8-14-23; Indiana WC Board Testing New PPI Portal Starting Right Now; IL Appellate Court, WC Div Orders Some Medical For Police Officer But Not All; IL WC Arbitrators Coming/Going and more
/Synopsis: Indiana Worker’s Compensation Board is Testing a new PPI Submission Portal Starting Now, 8/14/23. Article and analysis by our IN WC Defense Team Leader, Kevin Boyle, J.D.
Editor’s comment: IWCB is doing voluntary testing of their PPI Submission Portal for the rest of August 2023, and it will be mandatory by October 1, 2023.
Today, August 14th, 2023, the Indiana Worker’s Compensation Board will begin testing a PPI Submission Portal.
The Board anticipated that it will be available for use by all adjusters on September 1, 2023. Your Indiana adjusters may receive email blasts before the “go live” date. The portal will only be an available to adjusters for the time being.
We caution use of the new PPI Portal to submit PPIs will become mandatory on October 1, 2023. Please immediately start needed processes for this important change.
The PPI Submission Portal will be accessed through Gateway. The PPI Portal will allow adjusters to not only submit all documentation including the State Form 1043, Medical Report and Waiver electronically, but to monitor the status of each submission, once accepted, through review and IWCB approval. There also will be a Help document available on the Board’s website as well as on Gateway.
For more details, here’s a link to the 15 page Gateway User Guide that explains it all, too:
https://www.in.gov/wcb/files/PPI-Adjuster-portal-user-guide_July-2023.pdf
We appreciate your thoughts and comments. Feel free to ask any questions or concerns from Kevin at kboyle@keefe-law.com. Please post them on our award-winning blog.
Synopsis: IL WC Appellate Court rules East St. Louis Police Officer Gets WC Medical Expenses for Knee, Back, but Not Hip. See Gene’s Thoughts on How to Handle Such Claims, Moving Forward.
Editor’s comment: In East St. Louis Police Department v. IWCC, No. 5-22-0536WC, 05/22/2023, unpublished, the Illinois Appellate Court ruled that an injured police officer was not entitled to an award of payment for medical expenses for the treatment of his left hip, but he was entitled to awards for treatment of his left knee and lumbar spine.
Claimant Franklin suffered injuries in August 2018 while working as an East St. Louis police officer. According to Franklin, he injured his back, left knee and bilateral hips when he tackled a person running from the scene of a traffic stop.
The East St. Louis Police Department conceded Franklin had sustained injuries that arose out of and in the course of his employment, but it contended that his condition was not causally related to the August 2018 incident. Claimant Franklin had problems with his hips, spine and left knee that predated the August 2018 incident, and they were the subject of two previous workers' compensation claims. From what I can tell in research, Claimant Franklin had ten prior IL WC claims against the same Department.
Prior to the event in question, in 2013 to 2016, Dr. Mall repeatedly recommended surgery to repair a tear of the anterior cruciate ligament in Franklin’s left knee, but he declined the procedure when he learned that it would not be covered by his workers’ compensation benefits. From 2016, when Claimant last saw Mall, until August 2018, Franklin performed his full, unrestricted duties. Until the August 2018 incident, Franklin asserted, he experienced no symptoms from the ACL tear. After the incident, Franklin claimed his knee became unstable, causing him to trip or lose his balance.
Dr. Pitts reported no evidence that the left knee had been aggravated by the August 2018 incident, but Dr. Paletta opined the event “aggravated” the preexisting pathology. Dr. Robson opined that the incident had caused a temporary exacerbation of Claimant Franklin’s degenerative disc disease in his spine, but Dr. Gornet testified an aggravation of the lumbar spine was evident in the before-and-after diagnostic studies.
An IL WC Arbitrator heard the claim and found the opinions of Drs. Paletta and Gornet to be credible, but she found Claimant Franklin lacked credibility. The Arbitrator found a causal relationship between the August 2018 incident and the conditions of Franklin’s lumbar spine and left knee. She found no causal relationship for Franklin’s hip condition.
The Arbitrator awarded all past medical expenses for which Claimant Franklin sought reimbursement, including those for treatment of the cervical spine and the left hip, and for diagnostic procedures on the right hip, as well as future medical expenses for treatment of the lumbar spine, left knee and right hip. The Arbitrator also awarded temporary total disability benefits through August 2018, when Franklin declined an offer of light-duty work within restrictions.
On administrative review, the IL Workers’ Compensation Commission panel affirmed the Arbitrator's findings on causation and the award of medical benefits, except the award of prospective medical expenses for the right hip. The Commission panel said an award of future medical expenses for a mere strain of the right hip was unwarranted.
The Commission panel also extended TTD benefits through the date of the arbitration hearing and struck language from the arbitration decision that required the Police Department to indemnify Franklin from any claims by health providers or third parties arising from expenses for which they claimed credit.
