5-22-2017; Illinois Continues Financially Unsound Ways--WC Proposals/Changes; Thoughts on Jesse Jackson, Jr’s WC Claim; Arbs Moving and more

Synopsis: As Illinois Continues Efforts To Become as Financially Unsound as Puerto Rico, Greece and the City of Detroit, Work Comp Reform Is Still In the News.

Editor’s comment: More miserable news from the Land of Lincoln, this week:

·         Unpaid vendor’s bills in this nutty State now exceed $14.5 billion dollars and continue to rise by millions every day.

·         Butterball Meats and Caterpillar are shuttering two plants in the Aurora, IL area and about 1,400 jobs will be leaving shortly.

·         Illinois judges/justices are in what is being called “career paradise” with effectively part-time jobs that provide unlimited paid time off, unfundable benefits/pensions, salaries that start at $200K+. They are constitutionally guaranteed to get giant, automatic raises to salaries/pensions every year that will eventually quadruple (and more) their compensation.

·         State personal income tax is almost certainly going to be set at about 5% ormore in the near future—many states don’t have a state income tax at all.

·         Our General Assembly appears to be ready to add lots of new and unprecedented service taxes to all sorts of things, like storage space, including garages and boat docks; maintenance of property like cars; landscaping including sprinkler installation and snow removal; dry-cleaning; cable TV, satellite and digital streaming services; pest control; use of a private detective or installation of security systems; and personal care, ranging from tanning to tattooing but—whew--not including hairstyling.

You can’t make this stuff up, folks. No one seems to strongly care about how all those things are driving our taxpayers crazy. With all this State debt, departing jobs/businesses and overpaid government workers, the not-that-important government thing appears to be something as trivial as IL workers’ comp reform. We vote do something to get work comp out of the legislative gun sights and let our leaders get back to the big ticket issues.

From Keefe, Campbell, Biery & Associates--Two Simple IL WC Reform Proposals To Get Our Claims Industry in Line and Out of the Legislative Cross-Hairs.

We find it a bitpuzzling workers’ compensation reform continues to be such a focus of concern to the extent it is seen as a sticking point for our State’s budget. With the nation’s highest budgetary deficits and massive under-funding of state government pensions, it is our impression that tackling workers’ compensation reform in Illinois at this juncture is a bit like focusing on untangling a tiny knot in the dragon’s tail as he is about to breath fire over the entire state.

However, as recent reports appear to show only modest savings from the 2011 statutory changes to the IL Workers’ Compensation Act, we offer two very simple, yet effective changes which would almost immediately bring Illinois workers’ comp costs back into the average of most of our sister states.

First, we recommend a return to the pre-2005 schedule for PPD values. Veteran observers of our industry will recall 11 years ago when our General Assembly found it prudent to actually increase the PPDvalues for injuries by 7% across the board. This was viewed as nothing more than an effort to further line pockets of claimants and their attorneys in a State that already had generous PPD or “settlement” values.

For a simple and unquestioned IL WC reform--returning to the former PPD schedule will save 7% on awards and settlements immediately. We don’t feel anyone on either side of IL WC would beef about that change.

Second, rather than developing an needlessly complex system of geo-zip fee arrangements or worse, Medicare-linked reimbursements for medical care that will drive great doctors out of workers’ comp, why not simply average the two or three largest group provider fee schedules and set that as the standard workers’ comp medical fee payment schedule? Doing so will allow doctors to be paid the same, whether treatment is under workers’ comp or group health. Moreover, this method would eliminate the financial incentive for doctors to drive claims into workers’ compensation to collect higher rates, as we have certainly seen some medical providers do over the years.

Adjustments can be made every 3 years to keep the average current with any group adjustments. Doctors make money from Humana and Blue Cross and they would make the same treating workers’ comp claims too.

Making these two simple changes, which we expect should be fairly easy to pass with both the Governor’s and General Assembly’s approval, will save enough to make Illinois competitive again and also keep benefits adequate for our Illinois workers.

Where IL WC Reform Is Right Now in Springfield

Last week, the IL Senate's workers' compensation proposal received a new amendment. SB 198 (formerly SB 12) is essentially amendment 4 to SB 12 as reported on last week with two specific changes.

