Category: Workers Compensation
The National Institute for Occupational Health and Safety (NIOSH) has published educational information to prevent musculoskeletal injuries at work. Injuries caused by ergonomic factors have been a major issue of the Federal government for decades and have been the basis for repetitive trauma motion claims for workers’ compensation benefits. While the Clinton-Democratic administration had advocated strongly for ergonomic regulations, the Bush-Republican administration took action to reject the reporting of ergonomic injuries to OSHA.
Image via WikipediaOne repeat violation with a ,000 penalty has been cited for allowing workers to operate a mechanical power press that lacked machine guards, exposing workers to being pulled into the machinery and suffering possible amputations. A repeat violation exists when an employer previously has been cited for the same or a similar violation of a standard, regulation, rule or order at any other facility in federal enforcement states within the last five years.
One serious violation with a ,000 penalty also has been issued for exposing workers to amputation hazards by failing to use safety blocks when changing dies or equipment is being repaired. A serious violation occurs when there is substantial probability that death or serious physical harm could result from a hazard about which the employer knew or should have known.
“OSHA will not tolerate management waiting for a serious injury to occur before correcting violations that expose workers to potential amputation hazards,” said Darlene Fossum, the agency’s area director in Fort Lauderdale. “Employers must take proactive actions toward workplace safety.”
List Industries, a manufacturer of metal shelving and lockers with six locations in the U.S., has 15 business days from receipt of the citations and proposed penalties to comply, request a conference with OSHA’s area director or contest the findings before the independent Occupational Safety and Health Review Commission.
Guest Blog by Jon Rehm of the Nebraska bar
Editorial note:
Jon L. Gelman
Federal oversight of collection, credit agencies could benefit civil plaintiffs
By Jon Rehm
Consumer Financial Protection Bureau (CFPB) director Richard Cordray announced today that collection agencies could be subject to federal oversight by the newly-created bureau. This is good news for people who have lost their jobs because of a personal injury, a work injury and/or a wrongful termination. Loss of a job goes hand in hand with financial insecurity and mental and emotional distress. Any new federal regulations could give victims of injuries and wrongful terminations a bit more piece of mind if their attorneys are diligent in applying the potential new regulations.
One pro-debtor idea that has been discussed as a regulation would be heightened documentation standards for filing collections suits. This would be a preemption argument. The Roberts Court and the Federal Courts generally favor preemption. Plaintiffs lawyers, especially the class action bar, hates preemption. I think most plaintiff’s lawyers would be wary of federal intervention in state courts. But if the Supreme Court favors preemption it makes sense for attorneys who advocate for debtors to use whatever tools are available.
According to the New York Times article, the oversight will cover the 150 biggest collection firms that comprise about 2/3rds of the market share of the collections industry. But even if an over-aggressive collection agency is not covered by the new regulations, Nebraska lawyers defending collection cases for plaintiff’s in injury and employment cases have other remedies such as the option of removing collection actions from county court into district court in order to seek injunctive relief. Lawyers in other states should also check their jurisdictional statutes to see how they can use equitable remedies in collection defense.
The CFPB also announced a proposal of credit reporting agencies. I heard a speaker at the recent AAJ Winter Convention in Phoenix mention that insurers will run credit checks of plaintiff’s firms during litigation in order to gain more leverage in settlement negotiations. If that is true it would stand to reason that insurers and employers would run credit checks on the plaintiffs themselves. Such a tactic would likely run afoul of the Fair Credit Reporting Act and possibly create another cause of action. One practice pointer to counter such tactics would be to include questions about credit checks in written discovery.
County judge orders work comp collections case removed to District Court
by Jon Rehm
The threat of injunctive relief in a work comp related collections case gives injured workers more leverage in their negotiations with bill collectors. Hopefully more advocates for injured workers will use this tool to protect their clients.
Health Wonk Review – Jason Shafrin has posted the Health Wonk Review: More than Birth Control Pills edition at Healthcare Economist. And there is indeed much more than birth control in this issue: politics, health care reform, the Affordable Care Act, and a grab bag of other timely topics. Check it out!
