The Aggressor Rule Sometimes Makes Good Sense

In some jurisdictions, the one who initiates an assault is denied workers' compensation benefits. In others, it is not a bar to a claim as in California. One would expect that yet another change will be coming to the law in California. One would think that the conduct of this police officer gives rise to rethinking the concept of compensability. Today's post is shared from davisenterprise.com

The University of California and the former police officer who pepper-sprayed Occupy UC Davis protesters have reached a workers’ compensation settlement totaling $38,059.

John Pike, 40, of Roseville, suffered depression and anxiety brought on by death threats to him and his family that followed the Nov. 18, 2011, confrontation at an encampment on the Quad.

Administrative Law Judge Harter approved the settlement agreement on Oct. 16.

“This case has been resolved in accordance with state law and processes on workers’ compensation,” university spokesman Andy Fell said in an email message. Pike’s Sacramento attorney, Jason Marcus, declined to comment on Wednesday.

Bernie Goldsmith, a Davis attorney supportive of the student protesters, called it “interesting to see a dollars-and-cents compensation for universal revilement.”

“This sends a clear message to the next officer nervously facing off with a group of passive, unarmed students: Go on ahead. Brutalize them. Trample their rights. You will be well taken care of,” Goldsmith said.

The state’s Disability Evaluation Unit determines permanent disability ratings based on doctors’ reports. Richard Lieberman, a Piedmont psychiatrist acting as the agreed-upon expert, rated Pike ’s disability as “moderate,” according to a Jan. 5 psychiatric report released by the State Department of Industrial Relations in response to a public records request.

Pike faced...


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Jon L. Gelman of Wayne NJ is the author NJ Workers’ Compensation Law (West-Thompson) and co-author of the national treatise, Modern Workers’ Compensation Law (West-Thompson). For over 4 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.

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Costliest 1 Percent Of Patients Account For 21 Percent Of U.S. Health Spending

Today's post was shared by Kaiser Health News and comes from www.kaiserhealthnews.org

A 58-year-old Maryland woman breaks her ankle, develops a blood clot and, unable to find a doctor to monitor her blood-thinning drug, winds up in an emergency room 30 times in six months. A 55-year-old Mississippi man with severe hypertension and kidney disease is repeatedly hospitalized for worsening heart and kidney failure; doctors don't know that his utilities have been disconnected, leaving him without air conditioning or a refrigerator in the sweltering summer heat. A 42-year-old morbidly obese woman with severe cardiovascular problems and bipolar disorder spends more than 300 days in a Michigan hospital and nursing home because she can't afford a special bed or arrange services that would enable her to live at home. These patients are among the 1 percent whose ranks no one wants to join: the costly cohort battling multiple chronic illnesses who consumed 21 percent of the nearly $1.3 trillion Americans spent on health care in 2010, at a cost of nearly $88,000 per person. Five percent of patients accounted for 50 percent of all health-care expenditures. By contrast, the bottom 50 percent of patients accounted for just 2.8 percent of spending that year, according to a recent report by the federal Agency for Healthcare Research and Quality. Sometimes known as super-utilizers, high-frequency patients or frequent fliers, these patients typically suffer from heart failure, diabetes and kidney disease, along with a significant psychiatric problem. Some are...

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Report Recommends Raising Workers' Compensation Premiums

The California "too good to be true" reform effort, was just that, too good to be true. Rates are going up and benefits are going down. Today's post was shared by votersinjuredatwork and comes from www.californiahealthline.org

Workers' compensation premiums in California should increase by 3.4% in 2014, according to a report by the Workers Compensation Insurance Rating Bureau, the Sacramento Bee's "Capitol Alert" reports.The report represents a non-binding recommendation for insurers (Walters, "Capitol Alert," Sacramento Bee, 8/12). Background In September 2012, Gov. Jerry Brown (D) signed into law a bill (SB 863) that overhauled the state's workers' compensation system. The law -- by Sens. Kevin de León (D-Los Angeles) and Jose Solorio (D-Anaheim) -- changed the formula used to calculate benefits for injured workers, increasing their compensation by an average of 29%. It also eliminated benefits for certain health conditions that often are subject to lawsuits, such as psychiatric problems, sexual dysfunction and sleep loss.

