KY - Court Says Written-Off Medical Expenses Can Constitute 'Payments Received'
05/08/2024 | 0
In a case of first impression, the Kentucky Court of Appeals ruled that medical expenses written off by a provider constitute “payments received or the right to receive payment” that offset a worker’s recovery.
Greyson Findley worked for Western Kentucky University as a student intern in its Floral Design Training Center. He suffered a severe laceration when the blade of a stem cutter fell on his wrist.
Findley underwent surgery to repair severed muscles, tendons, nerves and an artery in his hand and wrist. He was left with physical limitations from the injur...
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The Washington Court of Appeals upheld the denial of a firefighter’s claim for post-traumatic stress disorder.
Case: Shaw v. Kittitas Valley Fire and Rescue, No. 39651-7-III, 05/02/2024 unpublished.
Facts: Frank Shaw worked from 1989 to 2007 as a firefighter and paramedic with the agency that ultimately became Kittitas County Fire and Rescue.
In 2010, Shaw was diagnosed with post-traumatic stress disorder. Shaw’s therapist opined that his condition was caused by his work.
Procedural history: Shaw filed a workers’ compensation claim with the Department of Labor and Industr...
A New York appellate court ruled that a worker was entitled to summary judgment on his Labor Law claim for his injuries from falling into a hole.
Case: Haskins v. Metropolitan Transportation Authority, No. 151643/20, 05/02/2024, published.
Facts: Darren T. Haskins fell into a hole while working on a construction project for the Triborough Bridge and Tunnel Authority.
The hole measured two to 2.5 feet deep, 18 inches wide and 3 feet long. It was covered by a thin piece of black plastic material.
Procedural history: Haskins filed suit against the TBTA, asserting a claim for a viola...
The South Carolina Court of Appeals upheld the denial of a Walmart employee’s claim for benefits for alleged injuries from a workplace fall.
Case: Brown v. Walmart Inc., No. 2022-000963, 05/01/2024, unpublished.
Facts: Helen Brown worked for Walmart Inc. She allegedly injured her arm in a fall at work and went to the hospital the same day.
Brown allegedly complained of arm and shoulder pain at the hospital, and she underwent X-rays. The X-rays, however, did not show signs of trauma to her left shoulder or arm. Additionally, a magnetic resonance imaging scan showed that ...
California workers’ comp fee schedules aren’t easy to keep up with.
Subject to constant revision, the complex formulas for calculating correct reimbursement are more than human brainpower can handle — hence the need for top-notch technology.
Recently, daisyBill alerted third-party administrator CorVel that it was incorrectly reimbursing providers for treatments rendered on or after April 1, 2024, when the rates under California’s Physician Fee Schedule increased for the second time this year.
Fortunately, CorVel was quick to acknowle...
WI - Commercial Baker Cited Over Worker's Disabling Injuries
The U.S. Occupational Safety and Health Administration on Monday said it cited a commercial baking company after a worker suffered “disabling injuries” at a Sun Prairie, Wisconsin, plant in October 2023.
OSHA cited St. Cloud, Minnesota-based Pan-O-Gold Baking Co. for two repeat violations, six serious violations and two other-than-serious violations, and proposed $262,953 in penalties after an employee was injured while adjusting a sensor in a bread pattern forming machine.
The exact nature of the injuries was not given.
OSHA said Pan-O-Gold failed to train employ...
The U.S. Occupational Safety and Health Administration said Tuesday that it cited a Missouri roofing contractor after inspectors found employees exposed to fall hazards five times in seven weeks.
OSHA cited St. Louis-based 13 Construction & Pro Services LLC for six willful and 20 serious violations, and proposed $258,063 in penalties following inspections at six Wentzville residential work sites in October, November and December 2023.
Employees were found working at heights greater than 6 feet without fall protection and the company didn’t have a “competen...
The California Department of Insurance set a virtual public hearing on June 6 to consider the Workers’ Compensation Insurance Rating Bureau of California’s Sept. 1 pure premium rate filing.
WCIRB submitted the filing to the CDI on April 25 and recommends that the department increase the advisory pure premium rate by 0.9%. The average proposed advisory rate for policies incepting on or after Sept. 1 is $1.42 per $100 of payroll, up from $1.41.
