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A CASE TO DIE FOR? LAWYER KILLED BY PROSPECTIVE CLIENT: INJURED WORKER IN THE NEWS, #22

Posted on March 15, 2022 by Edward Singer

It is reported that a New York Attorney was stabbed to death by a prospective client as a result of his refusal to take her case. It is also reported that the potential client had previously threatened the attorney and was removed from office. In a later encounter, the fatal attack occurred. Nypost.com

The facts of the incident raises the question of what the attorney was covered under workers’ compensation.

Can Attorneys Be Covered Under Workers’ Compensation?

Yes. Attorneys can be covered under workers’ compensation. Attorneys that are employees of Law Firms are covered under workers’ compensation law. Sole Practitioners or Partners may be covered under workers’ compensation insurance. For example, the Law Firm may be a corporation and the practitioners or partners are considered as employees. Their coverage may be dependent on the insurance contract. This would include acknowledging these individuals as employees covered as well as paying premium for their wages.

Given the story’s fact, it would appear that the lawyer may have been a sole practitioner. Thus, a determinations should be made by the insurance carrier covering the office as to whether the attorney was listed as an employee for the purposes of the policy.

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.

What You Need To Know About Amputations & Workers’ Compensation

Posted on July 20, 2021 by Edward Singer

Amputations can be a life-changing event for a Worker. Workers may lose their ability to perform their job as well as perform activities of daily living.

The Workers’ Compensation Community is concerned about amputation cases as they involve extensive medical costs and missed time from work.

This article will discuss amputations, special laws concerning amputations, and interesting data derived from a recent study.

What Is an Amputation?

The Workers’ Compensation Appeals Board defined amputation. In Cruz vs. Mercedes Benz, 72 C.C.C. 1281 (Panel Decision), the WCAB indicated “ Defining amputation as the severance or removal of a limb, part of a limb, or other body appendage comports with the ordinary meaning, and includes the range of potentially compensable scenarios, including both traumatic loss of a body part in an industrial injury and surgical removal during treatment. This definition conforms to our understanding of the common meaning of the term “amputation,” which encompasses external projecting body parts, not internal parts, even if they include bone. It is also consistent with the definitions in the International Dictionary of Medicine and Biology, Dorland’s Illustrated Medical Dictionary, and Stedman’s Medical Dictionary. To the extent that some definitions refer to organs, appear to encompass all body parts, or include an equivocal “etc.,” we reject them or interpret them in a manner consistent with our understanding of the term “amputation.”

Thus, surgery on a lumbar disc was found not to constitute an amputation.

Why Is an Amputation Important in California Workers’ Compensation?

An amputation in a workers’ compensation case triggers entitlement to additional periods of total temporary disability. 240 weeks is allowed in the case of amputations. Labor Code Section 4656. In these cases, there is no requirement that the temporary disability period be connected to the amputation. Jon Van Ness, Applicant v. Barbara Herzstein, 2007 Cal. Wrk. Comp. P.D. LEXIS 239 (Panel Decision)

How Do Amputations Occur on an Industrial Basis?

Occupationally related amputations can occur for many reasons. The accident itself can be the source of the amputation, i.e. a skill saw cutting off a finger. They can result of a crush injury which necessitates an amputation. They can be the result of post-surgical infection. They can be the result of an industrially related disease process such as diabetes.

Interesting Amputation Facts Are:

Males vs. Females

Men sustain most of the work-related amputations. (84.8%) Gomez NG, Gaspar FW, Thiese MS, Merryweather AS. Trends in incidence and correlation between medical costs and lost workdays for work-related amputations in the State of California from 2007 to 2018. Health Sci Rep. 2021 Jul 1;4(3):e319. doi: 10.1002/hsr2.319. PMID: 34250271; PMCID: PMC8247939.

Full-Time vs. Part-Time Employees

Full-Time Employees were more likely to sustain amputation versus Part-Time Workers. (71.7%.) Supra.

Most Amputated Parts

Most claims consisted of partial-hand amputations (82.0%). Most of those were partial-hand amputations, 66.7% were fingers without the loss of the thumb. Following partial-hand amputations, partial-foot amputations were the next most common claim at 5.9%. Supra.

Type of Business

Manufacturing is the industry with the highest number of claims (24.1%.) Supra.

What Should an Injured Worker Take from This Study?

The study noted that “[a]mputations represent high medical costs and number of lost workdays.” Gomez NG, Gaspar FW, Thiese MS, Merryweather AS. Trends in incidence and correlation between medical costs and lost workdays for work-related amputations in the State of California from 2007 to 2018. Health Sci Rep. 2021 Jul 1;4(3):e319. doi: 10.1002/hsr2.319. PMID: 34250271; PMCID: PMC8247939.

Due to the increased medical expense and missed time from work, Insurance Companies will make efforts to control the costs. They may do so by employing a Defense Counsel as well as a Nurse Case Manager.