SB 198 adopts the Illinois State Chamber’s recommended move from the current IL WC medical fee charge system to an RBRVS or resource-based relative value scale effective September 1, 2017. This is expected to cut IL WC medical costs in the area of 30% more than steep cuts made in 2005-6 and 2011.

In addition, the new amendment requires the Workers' Compensation Commission to investigate all procedures, treatments, and services covered under law for ambulatory surgical treatment centers and accredited ambulatory surgical treatment facilities and establish fee schedule amounts for procedures, treatments, and services for which fee schedule amounts have not yet been established. These loopholes will close.

Governor Rauner’s mixed-up efforts to reform or cut costs in IL WC by

      Changing our “causation standard,”

      Redefining and possibly expanding the nutty “traveling employee” concept and

      Strengthening AMA guidelines in setting PPD or “permanency/impairment.”

are not part of this compromise. As we have reported repeatedly, Governor Rauner doesn’t need legislation to make the changes above. He can make such changes with his administrative/executive control of the IWCC and either doesn’t know or doesn’t care to do it.

If there are changes made as part of a “Grand Bargain,” it would appear medical cost cutting is likely the extent of what will be considered the 2017 Amendments to the IL Workers' Comp Act.

Then we hope IL workers’ comp reform would be off the table and our industry can go back to the normal challenges. We would love to see the Governor and General Assembly tackle the monster, multi-billion dollar battles to cut government budgets and bring runaway spending into control before raising taxes so high even more folks will be driven away from this State.

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

Synopsis: Thoughts on Jesse Jackson, Junior’s Workers’ Comp Claim.

Editor’s comment: Please note Jesse, Jr. is actually getting federal and not state WC benefits. He has been receiving them in and out of prison for years, it seems. This information is coming from his divorce proceedings. You may note his soon-to-be-ex-wife was a longtime Chicago alderwoman who didn’t actually reside in or anywhere near Chicago and almost never, ever attended a City Council hearing. In the one-party political system that we have in Chicago due to a lack of term limits, no one stood up to point out her constant disappearing act.

Due to the disclosures about Junior’s pending federal WC claim, there is a legislative proposal for a bill to end Junior’s benefits, in a fashion that probably will affect just him. He could lose about $100,000 a year in tax-free workers' compensation benefits if a bill introduced Wednesday by an Illinois Republican becomes law.

U.S. Rep. Rodney Davis of Downstate Taylorville introduced the measure. It is a looooong way from becoming law—Junior may continue to be paid until something changes.

Jackson was convicted in 2013 for using about $750,000 from his campaign donations for personal use, like buying a $60,000 Rolex® watch. He allegedly receives the WC benefits because he has bipolar disorder and depression, which were diagnosed in 2012, according to court documents. I would be depressed too if I had to go to federal prison! Hard to imagine how that condition might be work-related.

Rep. Davis' measure would reform workers' compensation eligibility for members of Congress who convert campaign funds for personal use or are convicted of any of 28 other crimes related to their public duties.

The bill also would require the House's chief administrative officer to submit an annual report listing past employees who receive workers' comp. Davis sits on the House Administration Committee, which would receive the report.

Doesn't it seem mildly insane that we have to pass a federal law to have someone cut off benefits that should never have been paid to start with? Shouldn't the federal administrator who approved the non-injury WC claim be fired? Shouldn't someone investigate how many federal WC claims are being paid without any actual injuries?

Why does work comp always seem to be such a smoking mess? We appreciate your thoughts and comments. Please post them on our award-winning blog.

Synopsis: IL Arbs Moving Around.

Editor’s comment: As of July 1, 2017, Arbitrator Hegarty and Arbitrator Friedman will be switching dockets to ensure compliance with the Illinois Workers’ Compensation Commission Act. 

Arbitrator Hegarty who is considered moderate/liberal due to her legal background and training will be moving to Zone 5 or Rockford/Waukegan/Woodstock. All cases formerly assigned to Arbitrator Friedman and new filings will now be assigned to Arbitrator Hegarty. 

