12-9-2019; Q&A on New Recreational Marijuana Laws in IL Workplaces; Gene Keefe’s Year-End IL WC Contest to Locate Well-Paid Medium Duty Jobs for IL Injured Workers and more

Synopsis: Q & A From Defense Attorney John Campbell and Lobbyist Jay Shattuck About New IL Recreational Marijuana Laws in Your Workplaces.

 

Editor’s comment: Our name partner John Campbell had a good question from a client worth sharing; he asked lobbying expert Jay Shattuck of the IL State Chamber if he could provide some insight. Please note Jay is not a lawyer and doesn’t profess to be; that said, in my view, he is one of our State’s top experts on understanding legislation and its impact on your business.

 

John Campbell noted the IL recreational marijuana statute provides that employers can maintain a “zero tolerance” policy but then outlines parameters on grounds for termination such as a positive test and other evidence of impairment.

 

John was asked if a zero tolerance policy means that even trace amounts of marijuana found on a drug test (well below the vehicle code limit of 5 ng for impairment) would still permit termination under a “zero tolerance” policy by an employer?

 

Jay Shattuck felt the answer is yes.

 

Jay indicated the issue that will need to be defended [by IL employers] is whether the policy is “reasonable” and “non-discriminatory”. For example, having a zero tolerance policy that allows employer disciplinary action including termination for safety sensitive jobs (not just necessarily physical tasks but employees with tasks that could adversely impact themselves, other employees, clients/customers, the public or the organization) could have a policy prohibiting  any level of THC. However, it could be considered discriminatory if the zero tolerance was THC only and did not include other substances or if the policy was applied to only one set of safety sensitive jobs and not others.

 

Jay felt legislative intent clearly was provided during debate of HB 1438 that IL employers with drug testing policies prior to the law would be able to continue those policies as long as the policy was reasonable and non-discriminatory.

 

John Campbell then asked “in other words, there is no evidence of impairment, but marijuana screen was positive at low levels upon testing. Can an employer still terminate?

 

Jay Shattuck again felt the answer is yes. He pointed out Subsection (d) that refers to impairment says “an employer MAY consider.” It does not require an employer to show impairment. Jay would argue that the construction of the whole section is that each subsection stands on its own. There is no connection of the subsections with an “and”.

 

With the most recent changes, Jay and the State Chamber believed it was also important to separate the old e-1 into two parts which was accomplished. The good faith belief provision now stands on its own and the items in subsection e are separated by an “or” not an “and”.

 

John Campbell, Brad Smith and Matt Ignoffo of KCB&A are veteran lawyers who are developing a strong expertise on defending employers who will be dealing with marijuana use in and around your workplaces. Feel free to contact any of them to consult and advise you on all aspects of the new challenges you are certain to face.

 

We also strongly recommend our clients and potential clients join the IL State Chamber of Commerce that is the leading proponent/protector of IL business and local governments. We salute the hard work of Jay Shattuck and other Chamber folks that helped form this new legislation in a state legislature that is somewhat one-sided.

 

These opinions and statements are accorded to the persons outlined above. We appreciate your thoughts and comments. Please post them on our award-winning blog.

 

 

Synopsis: Gene Keefe’s Year-End IL WC Contest to Locate Well-Paid Medium Duty Jobs for IL Injured Workers.

Editor’s comment: I feel there is flawed math in many major IL WC claims. Peter or Paula Petitioner might be a large/strong person. Petitioner has a job in construction, trucking or any industry that pays well for healthy peeps but relies on the worker being able to lift 50-75lbs. regularly. The worker suffers a strain/sprain with maybe one surgery. After surgery, the unwitting and otherwise unknowing doctor who is treating Claimant prescribes an FCE or functional capacity evaluation—the claim moves into what I call “the IL WC FCE dance.”

 

The IL WC FCE Dance

 

Please note my continuing and well-founded disdain for FCE’s. The main issue I have is everyone who goes through surgery and then gets into post-surgical physical therapy is guided by RPTs or registered physical therapists. The RPT’s carefully and diligently record progress and complaints and do their very best to get their patients back to the best possible function. At the end of the course of PT, how can it make any sense to ignore the PT records/care and progress to then do a two-hour “test” where the patient’s life is measured by the hilariously unscientific and subjective methods of an FCE. Please also note a patient can’t “fail” physical therapy—if they don’t cooperate, the RPT will discharge them. In contrast, I have probably seen over a hundred “failed” FCE’s where the person conducting the test reaches the conclusion the patient isn’t cooperating and the testing is invalid. The problem with the finding of invalidity is our IL WC Arbitrators won’t toss out the invalid test, they will still “rely” on it to some extent in valuing wage loss and/or permanency.