Thousands of doctors practicing despite errors, misconduct

Today's post was shared by WCBlog and comes from www.usatoday.com

Dr. Greggory Phillips was a familiar figure when he appeared before the Texas Medical Board in 2011 on charges that he'd wrongly prescribed the painkillers that killed Jennifer Chaney.

The family practitioner already had faced an array of sanctions for mismanaging medications — and for abusing drugs himself. Over a decade, board members had fined him thousands of dollars, restricted his prescription powers, and placed his medical license on probation with special monitoring of his practice.

They also let him keep practicing medicine.

In 2008, a woman in Phillips' care had died from a toxic mix of pain and psychiatric medications he had prescribed. Eleven months later, Chaney died.

Yet it took four more years of investigations and negotiations before the board finally barred Phillips from seeing patients, citing medication errors in those cases and "multiple" others.

"If the board had moved faster, my daughter would still be alive," says Chaney's mother, Bette King, 72. "They knew this doctor had all these problems … (and) they did nothing to stop him."

Mari Robinson, executive director of the Texas medical board, says the Phillips case took "longer than normal, but we followed what we needed to do (by law)." Phillips could not be reached for comment.

Despite years of criticism, the nation's state medical boards continue to allow thousands of physicians to keep practicing medicine after findings of serious misconduct that puts patients at risk, a USA TODAY...

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Unpaid Intern? You Probably Aren't Protected Against Sexual Harassment

Today's post was shared by Mother Jones and comes from www.motherjones.com

This story first appeared on ProPublica.

In 1994, Bridget O'Connor began an internship at Rockland Psychiatric Center, where one of the doctors allegedly began to refer to her as Miss Sexual Harassment, told her that she should participate in an orgy, and suggested that she remove her clothing before meeting with him. Other women in the office made similar claims.

Yet when O'Connor filed a lawsuit, her sexual harassment claims were dismissed because she was an unpaid intern. A federal appeals court affirmed the decision to throw out the claim.

Unpaid interns miss out on wages and employment benefits, but they can also find themselves in "legal limbo" when it comes to civil rights, according to law professor and intern labor rights advocate David Yamada. The O'Connor decision (the leading ruling on the matter, according to Yamada) held that because they don't get a paycheck, unpaid interns are not "employees" under the Civil Rights Act—and thus, they're not protected.

Federal policies echo court rulings. The laws enforced by the US Equal Employment Opportunity Commission, including the Civil Rights Act, don't cover interns unless they receive "significant remuneration," according to commission spokesperson Joseph Olivares.

"At least with respect to the federal law that we enforce, an unpaid intern would not be legally protected by our laws prohibiting sexual harassment," Olivares said in an email to ProPublica.

It's unclear how many interns are sexually harassed at work....

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New DSM Criteria Manual Challenged by Expert for Lack of Validity

Setting standards for the assessment of psychiatric criteria in workers' compensation claims has been a major challenge. Subjective criteria has been difficult for the experts, evaluators and courts to yield an objective analysis.

With a new version of the Diagnostic and Statistical Manual of Mental Disorders, or

D.S.M., to be published a new challenge to the assessment tool has been made.

"Just weeks before the long-awaited publication of a new edition of the so-called bible of mental disorders, the federal government’s most prominent psychiatric expert has said the book suffers from a scientific 'lack of validity.'"

Read the complete article "Psychiatry’s Guide Is Out of Touch With Science, Experts Say" NY Times

NJ Supreme Court Bars Expansion of Injured Workers Remedies

Additional tort claim disallowed against insurance companies for intentional failure to comply with court of compensation's, an administrative agency, order to provide provide benefits.

Wade Stancil v. ACE USA (067640)
Argued 3/26/12 Decided 8/1/12 see http://tinyurl.com/d4pycqw

SYLLABUS 

(This syllabus is not part of the opinion of the Court.  It has been prepared by the Office of the Clerk for the 

convenience of the reader.  It has been neither reviewed nor approved by the Supreme Court.  Please note that, in the 

interests of brevity, portions of any opinion may not have been summarized.) 

Wade Stancil v. ACE USA (A-112-10) (067640) 

Argued March 26, 2012 -- Decided August 1, 2012

HOENS, J., writing for a majority of the Court.

