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83-Year-Old Home Depot Employee Death: Injured Workers in the News #72

Posted on December 6, 2022 by Edward Singer

An 83-year-old Home Depot Worker died six weeks after sustaining a work injury. He had been shoved to the ground by a serial shoplifter while apparently trying to stop a theft. The Home Depot Worker sustained injuries as a result of the shove and he lived for 5 weeks before passing. The medical examiner has ruled the death to be a homicide. Dailymail.com

This article will discuss how the Injured Worker’s death was work-related for the purposes of obtaining death benefits.

Does A Time Delay Between The Work Injury and The Death Matter for the Purposes of Pursuing a Death Claim?

Yes and No. California Workers’ Compensation Law provides for 240 weeks from the date of the injury to the date of death for the period of the delay. Deaths happening beyond this period are likely barred by the statute of limitations. Thus, a five week delay in the passing would be within the statute of limitation. The claim would be timely and dependency death benefits are warranted.

Does the Medical Examiner’s Opinion of Homicide Determine Industrial Causation?

No. The Medical Examiner’s opinion that the death was a homicide is a medical determination within the area of criminal law. In California, workers’ compensation and criminal law have different burdens of proof. California Workers’ Compensation Law has a reasonable medical probability standard. Likewise, the work injury’s relation to the death has a specific standard as well. The South Coast Framing case standard that applies: It is well established that for the purpose of meeting the causation requirement in a workers’ compensation injury claim, it is sufficient if the work is a contributing cause of the injury. (South Coast Framing, Inc. v. Workers’ Comp. Appeals Bd. (2015) 61 Cal. 4th 291, [188 Cal. Rptr. 3d 46, 349 P.3d 141, 80 Cal. Comp. Cases 489].) “

Thus,Workers’ Compensation medical examiners will have to express an opinion whether, within reasonable medical probability, that the work injury was a contributing factor in the Injured Worker’s death. Arguably, the Medical Examiner’s opinion, which most likely is criminal law based, expresses that it a higher standard than workers’ compensation law requires.

While one could argue that the Medical Examiner’s opinion should be binding, there argument is arguing apples and oranges. Even with such an opinion, it is likely that a carrier would also seek an opinion within the workers’ compensation system. This could be a QME, a Treating Doctor or an Agreed Medical Examiner on the issue.

What if I Need Advice?

If you would like a free consultation regarding workers’ compensation, please contact the Law Offices of Edward J. Singer, a Professional Law Corporation. We have been helping people in Central and Southern California deal with their workers’ compensation cases for 27 years. Contact us today for more information.

A QUESTIONABLE AMPUTATION WORK INJURY? INJURED WORKERS IN THE NEWS, #13

Posted on January 24, 2022 by Edward Singer

A story comes out of Maine in which a Man was found carrying a severed arm. He had severed it allegedly while operating a ban saw. The man worked at a store. The police department “ have not determined how the man lost his arm, beyond describing the gory amputation as a ‘workplace incident.’ From the story’s facts, there were no witnesses to the accident that were interviewed. dailymail.com

For the purposes of this blog post, the assumption will be given that there is some uncertainty as to how the accident happened.

Will The Workers’ Compensation Carrier Accept This Type of Claim Immediately?

No. Given the paucity of the hypothetical’s facts, the Insurance Company would likely wish to investigate the claim to determine whether there was a work injury. They would want to talk to the Injured Worker as well as his co-workers.

Are There Any Times Limits to the Investigation?

Yes. Labor Code Section 5402(b) provides for a 90 day period for an Insurance Carrier to investigate a clam.

Can The Injured Worker Get Medical Care During the Period of Investigation?

Yes. Labor Code Section 5402(c) provides for up to $10,000.00, of medical care to be provided up to the date of the carrier’s determination.

Are There Any Special Benefits That Applicant to Amputation Cases?

Yes. Labor Code Section 4656(c)(3) allows for 240 weeks of total temporary disability benefits as opposed to the 104 weeks which is provided for cases that are not afforded an exception.

What if I Need Advice?

What You Need To Know About Back Surgery, Return To Work, & Workers’ Compensation

Posted on April 23, 2021 by Edward Singer

Workers’ Compensation Medical Studies have been done on many topics. Studies have reported on surgeries performed within the workers’ compensation environment. Some studies have looked examined spinal surgeries.

Study results impact Injured Workers. Studies results can create insurance Company expectations concerning surgery success and recovery times. Insurance Company expectations from these studies can be imposed upon treating doctors concerning temporary and permanent disability.

This article will discuss back surgery, a study concerning back surgery, the back surgery study’s results. and what the study means for injured workers.

What Is Back Surgery?

The Spine has three segments: cervical, thoracic, and lumbar. The lumbar segment of the spine is usually referred to as back or low back. Back surgeries are generally on the area referred to as the lumbar spine. There are various types of surgeries. There are surgeries to address lumbar spine disks and there are other procedures that address the stability of the spine. Common surgeries are laminectomies, fusions and disc replacement.

Besides the problems being operated on, there is also issue of levels. The lumbar spine has multiple levels. Some surgeries operate on one level and others involve multiple levels.

There are a variety of reasons why a particular surgery may be indicated. This article will be addressing one of the reasons. A surgery to address a herniated lumbar disk. Specifically, a surgery to address a disk at only one level. This procedure is called a laminectomy.

Why Is Back Surgery a Significant Workers’ Compensation Issue?