CDC calls prescription drug problem “epidemic” – The CDC weighs in on the prescription drug abuse problem, calling it “epidemic” and “the fastest growing drug problem in the United States.” Risk & Insurance offers a concise summary. And on the same theme is a story about how New Jersey has implemented a Prescription Drug Monitoring Program. “In unveiling the program last month, state officials related that one patient obtained more than 2,500 doses of oxycodone and methadone in a four-week period. The patient presented what are now believed to be forged prescriptions to three pharmacies on 14 separate occasions, spread out his visits among the pharmacies, and paid sometimes with cash and sometimes by insurance.”
Affordable Care Act: What if… – What if the Supreme Court overturns the mandate? At Managed Care Matters, Joe Paduda looks at what the repeal of the mandate would mean for workers comp.
Marijuana & impairment Roberto Ceniceros recently discussed the issue of marijuana use and impairment. He cites a recent Louisiana appeals-court ruling that upheld benefits for an injured worker who showed positive in a post-injury test for consumption of marijuana and a prescription drug.
Emerging Risks: Exploding Hog Farms – Hog farmers take note: the Minnesota Daily covers reports of a mysterious foam that has caused Midwest swine barns to unexpectedly explode. The foam can build up to heights of four feet on manure pits. “The foam traps gases like methane and when a spark ignites it causes an explosion. About a half dozen barns in the Midwest have exploded since the foam was discovered in 2009. / In mid-September 2011, a barn in Iowa was added to the growing number of barns taken down by the foam. In the explosion, 1,500 pigs were lost, and one worker was injured.”
Contractors in conflict zones – At Risk Management Monitor, Jared Wade discusses contractor deaths in Afghanistan as reported in a recent New York Times article. He notes that, “In 2011, for the first time, there were more civilian contractors working for U.S. companies that died in Afghanistan than there were U.S. soldiers.” He follows up with excerpts and links to a prior Risk Management story on working in the world’s most dangerous locations
Economy & Insurance – Global financial woes will not derail the economy, according to Robert Hartwig, President and Economist at the Insurance Information Institute, who has been a reliable forecaster and source of information on both the overall economy and the impact on the insurance industry. He sees opportunities for insurers beyond waiting for rate increases. Read more in Chad Hemenway’s story at Propertycasualty360: Hartwig: U.S. Insurers Should Look at ‘New Trajectory of Growth’
Aging & Construction Work – The Center for Construction Research and Training analyzed 100,000 workers comp construction industry claims for the
state of Colorado to understand the relationship between the claimant
age and costs by the causes and natures of injuries and illnesses. Consistent with other aging studies, the report says “Older construction workers filed a small percentage of the total workers’ compensation claims; however, when they did file a claim the associated costs were greater.” Review the key findings: The Role of Age on the Cause, Type, Nature and Cost of Construction Injuries (PDF)
News briefs
- Some Downsides of Social Media for Doctors
- Would You Get Married to Avoid a Deposition? A Case Study…
- Workplace Violence: Fatal Shooting at Dental Office Was Not Sufficiently Connected to Employment
- Be one in a million this American Heart Month
- Police Union Seeks Data for Cancer Links to 9/11
- How 1-Minute Intervals Can Improve Your Health
- How healthy are your employees? Track via your state’s Well-Being Index
- Safety Precautions for Solo Workers
A couple of years ago we blogged the performance incentive program at Smurfit-Stone Container Corporation in California. The performance numbers were stellar, but not necessarily because the work was performed safely. Instead, the company conspired with local medical providers to secure limited treatment outside of the workers comp system. Two supervisors pled no contest in conspiring to deny comp benefits to injured workers.
With the recent conviction of chiropractor Robert Schreiner, we see into the black box of the conspiracy. Workers complaining of work-related problems were referred to doctors like Schreiner – giving rise, alas, to a new and ominous definition of provider network. In one instance a worker complained about a neck and shoulder injury. Schreiner denied that the problem was work related, saying that it was caused by carrying a back pack as a child. He provided a handful of treatments and then encouraged the worker to file the claim under his health plan to continue treatments. When the worker persisted and filed a comp claim, he was fired.
Schreiner is headed to jail to serve a mostly symbolic sentence of 30 days, to be followed by three years of probation. Perhaps he can provide some adjustments to his fellow inmates. Confined spaces sure can mess up the spine.
