State News

NWCDN is a network of law firms dedicated to protecting employers in workers’ compensation claims.


NWCDN Members regularly post articles and summary judgements in workers’ compensations law in your state.  


Select a state from the dropdown menu below to scroll through the state specific archives for updates and opinions on various workers’ compensation laws in your state.


Contact information for NWCDN members is also located on the state specific links in the event you have additional questions or your company is seeking a workers’ compensation lawyer in your state.


Now Considering Firms for Our Network in

KENTUCKY CHAMBER ADVANCED WORKERS' COMPENSATION SEMINAR

 
We would like to invite you to the 19th Annual Kentucky Advanced Workers' Compensation Seminar sponsored by the Kentucky Chamber of Commerce. The seminar will take place in beautiful Louisville, KY on May 9th, 2024. Click below for the agenda and registration information. We are pleased to be moderating and presenting at this informative event and hope you can attend!

WorkCompCollege.com is a community-driven effort to provide formal workers' compensation training that embraces whole person recovery management to help continue the trend towards lower costs and improved results through education, information exchange, and mentorship. WorkCompCollege.com offers comprehensive workers' compensation courses as well as state specific training. We are pleased to have partnered with WorkCompCollege.com to help produce the Kentucky training content.


KENTUCKY WORKERS' COMPENSATION CASE UPDATE

AMA Guides and Gait Derangement
General Motors v. Payne, 2023-CA-0722-WC rendered on 12/1/23, petition for rehearing filed 12/11/23 (not final)
 
Claimant fell down the stairs at work and was diagnosed with bilateral quadriceps tendon ruptures. His treating physician prescribed a cane and restricted him to seated duty only. Claimant testified he could not stand for more than one hour and could sometimes walk short distances without a cane but had difficulty maneuvering certain surfaces. Robert Byrd, M.D. (Claimant IME) assigned a 20% rating due to gait derangement and use of assisted device. Ellen Ballard, M.D. (Defense IME) assigned a 2% rating for pain and declined to use gait derangement noting that the Claimant walked in and out of her office without the cane, left the cane, was called back to retrieve it and stated that he had left it at other places but usually remembered by the time he got to his car.
 
The ALJ adopted Dr. Byrd’s opinions and the Employer appealed arguing there was no substantial evidence that Claimant routinely used an assistive device as required by the AMA Guides for the 20% rating for gait derangement. The Board affirmed the ALJ and the Employer appealed to the Kentucky Court of Appeals. The Court of Appeals also affirmed the ALJ, holding that the testimony of the Claimant, his treating doctor, and Dr. Byrd were substantive evidence to support the 20% rating. The Court reiterated the Supreme Court of Kentucky’s prior holding that an opinion must only be grounded in the AMA Guides and does not require strict adherence to the Guides. Since Dr. Byrd’s rating was based on the AMA I the ALJ did not err in choosing to rely upon that opinion.

Exclusive Remedy, Wrongful Death and Up-The-Ladder Immunity
Miller, et. al. vs. Kentucky Power Co. d/b/a Kentucky Power, et. al, 2022-CA-1200-MR rendered 11/3/23 (not final)
 
Utility company is entitled to immunity from civil liability for a tree trimmer’s fatal accident occurring while trimming a tree from the utility’s right of way. The decedent worked for Asplundh Tree Expert Company and was performing tree trimming pursuant to a contract with Kentucky Power. The surviving spouse settled a workers’ compensation claim with Asplundh Tree Expert Company. She also filed a civil suit against Kentucky Power. Kentucky Power filed a Motion for Summary Judgment arguing it was entitled to up-the-ladder immunity. Miller argued that Kentucky Power was not entitled to immunity because tree trimming was not work “of a kind that the business or similar businesses would normally perform or be expected to perform with employees.” The Court of Appeals upheld the trial court’s decision to grant Kentucky Power summary judgment, finding that tree trimming was recurrent maintenance work required by law.
 