Arbitrator Friedman who is considered moderate/conservative from his legal background will moving to Zone 6 or Wheaton/Geneva/Elgin and all cases formerly assigned to Arbitrator Hegarty and new filings will now be assigned to Arbitrator Friedman.

If a case had been tried or partially tried by either Arbitrator, that hearing officer will retain jurisdiction over the case. 

Please reply with any concerns.

Synopsis: Join Shawn R. Biery, J.D., MSSC for a nationally broadcast Webinar July 17th, 2017 3:00 PM to 4:15 PM ET

Editor’s comment:  Workers’ Compensation: Return to Work Issues & Strategies

Can't attend live? By registering, you will be able to view the course live, view a recording at any time for 12 months, or both. This webinar will provide an overview of strategies and tips for reintegrating injured workers to production. In addition, the course will also provide tools for effectively managing claimants’ expectations and implementing protocols for claim management.

Upon completion of this course, you will be able to:

·         Analyze options which can be utilized on a claim by claim basis to set targets for return to work

·         Understand avenues to develop relationships with key stakeholders to assist in management of claim issues with focus on rapid return to work

·         Set targets for accommodated and full duty return to work for injured workers

·         Determine more specific strategies for your industry to minimize lost time claims

·         Describe HIPAA compliance issues

Receive a 35% discount for being a friend of the firm by using the promo code: SPKR35

You can sign up to attend at:

http://clearlawinstitute.com/shop/webinars/workers-compensation-return-to-work-issues-strategies/

Please contact Shawn at sbiery@keefe-law.com with any questions or to find out how to have one of the KCBA attorneys provide a presentation to your office!

Workers’ Compensation in Illinois is complicated . . . Do you know everything you need to know about the Illinois WC system? Attorney Jim Egan of Keefe, Campbell, Biery & Associates will begin with a review of the basics of Workers’ Compensation in Illinois, including benefits, the Workers’ Compensation Commission, and handling a claim of injury from the beginning to end. He will then analyze and discuss in-depth important topics such as Temporary Total/Partial Disability, Nature and Extent of Injury, Wage Loss Differential, Discovery, Liens and related claims against WC benefits in Illinois, Surveillance, Retaliatory Discharge and How to Handle WC Death Claims.

The final section of the day will include a number of essential factors to be considered when you are dealing with any workers’ compensation claim. You will receive helpful information on pushing your claim targets, using real time examples. Keeping in touch with your workers and how to drive claim closure are key, so these will also be discussed.

This is a not to be missed workshop for anybody who handles Workers’ Compensation claims in Illinois.

Registration Information:

Tuesday, June 20, 2017

10:00 am - 4:00 pm

Holiday Inn Express, 1000 Plummer Drive, Edwardsville, IL 62025

Early Bird - (For everybody) - Sign up before June 10 - $249.00

Member (For members of the Illinois Chamber & local chamber partners) - $299.00

Retail Price - $349.00

5-15-2017; RBVRS to Hit IL WC--Snoozefest, Savings or Both?; Consider Reassignment to Fulfill ADA Requirements; When to Do Ex Parte Depositions in IL WC and more

Synopsis: IL Labor/Democrats Offer RBVRS (?!) as New and Blurring Part of IL WC Reforms.

Editor’s comment: A Chicago Democrat presented new IL WC reform legislation incorporating a “resource-based relative value scale” or RBRVS as the physician-healthcare payment system as a cost-savings mega-plum for IL employers and local governments. This concept is now included in the pending workers' compensation bill as part of a compromise with IL Republicans to solve our nutty State's budget deadlock. Please note our State hasn’t had a real “budget” under the current Governor Bruce Rauner. 

Sen. Kwame Raoul filed Amendment No. 4 to the “Grand Bargain” or Senate Bill 12 last Wednesday; it remains in the IL Senate Assignments Committee. The proposed change calls for a RBRVS or Medicare-based fee schedule to lower some of the highest workers’ comp medical costs in the U.S. In short, it appears the doctors, hospitals and other health care givers are again being pushed to take moderate to dramatic cuts to demonstrate WC cost savings. This will be the third major cut in medical costs in the IL WC industry since the 2005-2006 Amendments to the IL WC Act were created.