What If I Need Advice?

UPPER EXTREMITY SURGERY, POST-OPERATIVE VISITS AND WORKERS’ COMPENSATION: WHAT YOU NEED TO KNOW

Posted on June 7, 2021 by Edward Singer

Workers’ Compensation Studies will often provide Injured Workers insight as to Insurance Companies’ and Medical Providers’ tactics. Injured Workers often feel like there is an agenda working against them. A recent study about post-operative visits for Upper Extremity Surgery raises concerns.

This article will discuss Upper Extremity Surgery, the Study’s results and the Study’s implications for Injured Workers.

What Are Upper Extremity Surgeries?

In the workers’ compensation system, upper extremities can fit into two categories.

First, there are traumatic injuries which require surgeries. A skill saw accident involving amputation is one which may require extensive and specific procedures.

Second, there are surgeries that are due to Occupational Illness. These surgeries are most likely related to repetitive trauma.

One common occupational illness surgery is carpal tunnel.

What Are Typical Workers’ Compensation Upper Extremity Surgeries?

Typical workers’ compensation surgeries, which were also the subject to the Study, are Carpal Tunnel Release, Trigger Finger Release, Cubital Tunnel Release, and De Quervains.

With respect to these surgeries, sometimes two or more of these procedures can be done at the same time.

What Did the Study Find?

The study found that workers’ compensation patients have more post-operative visits after surgery than non-industrial surgeries. Henry TW, Townsend CB, Beredjiklian PK. Workers’ Compensation Status Confers a Greater Number of Postoperative Visits After Common Upper Extremity Surgeries. Cureus. 2021;13(4):e14629. Published 2021 Apr 22. doi:10.7759/cureus.14629

The study viewed these additional visits as being an additional cost which could be targeted for saving. Telehealth appointments were suggested as a means of lowering costs. Also, there is the concern overburdening the providers with additional appointments.

Comment: Workers’ compensation claims have reporting obligations. Therefore, there is a greater need for appointments. Likewise, there are return to work issues which may also cause the need for additional post-operative appointments.

Further, non-industrial patients, if they are satisfied with their result, may be inclined to cancel or not follow through with post-operative appointments. Thus, there are a number of drivers in the workers’ compensation system which cause more appointments than non-industrial patients. The notion of telehealth evaluations, however, may be of value. In matters where there is excellent post-surgery healing, an actual appointment with the provider may not be so important. A telehealth evaluation may suffice.

Besides Costs, What Are Other Concerns in the Workers’ Compensation System Claims involving Upper Extremities?

Risk Management concerns on post-operative cases include the Injured Worker’s compliance with treatment, their functional outcome, their symptom relief, their return to work and their satisfaction. Henry TW, Townsend CB, Beredjiklian PK. Workers’ Compensation Status Confers a Greater Number of Postoperative Visits After Common Upper Extremity Surgeries. Cureus. 2021;13(4):e14629. Published 2021 Apr 22. doi:10.7759/cureus.14629

What If I Need Advice?

What You Need To Know About The Cage-aid Questionnaire And Workers’ Compensation

Posted on March 3, 2021 by Edward Singer

Workers’ Compensation Medical Treatment can employ various questionnaires to assess an Injured Workers’ need for treatment. One of these questionnaires is called CAGE-AID.

This article will discuss the purpose of the CAGE-AID questionnaire, how it is used in an industrial treatment setting, and how it may impact an injured worker’s treatment.

What is the CAGE-AID Questionnaire?

The CAGE-Aid questionnaire is a substance abuse screening tool. Substance abuse applies to alcohol, legal drugs and street drugs.

Why is Substance Abuse a Problem with Workers’ Compensation Treatment?

Substance abuse is a multi-factorial problem in workers’ compensation. There are workers who, prior to their injury, have histories of either substance or alcohol abuse. Further, there are workers, as a result of their injuries, begin to abuse drugs or alcohol. This abuse can either be with prescription drugs, alcohol, or street drugs. Finally, there are injured workers who, not as a result of their work injuries, engage in substance abuse.

Why is The Questionnaire Called CAGE?

The abbreviation refers to some of the terms within the questions. The terms are cut, annoyed, guilty and eye opener.

What are the Questions Asked?

There are four questions. They are:

Have you ever felt that you ought to cut down on your drinking or drug use?

Have people annoyed your by criticizing your drinking or drug use?

Have you ever felt bad or guilty about your drinking or drug use?

Have you ever had a drink or used drugs first thing in the morning to steady your nerves or get rid of a hangover (eye opener)?

How is it Scored?

It is scored one for yes and zero for no.

How is The Score Interpreted?

If one or more responses is yes, then it is regarded as a positive screening test. Thus, possible substance abuse is something that the medical provider should explore with the partient.