 

Going back to Peter or Paula Petitioner above, when the large/strong claimant goes to the FCE, they are “coached” to fail. There are many easy ways to fail an FCE. I saw one claimant who had one operation to one knee. Pro football players could have the surgery this claimant had and return to work, pro football, in a week. This guy underwent surgery and had no real issues through physical therapy. At the end of PT, he was obviously coached in the IL WC FCE dance—during the supposedly scientific testing, whenever he lifted anything he would routinely tell the evaluator it caused subjective and unverifiable pain. He complained so often he convinced the evaluator who found his complaints somehow “valid,” as if he was able to look into this guy’s body to confirm he was telling the truth and not making it up.

 

After the somehow “valid” FCE test, the evaluator assigned medium work restrictions for the rest of this person’s entire life. As I indicate above, the FCE test can be two hours long but whatever claimant does for those two hours is “life-changing!!” What a hoot.

 

After being assigned work restrictions, claimant has now reached his goal of an IL WC ‘Jackpot.’ For construction workers and truck drivers the IL WC FCE Dance now supposedly documents a lifetime limited ability of being only able to work at minimum wage where their prior job required heavy lifting. In the IL construction industry, workers make $40-60 per hour so they win the IL WC FCE dance to be entitled to gigantic wage loss until they reach age 67. For most workers in their 30’s and 40’s, the discounted present value of such a claim is between $300-600K!

 

Okay, Gene, so what is the contest?

 

Well, I am not willing to accept that every large/strong worker with one surgery to one body part can only make minimum wage. I want your help to locate well-paid jobs that someone with a high school education and some training can do in relatively short order with sedentary, light or medium work restrictions. I am offering $50 of MY money to buy an Amazon Gift Card for each winner and will publish your recommendations if you give me authority to do so.

 

Examples of Medium/Light Jobs for Large/Strong Workers? I have a bunch.

 

First, please consider USPS—yep, the good ole Postal Service. If you go to the USPS jobs website, you will note starting pay for postal workers and managers in most places is $21 per hour! Median pay is $36 per hour with full federal healthcare and pension benefits. The USPS website indicates lots of their workers make over $100K a year!

 

Please note mail carriers with USPS have to lift up to 70lbs when they grab the mail sack. You don’t want medium/light duty claimants going for mail carrier positions, either in a city or rural. But all other USPS jobs, like window clerks and mail sorters are light or medium work and only have some training requirements. Selling stamps isn’t hard work.

 

Second, “no touch” city trucking jobs are another possible option for Peter or Paula Petitioner. Most Claimants have to drive to their doctors and FCE’s and all medical care. If they can drive their car, they can and should be able to drive a truck. The one downside to this path for getting a big person with restrictions back to medium work is they have to take a truck driving course and get a CDL or commercial driver’s license. That takes some time and has its own cost but it is better than paying a mildly injured worker a zillion bucks to get rid of them.

 

Third, I have posted this in the past and I need your thoughts on 911 Emergency Call Center jobs. Basically, this is manning or “womanning” phones. The worker needs about 90 days of training and has to learn “cop talk” to talk to reporting officers and others on the phone. This is a fully sedentary job. There are always openings because the position has to fill a chair on a 24/7 basis. Folks working at these positions are paid similar to police and firefighters—they make around $50K a year to start and quickly move up in the range of $100K with full pension and healthcare benefits.

 

What Do You Think?

 

Do you know of such positions? Again, they have to be well-paid jobs. They also have to be positions with sedentary, light or medium work. If the position will allow the worker to alternate sitting and standing, all the better. Training can’t be long because employers will have to pay TTD during training which could make the cost prohibitive if the training was a year or more.

 

Send in your best thoughts with or without permission to use your name. I appreciate your thoughts and comments. Please post them on our award-winning blog.

