Pinnacol Assurance is it private or public?

In the last few days a big dispute arose over a proposal to take what might be considered excess funds from Pinnacol to help the state in the present economic downturn. Pinnacol handles a great many workers comp claims and that means more then any other insurer. In any event Pinnacol has attacked this as a "raid" and outrageous. At the Pinnacol website here is their view. A former Colorado governor chimed in for Pinnacol here. But the Pinnacol story is not quite that simple. Pinnacol has a long story in Colorado. When you look at its history you can see why there is a controversy over the right of the state to take from Pinnacol. Under several names Pinnacol has evolved over time but it originally was set up and funded by the state of Colorado. It was intended to protect workers and employers from other insurers. Truly private companies don't like high risk businesses (construction is one high risk business) so Colorado just sought to ensure that such businesses could obtain coverage at a fair price. Over time Pinnacol has become more private then public but to this day it has some of each. It has a separate statutory section and its board is appointed by the governor. Clearly over time it has evolved away from being a public agency but it is not truly private yet. I am not saying that the effort to get some of Pinnacol's fund is appropriate but arguments that imply it is immune from legislative control are inaccurate. Want to see the statute itself that says Pinnacol is a political subdivision of the state but not a state agency? Go to 8-45-101 from this link.

Hyperbaric Oxygen Therapy

If you read up on hyperbaric oxygen therapy you will find that it has been useful in some types of treatment. I am writing this to encourage its use in injury and disability treatment where appropriate. We have all sorts of therapies in workers comp. Often these therapies are temporary in nature. However in my opinion I think hyperbaric treatment has the potential in some cases to actually improve the situation. I have seen videos of its use in brain injury, with wounds and burns, with improving athletes and in a host of disabilities from autism to cerebal palsy and much more. The treatment of the injured and disabled should not simply proceed along current approved standards. The trouble with standards is that they can inhibit or stall progress. Medicine is a science that should be forward looking. It should not be limited by laws and rules that sometimes restrict progress. Colorado has treatment guidelines. Sometimes these guidelines are useful but sometimes they seem too rigid. The problem is that medical providers seem to believe they are held to these guidelines yet medical science blows right by them as it progresses forward. Insurers need to realize that if the goal is improve the claimant that hyperbaric (HBOT) can be a win win situation. I am arguing for its increased use in workers comp and even with those totally disabled who may be made more functional with hyperbaric treatments. By the way think of hyperbaric treatment as the use of a decompression like chamber to assist with oxygen absorption into the muscles, tissues and organs of the body to promote healing. It is actually quite simple to do. You enter a small chamber where you spend about an hour a session getting the treatment. Sounds a bit strange until you research it and find out that it is associated with improvement after numerous treatments. Think of it as another form of physical therapy. If you truly research it you may be surprise at how many areas it may be able to improve functionality. A lawyers job is made easier if the doctors and insurers look at the goal of recovery at a reasonable cost. The legal area will only litigate this which causes more expense that could go towards giving hyperbaric a trial run in cases where a doctor suggests it is worth a trial. I must say that many times a client tells me that all they really want is to receive reasonable medical treatment. Many times they tell me that but for the denial of treatment or poor treatment they'd never even use an attorney. The point is that we need encourage whatever works to improve the injured and disabled. HBOT is one more tool to use to improve and increase the chance for recovery in certain types of areas. I would certainly go to bat to obtain approval for its use in workers' compensation.

Which do you prefer Colorado or NY workers comp?

The Hew York Times has a long article on the terrible state of comp in New York. It gave me the shivers to read. In Colorado much can be done to improve our state's workers comp system. I still believe that arm and leg injuries deserve more benefits especially when the person loses his trade or occupation. But there are parts of our system that have worked well especially the DIME or Division Independent Medical Exam process. No doubt there are many cases where things do not go well but overall it seems at least better then NY State. Anyway read about the horrible state of workers comp in NY here. Those of us in this field know that most of our judges do try to apply the law. They also know that many doctors are not just hired guns by the insurers or second rate. Those that are can often be overridden by the DIME process. Our system is not perfect and many times employees are treated like old newspapers but there are some safeguards and rules which can be used to equalize the case. At least with solid legal effort you can increase benefits but the NY article makes it seem like NY is out of control. I am not sure on that but the article is an interesting read.