The Court considers whether an injured employee may sue his employer’s compensation carrier for pain and suffering caused by the carrier’s delay in paying for medical treatment, prescriptions, and other services. Plaintiff Wade Stancil was injured in 1995 while employed by Orient Originals.  He received workers’ compensation benefits from his employer’s compensation carrier, defendant ACE USA (ACE).  In 2006, following a  trial, the court of compensation determined that Stancil was totally disabled.  In 2007, Stancil filed a motion in the compensation court seeking an order compelling ACE to pay outstanding medical bills.  

During a hearing on the motion, the compensation judge commented that ACE had a history of failing to make payments when ordered to do so.  On September 12, 2007, the compensation judge granted Stancil’s motion, warned ACE against any further violation of the order to pay, and awarded Stancil counsel fees.  On October 29, 2007, the parties returned to the compensation court for a further proceeding relating to the disputed bills.  After finding that the bills identified in the September 12 order remained unpaid and that ACE’s failure to make payment was a willful and intentional violation of the order, the court issued another order compelling ACE to make immediate payment and again awarding counsel fees.  

The court commented on its limited ability to ensure that carriers would comply with orders, noted that it lacked the authority to enforce orders through contempt proceedings, found that Stancil had exhausted his administrative remedies, and suggested that he seek further relief in the Superior Court.  In 2008, Stancil underwent additional surgery and psychiatric treatment.  Stancil’s physician attributed the need for additional treatment to an earlier treatment delay caused by the carrier’s delay in paying medical providers.  

On April 15, 2009, Stancil filed this lawsuit in the Superior Court.  In his complaint, Stancil claimed that ACE required him to undergo medical examinations by physicians of its own choosing and then rejected the recommendations of those physicians and refused to authorize the recommended medical care.  The complaint stated further that Stancil obtained orders from the compensation court, but ACE failed to comply.  Stancil contended that ACE’s failure to authorize needed treatment caused him unnecessary pain and suffering, a worsening of his medical condition, and expenses that should have been paid by ACE.  ACE responded by filing a motion to dismiss the complaint.  ACE argued that the Workers’ Compensation Act, N.J.S.A. 34:15-1 to -142 (the Act), is the exclusive remedy for the claims pled in the complaint and therefore no damages could be awarded.  The trial court granted ACE’s motion.  The court analyzed the impact of then-recently adopted amendments to the Act and found that the Legislature had foreclosed resort to the Superior Court for the kind of tort-based relief demanded by Stancil.

The Appellate Division affirmed.  418 N.J. Super. 79 (App. Div. 2011).  The panel agreed with the trial court that The Legislature’s amendments to the Act foreclosed Stancil’s claims.  The panel also rejected Stancil’s argument that ACE’s willful disregard of compensation court orders met the Act’s intentional wrong exception to the litigation bar. The Supreme Court granted certification limited to determining whether an employee who suffered a work-related injury has a common-law cause of action for damages against a workers’ compensation carrier for its willful failure to comply with court orders compelling it to provide medical treatment when the delay or denial of treatment causes a worsening of the employee’s medical condition and/or pain and suffering.  207 N.J. 66 (2011).  

HELD:  An injured employee does not have a common law right of action against a workers’ compensation carrier for pain and suffering caused by the carrier’s delay in paying for or authorizing treatment because 1) the workers’ compensation system was designed to provide injured workers with a remedy outside of the ordinary tort or contract remedies cognizable in the Superior Court; 2) in amending the Workers’ Compensation Act in 2008, the Legislature rejected a provision that would have given the compensation courts broader permission to authorize a resort to the Superior Court and adopted a remedy that permits compensation courts to act through a contempt power; and 3) 2allowing a direct common-law cause of action against a carrier would undermine the workers’ compensation system by substituting a cause of action that would become the preferred manner of securing relief.

CHIEF JUSTICE RABNER, JUSTICE LaVECCHIA, and JUDGE WEFING (temporarily assigned) join  in JUSTICE HOENS’s opinion. JUSTICE ALBIN filed a separate, dissenting opinion. JUSTICE  PATTERSON did not participate.

Related Blog Articles

Workers' Compensation: Bad Faith Claims Maybe Going to the Jury

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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...

http://workers-compensation.blogspot.com/

NJ Supreme Court To Rule on Several Critical Issues

Apr 23, 2012

A-112-10 Wade Stancil v. ACE USA (067640). 3. The Exclusivity Rule: Under the circumstances of this case, which include a finding by the federal Occupational Safety and Health Administration that the accident was the result ...