 

12-4-2019; IL WC Arbitrators “TBA” Finally “A-ed;” Northwestern U. Researcher Developing Implantable Naloxone Device and more

Synopsis: IL WC Arbitrators “TBA” Finally “A-ed.”

 

Editor’s comment: For months, we have been telling our clients a given claim or call was assigned to Arbitrator “TBA” or to be announced. This has led to other Arbitrators cycling in and out of the calls and picking and choosing claims to try or continue while awaiting a permanently assigned Arbitrator.  

 

Well, earlier this week, Governor Pritzker finally named six more IL WC Arbitrators, filling all TBA positions that had been vacant. It has been more than a year without a full staff of workers' compensation arbitrators. Of these newbies, very few of them are “good ole boys/gals.” Their first hearings will be of great interest to both sides of the IL WC bar. Two of the newbies are claimants' lawyers, one is an insurance defense attorney, and two have logged in time in non-arbitrator posts at the IL Workers' Compensation Commission.

 

The appointments, along with two people named in October, will bring the number of arbitrators up to the full complement of 34, easing concerns that some of the hearing officers have been spread too thin for too long.

 

The nominees must still be confirmed by the state Senate, but that is expected with a super-majority Democratic legislature. I expect none of the controversy that some of former Gov. Bruce Rauner's nominees experienced. The former Republican governor named 11 new IL WC arbitrators in 2018, but our Democratic House/Senate declined to act on them. A couple of appointments were eventually ratified, but the panel remained short-handed until Pritzker made this announcement on Monday.

 

Despite Pritzker's liberal political focus, the new IL WC arbitrators have not met with discord from business, government and insurance stakeholders. The gurus at the Illinois Chamber of Commerce endorsed three of the appointees and took a neutral stance on two others.

 

Perhaps the best known of the new faces, longtime claimants' lawyer Joseph Amarilio, was highly praised by all sides. I was quoted by a national WC news source as saying: “He's not a bad guy,” which I feel is accurate. I do feel Mr. Amarilio will be liberal but follow the rules. I am sure he won’t be happy to consider WC fraud issues and will strongly police such shenanigans. Amarilio has been a partner with the Chicago-based firm of Elfenbaum, Evers, Amarilio and Zielinska, which specializes in representing injured workers. He graduated from Northwestern University and earned his law degree from John Marshall Law School.

 

In what may be a first, another newly appointed arbitrator, Adam Hinrichs, also worked with the same law firm. Hinrichs was a claimants' lawyer for eight years.

 

Governor Pritzker also was applauded for expanding diversity of the IL WC arbitrator pool. The recent nominees include two African-American lawyers, an attorney of Cuban descent and three women.

 

Along with Joe Amarilio and Adam Hinrichs, the other IL WC arbitrators named Monday:

 

  • Deborah Baker is assistant deputy chief legal counsel and ethics officer for the Illinois Department of Corrections. She is a member of the Black Women Lawyers Association and previously was an appeals staff attorney at the Workers' Compensation Commission. She earned her bachelor's degree from the University of New Mexico and her J.D. from Loyola University.

 

  • Elaine Llerena has been a staff attorney for Seyfarth Shaw, specializing in employee benefits and retirement law. She previously was a staff attorney for the IL WC Commission. She graduated from Florida State University and from The UIC/John Marshall Law School.

 

  • William McLaughlin is now in private practice but until recently was a staff lawyer for the Illinois Department of Professional Regulation. Before that, he was an assistant state’s attorney in Cook County. McLaughlin earned his bachelor's degree from St. Xavier College and his law degree from the University of Nebraska.

 

  • Dennis O'Brien is vice president of Livingstone, Mueller, O'Brien and Davlin, a Springfield-based comp defense firm. He once worked as an assistant prosecutor and a news reporter, and spends much of his time as stage manager at the Springfield Municipal Opera. His bachelor's degree is from Dominican University and his law degree is from Loyola.

 

Arbitrators in Illinois WC are the first hearing officers in WC claims litigation. After the Arbitrator rules, claims may then be administratively appealed to a 3-member panel of Commissioners. The arbitrator position pays about $118,000 a year.

 

With three-year terms, arbitrators are subject to being passed over for re-appointment if the next governor is of a different political party, attorneys said. For claimants' attorneys, in particular, that can be a problem — having to leave a law practice for few years, then having to re-establish it later. One arbitrator in recent years found out in the middle of a hearing he was no longer in office.