Faking Safety
Smurfit-Stone was bought out last year by RockTenn. You can still read about the company in Wikipedia. Here is the (unattributed) description of the company’s safety program:
Smurfit-Stone has been an industry leader in safety performance since 2001 [NOTE: the conspiracy to under-report claims began in 1999!]. In 2007, Smurfit-Stone’s U.S. operations had an OSHA recordable case rate of 1.05, the best in company and industry history. This represents an 84 percent improvement in the company’s recordable case rate since the implementation of Smurfit-Stone’s SAFE process in 1995.The SAFE process, which stands for Smurfit-Stone Accident-Free Environment, promotes five core beliefs:
1.All injuries are preventable
2.Safety is everyone’s responsibility
3.Working safely is a condition of employment
4.Training employees to work safely is essential
5.Safety is good business
As litigation has proven, Smurfit-Stone’s low OSHA case rate has less to do with safety than with a conspiracy to under-report claims. Perhaps the SAFE program stood for something else: Screw All Forsaken Employees. Aggressive safety goals are a good business practice; circumventing the workers comp system is not just a bad practice, it’s illegal. Just ask Robert Schreiber.
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Louise Norris jumps into the political fray with this week’s Health Wonk Review – Campaign 2012 Edition at Colorado Health Insurance Insider. It’s a great edition with some solid submissions, and we are smitten by the great historic voting photos that Louise used to punctuate the posts. Check it out.
Other noteworthy news
Follow the money – In the continuing saga of Florida’s physician-dispensed workers comp drugs and the associated costly price tag for employers, Joe Paduda looks at the behind-the-scenes opposition muscle aimed at any legislative attempts to put limits on this practice. He cites a recent research report, which tracked more than million in political donations to “one Mirimar address, dozens of companies.” The Florida Independent news story goes on to say, “In suburban Tampa, a single-story building at 610 South Blvd. is home to countless political committees in Florida and all over the country, and is known as a veritable political action committee mill. A similar story lies in Miramar, where two doctors — Paul Zimmerman and Gerald Glass — run dozens of companies that, altogether, have funneled more than million into state political campaigns and committees in recent years.” Joe notes, “.2 million total shows clearly just how important Florida is to dispensing companies and their affiliates.”
Violence in the Workplace – “Workplace homicides ‘Are not crimes of passion committed by disgruntled coworkers and spouses, but rather result from robberies.’ And the majority of workplace assaults are committed by healthcare patients.” These are a few top line findings in the NCCI research report on Violence in the Workplace. Although homicides are trending down, they comprise 11% of workplace fatalities. You can download a copy of the complete report, which is part of NCCI’s ongoing research into the topic of work violence.
New blog of note – The folks at PRIUM, a workers’ compensation utilization management company, have recently launched Evidence Based, a blog that will focus on our favorite topic – workers comp – with particular emphasis on the over-utilization of prescription drugs in the treatment of injured workers. Recent posts have dealt with state efforts to control narcotics. See recent posts on Arizona: The Simple Path to Controlling Narcotics in Non-Monopolistic States and Ohio’s New Rules: A Good Start (with a Potential Gap).
Getting social – Pro tip for social media users: If you are going to file a workers’ comp claim, you should think twice about posting party pics on Facebook – judges may take them into consideration when evaluating the merit of your claim.
The Feds & Fraud – In Government Executive, Kellie Lunney explores the reasons why the federal workers’ comp program remains vulnerable to fraud. According to a study by the Government Accountability Office, limited access to data is a key culprit. “Specifically, we found that limited access to necessary data is potentially reducing agencies’ ability to effectively monitor claims and wage-loss information,” the report stated. In addition, agencies’ overreliance on self-reported data from claimants, the frequent use of physicians not employed or selected by the government, and the expense involved in conducting investigations and prosecutions have stymied efforts to stamp out fraud. GAO noted that investigations are the “most costly and least effective” way to reduce fraud, but the ability to prosecute those who cheat the system is a valuable deterrent.