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Medical Monitoring Available Under the Zadroga 9-11 Health Compensation Fund

The World Trade Center Medical Monitoring Program is funded by the National Institute for Occupational Safety and Health under the Zadroga Act which was enacted last year.

MEDICAL TREATMENT for 9/11 responders
The program provides free treatment, including: doctor's visits, diagnostic testing and medications for WTC-covered conditions. Here is a list of covered conditions:

Aerodigestive Disorders

New onset or aggravation of pre-existing conditions for which clinical findings suggest onset is related to WTC exposure/injury:

• Interstitial lung diseases
• Chronic Respiratory Disorder –Fumes/Vapors
• Asthma
• Reactive Airways Dysfunction Syndrome (RADS)
• WTC-exacerbated chronic obstructive pulmonary disease (COPD)
• Chronic Cough Syndrome
• Upper airway hyperreactivity
• Chronic rhinosinusitis
• Chronic nasopharyngitis
• Chronic laryngitis
• Gastro-esophageal Reflux Disorder (GERD)
• Sleep apnea exacerbated by or related to the above conditions

Mental Health Conditions
New onset or aggravation of pre-existing conditions for which clinical findings suggest onset is related to WTC exposure/injury:

• Post Traumatic Stress Disorder (PTSD)
• Major Depressive Disorder
• Panic Disorder
• Generalized Anxiety Disorder
• Anxiety Disorder (not otherwise specified)
• Depression (not otherwise specified)
• Acute Stress Disorder
• Dysthymic Disorder
• Adjustment Disorder
• Substance Abuse

“V codes” (treatments not specifically related to psychiatric disorders, such as marital problems, parenting problems etc.)

Musculoskeletal Disorders
New onset or aggravation of pre-existing conditions for which careful review of symptoms or other clinical information suggests relationship to WTC exposure/injury:

• Low back pain
• Carpal Tunnel Syndrome (CTS)
• Other musculoskeletal disorders

Are you eligible?
This program serves the workers and volunteers who responded to the September 11th attacks. If you did any paid work or volunteered, on or after September 11th, that was directly related to the disaster, you may qualify. To find out whether you are eligible, call 888-702-0630 or download and fill out an eligibility questionnaire and fax it to us at 212-241-1850.

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 and enviornmental exposures. Please contact our office if you require assistance in filing a claim under the newly enacted James Zadroga 9/11 Health and Compensation Act.

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Getting Tattoos Evidences Total Disability

An injured worker, who obtained tattoos to camouflage surgical scars of 6 surgical interventions, was held to be totally and permanently disabled. The evidence, presented at the time of trial, was found by the Judge of Compensation to provide a basis for an increase in the worker’s psychiatric disability that rendered the employee unable to work.

The worker testified that the side effects of a laundry list of medications that manifested low stamina and dry eyes. The drugs included:

• Buspar, an anti-anxiety medication, three times a day
• Nortiptyline, and anti-pain and antidepressant medication, three times a day
• Oxycontin, a pain medication, four times a day
• Topomax, a seizure medication used for pain relief, twice a day
• Methodone, a pain medication, four times a day
• Wellbutrin, an antidepressant, two to three times a day
• Bethanechol, a medication for dry mouth
• Prevacid, a stomach medication

The appellate forum affirmed the decision of the trial judge, Stephen Tuber, who in an extensive written decision  rejected the opinions of the respondent’s medical experts, Drs. Galina and Effron in favor of that of the petitioner’s expert, Dr. Peter Crain.

Dr. Crain testified that the reason why the injured worker obtained the tattoos made “psychological sense.” The reviewing form held that “…She explained that she obtained tattoos to help her deal with her "suicidal ideation" and to camouflage the scars she bore from the multiple operations.”

Kiessling v. Prudential Insurance Company, NO. A-3051-08T23051-08T2,  2010 WL 1928711 (Decided May 10, 2010)

To read more about psychiatric disability and workers' compensation click here.

Click here for more information on how Jon L Gelman can assist you in a claim for workers' Compensation claim benefits.

Trauma of Job Loss Often Includes Health Problems

Occupational heart attacks are notorious issues in workers' compensation claims. The New York Times reviews the phenomenon cardiovascular episodes attributed to work related stress due to plant closings.