Going and Coming Rule and Traveling Employee Exception
Lee v. W.G. Yates & Sons Construction Co., 2023-CA-0695-WC rendered 10/27/23 (not final)
 
Claimant works in construction and is a permanent resident in Louisiana where he lives with his wife and daughter. Employer is a construction company based in Mississippi that accepts jobs all over the country and recruits employees nationwide to work those jobs. Employer hired Claimant as a general foreman for a construction project in Kentucky and only for that project. Once hired, Claimant pulled his travel trailer with his pickup truck to a campground near the construction site where he stayed for the entirety of the employment for this job. He was not reimbursed for his travel to the job site but was provided a $100 daily per diem for food and lodging expenses. Employer had also approached Claimant regarding a future project in Mississippi, but no former agreement had been finalized.
 
After clocking out of work early in the morning and returning to his trailer, Claimant left his trailer to join a friend for dinner. He was scheduled to begin work again later that evening. On his way to the restaurant, Claimant was injured when a vehicle struck his motorcycle. The ALJ found the injury did not occur in the course and scope of employment and the Claimant was not a travelling employee. He had relocated for the job and the only travel he engaged in was reporting to a static work site. The Court of Appeals reversed, holding the Claimant was a travelling employee whose travel to Kentucky was a service to the employer. As he was not engaged in a significant deviation from the purpose of his trip at the time of the accident, the claim is compensable.


 
Should you have any questions or wish to discuss any related matters, please contact us at your convenience.


H. Douglas Jones, Esq. – djones@jsbattorneys.com, 859.594.4200
Margo Menefee, Esq. – mmenefee@jsbattorneys.com, 859.594.4200

"Money" (Pink Floyd)

 
Here are the top-billing workers’ compensation attorneys for 2023 according to the DWC along with the average number of hours worked per day assuming they billed at the DWC’s maximum rate of $200 per hour and worked every single day of the year, weekends and holidays included: 
 
Carrier AttorneyApproved FeesHours Per Day
Dean Pappas$923,472.5012.65
Jeremy Lunn$640,487.008.77
Mark Midkiff$523,012.207.16
   
Claimant AttorneyApproved FeesHours Per Day
Adam Henderson$1,029,800.0014.10
Bill Abbott$923,175.0012.64
Fyodor Clay$817,950.0011.20
 
On the claimant attorney side, Adam Henderson moves up from number two to number one this year overtaking Bill Abbott who was number one in 2022. Mr. Henderson was indicted for billing fraud by a Travis County grand jury in 2021. You can read the indictment here. Mr. Henderson’s criminal case remains pending with a pre-trial hearing scheduled for March 20, 2024. 
 
To view the amount of approved attorney’s fees for each of the top 100 Claimant and Carrier workers’ compensation attorneys for 2023, click the following link: Top 100 2023.


Copyright 2024, Stone Loughlin & Swanson, LLP 

It’s a beautiful Monday and with Spring just around the corner, we can’t help but be happy. After all, “Here Comes the Sun” (The Beatles) and we are looking forward to “Spring Vacation” (The Beach Boys)! There’s nothing like the power of music to help enhance the mood and make everything better!
 

"I Want You Back" (The Jackson 5)

 

 
We’ve frequently sounded the alarm over the years about the serious decline in the numbers of qualified doctors providing services in the workers’ comp system. Low reimbursement rates are one reason for the mass exodus from the system. After all, DWC has not adjusted reimbursement rates for workers’ compensation providers since January 2008. (Per a nifty online inflation calculator, $100 in 2008 has the same purchasing power in 2024 as $139.73.) 

Noting that this decline has been “particularly pronounced” among certified designated doctors and “especially” among licensed medical doctors and doctors of osteopathy, new rules were finally adopted this past month to more fairly compensate doctors performing MMI/IR and other DD exams. In sum, the rules were amended to: 
  • adjust fees by applying the Medicare Economic Index (MEI) percentage adjustment factor, with an annual adjustment on January 1st;
  • eliminate unnecessary billing modifiers and replace the diagnosis-related estimate (DRE) and range of motion (ROM) billing methods with a single method of billing;
  • create a $100 missed appointment fee and a $300 specialist fee;
  • pay DDs and RMEs for all issues addressed within one exam without reduction;
  • require an “assignment number” to assist a carrier with identifying a bill as originating from a designated doctor or a DD’s referral;
  • clarify that the 95-day period for submission of a DD’s bill begins on the date of service for additional testing or referral evaluation.
The new rules will take effect on June 1, 2024.