The hearing starts at 10 a.m. June 6 and be held by virtual participation only. To register for the virtual hearing, cl...
SAN DIEGO — To address weak links in disability management following a workplace injury, employers should look inward for ways to improve outcomes and return to work, according to a risk manager for a Texas manufacturer.
Overhead Door Corp., a multistate manufacturer of industrial doors and walkways, realized two years ago that, at some sites, more than half of its workers' comp claims wound up in litigation, said Andrew Shay, risk manager for the Lewisville, Texas-based company.
“We were developing some unfavorable claim trends, and there was an adversarial nature that w...
The Workers Compensation Research Institute's 2024 WCRI Annual Report is now available online and offers a comprehensive look at the institute’s studies from 2023.
The report also details how WCRI's studies influenced policy across the country.
“This past year was a strong one for WCRI," said Ramona Tanabe, WCRI's president and CEO. "We published studies on critical and emerging topics, including medical inflation, long COVID, provider consolidation, and prescription drug regulations and formularies. Our keystone benchmarking studies also monit...
A task force created by New Mexico lawmakers to analyze workers’ compensation attorney fees recommended upping the cap by 33% and increasing the current employer-paid discovery advance by 16%.
The House Memorial 83 Attorney Fee Cap Task Force in a report published Friday said the maximum attorney fee should be increased to $30,000 from $22,500 to account for inflation since the cap was set in 2013.
The task force also recommended increasing the employer-paid discovery advance to $3,500 from $3,000.
According to the group’s report, the task force seriously considered a bigger inc...
In a case of first impression, the Colorado Court of Appeals ruled that COVID-19 can be an occupational disease under the Workers’ Compensation Act.
Case: Life Care Centers v. ICAO, No. 23CA1295, 05/02/2024, published.
Facts: Vincent Gaines worked at a skilled nursing facility run by Life Care Centers of America. On May 2, 2020, the Colorado National Guard tested all facility residents and staff members for COVID-19. Gaines tested negative.
The first positive test of a resident was returned on May 24, 2020. Gaines became sick with COVID-19 shortly thereafter. On June 2, 2020, he was h...
The Alaska Supreme Court upheld the denial of a pilot’s claim for additional benefits for conditions he blamed on his injuries from a 1985 plane crash.
Case: Jespersen v. Tri-City Air, No. S-18526, 05/03/2024, published.
Facts: Jay Jespersen worked for Tri-City Air. He was piloting a small plane near Quinhagak in November 1985 when the plane crashed. Jespersen sustained multiple injuries, including several rib fractures and a vertebral compression fracture. He went home to Minnesota to recover.
In Minnesota, Jespersen first received treatment from a medical doctor but later changed to...
A Texas appellate court revived a civil suit against a nonsubscribing employer for the amputation of a worker’s leg after he stepped on a nail at the employer’s job site.
Case: Donaldson v. Pro-Craft General Contractors Inc., No. 02-23-00271-CV, 05/02/2024, published.
Facts: Robert John Aquino III worked for Pro-Craft General Contractors Inc. overseeing water damage mitigation projects.
Pro-Craft sent a crew to a customer’s home to pull up baseboards and flooring and set up drying equipment. After the customer called to complain about the crew’s work — cla...
A federal appellate court ruled that South Carolina’s workers’ compensation statutes did not deprive a trial judge of subject matter jurisdiction over a civil suit by three workers who were badly burned in a plastics plant fire.
Case: Wideman v. Innovative Fibers LLC, No. 23-1163, 05/02/2024, published.
Facts: Innovative Fibers LLC and Stein Fibers Ltd. owned and operated a plant in South Carolina that converted recycled plastics into polyester fibers.
The plant had two gas-fueled ovens encased in steel scaffolding superstructures that supported platforms above. The platforms pr...
The U.S. Occupational Safety and Health Administration said Thursday that it cited a Boston-based window cleaning company over the death of an employee who fell 29 stories.
OSHA cited Sky Safety Inc. for two “willful,” four “serious” and two “repeat” violations and assessed $447,087 in proposed penalties following the October 2023 incident in Boston’s financial district.
Sky Safety failed to ensure that personal fall protections and a rope descent system were in proper working order, did not inspect safety equipment for damage and other deterior...