Back Surgeries are expensive.T they cause periods of temporary disability and may result in findings of permanent disability. Back Surgeries can have complications that can be costly such as treatment for post-operative infections. Thus, Insurance Companies, in a risk management analysis, may wish to prevent surgery liability by either denying the treatment or settling the case.

What Were the Study’s Results?

The study addressed focused only on a single-level lumbar disk herniation surgery.

According to the study, “[p]atients receiving WC(workers; compensation) with shorter duration of radiculopathy before diskectomy had higher RTW(return to work) rates; fewer physical therapy, chiropractic, and psychotherapy sessions; and fewer postoperative diagnoses of psychological illnesses.” Ren BO, O’Donnell JA, Anderson JT, Haas AR, Percy R, Woods ST, Ahn UM, Ahn NU. Time to Surgery Affects Return to Work Rates for Workers’ Compensation Patients With Single-Level Lumbar Disk Herniation. Orthopedics. 2021 Jan 1;44(1):e43-e49. doi: 10.3928/01477447-20201202-06. Epub 2020 Dec 7. PMID: 33284984.

The study found that “within 12 weeks of injury, post-diskectomy patients do reasonably well, with a 70.0% (95% CI, 65.9%–74.1%) rate of RTW.”

The study also found that “[o]n the other hand, if a patient waited more than 2 years to have surgery for radiculopathy, RTW(return to work) rates decreased as low as 31.3% (95% CI, 26.3%–36.3%).” Ren BO, O’Donnell JA, Anderson JT, Haas AR, Percy R, Woods ST, Ahn UM, Ahn NU. Time to Surgery Affects Return to Work Rates for Workers’ Compensation Patients With Single-Level Lumbar Disk Herniation. Orthopedics. 2021 Jan 1;44(1):e43-e49. doi: 10.3928/01477447-20201202-06. Epub 2020 Dec 7. PMID: 33284984.

Note: the study’s results are confounding to Insurance Companies. The study suggests that acting promptly to approve a surgery can lead to more promising results. The study implies that a long drawn out battle for a back surgery can result in a poor result. Thus, acting quickly and spending a considerable amount of money for treatment leads to a better result in this circumstance. Thus, these types of cases are a true test for Adjusters.

Was There Anything Else Interesting from the Study?

Irrespective of surgery, the factors of legal representation, psychological co-morbidity and mean household income can negatively impact return to work. Ren BO, O’Donnell JA, Anderson JT, Haas AR, Percy R, Woods ST, Ahn UM, Ahn NU. Time to Surgery Affects Return to Work Rates for Workers’ Compensation Patients With Single-Level Lumbar Disk Herniation. Orthopedics. 2021 Jan 1;44(1):e43-e49. doi: 10.3928/01477447-20201202-06. Epub 2020 Dec 7. PMID: 33284984.

Is There Anything an Injured Worker Should Do?

Injured Workers with spinal problems should get appropriate medical care at the onset of injury. In the case of severe back pain and in cases with radiculopathy, they should seek out an orthopedic surgeon to have their condition assessed.

Per the study, if surgery is truly indicated, surgery it suggests that it be done promptly. Each individual’s medical condition and recovery, however, is different. Thus, the treatment course should be done on an individual basis and not per a study.

What If I Need Advice?

WHY IS MY WORKERS’ COMPENSATION CLAIM DELAYED? INJURED WORKERS, OUTSTANDING CLAIMS, AND WORKERS’ COMPENSATION: WHAT YOU NEED TO KNOW

Posted on January 25, 2021 by Edward Singer

Many Injured Workers have their workers’ compensation claims delayed.

This article will discuss why claims are delayed and what Insurance Company activities occur during the delay period.

Why Are Claims Delayed?

Insurance Companies delay claims in order to verify that there is a legitimate claim. Per the Labor Code, they are afforded this opportunity to investigate.

As part of their investigation, Insurance Companies will investigate the following matters.

Coverage: Insurance Companies need to verify that they actually insure the Employer for the date of the injury.

Employment Verification: Insurance Companies need to verify the Injured Worker actually worked for the Insured Employer.

Date of Injury: Insurance Companies need to verify the date of injury.

Employer Injury Knowledge: Insurance Companies need to know if the Employer knows about the work injury. They need to know the details how the injury happened, whether there were witnesses, and whether it was reported to management.

Medical Verification: Insurance Companies will seek to obtain the medical reporting from the Industrial Clinic or the Medical Provider who treated the worker.

Statements: Insurance Companies may seek the use of an investigator to take statements of the injured worker, other employees of the company, or witnesses, to verify the injury. Investigations can be done by Attorney who may take depositions.

Records: Insurance Companies may seek records from prior employers, insurance companies or medical providers

Qualified Medical Evaluation: An Insurance Company may seek a Panel Evaluator from the State of California to obtain a medical opinion on causation. .

What is the Authority for Delaying a Workers’ Compensation Claim?

Labor Code Section 5402(b) provides for a 90 day period upon which Insurance Companies have to deny a claim. Thus, there is a 90 day period to delay the claim and investigate. This 90 days is from the knowledge of the claim.

The date of knowledge is per LC 5402(a) which provides that “ [k]nowledge of an injury, obtained from any source, on the part of an employer, his or her managing agent, superintendent, foreman, or other person in authority, or knowledge of the assertion of a claim of injury sufficient to afford opportunity to the employer to make an investigation into the facts, is equivalent to service under Section 5400.” Thus, employer knowledge can trigger the start of the insurance company’s delay period

What If I Need Advice?