7-16-2019; Illinois WC Death Claim Bungled and Employer Penalized--Consider Better Defense!; Have Your Settlement Contracts Totally Clear on Cutting Off Medical Bills and more

Synopsis: Illinois WC Death Claim Bungled and Employer Penalized.

Editor’s comment: Please consider asking the defense team at KCB&A or me about any IL/IN/WI/IA or MI death claim/concern you might have. I have handled dozens of such significant claims and I know the ropes backward and forward. Getting a newbie defense attorney to handle these multimillion dollars risks who doesn’t know the ropes can cost thousands of unneeded claims dollars. If you aren’t sure, my law partner Shawn Biery’s IL WC Rate Chart outlines most IL WC Death claims are worth $700K+ to a widow/widower and can be over $2M! If you want a free copy of Shawn’s handy IL WC Rate Chart, send a reply.

Please note this claim occurred in year 2013 and hundreds of thousands in unpaid death benefits are probably due to Claimant—I truly feel with my advice that giant payout might have been avoided or ameliorated. If you are interested or are working on a WC death claim, send a reply and I will be happy to provide veteran guidance.

With respect, this IL WC death claim one looks like a smoking mess to me. In Ravenswood Disposal Services v. Illinois Workers' Compensation Comm'n, 2019 IL App (1st) 181449WC (June 28, 2019) Cook Co., WC Div. (opinion by Justice Hoffman), the worker was, while working with Respondent’s equipment/trucks, pinned between 2 vehicles sadly resulting in his untimely death. I cannot see any basis in the ruling for the employer to fight employer/employee but they did so and lost. For diligent members of the Claimant bar who read this blog, if you get a dispute about employment, consider filing a common law claim and protect the interests of your clients and yourselves in doing so.

In Ravenswood Disposal, after fighting employment, the employer fought the medical bills incurred from the passing of Decedent and then disputed the status of the minor child of decedent as a “child” under IL WC law. In my view, there are three types of children in IL WC:

• “DNA kids” who are the genetic offspring of the male/female decedent;

• Adopted kids—the scion has to be legally/formally adopted following the required rules.

• “In loco parentis” children—these are kids that are being maintained/paid for by decedent prior to their passing. The precise definition isn’t truly know but one rule of thumb I have read is the decedent has be providing 50+% of the child’s support.

In Ravenswood Disposal above, Decedent had a “DNA kid” at the time of his passing. After Decedent passed, the minor child came into the care of his mother and another person. The child was later legally adopted by the couple. For reasons I consider odd, the employer then fought the child’s status as a child/dependent of Decedent due to the adoption. I couldn’t disagree with that approach more, in light of the simple language of the IL WC Act.

The Appellate Court, WC Division ruled the employee/Decedent's minor son qualified as a “dependent” under Section 7(a) of the Workers' Compensation Act, even though he was later adopted by his stepfather after his father's passing. The IL WC Act contains no express language terminating a minor's right to benefits by reason of adoption where he otherwise qualified for benefits based on his status as a “child” and age at time of accident.

The ruling notes ample evidence supported the Commission's determination the minor was dependent on his father at the time of the accident. With respect to the members of the Appellate Court panel, I consider this finding wholly irrelevant and confusing in the case of a DNA kid—the status of being the child of a given decedent is all that is required by our law. That status can’t be “extinguished” by a later marriage or adoption. I am happy to explain if you have interest; send a reply.

As outlined above, the unanimous Appellate Court ruling also confirmed the employer lacked a reasonable basis for challenging the existence of an employment relationship, and Decedent's status as an employee gave rise to employer's obligation to pay his medical expenses. Thus, the members of Court ruled it was not irrational for the IL WC Commission to impose penalties and late fees on the employer for failure to pay Decedent's medical expenses. While I am not happy to see penalties levied against an employer, I cannot understand what they were thinking and strongly agree with our Appellate Court panel.

I appreciate your thoughts and comments. Please post them on our award-winning blog.

Synopsis: Have Your Settlement Contracts Totally Clear on Cutting Off Medical Bills That May Be Owed. Our Best Thoughts for Both Sides of the Entire IL WC Matrix.

Editor’s comment: I want the IL WC industry to note how settlement contracts should be handled by all claims handlers/risk managers. I point out one of the strongest aspects of IL WC law and practice is we have the ability to end/cut off medical bill liability completely. In some of the other states, that can’t happen.

The defense team has a clear protocol on settling any WC claim in any of the five states we cover—we draft the contracts and send for the client to approve from a claim/risk standpoint. When we have approval from our clients, we then sign and send contracts to OC for countersignatures and Arb. approval.

From the perspective of cutting off medical liability, I won’t approve or send a client an IL WC settlement contract that doesn’t limit the client’s responsibility to “treatment of which we are/Respondent is aware” based on an Appellate Court ruling that allowed $40K in medical bills to be presented and paid after settlement approval for care the employer/TPA/insurance carrier had no knowledge.

I consider it malpractice for an IL WC lawyer to not have a cut-off based on the client being aware of the care.

I have seen Claimant lawyers intentionally hide unpaid medical bills until after contracts are approved to then, for the first time, send medical bills and demand payment.

On the other side, if we have the language I recommend in the contracts and our client is aware of medical care/provider and there are outstanding bills after settlement approval—I tell the client we have to pay/process such bills.

Whatever we do, we don’t want to be globally responsible for all medical care up until a certain date because that sets up the “hidden bill” concept.

My law partner Joe D’Amato recommends you/we use this language:

Respondent has paid or will pay all known and submitted reasonable and related medical expenses incurred up to X date. Irrespective of date of service, the parties agree no medical expenses received by Respondent for the first time after approval of these contracts will be paid by Respondent.

What language do you use or recommend? The goal is to be fair and cover what the employer owes while also avoiding “hidden bills.”

I appreciate your thoughts and comments. Please post them on our award-winning blog.