OSHA Posting Compliance – Employers, did you remember to post OSHA Injury & Illness Reports on Feb 1? If not, make sure that you do. Rules require that employers post “…the official summary of all injuries and illnesses occurring in the previous year. The information must be compiled on the OSHA Form 300A or an equivalent and posted in a conspicuous place or places where notices to employees are customarily posted. The information must remain up through April 30, 2012.” For more information and to learn if this requirement applies to your organization, check out OSHA’s Recordkeeping page.
Quick takes
- The Emerging Risks of 2012
- The supersizing of America: retooling for the obesity crisis
- Some Downsides of Social Media for Doctors
- Report: U.S. may never get back its investment in AIG
- OSHA Pocket Guide – Protecting Yourself from Noise in Construction (PDF)
- Why inspectors might hesitate to shut down a mine
- Untreatable Tuberculosis Baffles Doctors
- 5 Ways Employers Can Reduce Worker Stress
A little more than a week ago, family members and coworkers watched helplessly as 39-year old Raul Zapata was buried alive when a wall of dirt fell on him at a residential construction worksite in Milpitas, California. Zapata was working in a 12-foot deep ditch, the foundation of a 5,800 square foot home in a gated community. The cave in was extensive enough that it took two days to rescue his body. Zapata and his coworkers should not have been working at all that day because three days prior, the city had issued a stop work order to the construction company, U.S. Sino Investments Inc. The order was issued after a city building inspector determined that the ditch was a safety hazard due to a lack of adequate shoring to prevent a cave-in.
To add insult to injury, the employer did not have workers’ comp insurance. They also lacked a permit, a state requirement for any projects deeper than five feet. In a case of closing the barn door, the Contractors State License Board has since suspended U.S.-Sino Investment’s general building contractor license for this failure. The flouting of the stop work order, the failure to get a trenching permit and the failure to carry workers comp coverage – these are not unsurprising accompaniments to trenching fatalities. Fatalities are often preceded by multiple citations or warnings and violators are often serial violators. It’s not uncommon for OSHA to issue mulitple “willful” citations related to trenching failures. OSHA defines a willful violation as one “committed with an intentional disregard of, or plain indifference to” OSHA requirements, the highest level of citation, carrying fines of ,000 to ,000 per incident.
Two workers a month are buried alive in trench collapses. Most of these tragedies are avoidable simply by following OSHA standards, which mandate that all excavations 5 feet or deeper be protected against collapse. It’s a stroke of luck that no other workers were killed at the Milpitas site – it’s not uncommon for rescuers to rush to the aid of a victim and become entrapped themselves when an a secondary collapse occurs. Trench rescues require speed, precision, and expertise.
To help curtail fatalities that OSHA describes as “entirely preventable,” in October they released new trenching safety guidance, including the following safety materials:
Fact sheet: Trenching and Excavation (PDF)
Quick Card: Working Safely in Trenches (PDF)
Poster: An unprotected trench is an early grave (PDF)
Other resources:
Trench safety – an eleven-lesson tutorial based on the latest OSHA requirements for construction excavation safety.
OSHA – Confined Space
Constructing a better trench rescue (PDF)
Guest Blog
by Julius Young of the California Bar
Are medical treatment recommendations sometimes driven by profit motive?
In my whole career I’ve met very few injured workers who expressed concern that the treatment recommendations of their doctor were influenced by physician income considerations.
Americans tend to trust their doctors. Some of us grew up watching Dr. Kildare, Ben Casey, or the MASH doctors. Others cut their teeth on ER or General Hospital.
Nothing pisses off an injured worker as much as having an outside, non-examining utilization reviewer doctor challenge the recommendations of their doctor.
But the reality is that sometimes medicine and economics are intertwined. Just as insurers want to limit costs, there are some doctors who are happy to push procedures and tests for profit.
In a prior post, “Upcoding”, I noted recent investigative reporting by California Watch that documented unusually high rates of billings for “cardiac failure” in some California hospitals:
http://workerscompzone.com/index.php?m=11&y=11
So it was no surprise to see today’s article in the Wall Street Journal which documents high rates of spinal surgery procedures in some California hospitals. The article, “In Small California Hospitals, the Marketing of Back Surgery”, was written by John Carreyrou, Tom McGinty and Joel Millman.
