Work-Accident -Compensation Accident Claim Work

Sabtu, 06 Agustus 2011

An Employer Is Responsible To Compensate For Pain

A NJ Appellate Court, in a dramatic reversal of a compensation judge's dismissal of a case, held that "an employer is responsible to compensate" an injured worker for pain. The reviewing court held that, "...the judge misapplied some standards bearing upon this case."

The trial judge's conduct, in baring the treating physician from testifying, was also cited as "a discretionary lapse." The trial judge's ruling was reversed and the case remanded for a hearing.

The case involved a long standing injury that required prolonged treatment for a chronic medical condition. The injury occurred in June of 1989 and was the subject of an Order Approving Settlement in January 2004 for 20% of partial total. That award was entered by another trial judge.

Even thought an Order had been entered by the prior trial judge for continued medical treatment and medication, the insurance company unilaterally terminated provision of those benefits without a court order. The claimant's attorney, George Goceljak, was required to file two motions for continued medical treatment and medication benefits. The trial court dismissed the case for lack of prosecution and then subsequently restored the matter for trial and then marked it "not moved" when a minimal one-cycle (3 week) adjournment was requested. Customarily, NJ workers' compensation cases are tried in piecemeal, every 3 to 6 weeks.

The trial judge then mandated that the trial should begin immediately on January 15, 2010, commenting that she was, "...not going to wait" any longer for the the claimant to proceed with his case. She denied a reconsideration of the application of the injured worker to allow the treating physician to testify, and then proceeded in a 5 month stagnated trial ultimately dismissing the case.

The NJ Appellate Division found, "the judge erred is using, out of its context, the simple thought that 'an employer is not required to compensate and employee for pain,' as a basis for denying this petitioner's application. The larger principle...is that, to the extent that a petitioner experiences continuing pain as a result of his work-connected injury, the employer for whom he worked at the time of the injury remains responsible.'"

Noto v. Staples, Inc., Docket No. A-0237-10T1, 2011 WL 3273921 (NJ App. Div. 2011) Decided August 2, 2010

Jumat, 05 Agustus 2011

Colorado Governor Reviewing Privatization of Pinnacol

As noted today in this Denver Post article it appears there still is interest in privatizing Pinnacol. Pinnacol Assurance is the state's largest workers comp insurer and originally was set up by the state to assist businesses especially high risk businesses in obtaining workers comp insurance. Despite many insurers saying otherwise usually premiums generate decent revenues. The so called cash reserves are amounts set aside to deal with claims or matters that require reserves but they do seem like profits when they get pretty high. Colorado legislators, in the past, thought about taking some of that to help with the budget problems but it never happened. New board members were appointed and there remains interest in exploring privitizing Pinnacol. The last time Pinnacol was willing to pay to obtain more private operations. One Republican legislator has said any cash to do so should go to the business owners who paid Pinnacol and are considered policyholders but of course Pinnacol also has a public side so once again we will see what happens.

Bad Faith Claims Maybe Going to the Jury

The NJ Supreme is going to review the procedure to bring bad faith claims against employers and insurance companies in workers' compensation actions. The Court accepted for review a case holding that workers' compensation bad faith claims are within the exclusive jurisdiction of the workers' compensation hearing official.

The case involves an injured worker who filed a civil action against his employer's workers' compensation insurance company for failing to comply with the Division of Workers' Compensation Order that medical treatment should proceed. The employee alleged that the delay and denial of medical care caused harm. The lower court had rejected the case and dismissed it holding that the jurisdiction for bad faith is exclusively within the purview of the Division of Workers' Compensation. Stancil v. ACE USA, 418 N.J. Super. 79, 12 A. 3rd 223 (App. Div. 2011), ___A.3d___, 2011 WL 3342730 (NJ). Decided June 7, 2011.

In another decision, the NJ Supreme Court held that bad faith, in a negligence action, was a contractual issue giving rise to a factual question that could only be decided by a jury.

"We conclude that a Rova Farms claim that an insurer in bad faith failed to settle a claim within the policy limits, thereby in fact exposing its insured to liability for any excess, represents a traditional contract claim that the insurer breached the implied covenant of good faith and fair dealing and to which the right to trial by jury attaches." Wood v. New Jersey Manufacturers Insurance Company, 21 A.3d 1131, 2011 WL 2314954 (NJ), Decided June 14, 2011.