“Like a Surgeon” (“Weird Al” Yankovic)

 
Under the category of notable enforcement actions, Richard Levy, MD (Dallas) was recently cited for performing unreasonable or medically unnecessary procedures, failing to document adequate explanations for deviating from the ODG, and submitting substantially similar reports amongst three different injured employees.  

Dr. Levy was ordered to pay an administrative penalty of $3,000; to attend and successfully complete a medical record keeping seminar and six hours of continuing medical education on the topic of shoulder arthroscopy or orthopedic shoulder surgery; and to purchase and maintain a current subscription to the ODG.

Also notable, James William Butler, MD (Houston) received a public reprimand for repeatedly failing to submit a DD report timely and was ordered to pay a penalty of $500. 

“So Long, Farewell” (Rodgers & Hammerstein)



 
Our kind friend, Benefit Review Officer Catherine Ripley, is retiring from the Division in a few short weeks. We wish her well!

“Let’s Get Together” (Hayley Mills)



DWC is offering quarterly webinars through Zoom to help system participants keep up with the latest information and trends. Sign up here for invitations to register each quarter.

Webinar recordings will be available at any time on the CompCourses webpage here.
 

"Tell Me What I Did Wrong" (James Brown)


The DWC is soliciting suggestions for new rules or revisions to DWC’s existing rules. If you have a proposal, you can complete the form on the TDI website here.

“Hello Again” (Neil Diamond)

 
We sometimes question whether appeals from bad CCH decisions end up in File 13, as the few decisions that are rendered each month by the Appeals Panel often address trivial issues like a “stipulation…incorrectly identifies a cervical strain rather than cervical sprain” (APD 231661). So we get excited when the Panel issues a decision that actually addresses the merits of a case. This month, we present two examples of decisions that give us hope: 

The Appeals Panel reversed an ALJ who adopted a designated doctor’s 20% impairment rating, which was assessed for “requiring routine use of cane” when the records reflected the claimant did not require routine use of a cane. The Appeals Panel refused to adopt a certification by the post-DD required medical examiner because the doctor assigned impairment ratings based only on his observations of the claimant while in and outside the office due to the claimant’s refusal to complete paperwork or undergo an examination unless he was allowed to record the exam and have a witness other than his treating doctor. The Panel thus remanded the case to the ALJ with instructions to ask the DD why he assigned an IR that required routine use of a cane when the claimant was independent with ambulation activities without the need of an assistive device. (AP Decision No. 231830) Note: The Appeals Panel did not address what the Carrier’s remedy is when they are thwarted by a claimant from obtaining an opinion from an RME doctor, although they did reference Rule 126.6(j) in a footnote and state that this was not an issue in the instant case. Rule 126.6(j) merely provides a carrier the right to suspend TIBs if a claimant fails to attend an RME and fails to reschedule

The Appeals Panel reversed an ALJ who found that a carrier did not sufficiently raise a defense of horseplay on its PLN-1 and therefore, the carrier was deemed liable for an injury despite the fact that the claimant’s horseplay was a producing cause of the injury. The Panel noted that “magic words are not necessary to contest the compensability” of a claim and reversing the ALJ, said that the carrier had sufficiently described the reasons for the dispute when it wrote “Investigation reveals the injured worker was riding a co-workers [sic] motorcycle recklessly at the time of the injury and was not furthering the affairs of the employer at the time of this incident.” (AP Decision No. 231750)
 

 

“Born on the Bayou” (Creedence Clearwater Revival)

 
For those of you who are clients of Stone Loughlin & Swanson, we would love to offer you the invitation to attend the upcoming NWCDN conference in New Orleans May 16th. Details will follow, but if you would like to be invited, please respond to Jane Stone and it will be done!
 