From what we can tell, the IL State Chamber and other business and insurance interests cautiously support this unexpected WC amendment.

What In Tarnation is RBVRS?

As my wife said yesterday—sounds like a complete SNOOZE-FEST! But it seems to be important for many IL WC industry folks to study, learn and start to understand. We assure you we feel it could only be loved by nerds and dweebs but sometimes those folks save you more money.

The AMA has an RBVRS overview online here:

https://www.ama-assn.org/rbrvs-overview

In their clear-as-mud explanation, they say:

The resource-based relative value scale (RBRVS) is the physician payment system used by the Centers for Medicare & Medicaid Services (CMS) and most other payers. The RBRVS is based on the principle that payments for physician services should vary with the resource costs for providing those services and is intended to improve and stabilize the payment system while providing physicians an avenue to continuously improve it.

Sounds simple, sort of like quantum physics--right? Huh?

The RBVRS concept appears to have been implanted into California’s work comp system by their nerds some years ago.

http://r.search.yahoo.com/_ylt=A0LEVvYktBlZWCcATwonnIlQ;_ylu=X3oDMTEybHVoZHJhBGNvbG8DYmYxBHBvcwMzBHZ0aWQDQjM4ODhfMQRzZWMDc3I-/RV=2/RE=1494885540/RO=10/RU=http%3a%2f%2fwww.dir.ca.gov%2fdwc%2fRBRVSReport%2fRBRVS_May2008.pdf/RK=0/RS=mV2cfHQLZDxOGDd06kjpoHXB9SQ-

Back to How RBVRS May Come to an IL WC Claim Near You

Stakeholders in the IL WC system feel the expected savings from RBVRS would depend on the percentages of Medicare reimbursement that would be allowed for doc’s and hospitals by the IL Workers’ Compensation Commission, should Amendment No. 4 and “the Grand Bargain” in SB 12 pass and then be signed by Gov. Rauner. The new bill directs the IWCC to set the rates, but establishes parameters tied to where current medical reimbursement rates stand.

Jay Dee Shattuck, executive director of the Illinois Chamber of Commerce’s Employment Law Council was quoted as saying “We believe the change will bring Illinois’ workers’ compensation medical fee reimbursements more in line with medical fee schedules of other states around the country.” He also said “It more fairly reimburses management and evaluation service codes, which are some of the lowest in the country, and reduces the codes — such as surgery — that are some of the highest in the country.” As we have advised our readers in the past, Jay Shattuck and Todd Maisch, the President of the IL State Chamber are among the top business leaders in the WC field in this state. If they did their homework and still like RBVRS, it is probably a solid idea, not matter how difficult and boring RBVRS may be to understand. If you are interested in learning more about IL WC reform and/or cutting workers’ comp costs, consider joining the IL State Chamber and the ELC—check out their website at www.ilchamber.org.

Illinois currently has a home-grown, charged-based medical fee schedule based on geographic areas called "geozips." Illinois medical reimbursement rates are considerably higher than our State's neighbors, even with a 30% across-the-board reductions created from the 2011 Amendments to the IL WC Act, per the Illinois Policy Institute.

WCRI or the Workers’ Comp Research Institute’s recent stat-rat study confirmed the average total cost per workers’ compensation claim in Illinois has decreased 6.4% since 2010 primarily due to significant cuts in medical costs. However, our overall WC costs continue to outpace most of the 17 other states studied in WCRI’s recent report. Before that overall WC claim decrease, Illinois had the second-highest WC Medical Fee Schedule — behind only Alaska — in a comparison with 43 other states and the District of Columbia, WCRI said in a 2016 study. After the IL WC Medical Fee Schedule reduction, Illinois had the 10th highest fee schedule rates among those 43 states when measured as a percentage of Medicare's maximums, WCRI said.

So How Would RBVRS Happen? How Would It Affect Your Claims?