A circuit court judge confirmed the Commission panel’s decision.
On appeal, the Illinois Appellate Court, WC Division noted even though Franklin took the position that a magnetic resonance imaging scan of his neck was related to the August 2018 incident, he declined to seek compensation for medical expenses associated with treatment of his neck. Thus, the Court ruled, the question of whether the Police Department should pay bills for the treatment of Franklin’s neck was not a contested issue and no causation conclusion was required.
The Appellate Court said it was unclear why the arbitrator's decision omitted a causation conclusion on the left hip, though, since Franklin alleged an injury, and the parties requested a written decision on this issue. Since the Arbitrator's decision lacked a finding of fact as to whether the condition of the left hip was causally related to the August 2018 incident, the Court ruled, the Commission panel lacked authority to order the payment of medical expenses without a finding of fact and conclusion of law from which the order results.
The Court ruled the Commission panel did not make a finding that was against the manifest weight of the evidence by finding that the August 2018 incident aggravated the preexisting problem in Franklin’s left knee or finding the incident had aggravated his low-back condition.
The Commission’s award of TTD benefits through the date of the arbitration hearing was not against the manifest weight of the evidence, either, the Court ruled, since the treating physician opined Franklin was physically incapable of any work.
In short, the portion of the Commission's decision ordering payment of medical expenses for treatment of the left hip was vacated and the circuit court's judgment was reversed insofar as it affirms that portion of the Commission’s decision.
From Your Editor--Consider a 911 Desk Job for Police/Fire Claimants Like This
My advice to Village/City/Town administrators in dealing with Claimants like Mr. Franklin is to transition them to 911 Desk jobs. Please consider Claimant Franklin has at least 10 IL WC claims at whatever cost. While we don’t want him to be injured again, it would appear he is almost certain to have another and another, ad infinitum. I would feel any active police work would aggravate something and he is going to again be on the dole.
Right now, as you read this, www.indeed.com has 28 pending East St. Louis area police dispatch jobs that would be perfect for such claimants. All of them pay well and have solid benefits. There are always openings, all across our State. As Claimant Franklin is a trained police officer, you wouldn’t have to train him in “cop talk” to man a 911 line. Please also note the 911 desk job will allow a worker to stand or sit at their option—there are headsets that can be worn during 911 desk duty. The position is sedentary with options for changing positions.
We appreciate your thoughts and comments. Please post them on our award-winning blog.
Synopsis: Some Current IL WC Arbitrators re-appointed; Some Depart and Two New Ones Enter the IL WC Fray.
Editor’s comment: On Friday, July 21, 2023, Governor JB Pritzker announced the reappointment of the following Arbitrators:
Jeanne AuBuchon Paul-Eric Seal
Linda Jean Cantrell Rachael Sinnen
Bradley Gillespie Charles Watts
Gerald Napleton Raychel Wesley
We congratulate each of the Arbitrators on their reappointment.
Arbitrators David Kane and Steven Fruth have announced their retirement, effective at the end of the month. Arbitrator Kane has been in that job since 1990! We congratulate Arbitrator Kane and Arbitrator Fruth and wish them good health and happiness upon their retirement.
Finally, Governor Pritzker has appointed two new Arbitrators to serve upon the retirement of Arbitrators Fruth and Kane. The new Arbitrators are:
Jennifer E. Bae
Ms. Bae has been a practicing attorney, with more than 25 years of experience, in various capacities. She is currently the Director of Employee Discipline for the Cook County Sheriff’s Office. As the Director, she is responsible for the handling of disciplinary matters for the more than 6000 employees of the office. She has acted in this capacity since 2019.
In the past, she has been self employed as a private practitioner, worked as a Staff Attorney for the City of Chicago, was a Member of the Cook County Sheriff’s Merit Board and worked as an Assistant State’s Attorney in Cook County. As an ASA, she worked in the Appellate, Traffic and Domestic Violence Divisions. She is a graduate of the University of Chicago Law School.
James Byrnes
Mr. Byrnes has been a practicing attorney for more than 30 years, with an emphasis on workers’ compensation matters. He is currently a partner at the firm of Ganan & Shapiro, in Chicago. He has been with the firm since 2002.
Mr. Byrnes has previously been an Associate Attorney at the firms of Freeborn & Peters and the Law Office of Patricia Cassiday. Additionally, Mr. Byrnes was a Staff Attorney at the IWCC, working with then Commissioner Linzey Jones, Jr. As is evident, Mr. Byrnes has a long career in the workers’ compensation field. He earned his Juris Doctorate Degree at the University of Illinois.
We congratulate Ms. Bae and Mr. Byrnes on their appointment. We are certain they will bring strong professionalism, accuracy and fairness to their new posts.