How Should Injured Workers Answer the Questions?

These questions may impact medical treatment decisions. Medical providers need accurate information in order to provide appropriate treatment. Substance abuse, when combined with prescription drugs, can lead to harmful and deadly drug interactions. Therefore, it is important to be honest when answering the questions.

Additionally, if an injured worker has a substance abuse problem that is preventing their recovery from a work injury, it is possible that the workers’ compensation medical system may provide some assistance with respect to substance abuse treatment. This, however, would be subject to the limitations within Labor Code Section 4600.

What If I Need Advice?

ARE INJURED WORKERS SATISIFIED WITH THEIR INDUSTRIAL MEDICAL TREATMENT? QUALITY WORK-RELATED MEDICAL CARE AND WORKERS’ COMPENSATION: WHAT YOU NEED TO KNOW

Posted on February 8, 2021 by Edward Singer

“I Can’t Get No, Satisfaction”

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California Industrial Medical Treatment is controlled by the Labor Code. Thus, it differs from both traditional Private Medical Care as well as Government Programs such as Medicare and Medicaid.

Industrial medical care is part of a risk management system designed to provide cost-cutting elements with respect to providing the service.

Researches have looked into Injured Workers’ satisfaction with respect to their treatment.

This article will discuss Injured Worker’s satisfaction with their medical treatment.

What is Industrial Medical Care?

In California, Industrial Medical Treatment is guided by the Labor Code. The Labor Code contains various treatment limitations.

Medical Control is one limitation. Insurance Company Managed Provider Networks limit the doctors that Injured Workers can choose.

Medical treatment is limited by utilization review of medical treatment requests. These utilization reviews can deny treatment that does not follow the set algorithms and schedules.

What Is Private Medical Care?

Private Medical Care can come from a variety of sources. There is cash payment in where there is a direct provider patient relationship. There are personal insurance policies for which the individual purchases the policy directly from the medical insurance company. Finally, there is employer provided health insurance policies.

What is Medicare?

Per the SSA, “Medicare is [the U.S]… health insurance program for people age 65 or older. Certain people younger than age 65 can qualify for Medicare, too, including those with disabilities and those who have permanent kidney failure.

The program helps with the cost of health care, but it does not cover all medical expenses.”

What Is Medicaid?

Per Medicaid.gov, Medicaid programs [are] designed to provide health coverage for low-income people. This program is separate from Medicaid.

Can Injured Workers have Multiple Insurance Coverages?

Yes. Injured Workers can have multiple coverages at the same time. It is possible that an Injured Worker can have private coverage, medicare and workers’ compensation at the same time. For Injured Workers with low income and are on social security disability, they may have medicare, medicaid, and workers’ compensation at the same time.

What was the Study’s Overall Finding? Were There Other Findings?

The study found that “that Workers’ Compensation status is independently associated with dissatisfaction with health care compared with other primary payer groups.” Compton J, Glass N, Fowler T. The Effect of Workers’ Compensation Status on the Patient Experience. JB JS Open Access. 2019;4(2):e0003. Published 2019 Jun 11. doi:10.2106/JBJS.OA.19.00003

The study, however, had other findings of interest as well.

Workers’ Compensation treatment rated lower than Private Insurance and Medicaid. It did, however, rate at about the same level of satisfaction as Medicare. Compton J, Glass N, Fowler T. The Effect of Workers’ Compensation Status on the Patient Experience. JB JS Open Access. 2019;4(2):e0003. Published 2019 Jun 11. doi:10.2106/JBJS.OA.19.00003.

With respect to mental health issues, workers’ compensation treatment, satisfaction was rated lower than private insurance. It was however comparable to both Medicare and Medicaid patients. Compton J, Glass N, Fowler T. The Effect of Workers’ Compensation Status on the Patient Experience. JB JS Open Access. 2019;4(2):e0003. Published 2019 Jun 11. doi:10.2106/JBJS.OA.19.00003.

There was one area in which there was some higher level of satisfaction with respect to industrial medical treatment. This was when the treatment included surgical authorization. Patients with Workers’ Compensation who were scheduled for a surgical procedure were more likely to be satisfied with their care. Patients with surgical authorization have higher levels of satisfaction. Compton J, Glass N, Fowler T. The Effect of Workers’ Compensation Status on the Patient Experience. JB JS Open Access. 2019;4(2):e0003. Published 2019 Jun 11. doi:10.2106/JBJS.OA.19.00003

What Can Be Done to Improve Care Injured Workers’ Satisfaction?

This author believes that the following items may improve the level of satisfaction of industrial medical care. First, expanded Managed Provider Networks with more doctors to choose from. Second, improvement of the utilization review process to allow for greater authorization of treatment.

As noted above, Injured Workers are happy when there are results that occur as part of the treatment. This is shown in their level of satisfaction with respect to surgical authorization.

What If I Need Advice?