and JSL Foods Inc., a maker and distributor of pasta and baked goods face more than $300,000 in fines for serious citations after a temporary worker lost two fingers cleaning machinery at a Los Angeles food manufacturing facility.
  • Accurate Comfort Systems Inc. received four citations and faces $75,750 in penalties after a worker suffered serious injuries in a fall from a ladder on a 12-foot-high work area.

Florida

  • Inspected as part of the Regional Emphasis Program on Falls in Construction, Florida Roofing Experts, Inc. faces $132,598 in fines after inspectors observed workers performing residential roofing activities without fall protection.

Georgia

  • Investigated under the National Emphasis Program on Trenching and Excavation, Riverside Military Academy Inc., a military college preparatory academy in Gainesville, was cited for exposing employees to trenching hazards, faces $381,882 in penalties, and was placed in the Severe Violator Enforcement Program. Citations included allowing employees to work inside a trench without cave-in protection and a safe means to enter and exit the excavation, and failing to locate underground utilities prior to work.
  • Specialty chemical manufacturer, Plaze Aeroscience, operating as Plaze GA, was cited for exposing employees to fire and burn hazards at the company’s facility in Dalton and faces $107,164 in penalties.

Michigan

  • Mt. Clemens-based Powder Cote II received seven citations and faces $65,000 in penalties for failing to provide fall protection or guardrail systems, guard rotating shafts and machinery, and failing to control the startup of machinery during maintenance.

New York

  • Remington Arms, LLC, based in Madison, North Carolina was cited for 27 violations of workplace safety and health standards and faces $210,132 in penalties after a worker’s fingertip was amputated while using an unguarded metalworking machine at its Ilion manufacturing plant.

Pennsylvania

  • Framing contractor, Navy Contractors, Inc. was cited for willfully exposing employees to fall hazards at residential construction sites in Royersford, Collegeville, and Center Valley after inspections saw employees working without fall protection. The company faces $603,850 in penalties.
  • A jury in the U.S. District Court for the Eastern District has found that Lloyd Industries Inc., a manufacturing company based in Montgomeryville, and its owner William P. Lloyd unlawfully terminated two employees because of their involvement in a safety investigation. Damages will be determined in phase 2 of the trial.
  • A jury has concurred with the findings of a whistleblower investigation and awarded $40,000 for lost wages, pain and suffering, and punitive damages to a former employee of Fairmount Foundry Inc. The employee claimed that the Hamburg iron-casting company terminated him for reporting alleged safety and health hazards.
  • New Jersey contractor, Brutus Construction, Inc. was cited for exposing workers to fall hazards at a Souderton residential construction site. Inspectors saw employees working on roofs without fall protection and the company faces nearly $182,000 in penalties.

Wisconsin

  • A follow-up inspection revealed that Beloit-based Avid Pallet Services, LLC, failed to correct violations related to wood dust and respiratory hazards. The company faces penalties of $188,302.

For additional information.

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

Understanding the drivers of serious injuries by industry Liberty Mutual Workplace Safety Index

Produced annually, the Liberty Mutual 2019 Workplace Safety Index identifies the leading causes of the most disabling non-fatal workplace injuries (resulting in more than five days of lost time) and ranks them by total Workers’ Compensation costs. While the findings have always provided insight into critical risk areas so businesses can better allocate safety resources, this year’s report delves deeper by reporting the causes and costs of the most serious workplace injuries by eight industries.

U.S. companies lose more than $1 billion per week due to workplace injuries, according to the report that is based on data from Liberty Mutual, the U.S. Bureau of Labor Statistics and the National Academy of Social Insurance. The top causes of the most serious workplace injuries have been stable over the past several years, with overexertion (lifting, pushing, pulling, holding, carrying) and falls from the same level topping the list. Here are the top ten causes and their costs:

  1. Overexertion involving outside sources. Cost: $13.1 billion
  2. Falls on the same floor level. Cost: $10.4 billion
  3. Struck by object or equipment including falling objects from above. Cost: $5.2 billion
  4. Falls to lower level from a ladder or platform. Cost: $4.9 billion
  5. Other exertions or bodily reactions from activities (crawling, reaching, bending, twisting, climbing, kneeling, or walking). Cost: $3.7 billion
  6. Roadway incidents involving motorized land vehicle. Cost: $2.7 billion
  7. Slip or trip without fall. Cost: $2.2 billion
  8. Caught in or compressed by equipment or object. Cost: $1.9 billion
  9. Repetitive motions involving microtasks, such as working on an assembly line. Cost: $1.63 billion
  10. Struck against object or equipment. Cost: $1.2 billion

Even when broken down by eight industry sectors, there was consistency with overexertion and falls on the same level in the top five causes for each of the sectors. Here are the industry results:

Construction – $9.87 billion in losses ($189.81 million a week)

  1. Falls to a lower level
  2. Struck by object or equipment
  3. Overexertion involving outside sources
  4. Falls on the same level
  5. Slip or trip without a fall

Professional and business services – $7.86 billion in losses ($151.15 million a week)

  1. Falls on the same level
  2. Overexertion involving outside sources
  3. Falls to a lower level
  4. Roadway incidents involving motorized land vehicle
  5. Struck by object or equipment

Manufacturing- $7.62 billion in losses ($146.54 million a week)

  1. Overexertion involving outside sources
  2. Falls on the same level
  3. Struck by object or equipment
  4. Caught in or compressed by equipment or object
  5. Repetitive motions involving microtasks

Health care and social services – $5.17 billion in losses ($99.42 million a week)

  1. Overexertion involving outside sources
  2. Falls on the same level
  3. Intentional injury by person
  4. Roadway incidents involving motorized land vehicle
  5. Other exertions or bodily reactions

Retail – $5.09 billion in losses ($97.88 million a week)

  1. Overexertion involving outside sources
  2. Falls on the same level
  3. Struck by object or equipment
  4. Other exertions or bodily reactions
  5. Falls to a lower level

Transportation and warehousing – $4.37 billion in losses ($84.04 million a week)

  1. Overexertion involving outside sources
  2. Falls on the same level
  3. Roadway incidents involving motorized land vehicle
  4. Other exertions or bodily reactions
  5. Falls to a lower level

Wholesale – $4.04 billion in losses ($77.69 million a week)

  1. Overexertion involving outside sources
  2. Struck by object or equipment
  3. Falls to a lower level
  4. Falls on the same level
  5. Other exertions or bodily reactions

Leisure and hospitality – $3.46 billion in losses ($66.54 million a week)

  1. Falls on the same level
  2. Overexertion involving outside sources
  3. Struck by object or equipment
  4. Struck against object or equipment
  5. Other exertions or bodily reactions

While James Merendino, Vice President and General Manager at Liberty Mutual Insurance, acknowledges that efforts to improve safety need to be based on a specific employer’s operations and employees, he says there are three techniques that have proven successful in improving safety in a variety of industries.

  • Establish a strategic safety plan. This involves identifying the top safety risks facing the company and how they will be mitigated and managed. This includes existing risks, as well as integration of new technologies or procedures.
  • Set expectations. The commitment of senior management must be unwavering, consistent, and visible. It must be an integral part of the business plan for the company’s success.
  • Directly involve front line employees in the strategic safety program. This is an on-going process that benefits both the employer and employees. These are the people who do the work, are closest to the hazards, and know the shortcuts that can be taken.

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