 

To ameliorate that problem and hopefully make the arbitrator and commissioner positions less political, the IL State Chamber of Commerce and others including me support legislation that would change the arbitrators' terms to five years. The proposed legislation, which was debated in the House Labor and Commerce Committee last month, also would set arbitrators' salaries at 65% of circuit court judges' salaries, taking them to about $130,000 annually. IL WC Commissioners' pay would be set at 70% of judges, bringing them from $122,000 to $140,000 annually.

 

I am happy to consult with any of the new or existing appointees and/or provide research at no charge. I appreciate your thoughts and comments. Please post them on our award-winning blog.

 

 

Synopsis: Northwestern University Researcher Developing Implantable Naloxone Device.

 

Editor’s comment: What Is Naloxone? It is part of the war against opioid abuse in workers’ comp and other treatment spheres. In the field of U.S. WC, when a Claimant becomes addicted to opioids, claim costs skyrocket.

 

Naloxone is a medication approved by the Food and Drug Administration (FDA) to prevent overdose by opioids such as heroin, morphine, and oxycodone. It blocks opioid receptor sites, reversing the toxic effects of the overdose.

 

Naloxone is administered when a patient is showing signs of opioid overdose. The medication can be given by intranasal spray, intramuscular (into the muscle), subcutaneous (under the skin), or intravenous injection. A doctor can prescribe naloxone to patients who are in medication-assisted treatment (MAT), especially if the patient is taking medications used in MAT or considered a risk for opioid overdose. Candidates for naloxone are those who:

 

  • Take high doses of opioids for long-term management of chronic pain

  • Receive rotating opioid medication regimens

  • Have been discharged from emergency medical care following opioid poisoning or intoxication

  • Take certain extended-release or long-acting opioid medications

  • Are completing mandatory opioid detoxification or abstinence programs

 

I just learned A researcher at Northwestern University is developing an implantable device that can automatically release opioid-antidote naloxone if a sensor detects a person’s blood-oxygen level has fallen to an unsafe level, according to a report by the Chicago Tribune.

 

Animal testing is scheduled to begin next year, and clinical trials in humans could start within five years, according to the report. John Rogers, director of the Center for Bio-Integrated Electronics at Northwestern, developed the device. He was quoted in the Tribune to describe it as a “fully autonomous system, almost like an implantable emergency response system, providing a first responder’s type of functionality but without human intervention.”

 

The device will also tethered to a user’s cellphone and automatically alerts paramedics when a person appears to be suffering an opioid overdose.

 

I will continue to report as more information is received.

 

11-29-2019; Retirement of IL Senate President Cullerton; Temporary Transitional Work Ruled Effective in IL WC; New Medicare Reference Guide and more

Synopsis: Retirement of IL State Senate President John Cullerton.

 

Editor’s comment: The defense team at Keefe, Campbell, Biery & Associates wants to salute the coming retirement of a great Illinois leader, John Cullerton. John is a quiet and strong legislator. John  He will be greatly missed by the IL WC community. He was a quiet force that kept the system intact over his 40+ year career. We hope he hangs around a little to continue giving great advice to the legislators he is leaving behind.

 

 

Synopsis: Temporary Transitional Duty Works Again in IL WC—Will It Work On Your WC Claims?

 

Editor’s comment: In Stegan v. Reladyne LLC, 27 ILWCLB 161 (Ill. W.C. Comm. 2019) Petitioner sustained a work-related injury to his shoulder that resulted in permanent light duty work restrictions felt to be “below” his prior occupation as a forklift operator.

 

Respondent Reladyne’s claims team hired Transitional Work Solutions to help Claimant find work within his restrictions.

 

Transitional Work Solutions placed Petitioner with Habitat for Humanity Restore in a charitable position within his restrictions, but Petitioner refused the position without any particular reason and did not show up for that work. Regular hourly wages were to be paid by the claims handler during all times Claimant showed up to Habitat for Humanity Restore—when Claimant didn’t show for the charity work, lost time benefits were terminated.

 

When the dispute came to hearing, the IL WC Arbitrator found Respondent Reladyne liable for temporary total disability benefits because of a controversial view the IL WC Act does not require Petitioner to accept an unpaid position from an entity other than Respondent.