The Stancil case highlights one of the most serious and costly issues in Workers' Compensation, both in NJ and the nation, the adequate and efficient delivery of medical care. While the courts are struggling with this issue that is compounded by arguments over reimbursement and treatment paths, the compensation system continues to be bogged down and unresponsive to the urgency of the need to delivery medical care to injured workers.

For over 3 decades the Law Offices of Jon L. Gelman 1.973.696.7900 jon@gelmans.com have been representing injured workers and their families who have suffered occupational accidents and illnesses.

Selasa, 02 Agustus 2011

New Policy on Prehearings

In an email sent to many representatives the word is out on some changes in setting up prehearings in Colorado workers compensation cases. Prehearings are useful in clearing up some disputes. For example if the other side has not provided discovery you might ask for a prehearing to compel the disclosures. Imagine going into a real hearing without disclosures of what the witnesses may say and what evidence will be submitted. A prehearing judge hears what is argued and decides on these preliminary but important matters. An order is issued which you disregard at your peril. A prehearing is not a full scale hearing with evidence and testimony but usually concerns legal arguments where the judge assists in moving the matter forward by issuing an order. In any event we are now told the email for this is dowc-phc@state.co.us. We are also told not to submit more then 10 pages by fax so seemingly they prefer that you email the materials. Should you do so at the last minute call them at 303-866-5508 (the number to set a prehearing)so they can retrieve the email in time for the prehearing. They also want you, when setting a prehearing, to confirm the date and time with the other side and provide email addresses to the prehearing unit. They also request being notified as soon as possible when a party is cancelling a settlement conference. Most of this is just common sense and contact information. No one likes it when someone is a no show or the proceeding is slowed. The prehearing judge does not have unlimited time to wait on faxed materials or emails so the point of this is to speed the process along. I can say that often in the past settlement conferences were cancelled at the last minute by the respondents. Usually it was because the respondent attorney did not have the dollar authority to settle.

Senin, 01 Agustus 2011

Workers Compensation Named to Top 50 Human Resources Blogs 2011

Evan Carmichael of The Entrepreneur Blog has named Workers Compensation Blog to the Top 50 Human Resources Blogs of 2011. Workers Compensation Blog is a resource for trends and developments in workers' compensation. It's popularity has grown exponentially over the last few years. The site contains hundreds of resource articles and links. It has received hundreds of thousands of hits and page views.

"Anyone who has ever run a business knows one thing – the most important resource you have at your disposal are the people around you. That is why getting your human resources strategy right is so crucial to business success. The following Top 50 Human Resources Blogs of 2011 can help you do just that.

"Written by the industry’s best, these blogs can help you with everything from hiring, to firing, to becoming a strong leader and managing your people in the best way possible. To reach the top, you need to have a solid team supporting you.

Why is the US Still in the Asbestos Business?

The US still has not banned asbestos. The recently released US Geological Survey just published the latest statistics reporting that 1,040 metric tons of asbestos, a know carcinogen and the cause of mesothelioma, a rare and fatal disease, was consumed in 2010 in the US. Roofing products account for about 72% of US consumption and other applications 28%.

Where does it come from? Our northern neighbor, Canada. Asbestos has not been mined in the US since 2002. The US imports 99% of the asbestos it consumed from Canada. In fact the US consumed 1,040 metric tons in 2010 which was an increased from 869 metric tons in 2009.

If Congress really wanted to improve the health of both its citizens and the economy, it would take appropriate action to ban asbestos in the US.

Australian Woman Claims sex accident is work related

This recent news article caught my eye so it makes for a good read. I am posting it here without any further comment other than to say that most of us in the field have had unusual situations that require research to assess if an injury could be considered compensable. Never let it be said that the law is boring! Those traveling for a company or stationed at some distance from their home are not simply limited to asserting a claim for injuries sustained during working hours. The average employee goes home and has his own time in his own home but when you are stationed elsewhere other factors may apply. Here this young lady in Australia was having sex in her hotel room when the activity caused an accident resulting in injury. Workers comp? In Colorado and elsewhere you should review the law for that jurisdiction.

Sabtu, 06 Agustus 2011

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