The article focuses on spinal surgery at Tri-City Regional Medical Center in the city of Hawaiian Gardens which is in southeast Los Angeles County near Long Beach.
According to the Wall Street Journal investigative reporters:
“For an operation known as spinal fusion, which joins two or more vertebrae, the small hospital billed workers’ compensation insurers million in 2010, up from less than million three years earlier, state hospital discharge data show.Helping spur the business was Paul Richard Randall, a consultant to whom Tri-City has paid millions of dollars in marketing fees. According to people familiar with his role, it was twofold: bringing surgery cases to the hospital by recruiting surgeons to operate there, and supplying metal implants for the surgeries through distributorships he owned.”
The article notes that Randall has been the subject of a federal investigation although charges have apparently not been filed nor have illegal acts been proven.
According to the Journal, many small hospitals are doing lots of workers’ comp spinal surgeries, noting that “California employers paid .1 billion in insurance premiums to cover their workers’ compensation liability in 2010. Spinal-fusion surgery is a growing part of the care these premiums pay for. It accounted for 40% of inpatient hospital charges to the state workers’ compensation system in 2010, up from 30% in 2001, a Journal analysis of hospital discharge data shows.”
Hospitals that did a large amount of spinal surgeries included university-based hospitals such as UCSF, well known treatment centers such as Cedars Sinai and Scripps La Jolla but also a number of small hospitals around the state.
While it would be unfair to assume that some of the hospitals mentioned in the article are encouraging spinal surgery cases as a “cash cow”, the article raises a number of questions worthy of further looks by policymakers.
Spinal hardware costs have already been addressed in a RAND study prepared for CHSWC, “Payment for Hardware Used in Complex Spinal Procedures Under California’s Official Medical Fee Schedule”, by Barbara O. Wynn and Giacomo Bergamo:
http://www.dir.ca.gov/chswc/Hardware_comp9.pdf
ABC news has picked up a story out of Arkansas: Zack Clement suffered a hernia while moving a refrigerator for his employer, Johnson’s Warehouse Showroom. He underwent multiple surgeries, but the pain lingered, so he filed for a continuation of benefits. Among the pieces of evidence at his trial were party photos posted on his Facebook page, which show Clement drinking (and little else). When his claim for reinstatement was denied, Clement appealed, citing the unfairness of the Facebook evidence.
ABC wrote as follows:
In an opinion, written by Judge David M. Glover, the Arkansas Court of Appeals states: “We find no abuse of discretion in the allowance of photographs. Clement contended that he was in excruciating pain, but these pictures show him drinking and partying.”
“Certainly these pictures could have a bearing on a Clement’s credibility, albeit a negative effect that Clement might not wish to be demonstrated to the ALJ or the Commission, ” Glover continues. “We hold that there was not an abuse of discretion in allowing the photographs.”
Justice in the Details
At first glance, the judge’s comments might be cause for alarm. An injured worker suffering from chronic pain might well be capable of having a few drinks with friends. (One can only hope that the alcohol does not interfere with any prescribed -or unprescribed – pain medications.) If the photos were the primary evidence of Clement’s condition and the basis for denying the claim, Clement would have good reason to object. However, this is not the case.
In the course of his carefully reasoned findings, Judge Glover reviews in detail the medical history of Clement’s claim. Even after multiple surgeries and several changes in treating doctors, Clement complained of ongoing pain. Extensive medical testing revealed no abnormalities and no evidence for the pain itself. He has been released to full duty. It is this detailed history and the lack of medical evidence that lead Glover to conclude that any further treatment would fall outside of the workers comp system. The Facebook photos are by no means the foundation of his findings. Nonetheless, he decides that the photos are a legitimate piece of the case file and admissable as evidence.
In my limited experience, Facebook seems to be a platform for superficial news and, for the most part, images of the good times. It is difficult to imagine that Clement would have used this public forum to post pictures of himself suffering excrutiating pain. If he had chosen to do so, this might have provided evidence in his favor. However, his friends would likely have chided him for being such a downer and even then, the court might have dismissed the images as theatrical exaggeration.
Facebook may now be the preferred means of presenting our personal narratives, but it is unlikely to help us make our case in a court of law.