Senator Raoul’s proposed IL WC Medical Fee Schedule would continue to use four regions for non-hospital fee schedule amounts and 14 regions for hospital schedules. It would task the IWCC, within 45 days of the bill’s enactment or sometime later this summer, to determine the Medicare percentage amount for each current procedural terminology and diagnosis-related group code using the most recent data available from the Centers for Medicare and Medicaid Services.

Within 30 days after the IWCC determines the percentage rates, it would be required to make several adjustments:

• If the percentage for a particular CPT or DRG code is 125% of the Medicare rate or less, it would be set at 125%.
• If the percentage is more than 125% but less than 150%, the rate would not be adjusted.
• If the rate is greater than 150% of Medicare but less than 225%, the rate would be set at the higher amount of 150% or 85% of the most recent maximum amount allowed for that CPT or DRG code in the current fee schedule.
• If the Medicare percentage is greater than 225% but less than 428.57%, the amount would be set at 191.25% of Medicare or 70% of  the current maximum rate.
• If the percentage is greater than 428.57%, it would be set at 300%.

By Sept. 1 of each year, the IWCC would be required to raise the maximum fee for each CPT and DRG code by exactly half of the most recent annual increase in the urban consumer price index.

Assuming you are still awake, we appreciate your thoughts and comments. Please post them on our award-winning blog.

Synopsis: Consider Reassignment to Fulfill ADA Responsibilities to Injured/Disabled Workers.

Editor’s comment: U.S. Employers may not realize you can safely reassign an injured or disabled worker to a vacant position within your organization to reasonably accommodate his or her disability. Instead, some HR and risk managers may mistakenly think a leave of absence is the last reasonable accommodation you should provide.

An employer that offers reassignment as a reasonable accommodation should document, document and document more, says Brad Smith of KCB&A. Send a letter to the injured/disabled employee you are accommodating to confirm for him or her you are seeking to reassign the worker to your open spot. The letter is a necessary step to keep the employer from having to offer reassignment indefinitely. The letter also should explain the worker can't currently be reasonably accommodated in their current job.

Once the letter is delivered, the employer has time to identify an appropriate reassignment.

Whenever and wherever possible, an employer should first attempt to reasonably accommodate the person in his or her current position. Then a leave of absence may be required under the Family and Medical Leave Act (FMLA) or the Americans with Disabilities Act (ADA), or both. Once leave starts to disrupt operations to the point reasonable accommodation is no longer “reasonable,” the employer should consider whether the employee can return to his or her current job with or without reasonable accommodation. If not, the employer should consider reassignment as a backup option.

The employer should look at vacant positions at all its facilities, not just the one the employee works at. If you find an open position at another facility, the employee may decline or accept the offer but you may be able to argue you have satisfied ADA to identify and offer the position. An employee with a disability may be required to apply for a transfer before being reassigned as long as all other employees seeking a transfer are required to do so.

Whether the employer has to give a preference to the employee with a disability for the vacant position over other employees is a challenging legal question and ultimately may have to be resolved by the U.S. Supreme Court.

This question may come down to what level of risk you as an employer are willing to accept. Reasonable accommodation is by its very nature something “extra,” for an injured or disabled worker. If an employee with a lasting injury or disability isn't given a preference in assignments/reassignments, then he or she is not receiving anything additional.

Please also note the concept of reassignment is one source of what I feel is appropriate criticism of “benefit-ocracies” in IL State and local governments. For one example, prison guards/correctional officers who are attacked by inmates suffer moderately disabling injuries. Following care to the point of MMI, they may not be able to return to correctional work.

Rather than bring them back to work at other administrative or low-impact light duty positions, they are allowed to remain off all work for months and years to then potentially become “odd-lot” total and permanent disability claimants who may receive several million dollars in benefits. The former gov’t workers become politically beholden to their “sponsors” who give them the biggest “perk” in government—tax-free money from taxpayers. In this government setting, I feel we are going to need to pass laws requiring government officials re-hire or re-assign such workers when light and sedentary work opens up appreciate your thoughts and comments. Please post them on our award-winning blog.

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

Synopsis: Practice Tip for IL WC Attorneys and Claims Handlers—How To Handle an IL WC Deposition When the Other Side Doesn’t Show.