A "....paper, published last year by Kate W. Strully, a sociology professor at the State University of New York at Albany, found that a person who lost a job had an 83 percent greater chance of developing a stress-related health problem, like diabetes, arthritis or psychiatric issues."

Defense Expert Found Contradictory in Psych Claim

The NJ Appellate Division affirmed the trial decision of Judge Kovalcik who ruled that the testimony of the defense expert was "contradictory and inconsistent and cannot credit his conclusion that Petitioner no longer suffers from post traumatic stress disorder."

The injured worker was struck from behind by two co-workers who had threatened to kill him.

Sormaz v. Alpha Moving & Storage, Inc. .. JERSEY APPELLATE DIVISION DOCKET NO. A-3482-08T33482-08T3  Decided 2.18.2010

Click here to read more about psychiatric claims and workers' compensation.

Subject of Smear Campaign Recovers for Psychiatric Condition

An employee, who was the object of a smear campaign that included being the subject of  circulated pornographic cartoons, was permitted to seek benefits for psychological residuals flowing from the humiliation, shock and anger that resulted in her loss of sleep. The worker was treated for an adjustment disorder with mixed anxiety and depressive mood.


The trial court, that was affirmed, had concluded:


"...[t]he aforementioned events cannot be characterized as an honest attempt to ensure that an office is running in an efficient and effective manner. Here, [p]etitioner was subjected, in part, to a resignation rumor, a potentially improper layoff, together with the aforementioned . . . sexual propaganda . . . . [I]t shocks the conscience that same would have occurred over such a long period of time without otherwise being addressed by the employer."


In affirming the Appellate Court held:


"In finding in petitioner's favor, Judge Leslie A. Berich applied correct legal standards.  The Workers' Compensation Act is 'humane social legislation designed to place the cost of work connected injury upon the employer who may readily provide for it as an operating expense.'"


Lori Ross v. City of Asbury Park, Docket No. A-0379-08T3 


Click here to read more about stressful conditions and workers' compensation.

NY Opens 1 Year Window for 9/11 Claims

NY Governor David A. Patterson has signed into law a bill that permits otherwise time-barred claims against NY municipalities arising out of terrorist activities that occurred on September 11, 2001.

The City of NY just released the 2009 Annual Report concerning the health consequences of the 9/11 attack. The report concludes:

"Results from large epidemiologic studies suggest that probable posttraumatic stress disorder (PTSD) is the most common WTC-related health condition among exposed adults. Probable PTSD means that individuals scored above a certain threshold when responding to a mental health screening questionnaire but have not undergone the psychiatric interview necessary to confirm the diagnosis.

I The risk for developing probable PTSD was higher among those who were:

• Caught in the dust cloud released by the buildings as they collapsed

• Injured as a result of the attacks

• Directly exposed to the events of 9/11, including proximity to the WTC site, witnessing horrific events and knowing someone who was killed or injured in the attacks

• Among rescue and recovery workers, working at the WTC site for a long time or doing tasks outside of their trained area of expertise.

I Several studies indicated that respiratory symptoms, sinus problems, asthma, and loss of lung function were found in people or reported by some who were exposed to WTC dust, including rescue and recovery workers, residents and evacuees. Other studies have suggested that risk of developing sarcoidosis (an inflammation that usually affects the lungs) was elevated in the first few years after the event. Many exposed adults were also diagnosed with or reported having heartburn, acid reflux or gastroesophageal reflux disease (GERD), often in conjunction with other respiratory or mental health symptoms. GERD is a common condition among the general population, however; further research is needed to understand the association between GERD, WTC exposure and other WTC-related health conditions.

I The risk for developing respiratory problems has been examined most thoroughly among rescue, recovery and clean-up workers, and was increased among those who:

• Arrived early at the WTC site • Worked at the WTC site for long periods of time.

I Few studies addressed the impact of WTC exposure on child and adolescent health, especially physical health.

I Whether there is a relationship between WTC exposure and other longer-term illnesses, including cancer, is unknown but clinicians, epidemiologists and other researchers are actively studying this. They also are studying the relationship between WTC exposure and mortality.

I At the time of the report’s publication last year, treatment for WTC-related conditions was available for exposed groups, including children and adolescents, in the NewYork City area."

For additional information on 9/11 Compensation click here.