Legal Update by Attorney Sandra Kromminga

The issues in Tweeten d/b/a Tweeten Farms v. Tweeten were: (1) Does the statutory bar under Iowa Code section 85.35(9) preclude further benefits following a compromise settlement between a claimant and the Second Injury Fund of Iowa (“SIF”); (2) Does the discovery rule toll the statute of limitations following amendments to Iowa Code section 85.26(1); and (3) How do amendments to Iowa Code section 85.39(2) affect reimbursement for independent medical examinations? This case was argued by Attorney Christopher S. Spencer.

The Claimant, Corey Tweeten, worked for his father on the family farm, Tweeten Farms. While Claimant and his father were vacuuming grain out of a bin on July 25, 2017, the Claimant injured his right arm. The Claimant sought treatment on August 14 and was diagnosed with right lateral epicondylitis or ‘tennis elbow.’ The Claimant eventually underwent an MRI in May of 2018 that showed a “significant deltoid insertional tear.” Surgery to repair the deltoid was done on June 18. At a follow-up appointment in October, Dr. Warme opined that Corey had likely overcompensated for the tennis elbow which had caused the deltoid tear. Dr. Warme believed that both injuries were related to the July 2017 grain bin incident.

In January of 2020, the Claimant filed an arbitration petition seeking benefits from Tweeten Farms and Grinnell Mutual for an upper right extremity injury, asserting his injury date was February 1, 2018. The Petition also included a claim against the Second Injury Fund of Iowa, premised on a prior right ankle injury in 2008. The Claimant also sought reimbursement for an independent medical evaluation (“IME”) with Dr. Robin Sassman at hearing. The cost of the IME was $4,650.00.

An arbitration hearing was set for March of 2021. The Second Injury Fund of Iowa filed a notice that they had reached a settlement with the Claimant and would not be at the upcoming hearing pending approval of the settlement. The case proceeded to hearing. In Defendants’ April 13 Post-Hearing Brief, they argued that the Compromise Settlement with the Second Injury Fund of Iowa extinguished Claimant’s claims for benefits under section 85.35(9). This divested the workers’ compensation Commissioner of jurisdiction to award him additional benefits. The settlement was approved in April. The deputy found that the Claimant did not learn of the seriousness of his injury until April 2018, meaning that his January 21, 2020, Petition was not barred by the two-year statute of limitations in section 85.26.

The Iowa Supreme Court held that the Commissioner’s decision in Millbrandt v. R.R. Donnelly recognized that “a claim brought by a claimant against the SIF is distinct from a claim brought by a claimant against an employer and an insurance carrier,” such that the claim against the employer was not “regarding the subject matter of the compromise.” Compromise settlements between an employee and the Second Injury Fund of Iowa will not always bar an employee from seeking benefits from their employer, but the extent of any bar will depend on the subject matter of the compromise. In this instance, the dispute was as to the applicability of the Second Injury Fund Act related to the prior loss in 2008.

As for the applicability of the discovery rule, the Court held that for purposes of section 85.26, the two-year statutory period begins to run when the employee knows or should have known that an injury is work-related, without regard to whether the injury is also serious enough to be compensable. The Claimant knew that he had a right-arm injury that was work-related more than two years before he sought benefits, and his claim is therefore barred as untimely. This holding modifies the prior common law discovery rule that would have tolled the statute of limitations until the injured worker also knew of the seriousness of the claimed injury.

Finally, the Court determined that Claimant was not entitled to reimbursement for Dr. Sassman’s examination under Iowa Code 85.39. The Claimant’s Petition had been untimely, meaning his injury was not compensable, and, as a result, was not entitled to reimbursement.


If you'd like to sign up for our e-newsletter, please click here.

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

NOTICE TO THE PUBLIC

The determination of the need for legal services and the choice of a lawyer are extremely important decisions and should not be based solely upon advertisements or self-proclaimed expertise. This disclosure is required by rule of the Supreme Court of Iowa.

Peddicord Wharton Legal Updates are intended to provide information on current developments in legislation impacting our clients. Readers should not rely solely upon this information as legal advice. Peddicord Wharton attorneys would be pleased to answer any questions you may have about this update. ©2024 Peddicord Wharton. All Rights Reserved.