Social Security Disability delays frustrate lawmakers

As noted in The Oregonian there are still heartbreaking stories about the delays in obtaining benefits. Apparently despite good intentions the delays can cause extreme hardship. In our area it is common to take a few months for the initial decision and then if denied over a year to obtain a hearing. After the hearing it can take many months to actually collect all the back benefits due, assuming you win. If you are receiving assistance and eligible for SSDI and SSI benefits it can take a great deal of time as the finance people at the agency compute the amounts. They must compute any deduction from your back benefits so you don't obtain more then you are entitled. We all know this should go much faster but historically delays seem ingrained in the system. The agency, according to the news article, has over 63000 employees and is trying to make itself more efficient. Nonetheless, imagine going down to your bank and being told it will take even a month to get your money. I really believe the math should not take that long. However it does take many months to obtain a hearing. Even if the Judge tells you the decision will be favorable at the hearing (which usually does not happen) it can take several weeks for him to issue the formal decision. I always tell those I represent to expect at least 6 weeks. Recently one case took 3 months to receive the favorable decision. Compare this to a workers comp decision which seldom takes very long. I suspect this is a case of inadequate funding to deal with the crush of cases that Social Security must handle. Can anything be done about this? More funding would help but also I think there should be other changes. The longest delays are waiting for a hearing. I'd require another legal review of all cases with claimants over 50 years old to see if perhaps the situation can be clarified so they obtain benefits. Many of these cases involve long term workers with severe enough health concerns that they can no longer work and should more easily qualify for benefits. Too often I've seen claimants denied who have enough health concerns to merit a more careful analysis. Such workers often have worked many years with decent earnings. For them seeking benefits is actually a come down. I also would give more credibility to pain complaints that are consistent with the medical evidence. Pain alone can be disabling and lately it seems that pain is discounted too much. I also think the treating doctor is discounted more then is fair since he likely knows far more about the claimant. There are many ways to improve the system with appropriate safeguards to prevent abuse but it takes an honest appraisal. It would take a dedicated effort to study the existing system. This study could include judges, attorneys, claimants and even doctors.

Antartica in Colorado workers comp case!

Decided on March 19, 2009 the Iler case involved a claimant hurt in Antartica. He sought to add the value of his room and board to the wage calculations by comparing it to his room/board in Colorado. So how do you calculate its value in Antartica? The judge felt he couldn't and the claimant appealed. The next level up in an appeal is called an ICAP decision. The Industrial Claim Appeals Panel decides at this stage. In his case they agreed with the Judge. The next appeal is to the Court of Appeals and here the claimant succeeded in getting his case remanded back down to the Judge to assess a reasonable value and add it to the calculations. Read the Iler case here. It is always in the best interests of a claimant to have a high average weekly wage. This figure is often used in determining the amounts of temporary and permanent benefits you are entitled to receive. The most common increase comes when they forget to add your overtime. Also they should add your health coverage if you are going to lose it through your employer. But also as is the case here an employer provides you with room and board. It may be part of your wage package so it too can be added. The Colorado statutory definition of what is your average weekly wage is as follows at 8-40-201:

(19) (a) "Wages" shall be construed to mean the money rate at which the services rendered are recompensed under the contract of hire in force at the time of the injury, either express or implied.

(b) The term "wages" shall include the amount of the employee's cost of continuing the employer's group health insurance plan and, upon termination of the continuation, the employee's cost of conversion to a similar or lesser insurance plan, and gratuities reported to the federal internal revenue service by or for the worker for purposes of filing federal income tax returns and the reasonable value of board, rent, housing, and lodging received from the employer, the reasonable value of which shall be fixed and determined from the facts by the division in each particular case, but shall not include any similar advantage or fringe benefit not specifically enumerated in this subsection (19). If, after the injury, the employer continues to pay any advantage or fringe benefit specifically enumerated in this subsection (19), including the cost of health insurance coverage or the cost of the conversion of such health insurance coverage, such advantage or benefit shall not be included in the determination of the employee's wages so long as the employer continues to make such payment.

(c) No per diem payment shall be considered wages under this subsection (19) unless it is also considered wages for federal income tax purposes.

The Top Ten Reasons

Why do injured workers hire attorneys? Over at the Workplace Injury and Law Advocacy Group one writer set forth ten major reasons. Quoting from the article here is the list:

TOP 10 REASONS
10. Does not know the value of Permanent
Partial disability final payment.
9. Harassment from employer while on
restricted duty.
8. Has other legal issues (SSD, Short/Long
Term, ERISA subrogation, unemployment).
7. Poor Medical Care.
6. Fear of losing job or loses job.
5. Poor Treatment by adjuster/nurse case
manager.
4. Total Permanent situation.
3. Temporary Total Benefits not paid timely or
in correct amount.
2. Employer ignores Injury and refuses to
refer for medical treatment.
1. Changes in the law.

It is rather clear above that "protection" is the biggest single consideration. I would also like to add that an attorney can not only protect but also will seek to maximize your medical and compensation benefits. This can mean doubling, tripling or multiplying by over 10 times what the insurer says they still owe you. It can mean taking a claim when the insurance says you've been treated and released without impairment and obtaining more treatment and benefits. A decent attorney can not only protect but also increase your benefits considerably.

Larson's National Workers Comp Advisory Board

I have just been invited to become a member of Larson's National Workers Compensation Advisory Board. This is maintained by LexisNexis a very large legal publisher. I do appreciate the invitation and accepted. So from time to time I'll provide information to them on Colorado workers comp matters. Larson's Workers Compensation Law is historically the major publication and source of knowledge in this field. With the internet much is now moving onto the web. For example I do my legal research using Westlaw which maintains a searchable database of legal materials. In the old days we had to search through digests and state law books followed by "shepardizing" cases just to verify the decided issue was still good law. Now we can do all this and more in less time.