Editor’s comment: Please note depositions in IL workers’ comp are evidence depositions only. Unless the other side agrees, you can’t do a discovery dep in a WC proceeding.

IL WC deps are not technically “set” by notices of deposition—there is no statutory provision for WC dep notices, as there is at common law.

If an IL WC attorney receives a WC dep notice, we still have to agree to attend—if you are going to agree to depose the other side’s expert, confirm you will do so. If you aren’t going to attend upon receipt of a WC dep notice—tell the other side in writing.

The other side either “agrees” to the deposition date/time or the dep is set by an odd process called a dedimus potestatem (I am not going to explain that moderately complex process here—send a reply if you want that info).

Those are the only paths to set/conduct a dep in IL WC.

If we set our expert’s dep and the other side forgets or isn’t there and is unwilling to proceed by phone, we vote DO THE DEP.

About three months ago, we had a deposition scheduled and OC knew of the dep and then forgot about it. Our attorney was there with the doctor and court reporter. Our doctor was already paid in advance and the court reporter will always bill for attendance. As OC didn’t show up, our attorney then mistakenly “cancelled” the dep and left.

In my view, I strongly recommend IL WC attorneys NOT do that—if you are there for your doctor’s dep--take the deposition without opposing counsel present. You and our client paid for the doctor’s time and attendance. You will be billed for the court reporter’s attendance. No client will want to pay again and you will get into a total storm to then have to go before an Arbitrator and fight over who has to pay for the second setting to allow cross-exam, etc.

Do the deposition as an “ex parte” dep—do the normal preliminaries but also put into evidence the correspondence/emails from and to OC confirming they were aware of the dep and were supposed to attend. Then ask all the questions you need from your expert.

If the other side wants to cross-examine your expert (and they should due to malpractice concerns), it is on them to set the second dep by agreement and pay for the doctor to attend and the court reporter.

If you appear at the dep of the other side’s expert and OC doesn’t attend, if the expert will proceed, it is a judgment call to go forward without your opponent.  In that setting, I would typically tell the doctor to contact the attorney and reset at the other side’s expense. I would also confirm all of it in writing to OC and your/our clients

Happy to discuss—send a reply. we appreciate your thoughts and comments. Please post them on our award-winning blog.

5-8-2017; Do You Want A College Intern, Student or Layperson to Write Your IME Background Letters?; Another IL Police Officer/Firefighter Forced to Deal with Combined WC and Line-of-Duty Denial

Synopsis: Are You Sure You Want A College Intern, Student or Other Layperson to Write Your Claim-Changing IME Background Letters?

Editor’s comment: The defense team at KCB&A has been mildly surprised to note a recent development in our WC defense law practice. Along with the growth of IME vendors that select IME doctors and set appointments for national and regional defense clients, we note many of these vendors are now trying to “take over” the practice of doing IME letters. Our concern is the vetting of such persons at the IME companies—are they college interns, students, laypersons, as we have been told? Whose fault is it if an unnamed and questionably qualified individual messes up an IME background letter so a defensible and major WC claim turns sour?

We are sure a typical WC claims adjuster is swamped by the exigencies of this business. Most claims adjusters are overwhelmed with claims and don’t have time to do detailed and lengthy IME background letters, so they don’t particularly mind letting anyone else in the WC matrix provide that service for their accounts.

We have also seen nurse case managers try to take over this aspect of the claims process. With respect to the nurses we work with and who do a great job tracking and managing ongoing medical care, they aren’t lawyers and don’t have the legal background required to cover all the bases in a litigation dispute.

Please note just about every workers’ comp claim can turn into a major financial issue—I know of many WC claims where minor surgery went south resulting in lifetime benefits that can go into the six and seven-figures. Risk managers and claims handlers don’t spend the money on IMEs for fun and games—if you need a medical-legal expert on a WC claim, be sure you are getting value from the money you are spending.

We assure all of our readers, workers’ comp litigation is the only area where anyone would even consider using the help of an uneducated vendor or even the claims handler to write a background letter to a medical, technical or engineering expert.