 

The IL WC Commission reversed the Arbitrator and denied wage replacement benefits, noting the charitable position was not unpaid. Respondent would have remained his employer and maintained control with his normal pay and other benefits. The only change to his employment would be where he was reporting to work and his work activities.

 

The Commission found the Petitioner had no justification for his refusal to participate in the return to work program and ruled Respondent was not liable for TTD benefits.

 

This concept is called “temporary transitional duty” in other states. I looked up Transitional Work Solutions and they can be reached at their website at https://www.twsworks.com/ Whether you use them or some other vendor, I strongly recommend this concept for all IL and U.S. employers and insurance carriers.

 

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

 

 

Synopsis: The Feds issue a New and Updated WCMSA Reference Guide for Medicare’s Handling of this Complex Process.

 

Editor’s comment: In October, CMS released a revised Workers’ Compensation Medicare Set-Aside (WCMSA) Reference Guide. The updated guide is version 3.0, dated October 10, 2019, and can be found at this link: Guide.  As with other versions of the guide, updates are found in Section 1.1.  Of the updates, there are two of great significance that will likely have an immediate impact on your claims:

  1. Required language for the CMS Consent to Release has been amended to include that a beneficiary understands the intent, process, and administration of WCMSAs. This language must be included on all release forms starting April 1, 2020; and

  2. The Amended Review timeframe has been extended from 1-4 years to 1-6 years after a CMS approval has been issued.

Changes to Required Language on CMS Release Form

The Consent to Release form is Claimant’s signed authorization for CMS, its agents and/or contractors (the Workers’ Compensation Review Contractor (WCRC) specifically) to discuss a claimant’s case/medical condition with the parties identified on the authorization.  As of April 1, 2020, all forms must include language indicating the beneficiary reviewed the WCMSA submission package and understands the WCMSA intent, submission process, and associated WCMSA administration.

The section of the consent form, referencing understanding of the WCMSA, must include at least the beneficiary’s initials to indicate their validation. The new reference guide includes a template CMS release form which can be referenced for use. 

Amended Review Opportunity Expanded from Four to Six Years

CMS first introduced the amended review opportunity in 2017, allowing for an additional review of cases which have not settled, and reflect a significant change in treatment based upon new medical records/information. This additional review was limited to a period of 1-4 years from the date of the approval letter.  The expansion of the eligible amended review criteria is significant, allowing for the review of cases which have not settled and now fall in line with the following criteria:

  • CMS has issued a conditional approval within at least 12, but no more than 72 months prior;

  • A prior Amended Review has not been submitted;

  • The case has not yet settled as of the date of the request for re-review; and

  • Projected care has changed so much that the submitter’s new proposed amount would result in a 10% or $10,000 change (whichever is greater) in CMS’ previously approved amount.

This is a nice change to the Amended Review process, which should be perceived as an opportunity to settle cases which have remained unresolved.  With the expansion to six years, parties now have additional time by which to utilize this process. While this expansion still limits the process to a subset of cases, it is nonetheless an opportunity to obtain an updated CMS approval to reflect a claimant’s current medical status.  Of note, MEDVAL’s clients that are taking advantage of this opportunity are seeing significant reductions in MSAs and are able to settle previously “un-settleable” cases.

WCMSA Administration Updates

·         “Death of a Claimant” information has been updated and standardized with the Self Administration Toolkit;

·         CMS’ expectations for administration of WCMSA funds when “frequently abused drugs” are prescribed for a claimant have been clarified, with a policy and guidance link;

·         Updates include a newly created professional administrator role/electronic attestation enhancement in the portal.

Pricing of Hospital Fee Schedules Clarified

CMS clarified how pricing of hospital fees is derived. CMS notes hospital fees are priced based upon “the Diagnosis-Related groups payment for the median Major Medical Center within the appropriate fee jurisdiction for the pricing ZIP code, unless otherwise defined by law.” Of note, CMS has been utilizing this pricing for years.

Updated Life Table Link

The Life Table link has been updated to reflect use of the 2016 life table.

Keefe, Campbell, Biery & Associates has two certified Medicare specialists—please send an email or call with questions or concerns about this complex Federal morass!