For one simple example, in Illinois workers’ compensation, it is crucial to ask the IME expert if their opinions are voiced “within a reasonable degree of medical and surgical certainty.” Illinois case law requires such a statement if the opinions voiced are to be admissible. The reasoning behind that requirement isn’t truly pertinent other than to render an IME opinion admissible and something a claims handler can rely upon. Very few outside IME vendors or nurse case managers know of this requirement or include it in IME form letters.

We were recently advised a WC IME vendor was writing or had written the IME background letter on an important claim for our client. With respect, we have to advise we don’t agree with having the lead medical expert respond to “one-letter-fits-all” questions from a vendor that may or may not have any idea what IL WC law requires. We also wonder—is the IME vendor using a form letter as the background information for the expert?

We confirmed for the client and the WC claims handler, they hired this medical expert to get a solid opinion on their claim. The client will be paying a lot of money for the medical-legal opinions. In other claims, we have seen vendors/clerks/NCM’s ask questions or possibly not ask important medical-legal questions that may “cook” the claim and possibly render it indefensible by asking poorly thought-out questions in an IME letter.

I personally feel it borders on negligence to use many of the blanket “form” IME background letters that have sprung up across our industry—each WC claim is unique and a blanket inquiry almost never works to get the important opinions needed on a single WC claim.

It is hard to blame the medical expert who may be innocently responding to poorly drafted or form interrogatories, as the result of being asked important questions by someone that doesn’t know what to ask.

At a minimum, we recommend you allow your defense attorney to quickly review the IME background letter for medical-legal accuracy and cover all your defense needs for the litigation.

If you don’t do this, let the buyer beware! The IME may come back to bite you, “cook” the claim against you and/or a valuable medical-legal opinion may be rendered worthless due to missing information.

We are happy to assist in finalizing IME background letters in both litigated and non-litigated claims. Just email the letter with enough time to allow us to rapidly review and return it.

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

Synopsis: Another Illinois Police Officer/Firefighter Forced to Deal with Combined Workers’ Comp and Line-of-Duty Pension Claim Denial.

Editor’s comment: We are mildly amazed to see Illinois’ hyper-liberal Appellate Courts now turn down the third reported claim in a row by an Illinois firefighter or police officer. We are not sure this has ever happened in our State!

In Village of Alsip v. Portincaso, 2017 IL App (1st) 153167 (May 5, 2017) Cook Co., 5th Div., the Appellate Court considered a claim by an Alsip police officer in which the officer responded to a domestic relations beef and claimed he was injured.

We note, some years ago, the IL WC Commission panel heard the underlying WC claim involving this officer claiming injury in response to the domestic relations call. The IWCC panel denied the claim for lack of causal connection and their ruling was later affirmed after multiple appeals.

Following the denial, this ruling incorporated the longstanding legal term “res judicata” or what is also called issue preclusion for any related accident/injury claim about the event. Please note it is our experience Illinois’ reviewing courts don’t always follow longstanding rules, particularly when their decisions involve police officers and firefighters who have influential and politically powerful unions. Sometimes the rules get “bent” in this nutty state—not here.

The IL Appellate Court was asked to consider a claim for line-of-duty disability benefits that would require the Village to pay the officer line-of-duty disability benefits for the rest of his life.

In consideration of that claim, the IL Appellate Court reversed the Board of Trustees of the Police Pension Fund's award of a lifetime line-of-duty disability pension to Plaintiff.

The Court ruled the Board of Trustees of the Police Pension Fund abused its discretion in denying the Village of Alsip's petition to intervene. The Court ruled to reach the issue of res judicata or issue preclusion, the Village would need to have been made a party to proceeding, as it was the only party with an interest in raising the defense.

As the discreet question of whether Plaintiff had been injured during an arrest for domestic violence incident had already been answered and fully litigated in front of Workers' Compensation Commission, that litigation and outcome precluded any redetermination of whether Plaintiff was, in fact, injured during the domestic relations call. The Commission’s ruling was a final determination of such claim, rendering a contrary ruling impossible.

We salute the IL Appellate Court for adhering to longstanding and well-settled legal principles.

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